1. Reporter: R4 何承宇 Supervisor : VS 林虞軒
台灣耳鼻喉科醫學會105屆
Nasopharyngeal Mucoepidermoid Carcinoma - A Common Entity at an Uncommon Location
Reporter: R4 何承宇
Supervisor : VS 林虞軒

2. Case general profiled Name:吳XX Age: 47 years old Gender: Male
Date of OPD visited : 2017/09/20
Past history : denied

3. Chief Complaint
Double vision while looking at right side was found at 9/17 morning.

4. Present Illness (1)
Dizziness without spinning sensation ; no postural-related
No headache or other neurological sign, such as weakness, hearing loss, ear fullness, extremities numbness, facial asymmetry, neck stiffness, photophobia or phonophobia
Associated symptoms/signs:
Weakness(-)
Hearing loss(-)
Ear fullness (-)
Limbs weakness(-)
Facial palsy(-)

5. Brain MRI T1 with contrast
A 1.8cm enhancing lesion in right nasopharynx.

6. Brain MRI

7. Consult ENT
One polypoid lesion was noted at right rosenmuller fossa

8. Arrange Biopsy
( )
PATHOLOGICAL DIAGNOSIS: Nasopharynx, biopsy: Lymphoid hyperplasia with a cluster of atypical cells
( )
PATHOLOGICAL DIAGNOSIS: Nasopharynx, biopsy: Granulation tissue with fibrin deposition and suppurative inflammation

9. Admission for open diopsy
Admission to our ward for deep biopsy ( )
Frozen : Nasopharynx, right, Rossenmuller fossa, biopsy: Mucoepidermoid carcinoma

10. Final pathology PATHOLOGICAL DIAGNOSIS:
1.Nasopharynx, right, debulking surgery: Mucoepidermoid carcinoma, low-grade.
2.Nasopharynx, labeled "deep margin", right, debulking surgery: Mucoepidermoid carcinoma, by invasion.
Tumor cells are positive for CK7 and p63, but negative for S100 and EBER in situ hybridization.

11. Mucoepidermoid carcinoma, low-grade
Higher proportion of mucous cells to epidermoid cells.

12. Tumor staging MRI: Tumor (1.8cm)  cT1N0 Neck echo: N0
Abdominal echo / Chest X-ray / Bone scan : M0
 cT1N0M0

13. Treatment  Discussion with patient. At first do operation first
 However, severe complication was considered
 refer to radiooncologist
 Finally, do RT ( Since 2018/6/4)
 Finish RT on 2018/8/7

14. Post Treatment follow up
10/01 Fiberscopy exam:
right nasopharynx: grossly smooth, mild necrotic tissue

15. Discussion
To date, there are only 44 adult patients with nasopharyngeal MEC from 9 English-language studies in the literature.
No gender preponderance (NPC: 3-fold higher in males compared with females. )
More Local symptoms ( ear stuffness / Nasal obstruction)
Less regional (16.7%) or distant metastasis (8.6%)
Larger proportion of nasopharyngeal MEC patients present with early stage disease (57.1%), although histologically most tumors (61.8%) are intermediate or high-grade tumors

16. Discussion-surgical treatment
Surgical treatment is the gold standard for MEC, and the challenge is the anotomy. ( Skull base , ICA)
lateral rhinotomy
transmaxillary swing
transoral-palatal
lateral infratemporal fossa
subfrontal routes
Endoscopic approach

17. Discussion-outcome
Data on survival rate for nasopharyngeal MEC is limited due to the small numbers of patients in the studies.
The largest patient series of 13 patients reported an overall median survival of 43 months.

18. Thank you for your attention