Jinzhi Wu

Background Glomangiopericytoma (GPC) is a rare sinonasal mesenchymal neoplasm with distinctive morphologic and molecular features, most commonly arising in the nasal cavity and paranasal sinuses. Occurrence in the nasopharynx is exceptionally uncommon and may create a substantial diagnostic challenge, particularly in long-term survivors of nasopharyngeal carcinoma (NPC) after radiotherapy, in whom a newly detected nasopharyngeal mass is often clinically presumed to represent recurrent carcinoma.In this setting, diagnosis should rest on the combined assessment of growth architecture, cytologic blandness, and a targeted exclusionary immunohistochemical panel rather than on clinical history, imaging appearance, or any single marker alone. Case presentation A man in his early seventies, previously treated with chemoradiotherapy for NPC approximately 30 years earlier, presented with a 15-day history of right-sided ptosis and headache. Nasoendoscopy demonstrated a smooth, highly vascular mass arising from the right posterior nasopharyngeal wall. Magnetic resonance imaging revealed a skull-base lesion extending toward the cavernous sinus, with radiologically suspicious cervical lymphadenopathy that was not pathologically sampled, raising concern for recurrent malignancy. Endoscopic biopsy showed a spindle-cell neoplasm composed of bland oval-to-spindle cells arranged in storiform and whorled patterns around branching thin-walled vessels. Immunohistochemically, the tumor cells showed diffuse vimentin expression, focal-to-patchy nuclear β-catenin positivity, scattered Cyclin D1 nuclear positivity, and partial Bcl-2 positivity, whereas STAT6, CD34, cytokeratin, S100, and SMA were negative. These combined morphologic and immunophenotypic findings, although not molecularly confirmed, supported the diagnosis of GPC and argued against recurrent NPC, solitary fibrous tumor, and other spindle-cell neoplasms. Because of extensive skull-base and cavernous-sinus involvement, the lesion was considered unresectable. Empirical palliative docetaxel-cisplatin treatment produced transient symptomatic improvement but was followed by fatal neutropenic sepsis. Conclusions This case highlights that a vascular submucosal nasopharyngeal mass arising decades after radiotherapy is not necessarily recurrent NPC. In this setting, careful histomorphologic evaluation combined with a practical immunohistochemical panel, particularly focal-to-patchy nuclear β-catenin positivity with STAT6, CD34, and cytokeratin negativity, can support a diagnosis of GPC and help avoid misclassification as recurrent carcinoma or other spindle-cell neoplasms in a previously irradiated field. Because CTNNB1 testing was not performed, the diagnosis should be interpreted as morphologically and immunohistochemically supported rather than molecularly confirmed.

Objective: To investigate the relationship between nutritional status and quality of life (QoL) among hospitalized patients with nasopharyngeal carcinoma (NPC), analyze the influencing factors of malnutrition, and develop a predictive nomogram model for severe malnutrition to inform clinical nutritional support strategies. Methods: This retrospective study included NPC patients admitted to the Department of Head and Neck Oncology from January 1, 2014 to December 31, 2019. Nutritional risk was assessed using the Nutritional Risk Screening 2002 (NRS 2002), while nutritional status was evaluated via the Patient-Generated Subjective Global Assessment (PG-SGA). The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30 v3.0) was used to assess QoL. Logistic regression was employed to identify independent risk factors for severe malnutrition (PG-SGA ≥ 9), and a clinical nomogram model was constructed and validated. Results: A total of 216 NPC patients were included (77.78% male; mean age 50.5 ± 10.58 years). Nutritional screening showed 26.85% had nutritional risk (NRS 2002 ≥ 3), and nutritional assessment revealed that 23.15% had severe malnutrition. Physical measurements, biochemical indicators (including BMI, TSF, MAC, handgrip strength, prealbumin, urea nitrogen), and QoL scores significantly differed among groups with varying nutritional status (p < 0.05), with worsening nutrition associated with poorer outcomes. PG-SGA scores were negatively correlated with QoL function and global health scores, but positively with symptom burden (p < 0.05).Univariate analysis identified age ≥ 65 years, nutritional risk (NRS 2002 ≥ 3), and pain as risk factors for severe malnutrition, while higher KPS score, BMI, and prealbumin were protective. Multivariate analysis confirmed NRS 2002 (OR = 17.14, p < 0.001), KPS (OR = 0.91, p = 0.004), and pain (OR = 2.79, p = 0.002) as independent predictors. A nomogram incorporating these variables demonstrated excellent predictive performance (AUC = 0.903 in training set; 0.825 in validation set), with good calibration and clinical utility per decision curve analysis (DCA). Conclusion: Malnutrition is prevalent in hospitalized NPC patients and is associated with poorer QoL. The predictive nomogram based on NRS 2002, KPS score, and pain score provides a reliable tool for early identification of patients at risk for severe malnutrition, supporting timely and personalized nutritional intervention.