Paget’s disease in association with undifferentiated nasopharyngeal carcinoma

IntroductionIn the case of an undifferentiated nasopharyngeal carcinoma coexisting with asymptomatic Paget’s disease it may be difficult to determine the stage. A case of a clinically localized nasopharyngeal carcinoma coexisting with incidental Paget’s disease is reported herein.Case reportA 51-year-old woman was admitted who presented a permanent left nasal obstruction, combined with ipsilateral epistaxis. She was diagnosed as having a nasopharyngeal carcinoma. The bone scan showed widespread homogenous increased remodelling throughout the skeleton. Radiographs showed an increase in bone density and cortical thickening. Magnetic resonance imaging (MRI) of the right leg excluded bone metastases. We concluded that this was a localized nasopharyngeal carcinoma associated with asymptomatic Paget’s disease of the bone. The patient showed a good response to concomitant radio chemotherapy.DiscussionIn imaging, the skeletal lesions of both nasopharyngeal cancer and Paget’s disease may closely resemble each other. No biological markers of bone resorption or formation can differentiate between the two entities. We used three radiological explorations to make the diagnosis. However we believe, after reviewing the literature, that fluorodeoxyglucose positron emission tomography (FDG PET) can be helpful in this situation.