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CASE REPORT
A challenging presentation of invasive nasopharyngeal sarcomatoid carcinoma
  1. Alexander Yao1,
  2. Haroon Saeed1,
  3. Gavin Udall1,2,
  4. Vivek Kaushik1 and
  5. Lip Wai Lee3
  1. 1 Department of Otolaryngology, Stockport NHS Foundation Trust, Stockport, UK
  2. 2 Department of Pathology, Stockport NHS Foundation Trust, Stockport, UK
  3. 3 Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
  1. Correspondence to Alexander Yao, alexander.c.yao{at}gmail.com

Abstract

Sarcomatoid carcinoma is a rare clinical entity, especially when presenting in the nasopharynx. We describe the first documented case of nasopharyngeal sarcomatoid carcinoma with intracranial extension in a 59-year-old Caucasian man presenting with severe bifrontal headache and diplopia, secondary to left abducens nerve palsy. We highlight some of the major diagnostic challenges and describe its unusual histological appearance. We outline the importance of a multidisciplinary approach to his management, which includes input from the medicine, neurosurgery, Ear, Nose and Throat (ENT), pathology, radiology, oncology and respiratory teams. In the context of limited evidence, we then describe the rationale to proceed with induction chemotherapy followed by concurrent chemoradiotherapy. Although there was a partial response to treatment, it was not sufficient enough to allow subsequent surgical clearance. The plan going forward is to palliate with chemotherapy as and when the disease progresses.

  • head and neck cancer
  • pathology
  • cancer intervention
  • chemotherapy
  • radiotherapy
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Footnotes

  • Contributors AY was the main author involved in the writing and compiling all the elements of work of the manuscript, and the editing of pictures. He was also involved in the conception, design of work, drafting, and revision of the manuscript. HS was involved in the conception, design of work, writing of the article,drafting, revision, and critique of the manuscript. HS was also involved in obtaining the sphenotomy specimens. GU was involved in the conception, design,drafting, and critical revision of the manuscript. He provided the images for histology and the information on the histological features. VK was involved in the conception,overall design of work, drafting, revision, and critical analysis of the final work. He was also involved in obtaining the sphenotomy specimens. LWL was involved in the design of work, interpretation of data, revision, and final approval. He wrote the background on the management, rationale, evidence-base, and addressed reviewers' comments in regard to chemotherapy and management.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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