Please help my wife, she has a disease that is difficult to diagnose

[bernovikes]

Symptoms include crooked tongue, difficulty swallowing, bloody sputum, and headaches from the back of the head to the top of the head and eye sockets. The pain lasts for about 18-20 hours without taking hydroxycodone acetaminophen tablets. The current medications are hydroxycodone acetaminophen tablets, pregabalin, and methylcobalamin. The effectiveness of hydroxycodone acetaminophen tablets has been reduced from 6 hours to 4 hours.

Two biopsies were performed on the nasopharynx and found to be inflammation.

The doctor has not found a good solution yet, please help my wife

She started having headaches in mid-January 2025. She had no symptoms before, but it was sudden. Her tongue became slightly crooked on February 20, 2025, and became noticeably crooked on February 22, 2025. Her tongue also atrophied.

PET/CT

After fasting for more than 6 hours, the fasting blood glucose was measured at 4.7mmol/L, and the imaging agent 18F-FDG 9.5mCi was injected intravenously. After lying still for 65 minutes, the whole body PET/CT tomography was performed. The images were integrated with the machine and the images of all parts of the body were clear. Diffuse mass-like radioactive uptake abnormal concentration shadows were seen on the posterior wall and bilateral walls of the nasopharyngeal roof, with the maximum display range of about 6.4cmx3.9cm, the maximum SUV value of about 20.9, and the average value of about 17.2CT showed abnormal thickening of soft tissue in the corresponding parts, blocking the nasopharyngeal cavity forward, and the bilateral pharyngeal recesses became shallow and disappeared, growing upward to involve the sphenoid sinus, and involving the occipital slope, the bilateral petrous part of the temporal bone, the left sphenoid pterygoid process and the type bone. Osteolytic bone destruction was seen in some parts, involving the adjacent bilateral longus capitis and tensor veli palatini. Multiple nodular shadows with slightly increased radioactivity uptake were found in the left parapharyngeal space, bilateral neck (zone I), and left neck (zone I), with the largest shadow being about 1.1cmx0.7cm, the maximum SUV being about 3.7, and the average being about 3.5. Multiple enlarged lymph nodes were found in the corresponding parts of CT. Multiple slightly enlarged lymph nodes were found in the bilateral neck (zones Ib and V), with the largest shadow being about 0.8cmx0.5cm, and no abnormal increase in radioactivity uptake was found. The sinus and bilateral ethmoid sinus mucosa were thickened, and no abnormal increase in radioactivity uptake was found. Thyroid density, size, and radioactivity distribution were normal. The rest of the maxillofacial and neck tissue structure, morphology, and radioactivity distribution were normal. The brain was normal, and the radioactivity distribution of the bilateral frontal lobes, parietal lobes, temporal lobes, occipital lobes, bilateral basal ganglia, thalamus, and bilateral cerebellum was symmetrical, with no obvious abnormalities. CT showed no areas of increased or decreased radioactivity uptake in the brain parenchyma. Normal density shadows, no widening or expansion of the pericerebral sulci, brain fissures, and cerebral cisterns, and the density inside them was normal. The texture of both lungs was clear, and no substantial lesions or abnormal increased radioactive uptake were found. No enlarged lymph nodes or abnormal increased radioactive uptake were found in the bilateral hilum and mediastinum. A dot-shaped high-density calcification was found in the upper outer quadrant of the left breast, and no space-occupying lesions or abnormal increased radioactive uptake were found in the right breast. There were no obvious abnormalities in the morphology, size, density and radioactive distribution of the liver. The gallbladder was normally developed, the gallbladder wall was not thickened, and no positive stone shadows were found. There were no abnormalities in the size, density and radioactive distribution of the spleen. The stomach and duodenum were normally developed. The pancreas was normal in morphology and size, and no abnormal radioactive concentration was found. The left adrenal gland was thickened, and no abnormal increase in radioactive uptake was found; the right adrenal gland was normal in morphology, density and radioactive distribution. Both kidneys and bilateral ureters were normally developed. A small amount of physiological uptake was found in each segment of the colon, and no obvious space-occupying lesions were found. No enlarged lymph nodes or abnormal radioactive concentrations were found in the retroperitoneum. The bladder was normal. A strip-shaped radioactive uptake was slightly increased in the uterine cavity, with a maximum SUV of about 3.2 and an average of about 2.5. A slightly low-density shadow was seen in the corresponding part of the CT scan, with unclear boundaries. A cystic low-density lesion was seen in the right adnexa, about 1.7cmx1.6cm in size, with a CT value of about 13Hu. There was no abnormality in the radioactive uptake, and no obvious abnormality in the density and radioactive distribution of the left adnexa. A small amount of liquid low-density shadow was seen in the pelvic cavity, and no abnormal increase in radioactive uptake was found. There was no obvious abnormality in the bone density and radioactive distribution of the whole body.

diagnosis

1. Swelling of the soft tissues of the posterior wall and bilateral walls of the nasopharynx accompanied by increased metabolism, which may be a malignant tumor lesion (lymphoma?), and involving the sphenoid sinus, adjacent skull base bones and muscles (described above). Please combine the pathology to make a clear diagnosis. 2. Multiple enlarged lymph nodes in the left parapharyngeal space, bilateral neck (zone I), and left neck (zone I), with slightly increased metabolism, lymphoma infiltration or metastasis cannot be ruled out, and regular reexamination is recommended; multiple lymph nodes in the bilateral neck (zones Ib and V), with low metabolism, are likely to be inflammatory hyperplasia. 3. Thickening of the sphenoid sinus and bilateral ethmoid sinus mucosa; punctate calcification in the upper outer quadrant of the left breast: left adrenal hyperplasia; low density of the uterine cavity with slightly increased metabolism, which may be a physiological uptake, and it is recommended to combine clinical findings; cystic lesions in the right adnexal area, which may be benign lesions (corpus luteum cyst?); a small amount of fluid in the bifurcation cavity. PET/CT imaging of other parts of the body showed no obvious abnormalities