Coexistence of Tuberculosis and Metastatic Undifferentiated Carcinoma of Nasopharynx in Cervical Lymph Node

Sameh Mezri*, Sameh Sayhi, Marwa Ben Amira, Issam Msakni, Besma Laabidi, Rania Ben M'hamed and Khemaies Akkeri

Coexistence of Tuberculosis and Metastatic Undifferentiated Carcinoma of Nasopharynx in Cervical Lymph Node.

The coexistence of a head and neck cancer and a lymph node tuberculosis is rarely described. The problem is essentially diagnostic. We report the case of a patient with cervical lymphadenopathy and non suspect swelliing of nasopharynx.

Histopathological study of lymph node reveled an association of a tubercular adenitis and a
metastasis of a squamous cell carcinoma. To our knowledge, only one case of coexistence of cervical
tubercular lymphadenitis with metastatic cervical lymph nodes of nasopharynx
cancer has been reported.  Interrogation was poor, with no signs of tuberculous impregnation or rhinological complaints.

Nasal endoscopy noted a thickening of the left side wall of nasopharynx considered not suspect. The tuberculin incidence
density ratio was positive. Cervical ultrasound noted the presence of bilateral
hypoechogenic adenomegalies, with preserved echostructure, well limited.

On the cervico-thoracic computed tomography, the adenomegalies had a necrotic center, a sequelae of an old pulmonary tuberculosis, bronchiectasis and a respiratory collapse of the right upper lobe.

In front of this clinical presentation, we evoked the diagnosis of lymph node tuberculosis and we opted for a cervicotomy with excision of the left subdigastric adenopathy. Anatomopathological examination concluded
that a coexistence of tuberculosis adenitis and lymph node metastasis of an
undifferentiated squamous cell carcinoma that nasopharyngeal origin is more likely.

A new cavum CT objectivated an irregular thickening of the nasopharynx filling the Rosen Muller fossa and necrotic adenomegalies of all the cervical and retropharyngeal chains. Anatomopathological study of the biopsy curettage of the cavum confirmed the diagnosis of the undifferentiated nasopharyngeal
carcinoma (UCNT) of nasopharynx.

Otolaryngol Open J. 2019; 5(2): 26-28. doi: 10.17140/OTLOJ-5-156