Nasopharyngeal carcinoma (NPC) with liver metastasis in pregnancy

Introduction: Cancer in pregnancies is the second most common cause of death after trauma in woman of reproductive age and confounds about 0.1 to 0.2% of pregnancies1,2) and rarely nasopharyngeal carcinoma being the aetiology. Objective: This report describes a pregnant woman in which an advanced-stage NPC was diagnosed and managed accordingly with a review of some related literature reviews. Case report: 29 year old Chinese lady was diagnosed with nasopharyngeal carcinoma (NPC) during her third trimester with very short history. She initially presented to us at 34 weeks of pregnancy with a painless right neck swelling and a chronic non-productive cough for one month duration. She was initially thought to have tuberculous lymphadenitis. A routine rigid endoscopic nasopharyngoscope examination revealed a right Fossa of Rosenmuller (FOR) mass. Biopsy of the nasal mass and fine needle aspiration cytology (FNAC) of the neck swelling further confirmed nasopharyngeal carcinoma- non keratinizing type. After discussion with her obstetrician and the patient, she underwent an elective induction of labor at 36 weeks of gestation, and delivered a healthy 2.77 kg baby boy. Computer tomography (CT) neck, thorax and abdomen were performed 2 weeks postpartum. The imaging showed fullness of the right FOR with metastases to right level 2 cervical lymph node along with metastatic deposits in 2 segments of the liver. She was then referred to oncology unit for further management. Conclusion: In conclusion, high index of suspicion is important in detection of NPC even in pregnant ladies with suspicious neck swelling. Method of detecting NPC early in pregnancy is essential in order to give optimize treatment, achieve potential for full recovery and also reduced the adverse risk and complications associated with NPC

The value of PET-CT scan in determining remission status in lymphoma patients involving the head & neck region

In lymphoma, Positron Emission Tomography-Computerized Tomography (PET-CT) provides greater prognostic information than conventional imaging. However, false positivity occurred particularly in the head & neck due to predilection for infection and inflammation. We investigated the association between positive scans in the head & neck at the end of therapy with histology, and its diagnostic and prognostic values. 488 PET-CT were retrospectively assessed in 2012-2016 (40 months). Positive uptakes in the head & neck (five-point scale ≥4) were biopsied. Prevalence of positive scans was 10.9% (53/488). Two positive scans were histologically lymphomatous with mean maximum standardized uptake value (SUVmax) of 9.0±2.69. False positivity (96.2%) was histologically attributed to reactive lymphoid hyperplasia (SUVmax 9.0±3.88). Positive and negative predictive values, sensitivity and specificity were 3.8%, 100%, 100% and 89.5%, respectively. False positivity was associated with age, gender, extra-nodal involvement, Eastern Cooperative Oncology Group score (ECOG), positivity only in the head & neck and its pattern of positivity. No significant predictors were identified. Hodgkin Disease (HD) was more likely to have positivity only in the head & neck compared to Non-Hodgkin Lymphoma (NHL) (p=0.019). 106 patients with negative scans remained negative during study period, hence regarded as true negatives. Positive scans in the head & neck at post therapy yielded high false positivity and should not be routinely performed. HD has higher likelihood of scan positivity only in the head & neck than NHL. The value of PET-CT to detect true lymphomatous relapse in selected high-risk patients remained to be confirmed in future trials