Nasopharyngeal Carcinoma: Recognizing the Radiographic Features in Children

Background And Purpose: Children often present with enlargement of the nasopharyngeal soft tissues, which is usually due to benign hypertrophy of adenoids. The objective of this report is to emphasize that, although rare, nasopharyngeal carcinoma (NPC) does occur in children and can be diagnosed reliably when certain key radiographic features are recognized.

Methods: The presenting scans of 11 patients with biopsy proven NPC were reviewed retrospectively by a CAQ-certified neuroradiologist. The age range was 12-17 years (median 15 years). Fifteen scans were reviewed, including 8 CT scans of the neck with intravenous contrast and 7 MR scans of the nasopharynx without and with gadolinium.

Results: All 11 patients had a nasopharyngeal mass. The nasopharyngeal mass had invaded the central skull base in 10 patients (91%). Widening of the petroclival fissure was present in 8 (73%) patients; all except one patient had accompanying skull base invasion. The tumor had extended into the adjacent parapharyngeal space in 6 (55%), the pterygopalatine fossa in 2 (18%), and the masticator space in 2 (18%). Unilateral cervical lymphadenopathy was present in 4 (36%) and bilateral in 7 (64%). Lateral retropharyngeal lymphadenopathy that measured greater than 1 cm in maximal transverse dimension was present in 10 (91%).

Conclusion: Pediatric NPC is generally not suspected clinically until late into the disease process. Awareness that NPC can occur in children should prompt careful evaluation for distinctive radiographic features. Earlier diagnosis may then direct the patient to timely appropriate therapy when these key radiographic features are present and recognized.