Clinical Cases

Malignancy of the Nasopharynx

A useful article about Malignancy of the Nasopharynx.Full details about Malignancy of the Nasopharynx

2.7.2002:

Mrs. TEF aged 67 years, consulted me for the following complaints:

Growth in the left side of the nasopharynx since two years, with epistaxis, headache and loss of hearing on the same side. She gradually developed hearing loss on the right side. She also has vertigo and ataxia. She complained of post-auricular pain radiating to the neck and left shoulder. There was a history of sudden falls three times due to ataxia. Diagnosed on CT scan as malignancy of the nasopharynx.

She also complains of:

Breathlessness since one month even while sitting, accompanied with pain in the right side of the chest.

Her appetite is poor with weak digestion since cholecystectomy done in 2001. She feels a constant abdominal pain and distention. She cannot wear tight clothes. She also feels extremely weak after the operation.

Past History:

After the delivery of the second child she developed rheumatic fever with joint pains and itching all over the body especially of the palms with erythema.

Hysterectomy after the delivery of the second child at the age of 32 years followed by left oophorectomy two years after that. After 1-1.5 years the right ovary was also removed.

In 1998 developed adhesions in the abdominal cavity was operated on and the colostomy done.

Cholecystectomy done in 2001.

She suffers from recurrent colds with a loss of voice every six but not since the last 2 years.

Family History:

Mother had cancer of the stomach.

Father also had cancer of (?) stomach.

Two sisters have osteoporosis.

One sister was diagnosed with bone cancer,

All brothers have ?? neurofibromatosis.

Life Space:

She stays with one of her sons, daughter-in-law and two grandchildren. One son and his family stay separately. Her husband died in 1992 due to cardiac arrest. “He was a very nice man and even my children are wonderful.”

“I am a very “bindaas” (bold) person. I like going out and partying. I am the live wire at all the parties. With children I am like a child. Without me, nothing gets done in the family. I love dancing and cannot resist it. I am a very good singer, love music and am extremely fond of dancing. Whenever I am tensed, dancing makes me feel better. I am a follower of Suky Mahikari a form a Japanese art, a form of spiritualism. I turned towards it after my oophorectomy operation in 1988 but more so from 1997. It has helped me a lot with my complaints. I once had a dream of sleeping in an air-conditioned room and a hand coming over my head and blessing me and then I perspired too much.” She views this as a blessing and a call for her to join the Japanese temple. The ‘light’ she received helped her to feel better in all her complaints. After this, her nature has changed. Previously she used to argue a lot, but now she had become very tolerant of people and things.

“I am a practical and straight forward person. I am always adjusting and never make a fuss. I value things very much. I am not anxious.

After my husband’s death, there was a robbery in the house and a lot of valuables were robbed. I was very upset about it but now I feel it was something I had to go through and have let go of it now. God is my good friend. We are all here to enjoy life and be happy and make others happy. As being taught in my teachings, I believe that spirits influence our life. We should all be sympathetic and help others. According to me, love is the most important thing in life. We should love one and all.”

I like being in company. Since childhood I am very helpful and generous. I have never been obstinate.

Previously I was a beautician and clients used to share their problems with me and I never shared their secrets with anyone. I love solving others’ problems. I try to help the poor and give ‘light’ to birds, trees, plants, everything. I want things to be done perfectly and always.

Of late, because of the unbearable pain; I get irritated, otherwise I seldom get angry. Now, I am fed up because of my illness.

I am very talkative and mischievous. Even as a child, I was very mischievous. I never played with girls; always with boys as I liked playing cricket, climbing trees, etc. I was a free bird. I fell in love at the age of 13 years but got married at the age of 21 years. My husband was very strict and never allowed me to sing or dance.”

Dream as stated above.

Observation:

The patient was extremely friendly and gives a hug to me and my assistant while leaving the room.

Physical Generals:

Appetite : Decreased. Loved food but now no appetite.
Thirst:      Decreased.
Craving:   Fruits2, spicy2  (but now avoids eating spicy as it causes acidity)
Aversion: Not specific.
Perspiration: Scanty.
Thermals: Fan seasonal, Bath seasonal,
Covering thin in summer, thick in winter.
Ambithermal to chilly.
Urine: normal
Stools: Colostomy bag.
Sleep: Better since 8 days. Previously, she kept awake the whole night. No worries, no thoughts, but still no sleep. Kept reading the whole night and used to get sleep around 6 o’clock in the morning and then slept till 9 a.m.

Obstetric History:

G2 P2 A0 L2: FTND.

Sons aged 41 and 38 years.

Menopausal. Uterus removed at the age of 32 years after delivery of second child due to profuse bleeding. Ovaries were excised one after another.

Investigations Done:

CT of  nasopharynx (plain and contrast) on 14.5.2002

Findings are suggestive of malignancy involving the nasopharyngeal mucosal space causing effacement of left para-pharyngeal space. Small bilateral jugulo-digastric and submandibular lymph nodes.

Xray Chest – Senile changes in the lung with right-sided pleural effusion.

On Examination:

Chest: Air Entry decreased, on the right side .

The following rubrics were appropriately taken: (Complete Repertory)

Mind: Cheerful, gaiety
Mind: Affectionate
Mind: Company: desires for
Mind: Sympathetic, compassionate
Mind: Dancing: Ameliorates
Mind: Numerous, various things
Food Drinks: Fruits, desires
Chilly

On repertorization, the following remedies prominently appeared: Ign, Phos, Nat Mur, Puls, Ars Alb, Nux Vomica, Sepia, Nat Carb, Carc and Lach etc

Remedy Selection and Follow-up:

2.7.2002

Based on the above rubrics and the family history of cancer, and the modality of Dancing >, CARCINOSIN 200 1 dose was prescribed.

19.7.02

Not >
Breathing difficult.
Slight forgetfulness.
Giddiness.
Left nose block ++.
No epistaxis.
Hearing SQ.
The patient says, “I want the cold to come on, only then, I will feel better”.

Rx SL

29.7. 02

No Change.

Case reviewed: Temperamentally  the patient seemed to be more sanguine than melancholic. Carcinosin is predominantly melancholic, sanguine and choleric. Hence Phos was considered instead.

Rx: PHOS 200C 1 dose.

16.8.02

Pain in the abdomen at the site of the operational scar.
Sleep SQ.
Nose block: SQ     Rx: PHOS 1M 1 dose.

17.9.02

Sleep better; Headache and hearing >>.
Nose block SQ

Rx: SL

16.10.02

Pain in abdomen SQ. Rest all >
CT Naso-pharynx: 12.10.2002

As compared to the previous CT study dated on 14.5.2002:

There is seen minimal regression in the bulging left nasopharyngeal space lesion with good visualization of the left fossa of Rosenmuller with clearing of the left mastoid air cells. Soft tissue opacity is seen in the left maxillary sinus suggestive of mucosal polyp/ retention cyst.

Rx:. SL.

17.12.02

The patient developed a cold.
She says, “Do not stop my cold, let it come out”.
Rest >>

Rx. SL

4.2.03

Nose block < more at night and hence sleep disturbed
Appetite low.

Rx: PHOS 10M, 1 dose

28.2.03

Itching ++ on the whole body, especially on the palms with erythema (old symptom).
Rest >.
Appetite improved.

Rx: SL

1.4.03

Itching palms SQ.
Nose block persists.
CT: Paranasal sinuses (Plain+Contrast) dated

29.3.03 shows:

Complete regression in asymmetrical left nasopharyngeal mucosal space; differential enhancement is seen now as compared to given immediately  previous CT study dated 12.10.02

Rx: SL

16.4.03

Severe nose block:
Rest >
Itching SQ

Rx: PHOS 10 M 1 dose

24.4.03

C/O yellow nasal discharge.
Itching palms SQ.
Nose block Better>
Rest >>

Rx: SL.

27.6.03

>> Nose block >>
Itching better.

Rx: SL

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Dr. Parinaz Humranwala MD (Hom)
583, Vipin Villa, Jame Jamshed Road,
Dadar Parsi Colony,
Matunga, Mumbai 400019.

Ph: 022-24165496, 022-24129990

About the author

Parinaz Humranwala

Parinaz Humranwala

Dr. Parinaz Humranwala MD (Hom)
583, Vipin Villa, Jame Jamshed Road,
Dadar Parsi Colony,
Matunga, Mumbai 400019.

Ph: 022-24165496, 022-24129990

1 Comment

  • It very excellent topic and this disease is suffered the patient. In future, discussed & mentioned part by part, please discuss broadly.

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