UNUSUAL ENDOCRINE PRESENTATIONS OF NASOPHARYNGEAL CARCINOMA

BACKGROUND. Nasopharyngeal carcinoma is endemic in Southern China and the majority of patients present with local symptoms due to the tumor. METHODS. This report describes two unusual cases of occult nasopharyn geal carcinoma in which the patients initially presented with endocrin e manifestations.RESULTS. The first patient presented with Gushing's s yndrome secondary to ec topic adrenocorticotropic hormone (ACTH) produ ction. Nasolaryngoscopy showed a growth in the left nasal fossa and bi opsy revealed a poorly differentiated nasopharyngeal carcinoma that ex hibited positive immunostaining for ACTH. The second patient presented with a 10-month history of bone pain over both lower limbs. She was n ormocalcemic but her serum alkaline phosphatase was markedly elevated. A bone biopsy showed both osteoclastic and osteoblastic activity with widespread fibrosis suggestive of Paget's disease. Three months later , she developed third cranial nerve palsy Computed tomography investig ation revealed a soft tissue mass filling the sphenoid and ethmoid sin uses. Biopsy showed a poorly differentiated nasopharyngeal carcinoma. The bone biopsy was reviewed and immunohistochemistry demonstrated the presence of cells positive for the epithelial marker AE1/3 within the fibrous stroma. Radio-labeled in situ hybridization showed that Epste in-Barr virus early RNA was present in these tumor cells and the bone lesions were in fact metastases. CONCLUSIONS. Nasopharyngeal carcinoma can present with rather atypical symptoms that may lead to a delay in diagnosis. Therefore, in high risk populations, it is important to co nsider nasopharyngeal carcinoma as a possible primary tumor in patient s with occult carcinomas. (C) 1996 American Cancer Society.