title: Nasopharyngeal granulomatous mass after radiotherapy for nasopharyngeal carcinoma.
abstract: OBJECTIVE
  To evaluate the diagnosis, management and nasal endoscopic surgical outcome of nasopharyngeal granulomatous mass in post-radiation nasopharyngeal carcinoma (NPC) patients.
  
  
  METHODS
  A total of 23 cases of granulomatous mass after radiotherapy for NPC from 2008 to 2013 treated with nasal endoscopic surgery were retrospectively reviewed.
  
  
  RESULTS
  Radiotherapy dose (p=0.036) and chemotherapy (p<0.001) correlated with the latency period after the treatment against NPC. The symptoms of the 23 patients before the treatment were nonspecific including nasal obstruction, purulent discharge, headache, epistaxis, foreign body sensation and/or hearing impairment. 12 patients (52.2%) were misdiagnosed to be recurrence of NPC by imaging examination (CT/MRI). After the endoscopic surgery treatment, 18 patients were disease free while the other 5 patients had developed a recurrence. Four of those five recurrent patients were cured with the repeated treatment. Histologic findings of granulation tissue with fibrin and inflammatory cells were found in all of the patients.
  
  
  CONCLUSIONS
  In situ granulomatous masses in post-radiation NPC patients are very prone to be misdiagnosed as recurrence of nasopharyngeal carcinoma. Chemotherapy is a significant independent factor affecting latency period (p=0.029). The nasal endoscopic surgery is an effective therapy for post-radiation nasopharyngeal granuloma; surgery can not only alleviate symptoms, what is more important, but it also helps to confirm the diagnosis.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China.
authors.forename: Lu
authors.initials: L
authors.lastname: Yang
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China.
authors.forename: Houyong
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China.
authors.forename: Huan
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China.
authors.forename: Huankang
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Pathology, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China.
authors.forename: Shuyi
authors.initials: S
authors.lastname: Wang
authors.affiliation: Florida Ear, Nose, Throat & Facial Plastic Surgery, Orlando, USA.
authors.forename: Allison N
authors.initials: AN
authors.lastname: Fry
authors.affiliation: Florida Ear, Nose, Throat & Facial Plastic Surgery, Orlando, USA.
authors.forename: Wade W
authors.initials: WW
authors.lastname: Han
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China. Electronic address: wangdehuient@sina.com.
authors.forename: Dehui
authors.initials: D
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma; D017024:Chemotherapy, Adjuvant; D003951:Diagnostic Errors; D004724:Endoscopy; D005260:Female; D006099:Granuloma / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009302:Nasopharyngeal Diseases / Q000601:surgery; D009303:Nasopharyngeal Neoplasms / Q000532:radiotherapy*; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging; D011832:Radiation Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D011878:Radiotherapy; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Chemotherapy; Endoscopic surgery; Nasopharyngeal carcinoma; Nasopharyngeal granulomatous mass; Radiotherapy