ROENTGENOLOGIC MANIFESTATIONS OF MALIGNANT TUMORS OF THE NASOPHARYNX

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Abstract
Clinical, pathologic, and roentgenographic findings in 102 cases of malignant disease of the nasopharynx were reviewed, as were abnormal roentgenographic findings in 92 cases of other diseases of the nasopharynx. Carcinoma of the Nasopharynx. Usually, this could be seen roentgenographically as a soft-tissue mass in the nasopharynx. When both routine and submental-vertical roentgenograms of the skull were available, evidence of osseous destruction was present on the routine views in 22 cases and on the submental-vertical projections in 31. When destruction was visible on routine roentgenograms, extensive destruction of the middle fossa floor was always seen on the submental-vertical projections and usually a large soft-tissue nasopharyngeal mass could be seen on the lateral skull roentgenogram. When bone involvement was visible on the routine skull roentgenograms, usually the changes were seen on the lateral skull roentgenogram; but in 8 instances the only evidence of destruction was present on the Caldwell and Towne views, where the tip of the petrous pyramid, mainly at the inferior aspect, was seen to be destroyed. The destruction seen on the lateral skull roentgenograms involved the sphenoid sinus and body of the sphenoid bone in every instance; in addition, the sella turcica and clivus were often destroyed. On the submental-vertical roentgenograms, in all cases with osseous destruction, some portion of the sphenoid sinus and body of the sphenoid bone appeared to be destroyed. Extension of destruction to include at least one bony margin of the foramen lacerum was seen in 30 of the 34 cases, and extension to other adjacent structures, such as the tips of the petrous pyramids, the sella turcica, and the clivus, was frequent. Diffuse clouding of mastoid cells was evident in 41 cases. Differential Diagnosis. Roentgenograms in 92 cases—representing 19 different pathologic conditions characterized by roentgenographic evidence of either a soft-tissue mass in the nasopharynx or destruction of the floor of the middle fossa or both—revealed changes very similar to those of the nasopharyngeal carcinomas in some instances, specifically in cases of enlarged adenoids, Thornwaldt's bursitis, carcinoma of the tonsil or pharynx, metastatic melanoma, neurofibroma, chordoma, carcinoma of the sphenoid sinus, and meningioma of the middle fossa floor. Several of these conditions had either characteristic pathologic or clinical features which differentiated them from nasopharyngeal carcinoma. Juvenile nasopharyngeal fibromas especially could be differentiated from nasopharyngeal malignant tumors. They were located more anteriorly in the nasopharynx than were most of the malignant tumors and in some instances produced highly characteristic features, the most diagnostic of which were: (1) anterior bowing of the posterior antral wall; (2) erosion of a hole through the floor of the sphenoid sinus; and (3) erosion and enlargement of the superior orbital fissure. Chordomas usually produced destruction farther posteriorly than did nasopharyngeal carcinomas. On submental-vertical projections, the destruction seen roentgenographically due to the chemodectomas involved the inferior aspect of the petrous pyramids and adjacent temporal bone, whereas the principal destruction of the nasopharyngeal carcinomas was more medial. Occasionally the pedicle of the choanal or antrochoanal polyps could be seen leading anteriorly from the mass in the nasopharynx in a rather typical fashion.

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