1. Dr/ ABD ALLAH NAZEER. MD.
Radiological imaging of the
nasopharyngeal diseases.

10. Adenoids

15. Nasopharyngeal abscess (MRI scan, sagittal view).
Nasopharyngeal abscess (MRI scan, axial view).

16. Latero and Retropharyngeal abscess (CT scan, axial view). B. Latero and
Retropharyngeal abscess (CT scan, sagittal view). C. Lateropharyngeal abscess
(CT scan, coronal view). D. Lateropharyngeal abscess (CT scan, axial view).

17. Inflammatory pseudotumor of the nasopharynx and skull base
is a benign, idiopathic disease that is often mistaken for a
neoplasm or infection owing to its aggressive behavior and
clinical presentation. It can present as a progressively
destructive mass and should be considered when repeated
tissue biopsies reveal acute or chronic inflammation without
evidence of malignant disease or infection. Nasopharyngeal
inflammatory pseudotumor with skull base invasion occurring
in patients with diabetes mellitus (DM). These patients had
repeated negative results from biopsies and cultures, and none
had associated cervical lymphadenopathy despite having an
aggressive destructive mass. We suggest that these findings,
coupled with clinical suspicion, will be helpful in making the
correct diagnosis of inflammatory pseudotumor. This is critical
in the management of these patients to institute the correct
treatment plan.

18. A 32-year-old man with right ptosis, trigeminal neuralgia and facial palsy 2 days after an
episode of acute otitis media treated with tympanocentesis. (a) Axial T1 weighted image
shows an intermediate signal intensity mass lesion involving the right nasopharyngeal
submucosal region (arrows). (b) Axial T2 weighted image shows low signal intensity
change of the lesion (arrows). Note the right mastoiditis change. (c) Coronal contrast-
enhanced T1 weighted image shows extension of the lesion to the right skull base,
cavernous sinus and Meckel’s cave (black arrows). Enhancement of the thickened
pachymeninges is also present (white arrows). (d) Axial T2 weighted and (e) contrast-
enhanced images obtained 2 months after a course of intravenous high-dose pulse
solumedrol therapy followed by oral corticosteroid medication show the mass lesion to be
significantly reduced in size. The pachymeningeal enhancement has nearly disappeared

19. A 32-year-old man with left hemicrania of 5 months’ duration and hemitongue atrophy of 1
months’ duration. (a) Axial T1 weighted image and (b) axial T2 weighted image show an ill-
defined hypointense lesion in the left nasopharyngeal submucosal region with extension to
the carotid space and skull base. The left internal carotid artery is encased and narrowed
(white arrow). Involvement of the hypoglossal canal (black arrow) is evident. The mass lesion
is distinguishable from the nasopharyngeal mucosa on T2 weighted images. (c) Axial contrast-
enhanced T1 weighted image with fat saturation shows moderate enhancement of the left
nasopharyngeal lesion, with extension around the left internal carotid artery into the skull
base, and involving the prevertebral muscles and hypoglossal canal (black arrow). (d) Axial T2
weighted and (e) contrast enhanced T1 weighted image obtained 2 months after a course of
oral corticosteroids show nearly complete resolution of the mass lesion.

20. A 37-year-old man with right hemicrania of 2 months’ duration. (a) Axial T2 weighted image
shows hypointensity and (b) axial contrast-enhanced T1 weighted image shows moderate
enhancement of the lesion in the right nasopharyngeal submucosa and carotid space (white
arrows), which encases the right internal carotid artery with extension to the skull base. There
is high signal change on T2 weighted images and abnormal contrast enhancement in the bone
marrow of the right occipital condyle (black arrows). (c) Contrast-enhanced MR angiography
shows segmental narrowing of the right upper cervical internal carotid artery (white arrows)
owing to the encasement by the carotid space lesion.

23. Thornwaldt cyst.

24. Thornwaldt cyst

29. Juvenile nasopharyngeal angiofibroma.

30. Juvenile nasopharyngeal angiofibroma.

32. Neonatal teratomas are very rare congenital tumors which are formed from
cells derived from all three embryonic germ cell layers. The incidence of
neonatal teratomas is between 1:20,000 and 1:80,000 live births. Most occur in
the sacrococcygeal region and only 5% are found in the head and neck region,
specifically the cervical region followed by the nasopharynx. They can be
associated with a cleft palate, intracranial abnormalities including hemicrania
and anencephaly, other head and neck anomalies, diaphragmatic hernia and
renal and vertebral anomalies.
Nasopharyngeal teratomas most commonly present with difficulties in
swallowing and obstructive respiratory distress. The size and location serve as
the major causes of morbidity and mortality. Rapid airway stabilization,
including endotracheal intubation, cricothyrotomy or tracheotomy, is crucial in
the management of these patients. After securing the airway, imaging is very
useful to help differentiate this tumor from other masses. Ultimately surgical
excision is the mode of treatment. These tumors are often encapsulated or
pseudoencapsulated which yields excellent surgical prognosis.
The differential diagnosis for neonatal nasopharyngeal lesions is extensive and
includes: teratoma, dermoid, craniopharyngioma, encephalocele, cystic
hygroma, rhabdomyoscarcoma, hemangioma, lipoma, chordoma,
neurofibroma, Rathke’s pouch and sarcoma botryoides.

33. Nasopharyngeal teratoma.

34. Nasopharyngeal teratoma.

35. (a) T2 weighted sequence in coronal plane showing the external portion of the tumour
consisting of lobulated well defined areas of fluid, solid tissue and fat, in keeping with
teratoma. There is involvement of the left temporal lobe of the brain (red arrow); (b) T1
weighted contrast enhanced sequence in sagittal plane. Internally, the tumour is occupying
the oropharynx, nasopharynx and oral cavity, effacing normal anatomy (red arrows).

36. Pleomorphic adenoma of the nasopharynx.

37. Nasopharyngeal hemangioma.

38. Chordoma is a low-grade malignant tumor that
arises from the remnants of notochord. They account
for 1-4% of malignant bone tumors and most
commonly present after the age of 30 years. Male to
female ratio is 1.8:1. Majority occur in sacrum or in
the clivus (a bony surface in the posterior cranial fossa
sloping upward from foramen magnum to dorsum
sella). Those located in the clivus are often associated
with a chronic headache and symptoms due to
compression of a cranial nerve. Lateral extension can
lead to a cerebellopontine angle tumor
symptomatology. In case of inferior spread, nasal
obstruction, bleeding, and even nasal mass appear.

39. Extraosseous Chordoma of the Nasopharynx.

40. Chordoma.

41. Two cases of cystic choristoma along the nasopharynx and the prestyloid spaces.

42. Paraganglioma of the nasopharynx.

43. Naso and parapharyngeal para-ganglioma.

44. Nasopharynx cancer or nasopharyngeal carcinoma (NPC) is the
most common cancer originating in the nasopharynx, the
uppermost region of the pharynx ("throat"), behind the nose
where the nasal passages and auditory tubes join the remainder
of the upper respiratory tract. NPC occurs in children and adults.
NPC differs significantly from other cancers of the head and
neck in its occurrence, causes, clinical behavior, and treatment.
It is vastly more common in certain regions of East Asia and
Africa than elsewhere, with viral, dietary and genetic factors
implicated in its causation. It is most common in males. It is a
squamous cell carcinoma or an undifferentiated type.
Squamous cells are a flat type of cell found in the skin and the
membranes that line some body cavities. Differentiation means
how different the cancer cells are from normal cells.
Undifferentiated is a word used to describe cells that do not
have their mature features or functions.

45. Classification:
Nasopharyngeal carcinoma, commonly known as
nasopharyngeal cancer, is classified as a malignant
neoplasm, or cancer, arising from the mucosal epithelium
of the nasopharynx, most often within the lateral
nasopharyngeal recess or fossa of Rosenmüller (a recess
behind the entrance of the Eustachian tube opening). The
World Health Organization classifies nasopharyngeal
carcinoma in three types. Type 1 (I) is squamous cell
carcinoma. Type 2a (II) is keratinizing undifferentiated
carcinoma. Type 2b (III) is nonkeratinizing undifferentiated
carcinoma. Type 2b (III) nonkeratinizing undifferentiated
form also known as lymphoepithelioma is most common,
and is most strongly associated with Epstein-Barr virus
infection of the cancerous cells.

50. Axial T2 weighted images shows a carcinoma that has infiltrated lateral to the
tensor and levator veli palatini. Solid arrow shows normal tensor veli palatini on
the right. Dashed arrow shows the abnormal left levator muscle which is being
displaced and the presence of tumor lateral to it.

53. Sagittal T1 image that shows NPC invasion into the clivus. There is a loss of
the inferior cortical margin of the clivus. The clivus is also of uniform lower signal
that reflects sclerotic change. 10B is as coronal T1 image in another patient that
shows NPC infiltration into the left aspect of the clivus (arrow).

54. Coronal T2 (left) and post gadolinium enhanced T1 (right) weighted images show
superior extension of NPC through the floor of the sphenoid sinus (arrows).

57. Two cases of nasopharyngeal tumour, extended laterally into the left masticator space and
subsequent perineural tumor tracking superiorly along V3 into the left cavernous sinus.

58. Carcinoma of the nasopharynx. Coronal T1 weighted, fat suppressed, contrast
enhanced MR image shows an enhancing lesion(T) in the nasopharynx with
extension into bilateral cavernous sinuses(white arrows) via foramen ovale (black
arrows). Both cavernous internal carotid arteries are encased by the lesion. There
is also extension into left infratemporal fossa(small open black arrow).

60. A case of locally advanced nasopharyngeal
carcinoma in a 44-year-old man with right-ear
tinnitus and hearing impairment of 1 year’s
duration. (a)AxialT1weighted image shows a
bulging right nasopharyngeal mass with
extension to the skull base, partially encasing
the right internal carotid artery. The right
parapharyngeal fat is obliterated. (b) Axial T2
weighted image shows mild hyperintensity of
the right nasopharyngeal mass. The signal
intensity of the mass is similar to that of the
nasopharyngeal mucosa, and the margin
between the normal mucosa and the mass
could not be delineated. Note the presence of
right mastoiditis change. (c) Axial and (d)
coronal contrast enhanced T1 weighted
images with fat saturation shows vivid
enhancement of the nasopharyngeal mass.
There is skull-base and cavernous sinus
invasion with encasement of the right internal
carotid artery, which is not narrowed (white
arrows). Bilateral neck lymphadenopathy
(black arrows) is prominent.

61. Burkett lymphoma of the nasopharynx.

62. Nasopharyngeal non-Hodgkin lymphoma.

63. Granulocytic sarcoma
in the right lateral
wall of the
nasopharynx (black
arrow), involving the
right pterygoid
muscles,
parapharyngeal space
Figure 1b: CT sagittal
image shows mass in
the nasopharynx with
extension into
sphenoid sinus Figure
1c: CT coronal image
shows that the mass is
confined to the
nasopharynx without
intracranial extension.

64. Leiomyosarcoma in the Nasopharynx:

65. Thank You.