title: Isolated osteoradionecrosis of the dens mimicking metastasis of nasopharyngeal carcinoma after radiotherapy.
abstract: Nasopharyngeal carcinoma (NPC) is common in southern China, and radiotherapy remains the mainstay of treatment. A rare late complication of this treatment is the development of osteoradionecrosis (ORN), which seldom involves the cervical spine. We describe a 47-year-old female with undifferentiated carcinoma of the nasopharynx, stage II (T2N0M0), who had undergone radiotherapy 51 months prior, and complained of a twitching headache on neck flexion/extension. Imaging studies, including MRI and 18-fluoro-2-deoxyglucose positron emission tomography scan, suggested the diagnosis of cervical spinal metastasis. However, plasma Epstein-Barr virus DNA was undetectable, favoring absence of tumor recurrence. The patient underwent atlantoaxial sublaminar wiring for an unstable spine and a subsequent transoral biopsy, the histopathologic diagnosis of ORN. The postoperative clinical course was uneventful and follow-up MRI, 2 years later, revealed gradual resolution of the lesion. To our knowledge this is the first report of an isolated ORN lesion of the dens confirmed surgically in a patient with a history of previously treated NPC, a lesion at the cervical spine, and inconclusive imaging and biological marker results. We recommend that ORN be suspected until proven otherwise in a previously irradiated patient.
authors.affiliation: Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Jung-Shun
authors.initials: JS
authors.lastname: Lee
authors.forename: Chih-Ming
authors.initials: CM
authors.lastname: Huang
authors.forename: I-Chun
authors.initials: IC
authors.lastname: Yeh
authors.forename: Helen Hai-Wen
authors.initials: HH
authors.lastname: Chen
authors.forename: Jin-Ching
authors.initials: JC
authors.lastname: Lin
authors.forename: Hsing-Hong
authors.initials: HH
authors.lastname: Chen
mesh_terms: D001859:Bone Neoplasms / Q000556:secondary*; D002277:Carcinoma / Q000532:radiotherapy / Q000556:secondary*; D002574:Cervical Vertebrae / Q000473:pathology* / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000473:pathology* / Q000532:radiotherapy; D010025:Osteoradionecrosis / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome