a rare presentation of primary nasopharyngeal carcinoma (npc) in mediastinum

Introduction: nasopharyngeal carcinoma among the children has been rare accounting for only 1% of all pediatric malignancies. both genetic and environmental factors have contributed to the development of nasopharyngeal carcinoma. among the children there was a higher rate of undifferentiated histology. the mean age of nasopharyngeal carcinoma diagnosis has been 11 years old age; and the most common site was nasopharynx. palpable lymphadenopathy, dysphasia and neural defect were common associated signs. case presentation: a 15-year-old boy has presented with a mass that located near by the heart in the left side of mediastinum with invasion to anterior mediastinum from two years ago. in biopsy, nasopharyngeal carcinoma, non-keratinizing type, has diagnosed while there was no involvement of nasopharyngeal region. patient has treated by 70 gy (2.0 gy/fraction) radiotherapy plus concomi- tant chemotherapy with base of docetaxel. but the mass had no regression. then, the patient has treated with cisplatin 100 mg/m2 iv on days 1, 22, and 43 with radiation, then cisplatin 80 mg/m2 iv on day 1 plus fluorouracil (5-fu) 1000 mg/m2 /day by continuous iv infusion on days 1 - 4 every 4wk for 3 cycles and after remission interferon beta has added to treatment for 6 months duration as a maintenance therapy. after 1 year follow up; the patient was in complete remission. in the course of therapy, only hypothyroidism has occurred. conclusions: nasopharyngeal carcinoma in childhood, without nasopharyngeal involvement, initially could be detected in other sites such as pericardium. also good results could be respected by cisplatin and 5-fluorouracil based neoadjuvant chemotherapy before radiotherapy plus interferon beta as a maintenance therapy in childhood aggressive nasopharyngeal carcinoma.