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KARSINOMA NASOFARING

RURI GUSTIYANTI
1102011248
Pembimbing : dr. Pherena Amalia, Sp.Rad
Anatomy
DEFINISI

Karsinoma Nasofaring (KNF) merupakan karsinoma


yang muncul pada daerah nasofaring (area di atas
tenggorok dan di belakang hidung), yang
menunjukkan bukti adanya diferensiasi skuamosa
mikroskopik ringan atau ultrastruktur.
RISK FACTOR
Pathology
The most common is squamous cell
carcinoma
Most common position is Rosenmuller
fossa
Mass lesion
exophytic mass
Ulcerative mass
Infiltrative mass
Tumor Spreading
Lymphatic spreading

Most common is neck node spreading


Bilateral involvement
Most common position is upper jugular node
Least at submandibular
& submental node
Distance metastasis
Most common is
Bone
Lung
Liver
Other sites are rare
STADIUM
(SISTEM TNM MENURUT UICC 2002)
T = Tumor Primer.
To= Tidak tampak tumor.
T1= Tumor terbatas di nasofaring.
T2= Tumor meluas ke jaringan lunak.
T2a : Perluasan tumor ke orofaring dan atau rongga hidung tanpa
perluasan ke parafaring*.
T2b : Disertai perluasan ke parafaring.
T3= Tumor menginvasi struktur tulang dan/ atau sinus paranasal.
T4= Tumor dengan perluasan intrakranial dan/ atau terdapat keterlibatan saraf cranial, fossa
infratemporal, hipofaring,orbita atau ruang masticator.

Catatan : *Perluasan parafaring menunjukkan infiltrasi tumor ke arah postero-lateral melebihi fasia
faringo-basilar.
N = Pembesaran kelenjar getah bening regional .
Nx = Pembesaran Kelenjar Getah Bening tidak dapat dinilai.
No = Tidak ada pembesaran.
N1 = Metastase kelenjar getah bening unilateral, dengan ukuran terbesar
kurang atau sama dengan 6 cm, di atas fossa supraklavikula.
N2 = Metastase kelenjar getah bening bilateral, dengan ukuran terbesar
kurang atau sama dengan 6 cm, di atas fossa supraklavikula.
N3 = Metastase kelenjar getah bening bilateral dengan ukuran lebih besar
dari 6 cm, atau terletak di dalam fossa supraklavikula.
N3a = ukuran lebih dari 6 cm.
N3b = di dalam fossa supraklavikula.

M = Metastasis jauh
Mx = Metastasis jauh tidak dapat dinilai
Mo =Tidak ada metastasis jauh
M1 =Terdapat metastasis jauh
STADIUM
Stadium 0 T1s N0 M0
Stadium I T1 N0 M0
Stadium IIA T2a N0 M0
Stadium IIB T1 N1 M0
T2a N1 M0
T2b N0,N1 M0
Stadium III T1 N2 M0
T2a,T2b N2 M0
T3 N2 M0
Stadium IVa T4 N0,N1,N2 M0
Stadium IVb semua T N3 M0
Stadium IVc semua T semua N M1
Radiologic evaluation

Plain film head & neck


CT scan head & neck
MRI
Radioanatomy
Case 1 Patient Data
Age : 62 -year old
Gender : male
Clinical manifestation
gradual onset progressively with
increased left sided ptosis and inability
to move the left eye ball of 5 months
duration.
Radiology :
MRI axial T1 (left) and T2 (right) images
showing the carcinoma of the
nasopharynx. There are hyperintesnse
signals in left mastoid air cells and
sphenoid sinus
Case 2 Patient Data
Age : 16-year-old
Gender : male
Clinical manifestation
one-month swelling on the right side
of the neck. Additionally, for the
previous three months the patient had
been complaining of nasal congestion
and obstruction, as well as occasional
epistaxis and headaches, attributed to
a seasonal allergy.
Radiology :
Multislice computed tomography
(MSCT) of the head showing a
nasopharyngeal tumor measuring
37.6 x 31.7 mm
Case 3
Patient Data
Age : 40-year-old
Gender : female
Clinical manifestation
history of left- sided headache,
defective vision, drooping of
left upper eyelid and loss of
smell of 9 months duration.
Radiology :
NCCT head (axial section)
showing a mass in the left
ethmoidal sinus and
obliterating left cavernous sinus
Case 4
Patient Data
Age : 60-year-old
Gender : male
Clinical manifestation
headache and nasal block for 1 month
Radiology :
a) Axial contrast-enhanced computed
tomography image shows heterogenous
nasopharyngeal mass lesion (m) with anterior
extension into the nasal cavity (*) and
posterior extension to the longus muscle
(arrows).
(b) Axial contrast- enhanced computed
tomography image shows heterogenous mass
with Superior extension and invasion of the
sphenoid sinus (straight arrow).
(c) Axial computed tomography window shows
erosion of the basisphenoid and petrous apex
of temporal bone (arrow)
(d) Axial computed tomography window shows
erosion of right medial pterygoid plate (arrow)
Patient Data

Case 5
Age : 55-year-old
Gender ; male
Clinical manifestation
complaints of right ear discharge, hard of hearing and right-sided facial pain
for 1 month. On examination, tender swelling seen in the right side of the
neck.

Axial contrast-enhanced computed


tomography image shows a
heterogeneously enhancing mass filling
the right fossa of rosenmuller (*) with
parapharyngeal involvement on the Axial computed tomography bone
right side window shows erosion of the
basisphenoid and petrous apex of
temporal bone
Differential diagnosis

1. nasopharyngeal angiofibroma
More common in young people, men significantly more than women.
Nasopharyngeal microscope, tumor surface is smooth, the color is similar to
the normal mucosal tissue.
Radiology : masses in nasopharynx, bone destruction, (Hofman-Miller sign).
2. nasal polyp