Christine M. Glastonbury MBBS, Presenter: Consultant, Amirsys, Inc Investor, Amirsys, Inc

1) Understand the normal anatomical landmarks and relations of the nasopharynx and in particular the relationship of the nasopharynx to the central skull base. 2) Recognize normal physiological variations and inflammatory processes of the nasopharynx that might be mistaken for more sinister pathology. 3) Understand the pathological behavior and important staging features of nasopharyngeal carcinoma and lymphoma, the two most common nasopharyngeal malignant processes.

The nasopharynx is the most superior portion of the pharynx, extending anteriorly to the posterior choanae and inferiorly to the level of the soft palate. The nasopharynx ‘attaches’ to the undersurface of the clivus via the pharyngobasilar fascia of the superior constrictor muscle. This fascia is in continuity with the buccopharyngeal fascia surrounding the pharynx. The foramen of Morgagni is a hiatus between the base of skull and constrictor muscle, through which the Eustachian tube, tensor veli palatini and levator veli pass. It is thus a potential ‘weak spot’ in the head and neck, through which pathological processes may reach the skull base and spread intracranially. Other important imaging landmarks include the lateral nasopharyngeal recess or fossa of Rosenmüller and the midline nasopharyngeal tonsil, or adenoids. Nasopharyngeal carcinoma (NPC) is a distinct entity from pharyngeal squamous cell carcinoma (SCCa). NPC has a unique histological appearance, has different inciting factors to SCCa, and has unique familial, genetic, and geographic predispositions. Nasopharyngeal carcinoma also has a different pathological behavior to pharyngeal SCCa, with a tendency for clival invasion, intracranial spread, and early systemic metastasis. In keeping with this distinct pathological behavior, NPC has particular imaging manifestations and staging criteria that differ significantly from pharyngeal SCCa. In this session we will review the key anatomic landmarks and the key imaging features of the nasopharynx and of nasopharyngeal carcinoma, reviewing the 2010 TNM staging updates. We will also review important differentials for masses in this region.  

Glastonbury, C, Nasopharynx.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/6005725.html