Isolated Sixth Nerve Palsy as a First Presentation of Nasopharyngeal Carcinoma: A Case Series

External auditory canal involvement by nasopharyngeal carcinoma via eustachian tube spread: A case report

We present the imaging findings of a 44-year-old female patient who was diagnosed with nasopharyngeal carcinoma (NPC) extending from the nasopharynx to the external auditory canal (EAC) through the Eustachian tube (ET). The patient presented with a left neck submandibular lump on initial presentation that showed NPC upon fine needle aspiration, leading to chemoradiotherapy. Despite treatment, the patient experienced multiple relapses and later presented with aural symptoms, including left ear pain, foul-smelling drainage, and trismus on recurrence, and was subsequently diagnosed through biopsy. CT, MRI, and PET-CT scans revealed an extensive infiltrative nasopharyngeal mass extending into the left ET, involving the EAC. This rare case highlights the importance of considering the extension of NPC into the EAC as a potential etiology in patients who present with aural symptoms.

Isolated sixth nerve palsy: a rare first presentation in multiple sclerosis

True isolated sixth nerve palsy as the initial presentation of multiple sclerosis (MS) is rare. MS is a chronic inflammatory, immune-mediated disease of the central nervous system. This is the most common cause of neurological disability in young adults. Common symptoms include acute episodes of muscle weakness, altered sensation, balance and gait disturbances, visual loss and bladder dysfunction.Diagnosis of MS is supported with the incidence of symptomatic clinical episodes with subsequent cross-sectional imaging to confirm radiological lesions that are disseminated in space and time.In the following report, we discuss the case of a woman in her 30s who presented to ophthalmology with a sixth nerve palsy in the absence of ocular or systemic disease. This is the first presentation of MS, a rare clinical event.

Effects of CIK Cell Therapy Combined with Camrelizumab on the Quality of Life in Patients with Nasopharyngeal Carcinoma and Analysis of Prognostic Factors

Objective

To investigate the effects of CIK (cytokine-induced killer) cell therapy combined with camrelizumab on the quality of life in patients with nasopharyngeal carcinoma and prognostic factors.

Methods

In this retrospective study, the materials of 80 patients with nasopharyngeal carcinoma treated in our hospital (February 2017-February 2019) were retrospectively analyzed, and they were equalized into experimental group (n = 40) and control group (n = 40) according to the order of admission. Both groups received 200 mg of camrelizumab on day 1 combined with 10 mg of anrotinib from day 2 to day 4. The patients received the above program every 3 weeks and 4 treatment cycles. The experimental group also received CIK cell therapy simultaneously. The patients' quality of life, immune indexes, local control, metastasis, and survival rate were compared between the two groups, and the prognostic factors were analyzed by logistic analysis.

Results

Compared with the control group, the experimental group achieved much higher scores of physical well-being (18.38 ± 2.31), social/family well-being (16.40 ± 2.24), emotional well-being (15.35 ± 2.30), functional well-being (17.30 ± 2.20), and head and neck cancer subscale (15.40 ± 2.01, P < 0.001) and eminently better immune indexes (P < 0.001) after treatment. During the 24-month follow-up, there were 2 recurrent cases (5.0%) and 2 cases (5.0%) with distant metastasis among the 40 patients in the experimental group; there were 8 recurrent cases (20.0%) and 7 cases (17.5%) with distant metastasis among the 40 patients in the control group. In the experimental group, the median survival period was 18 months and the 2-year survival rate was 97.5% (39/40). In the control group, the median survival period was 14 months and the 2-year survival rate was 85.0% (34/40). Among the 80 patients, 7 cases (8.75%) died and 73 cases (91.25%) survived. After conducting the single-factor analysis, remarkable differences in the cases of IV stage, quality of life after treatment, and immune indexes after treatment between the survival group and the death group were observed (P < 0.05). According to the multiple-factor analysis, the clinical stage and immune indexes were identified as the prognostic factors.

Conclusion

CIK cell therapy combined with camrelizumab can enhance the life quality and immune function of the patients with nasopharyngeal carcinoma, thus improving their prognoses.