42 years old man

Mass in his neck

(since 1 month ago)
and epistaxis

Physical examination
Anamnesis: • Otoscopy
• the mass on the left neck since 1 month is Left ear: - intact tympanic membrane
getting bigger and painless - the processus brevis protrudes
• have been treated once but not reduced - gloomy light reflex decreased
• occasional colds • Posterior rhinoscopy
• left nasal congestion since 2 months mass in the left nasopharynx uneven fragile
• 3 times epistaxis impression
• There is also water in the left ear, grebeg- • Neck region
grebeg and less hearing mass in the left submandibular solid spongy
flat, firm border size 2x2x1 cm, painless.

Diferential Diagnosis
Nasopharyngeal ca, Nasal Tumor, Limfoma

Support Examination
• Undifferentiated left
nasopharyngeal biopsy ca DX: Nasopharyngeal ca
• FNA biopsy mass in left
submandibular metastatic
undifferentiated ca
Management

Chemotherapy
Radiotherapy
Simtomatic Therapy

Education Monitoring