Brain Tumor Res Treat.  2022 Jan;10(1):55-60. 10.14791/btrt.2022.10.e26.

Coincidental Nasopharyngeal Carcinoma and Ventral Foramen Magnum Meningioma: Case Report and Review of the Literature

• Bae Y
• Oh W
• Chung Y
• Won YS
• Hong JB

• KMID: 2525304
• DOI: http://doi.org/10.14791/btrt.2022.10.e26

Abstract

Multiple primary tumors at adjacent site are rare. We report a rare case of coincidentally found nasopharyngeal cancer and ventral foramen magnum meningioma. The 68-year-old male patient presented with a year history of ataxia. Radiological examination revealed lesions in the nasopharyngeal space and ventral foramen magnum. A needle aspiration biopsy for nasopharyngeal space and surgical removal for foramen magnum lesion were performed. The pathological diagnoses were nasopharyngeal cancer and meningioma, respectively. The concomitant occurrence of these two tumors is very rare and there is no known association between these two tumors. We report a case of ventral foramen magnum meningioma simultaneously present with nasopharyngeal carcinoma.

Keyword

Nasopharyngeal carcinoma; Foramen magnum; Primary brain neoplasms

Figure

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  Fig. 1 Preoperative axial (A), coronal (B), and sagittal (C) gadolinium-enhanced T1 weighted MRI scans. A 4.2×2.3×3-cm sized well enhancing mass at retroclival area is compressing medulla and shows bilateral V4 segments encasements. Another heterogeneous enhancing mass in the posterior nasopharyngeal wall with invasion into the prevertebral muscle and clivus is observed.

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  Fig. 2 Photomicrograph of nasopharyngeal mass (A and B) and an excised specimen of foramen magnum mass (C and D). On pathological examination, poorly differentiated basaloid cellular nests in fibrotic stroma (A; H&E, ×20) and diffusely positive reaction on p63 stain (B, ×20) were observed confirming nasopharyngeal carcinoma. Meningothelial cellular proliferation and hyalinized vessels with occasional microcalcifications were noted (C; H&E, ×20). EMA stain (×20) shows diffusely positive reactionsuggestive of meningothelial meningioma (D).

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  Fig. 3 Postoperative axial CT (A), gadolinium-enhanced T1 weighted axial (B), coronal (C) and sagittal (D) MRI scans. A: CT image shows the patient’s bone status after C1 partial laminectomy and partial condylectomy. B-D: Postoperative MRI scans show subtotal removal of the foramen magnum mass with residual tumor in the area where the lower cranial nerves responded to the neurostimulator.

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  Fig. 4 Intraoperative photographs. A: Preremoval photograph showing the dural attachment of the tumor in the ventral portion of the foramen magnum and clivus from the anterior side of the vertebral artery. B: Surgical image shows cranial nerve (CN) VII, VIII, IX, X, XI remain intact after internal bulking was repeated while detaching the tumor from the dura. C: After sufficiently removing the tumor, the tumor in the lower CN area that responds to the neurostimulator was left behind. D: Postremoval photograph revealing the preserved vertebral artery and lower CNs.

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