Zilan Ying, Ye Zhimin
Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China.
Am J Case Rep. 2025 Sep 16;26:e947790. doi: 10.12659/AJCR.947790.
BACKGROUND Nasopharyngeal carcinoma can directly invade the intracranial cavity through skull base foramina in advanced-stage patients. Due to both the multiple cranial nerve injuries associated with nasopharyngeal base invasion and the proximity of the pituitary gland, it is challenging to differentiate this condition from intracranial space-occupying lesions, such as meningiomas and pituitary adenomas, in the early stages. This report describes a 37-year-old woman with bilateral nasal congestion, diplopia, hearing loss, and headache diagnosed with a large nasopharyngeal carcinoma invading the cerebellum, pons, medulla oblongata, and cervical spinal cord. CASE REPORT A 37-year-old woman with nasopharyngeal carcinoma (NPC) exhibiting extensive intracranial invasion - involving the mesencephalon, cerebellum, pons, medulla oblongata, and cervical spinal cord - was, with difficulty, diagnosed as having intracranial space-occupying lesions (meningiomas/pituitary tumors) by some renowned neurosurgical centers. She came to our hospital using a wheelchair, exhibiting vague pronunciation, decreased bilateral hearing, headache, facial numbness, diplopia, and coughing when drinking water. Following definitive diagnosis through nasopharyngeal biopsy confirming non-keratinizing carcinoma, we quickly proceeded with treatment. After receiving 6 cycles of chemotherapy with anti-PD-1 immunotherapy, followed by tomotherapy with concurrent nivolumab, the lesion was dynamically reduced, and efficacy was assessed as a complete response (CR). Therapy significantly improved her symptoms, with the holocranial headache resolving, intelligible speech restored, and facial sensation recovered. CONCLUSIONS This case highlights the importance of routinely integrating nasopharyngeal MRI and biopsy when evaluating patients with atypical cranial neuropathies. Furthermore, multidisciplinary team (MDT) collaboration is essential to avoid delayed diagnosis in NPC cases with extensive skull base invasion.
晚期鼻咽癌患者可通过颅底孔道直接侵犯颅内腔。由于鼻咽癌侵犯颅底会导致多条颅神经损伤，且垂体位置临近，早期很难将这种情况与颅内占位性病变（如脑膜瘤和垂体腺瘤）区分开来。本报告描述了一名37岁女性，她因双侧鼻塞、复视、听力丧失和头痛被诊断为患有侵犯小脑、脑桥、延髓和颈髓的巨大鼻咽癌。
一名患有鼻咽癌（NPC）且出现广泛颅内侵犯（累及中脑、小脑、脑桥、延髓和颈髓）的37岁女性，曾被一些著名的神经外科中心误诊为难治性颅内占位性病变（脑膜瘤/垂体瘤）。她坐着轮椅来到我院，发音含糊，双侧听力下降，头痛，面部麻木，复视，饮水时咳嗽。经鼻咽活检确诊为非角化癌后，我们迅速开始治疗。在接受6个周期的抗PD-1免疫化疗，随后进行托姆刀放疗并同步使用纳武单抗后，病灶动态缩小，疗效评估为完全缓解（CR）。治疗显著改善了她的症状，全颅头痛消失，言语清晰，面部感觉恢复。
本病例强调了在评估非典型颅神经病变患者时常规进行鼻咽MRI检查和活检的重要性。此外，多学科团队（MDT）协作对于避免颅底广泛侵犯的鼻咽癌病例延迟诊断至关重要。
