Many of us experience on and off nasal congestion and discharge which we often attribute to allergy or change in season. Nonspecific headaches sometimes accompany this problem and we shrug it off as sinusitis. It has become so prevalent that we brand it as "common cold". Here's an account of a patient I recently saw which might change your perspective of the common cold. Read on.
This is the case of a 54 year-old male who called me up the day after Christmas due to a sudden onset of diplopia which he noted on the Christmas day itself. I was previously treating him as a case of Allergic Rhinosinusitis. His symptoms previously were on and off nasal congestion with watery to greenish nasal discharge, and occasional mild to moderate frontal headache. Repeated anterior rhinoscopy showed congested turbinates with watery nasal discharge, sometimes greenish. X-ray of the paranasal sinuses were unremarkable. I started him on oral steroid + antihistamine and antibiotics which relieved him of the symptoms and maintained him on antihistamines. He is compliant and regularly comes back for follow-up.
I immediately asked him to visit me when he made the call. On physical examination, there was a limitation in the lateral excursion of the right eyeball. The rest of the eyeball movements were normal bilaterally. On anterior rhinoscopy, the turbinates were slightly congested and watery nasal discharge was noted on both nostrils. Nasopharyngoscopy with a rigid endoscope revealed a fungating friable mass on the left nasopharynx with minimal extension across the midline. No mass was noted in the oral cavity, oropharynx, hypopharynx, as well as in the neck.
Punch biopsy of the nasopharyngeal mass was done and histopathological studies revealed Undifferentiated Carcinoma. CT Scan of the nasopharynx showed a large nasopharyngeal tumor mass lesion with tumor growth extension into the sphenoid, pituitary gland, and left paracavernous region consistent with nasopharyngeal malignancy.
My impression is NPCA, Undifferentiated, Stage IVA: T4, N0-2, M0 ( The tumor has spread to the skull and has affected the left cranial nerve VI and its nearby tissues and may or may not have spread to lymph nodes smaller than 6 cm but not to distant sites). He is now under chemo-radiotherapy.
This is an unusual case of nasopharyngeal carcinoma as diplopia being a presenting symptom occurs only in 8% of all reported cases. In the Philippines, just like in my experience, lateral neck mass is still the more common complaint. Although headache maybe considered a symptom as well, the type experienced by the patient is so characteristic of sinusitis that it would not warrant suspicion of NPCA. Was the "common cold" part of the cancer process or was it a totally different entity? I am not sure of that. One thing is certain though, if cases like this happen, then we should not dismiss "cold" as just "common". Instead, a deeper investigation should be done always.
This is the case of a 54 year-old male who called me up the day after Christmas due to a sudden onset of diplopia which he noted on the Christmas day itself. I was previously treating him as a case of Allergic Rhinosinusitis. His symptoms previously were on and off nasal congestion with watery to greenish nasal discharge, and occasional mild to moderate frontal headache. Repeated anterior rhinoscopy showed congested turbinates with watery nasal discharge, sometimes greenish. X-ray of the paranasal sinuses were unremarkable. I started him on oral steroid + antihistamine and antibiotics which relieved him of the symptoms and maintained him on antihistamines. He is compliant and regularly comes back for follow-up.
I immediately asked him to visit me when he made the call. On physical examination, there was a limitation in the lateral excursion of the right eyeball. The rest of the eyeball movements were normal bilaterally. On anterior rhinoscopy, the turbinates were slightly congested and watery nasal discharge was noted on both nostrils. Nasopharyngoscopy with a rigid endoscope revealed a fungating friable mass on the left nasopharynx with minimal extension across the midline. No mass was noted in the oral cavity, oropharynx, hypopharynx, as well as in the neck.
Punch biopsy of the nasopharyngeal mass was done and histopathological studies revealed Undifferentiated Carcinoma. CT Scan of the nasopharynx showed a large nasopharyngeal tumor mass lesion with tumor growth extension into the sphenoid, pituitary gland, and left paracavernous region consistent with nasopharyngeal malignancy.
My impression is NPCA, Undifferentiated, Stage IVA: T4, N0-2, M0 ( The tumor has spread to the skull and has affected the left cranial nerve VI and its nearby tissues and may or may not have spread to lymph nodes smaller than 6 cm but not to distant sites). He is now under chemo-radiotherapy.
This is an unusual case of nasopharyngeal carcinoma as diplopia being a presenting symptom occurs only in 8% of all reported cases. In the Philippines, just like in my experience, lateral neck mass is still the more common complaint. Although headache maybe considered a symptom as well, the type experienced by the patient is so characteristic of sinusitis that it would not warrant suspicion of NPCA. Was the "common cold" part of the cancer process or was it a totally different entity? I am not sure of that. One thing is certain though, if cases like this happen, then we should not dismiss "cold" as just "common". Instead, a deeper investigation should be done always.
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