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Nasopharyngeal Mass
This case features a patient presenting with a nasopharyngeal mass, ultimately diagnosed as IgG4-related disease.
Imaging overview:
Axial contrast-enhanced CT demonstrates a trans-spatial mass involving the enlarged left torus tubarius, extending into the parapharyngeal space, retropharyngeal space, carotid space, and masticator space. Axial T2 MRI shows the mass to be low in signal intensity, reflecting underlying fibrosis and hypercellularity. Axial T1 post-contrast MRI demonstrates marked hyperenhancement of the mass.
Clinical insight:
IgG4-related disease is a fibroinflammatory condition that can present as a mass-like lesion in virtually any anatomic location, including the head and neck. A key imaging clue is a fibrotic mass that is T2 dark with marked enhancement and is negative for malignancy on biopsy. The low T2 signal, caused by dense fibrosis and hypercellularity, is an important distinguishing feature from more common nasopharyngeal malignancies, which tend to be T2 intermediate to bright. When a trans-spatial, non-malignant fibrotic mass is encountered in this region, IgG4-related disease should be raised as a diagnostic possibility and confirmed with tissue biopsy or serum IgG4 levels.
Case courtesy of Daniel Warren, MD, University of Illinois Carle College of Medicine, Carle Foundation Hospital.