RT Journal Article
SR Electronic
T1 A challenging presentation of invasive nasopharyngeal sarcomatoid carcinoma
JF BMJ Case Reports
JO BMJ Case Reports
FD BMJ Publishing Group Ltd
SP e226168
DO 10.1136/bcr-2018-226168
VO 12
IS 7
A1 Alexander Yao
A1 Haroon Saeed
A1 Gavin Udall
A1 Vivek Kaushik
A1 Lip Wai Lee
YR 2019
UL http://casereports.bmj.com/content/12/7/e226168.abstract
AB 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.