Nasopharyngeal carcinoma (NPC) in the ophthalmic practice: A serious neoplasm presenting initially to ophthalmologists

Abstract

Purpose: Nasopharyngeal carcinoma (NPC) is an aggressive malignant tumor that arises from the nasopharyngeal epithelial lining. Most patients with NPC present with a neck mass or cranial nerve palsy. It is infrequent for patients with NPC to present to an ophthalmologist initially with ophthalmic complaints and absence of prior diagnosis of NPC. We are reporting a series of six NPC cases that presented solely with ophthalmic complaints, to attract the attention of ophthalmologist to such a serious neoplasm.

Methods: A retrospective observational study of all consecutive patients diagnosed with NPC based on their initial ophthalmic presentation with no prior diagnosis of this neoplasm. Patients presented for the first time to two tertiary eye hospitals. Data were collected by the chart review for demographics, clinical presentation, radiological imaging, treatment regimen, and follow-up. Histopathological review of their tissue specimens was conducted by two pathologists.

Results: We had six patients who presented for the first time to our ophthalmic service complaining mostly of limitation of extraocular muscle motility with or without diplopia (4/6), orbital or facial pain (2/6), and disturbance in vision (2/6). The age ranged from 35 to 92 years with a mean of 58 years. A male predominance was observed with male-to-female ratio of 5:1. The cases are described along with their imaging and histopathological findings. Relevant literature review was also presented. Most of our patients (5/6) received combination of radiotherapy and chemotherapy. One patient refused treatment and 2 eventually passed away after 7 months.

Conclusion: Ophthalmologists may play a major role in diagnosing such patients accurately and referring them for early management and better prognosis.

Keywords: Cranial nerve palsy; diplopia; nasopharyngeal carcinoma; orbital invasion.

Figure 1

A graph showing the ophthalmic clinical signs and symptoms of the 6 cases as their initial presentation of nasopharyngeal carcinoma

Figure 2

(a) Histopathological appearance of the non-keratinizing squamous area of the mixed type nasopharyngeal carcinoma in case 1 (Original magnification ×200 Hematoxylin and eosin). (b) The appearance of the keratinizing squamous area in the same case (Original magnification ×400 Hematoxylin and eosin)

Figure 3

(a) Axial T2-weighted magnetic resonance imaging (in case 3) with an infiltrative nasopharyngeal soft tissue mass showing skull base invasion and intracranial extension. (b) The tumor in the same case showing areas of non-keratinizing squamous cell carcinoma with surrounding lymphocytes, plasma cells and Russel bodies (Original magnification ×400 Hematoxylin and eosin). (c) The tumor cells expressing epithelial cell marker (Original magnification ×200 CK5-6). (d) Another immunohistochemical stain showing p63 expression by the tumor cells (Original magnification ×400 p63)