Diagnosis of Pediatric Nasopharynx Carcinoma after Recurrent Adenoidectomy

Nasopharyngeal soft tissue is most commonly adenoid hypertrophy in children. Although rare, nasopharyngeal carcinoma (NPC) does occur in children. Nasal obstruction, serous otitis media, hearing problems, and tinnitus are common signs and symptoms of all nasal diseases. For this reason, the majority of NPC presents with advanced disease at the time of the diagnosis. This paper reported 7-year-old boy who was admitted to the hospital for adenoidectomy. He had recurrent adenoidectomy operation due to nasal obstruction. NPC had been diagnosed suspecting the hard mass in the nasopharynx during the operation. Adenoidectomy is the most commonly performed surgical procedure in ENT practice and NPC is unlikely to be considered in the differential diagnosis. Surgeon should be careful about signs and symptoms that alert suspicion. 1. Introduction Nasopharyngeal soft tissue is most commonly adenoid hypertrophy in children. However, NPC is rare accounting for 1–3% of all pediatric malignancies and pediatric NPC constitutes 20–50% of all NPC [1, 2]. The annual incidence of NPC is 0.3 per million at age 0–14 years, and 1 to 2 per million at age 15–19 years [3]. Peak is the fifth and sixth decades. According to WHO classification, NPC is histopathologically divided into three categories: keratinizing squamous cell carcinoma (WHO type I), nonkeratinizing squamous cell carcinoma (WHO type II), and undifferentiated carcinoma (WHO type III). Most of the cases are diagnosed as undifferentiated nasopharynx carcinoma (WHO type 3) in the advanced stage [4]. Epstein-Barr virus (EBV) infection combined with frequent exposure to environmental carcinogens is suggested in the etiology [5]. Five-year disease-free survival rates are between 29–60% [6]. Radiation therapy is effective in 75–100% of local control of the locoregional disease. Systemic metastasis at diagnosis is between 30–50% and this creates the main difficulty in the treatment. This study presents a case of childhood NPC suspected during adenoidectomy. This is a very common surgical procedure in daily practice and surgeons should keep this diagnosis in their minds. This study also reveals alarming signs and symptoms for diagnosis. 2. Case Report Seven-year-old male patient was admitted with complaints of nasal obstruction and snoring. He had a complaint of nosebleeds for the last two days. ENT examination was unremarkable. Flexible nasal endoscopy showed a soft tissue mass compatible with adenoid hypertrophy in the choana. Lateral radiograph of the nasopharynx revealed obstruction in the nasopharynx, so adenoidectomy