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Medical and Pediatric Oncology 32:75–76 (1999)
BRIEF REPORT
Multiple Chest Wall Masses Presenting in Nasopharyngeal Carcinoma
Ahmet Baydur, MD,1,3* Augustine Iluore, MD,2,3 Thomas Fisher, MD,2,3
Nadeznalyn Ang, MD,2,3 and Gayle Lucas, MD4
Key words: nasopharyngeal carcinoma; chest wall metastases; head and neck
cancer; needle biopsy
Bone is the most common site of deposits in patients
with nasopharyngeal carcinoma (NPC) in whom metastases are diagnosed clinically. The presentation of chest
wall metastases arising from ribs in patients with NPC
has not been previously described.
A 39-year-old Vietnamese man presented with dyspnea, weight loss, left facial paralysis, back pain, progressive leg weakness and multiple chest wall growths
progressive over a 3-month period. Physical examination
revealed an afebrile, pale, cachectic man with drooping
of the left face and maxillary sinus tenderness. The chest
wall was studded with several hard, non-tender masses,
the largest of which were 4 to 6 cm in size and located
over the sternum (Fig. 1). Neurologic examination revealed a left facial and bilateral lower extremity paralysis, and fine touch reduced in the left lower extremity.
Serum IgG antibody titer to Epstein-Barr virus was
1:5,120. Chest roentgenogram showed multiple pulmonary and chest wall densities. Computed tomography of
the head revealed a hypodense area in the left temporal
lobe. Magnetic resonance imaging of the thoracolumbar
spine showed metastatic deposits involving all vertebral
bodies and posterior elements, associated with cord and
nerve root compression at multiple lower thoracic and
lumbar levels. Percutaneous fine needle aspiration of the
largest of the sternal masses showed cellular smears with
cohesive clusters of markedly pleomorphic cells consistent with poorly differentiated squamous cell carcinoma
(Fig. 2). The patient was treated with intravenous fluids,
steroids and opioids, and started on radiation treatments
to the spine. After radiotherapy totaling 2,800 cGy, he
was lost to follow-up.
The incidence of distant metastases in nasopharyngeal
cancer (NPC) is from 17% to 53% clinically, and from
38% to 87% on necropsy [1,2]. These occur more frequently in NPC than in other tumors of the head and neck
[3]. Bone is the most common site of deposits in patients
in whom metastases are diagnosed clinically. Rib and
sternal lesions can appear as lytic or sclerotic deposits on
chest roentgenogram [4,5]. Since the incidence of skeletal metastasis in the patient with an extraskeletal primary malignancy ranges from 25% to 30% [6], a meta© 1999 Wiley-Liss, Inc.
Fig. 1. Multiple hard, fixed masses arising from sternum and ribs.
A: Anterior view. B: Lateral view.
1
Division of Pulmonary and Critical Care, University of Southern
California, Los Angeles, California
2
Division of General Internal Medicine, University of Southern California, Los Angeles, California
3
Department of Medicine, University of Southern California, Los Angeles, California
4
Department of Pathology, University of Southern California, Los Angeles, California
*Correspondence to: Dr. Ahmet Baydur, Pulmonary and Critical Care
Division, University of Southern California, School of Medicine, 2025
Zonal Avenue, GNH 11-900, Los Angeles, CA 90033.
Received 11 May 1998; Accepted 23 June 1998
76
Baydur et al.
priate diagnostic step. An inconclusive needle aspiration
should be followed by an incisional biopsy for definitive
diagnosis.
REFERENCES
Fig. 2. Fine needle aspiration of subcutaneous sternal lesion showing
tumor cells with marked pleomorphism, coarse nuclear chromatin, and
prominent nucleoli. Poorly differentiated carcinoma. Hematoxylin and
eosin, Diff-Quick stain, ×425.
static lesion must be considered in any patient who
presents with a chest wall mass. Therefore, needle biopsy
by the core technique or aspiration cytology is an appro-
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fish and inhalants as risk factors for nasopharyngeal carcinoma in
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2. Ahmad A, Stefani S. Distant metastases of nasopharyngeal carcinoma: A study of 256 male patients. J Surg Oncol 1986;33:194–
197.
3. Probert JC, Thompson RW, Bagshaw MA. Patterns of spread of
distant metastases in head and neck cancer. Cancer 1974;33:127–
133.
4. Daly BD, Leung SF, Cheung H, Metreweli C. Thoracic metastases
from carcinoma of the nasopharynx: High frequency of hilar and
mediastinal lymphadenopathy. AJR 1993;160:241–244.
5. Sham JST, Cheung YK, Chan FL, Choy D. Nasopharyngeal carcinoma: Pattern of skeletal metastases. Br J Radiol 1990;63:202–
205.
6. Moser RP, Madewell JE. An approach to primary bone tumors.
Radiol Clin North Am 1987;25:1049–1093.
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