Nasopharyngeal carcinoma with osseous metastases in an 8-year-old girl: a case report
Alaa Eid Alfarhan, Doha Mohammed Alhawarnh, Mouhammed Sleiay, Mohammad Kokash, Mhd Omran Khedr, MHD Ali OthmanIntroduction and importance:
Nasopharyngeal carcinoma is exceptionally rare in young children, particularly those under 10 years of age. Presentation with widespread osseous metastases at diagnosis is even more uncommon, posing diagnostic and therapeutic challenges.
Case presentation:
An 8-year-old girl presented with an 8-month history of a gradually enlarging right cervical mass associated with fever, weight loss, night sweats, generalized bone pain, and fatigue. Examination revealed a firm, nontender neck mass of size 10 × 8 cm with bilateral cervical lymphadenopathy. Laboratory findings showed elevated inflammatory markers and LDH. Imaging demonstrated a primary nasopharyngeal tumor with extensive nodal involvement and osseous metastases confirmed by bone scan. Biopsy revealed metastatic nonkeratinizing nasopharyngeal carcinoma.
Clinical discussion:
The patient received three cycles of cisplatin/5-FU induction chemotherapy, followed by concurrent chemoradiotherapy (cisplatin 30 mg/m 2 weekly for 7 weeks). This approach achieved disease control despite the advanced stage at presentation.
Conclusion:
This case highlights the importance of considering nasopharyngeal carcinoma in children with cervical lymphadenopathy and systemic symptoms. Multicenter studies are needed to establish standardized pediatric protocols and to investigate molecular biomarkers.