Ovarian Metastasis from Schmincke-Regaud’s Tumor

Case Report

Austin Head Neck Oncol. 2017; 1(1): 1003.

Ovarian Metastasis from Schmincke-Regaud’s Tumor

Ennaji M¹*, Willemse E¹, Veys I², Larsimont D², Andry G¹ and Digonnet A¹

¹Department of Head and Neck Surgery, Jules Bordet Institute (ULB), Brussels, Belgium

²Department of Mammo-Pelvic Surgery, Jules Bordet Institute (ULB), Brussels, Belgium

³Department of Pathology, Jules Bordet Institute (ULB), Brussels, Belgium

*Corresponding author: Meriem Ennaji, Department of Head and Neck Surgery, Jules Bordet Institute (ULB), Brussels, Belgium

Received: July 27, 2017; Accepted: August 30, 2017; Published: September 06, 2017


Nasopharyngeal Carcinoma (NPC) has an established potential for distant metastasis however it is generally localized at diagnosis. Metastatic sites are usually multifocal and involve the bones, lungs and distant lymph nodes [1]. To the best of our knowledge, this is the first report of a nasopharyngeal carcinoma that metastasized to the ovary.

In the present study, the case of a 57-year-old female patient with a history of nasal obstruction and epistaxis is presented. Following a series of examinations and a biopsy of the cavum, the patient was diagnosed with an undifferentiated carcinoma of the nasopharynx (cT2bcN1M0). Subsequently, the patient received a concurrent Chemoradiation Therapy (CRT). She was in complete remission after the treatment.

Fourthy one months after primary diagnosis, during her regular follow up examination, a voluminous hypermetabolic lesion was discovered in the left ovary through Positron Emission Tomography-Computed Tomography (PETCT). The histological results confirmed the evidence of an ovarian metastasis from Undifferentiated Carcinoma of the Nasopharyngeal Type (UCNT).

The aim of this report is to present the unusual case of ovarian metastasis from nasopharyngeal carcinoma, an extremely rare event but worth considering in patients presenting an ovarian lesion at imaging and a history of primary or recurrent nasopharyngeal carcinoma.

Keywords: Nasopharyngeal carcinoma (NPC); Undifferentiated carcinoma of the nasopharyngeal type (UCNT); Epstein- barr virus (EBV); Positron emission tomography-computed tomography (PET-CT)


NPC: Nasopharyngeal Carcinoma; CRT: Chemoradiation Therapy; PET-CT: Positron Emission Tomography-Computed Tomography; UCNT: Undifferentiated Carcinoma of the Nasopharyngeal Type; WHO: World Health Organization; EBV: Epstein - Barr virus; EBER: In-Situ- Hybridization for EBV-DNA; MOC: Multidisciplinary Oncologic Consultation; TPN: Total Parenteral Nutrition


Nasopharyngeal Carcinoma (NPC) is a tumor arising from the epithelial cells that cover the surface and line the nasopharynx. It was first described as a distinct entity by Regaud and Schmincke in 1921 [2-3].

The World Health Organization (WHO) classifies nasopharyngeal carcinoma in three types: keratinising squamous cell carcinoma (Type I), non-keratinising differentiated carcinoma (Type II) and non-keratinising undifferentiated carcinoma (Type III) [4].

The undifferentiated tumor (type III), also called Schmincke’s tumor or lymphoepithelioma is the most common type of NPC. It is also more prevalent in North African and Chinese populations [5]. Consumption of salted fish is one of the factors leading to NPC, which might be related to carcinogenic nitrosamine detected in fish.

Epstein-Barr Virus (EBV) infection also plays a role in the etiology of type II and III NPC [6].

The incidence of such tumors peaks between 20 and 30 years of age, and after 60 years of age.

NPC is typically unresectable at diagnosis, but is more responsive to chemotherapy and radiotherapy than other head and neck cancers [7]. Cervical lymph node metastases are present at diagnosis in 75- 90% of cases and are bilateral in more than 50% cases [8].

Distant metastases are present at diagnosis in 5-11% of patients, and the most common sites are bone, lung and liver tissue [9].

Metastases to the ovary commonly arise from the gastrointestinal tract, breast, lungs and controlateral ovaries.

Other rare primaries include endometrium, melanoma, pancreas and carcinoid [10].

To our knowledge, the current study describes the only case of a patient with an ovarian metastasis from nasopharyngeal carcinoma.

Case Presentation

In October 2012, a 57-year-old 0 from Algiers was admitted to the department of Head and Neck Surgery at Jules Bordet Institute in Brussels. She was suffering from nasal obstruction, sinusitis and intermittent epistaxis since a few weeks. The patient did not smoke or consume alcohol. She didn’t notice any weight loss over the past months. Physical investigation was totally normal. Endoscopic inspection showed a large nasopharyngeal mass localized in the posterolateral wall of the cavum. The histological examination of the biopsy resulted in the diagnosis of undifferentiated NPC (UCNT, WHO III) (Figure 1). Serological tests for EBV were positive.