brain metastasis of nasopharyngeal carcinoma at presentation: a case report

Background: brain metastasis of nasopharyngeal carcinoma is very rare, and only a few cases have been reported. typically brain metastasis reveals after diagnosis and treatment of the aggressive primary tumor. diagnosis of metastatic nasopharyngeal carcinoma to the central nervous system at presentation is extremely rare. to the best of our knowledge, our patient is the first-ever reported case of brain metastasis of nasopharyngeal carcinoma at presentation. case presentation: a 30-year-old woman presented with repeated and severe headache and diplopia in november 2011, and clinical examination revealed increased intracranial pressure. brain magnetic resonance imaging showed an enhancing mass in the right frontal lobe. a thorough evaluation of the whole body revealed no any other problem. suboptimal resection of the mass by craniotomy revealed metastatic carcinoma. cea, ck20, ck7 were negative, and ttf-1 was positive. treatment was followed by whole brain radiotherapy and chemotherapy with the resultant complete improvement of the patient’s symptoms during the following two years. 17 months after the operation, the patient noticed left neck adenopathy but did not care. ultimately eight months later, when she was at five months of her first pregnancy, fine needle biopsy of her left neck mass revealed undifferentiated carcinoma. it was followed by panendoscopy” of the head and neck, and advanced nasopharyngeal cancer was shown. treatment conducted by chemotherapy after the 24th week of pregnancy, delivery at term and radiotherapy after that. the patient is alive with no evidence of disease, 15 months after completion of radiotherapy. conclusion: probability of nasopharyngeal origin should be considered in rare instances of metastatic brain carcinoma with unknown origin. close follow up after treatment of unknown primary brain metastases is mandatory to reveal and control the primary site in future. successful treatment of nasopharyngeal carcinoma at the third trimester of the pregnancy is possible and recommended.