Tornwaldt's cyst formation after concurrent chemoradiotherapy for nasopharyngeal carcinoma

Abstract

The complications of concurrent chemoradiotherapy for nasopharyngeal carcinoma include dryness of mouth, sensorineural hearing loss, dental caries, trismus, pituitary dysfunction, myelitis, paralysis of cranial nerves IX-XII, massive neck fibrosis and pharyngeal wall necrosis. Tornwaldt's cyst formation after concurrent chemoradiotherapy for nasopharyngeal carcinoma has not been reported previously in the world literature. Tornwaldt's cyst, a persistent pharyngeal bursa, is found in about 3 per cent of the adult population, although the majority of these are asymptomatic. We describe the previously unreported complication of Tornwaldt's cyst formation after concurrent chemoradiotherapy for nasopharyngeal carcinoma.

Nasopharyngeal cyst in an adolescent boy: differential diagnosis – embryological and anatomical considerations

“…Several specific cystic developmental or acquired lesions may be encountered in the nasopharynx, including adenoid retention cysts, Tornwaldt’s cysts, Rathke’s pouch cysts, meningoceles and second branchial arch cysts 3 4 9 11–16. Therefore, a deliberate knowledge of the embryological development of the nasopharynx and its neighbouring anatomical structures is crucial for understanding the formation of these developmental cysts.…”

“…Its incidence ranges between 1.9% and 7% of the general population,3 9 12 16–21 with a peak incidence at 30–60 years,9 18 19 and no sex predilection 9 21 22. Recurrent infections and local trauma, like in the case of an adenoidectomy, may block the orifice of the pouch leading to subsequent Tornwadt’s cyst formation lined with respiratory epithelium and filled with proteinaceous content of varying viscosity 3 4 6 9 11 13 14. The latter attributes to the characteristic MRI findings of the lesion, which appears hyperintense on T2-weighted images and with variable intensity, according to the viscosity of the content on the T1-weighted images 14 17 19 23 24.…”

Lesiones quísticas de línea media de base de cráneo anterior

“…Tiene una incidencia aproximada de 3,3% por estudio de necropsias 19 . Si bien su origen en predominantemente congénito por la comunicación ya descrita entre el remanente embrionario de la notocorda y la mucosa faríngea, puede también originarse tras un proceso infeccioso (nasofaringitis), quirúrgico (adenoidectomía) o quimiorradioterapéutico (carcinoma nasofaríngeo) 20,21 . Mayoritariamente y asintomáticos, puede manifestarse clínicamente por su compromiso obstructivo o una sobreinfección, pudiendo presentar obstrucción nasal, disfunción de la trompa de Eustaquio, descarga posterior, halitosis, rigidez de nuca o cefalea occipital.…”

Nasopharyngeal Cysts

“…The cyst represents the embryonic communication between mesenchymal notochord remnant and endodermal-derived nasopharyngeal mucosa [19]. However, these cysts may also be acquired, following nasopharyngitis [19], surgical trauma (adenoidectomy) [20] and chemoradiation for nasopharyngeal carcinoma in adults [21]. Tornwaldt's cysts can be classified to either crusting cysts that freely drain to the nasopharynx, or to true cystic cysts that do not [19].…”