Difference between revisions of "Nasopharyngeal carcinoma"
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Nasopharyngeal carcinoma - alt -- high mag.jpg | |||
| Width = | |||
| Caption = Nasopharyngeal carcinoma. [[H&E stain]]. | |||
| Synonyms = nasopharyngeal-type undifferentiated carcinoma, non-keratining nasopharyngeal carcinoma undifferentiated type | |||
| Micro = Cohesive typical (squamoid) cells (abundant dense eosinophilic cytoplasm, central nuclei +/- small/indistinct nucleoli), prominent lymphoid component | |||
| Subtypes = keratinizing SCC; nonkeratinizing carcinoma, differentiated; nonkeratinizing carcinoma, undifferentiated; basaloid SCC | |||
| LMDDx = [[HPV-associated head and neck squamous cell carcinoma]], [[squamous cell carcinoma of the head and neck]], [[sinonasal undifferentiated carcinoma]] (SNUC) | |||
| Stains = | |||
| IHC = p16 -ve, LMP-1 -ve/+ve | |||
| EM = | |||
| Molecular = [[EBER]] +ve | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Site = nasopharynx - see ''[[head and neck pathology|head and neck]]'' | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = | |||
| Signs = neck mass | |||
| Symptoms = | |||
| Prevalence = uncommon in West | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = | |||
| Other = | |||
| ClinDDx = | |||
| Tx = | |||
}} | |||
'''Nasopharyngeal carcinoma''', abbreviated '''NPC''', is malignant epithelial tumour of the [[Head and neck pathology|head and neck]] closely related to [[squamous cell carcinoma]]. | '''Nasopharyngeal carcinoma''', abbreviated '''NPC''', is malignant epithelial tumour of the [[Head and neck pathology|head and neck]] closely related to [[squamous cell carcinoma]]. | ||
| Line 4: | Line 35: | ||
*"Nasopharyngeal carcinoma" is the name of an entity - it is not a descriptive term. | *"Nasopharyngeal carcinoma" is the name of an entity - it is not a descriptive term. | ||
*Strong association with [[Epstein-Barr virus]] (EBV). | *Strong association with [[Epstein-Barr virus]] (EBV). | ||
*Moderate risk increase for [[smokers]].<ref name=pmid23785114>{{Cite journal | last1 = Xue | first1 = WQ. | last2 = Qin | first2 = HD. | last3 = Ruan | first3 = HL. | last4 = Shugart | first4 = YY. | last5 = Jia | first5 = WH. | title = Quantitative association of tobacco smoking with the risk of nasopharyngeal carcinoma: a comprehensive meta-analysis of studies conducted between 1979 and 2011. | journal = Am J Epidemiol | volume = 178 | issue = 3 | pages = 325-38 | month = Aug | year = 2013 | doi = 10.1093/aje/kws479 | PMID = 23785114 }}</ref> | |||
*Uncommon in the Western World<ref name=pmid23337060>{{Cite journal | last1 = Colaco | first1 = RJ. | last2 = Betts | first2 = G. | last3 = Donne | first3 = A. | last4 = Swindell | first4 = R. | last5 = Yap | first5 = BK. | last6 = Sykes | first6 = AJ. | last7 = Slevin | first7 = NJ. | last8 = Homer | first8 = JJ. | last9 = Lee | first9 = LW. | title = Nasopharyngeal carcinoma: a retrospective review of demographics, treatment and patient outcome in a single centre. | journal = Clin Oncol (R Coll Radiol) | volume = 25 | issue = 3 | pages = 171-7 | month = Mar | year = 2013 | doi = 10.1016/j.clon.2012.10.006 | PMID = 23337060 }}</ref> - endemic in the East. | |||
Clinical: | |||
*Neck mass - most common presentation.<ref name=pmid23337060/> | |||
Note: | Note: | ||
| Line 10: | Line 46: | ||
==Gross== | ==Gross== | ||
*Nasopharynx - as the name would suggest. | *Nasopharynx - as the name would suggest. | ||
**Nasal cavity involvement - common in early disease.<ref name=pmid22194474 >{{Cite journal | last1 = Abdel Khalek Abdel Razek | first1 = A. | last2 = King | first2 = A. | title = MRI and CT of nasopharyngeal carcinoma. | journal = AJR Am J Roentgenol | volume = 198 | issue = 1 | pages = 11-8 | month = Jan | year = 2012 | doi = 10.2214/AJR.11.6954 | PMID = 22194474 }}</ref> | |||
==Microscopic== | ==Microscopic== | ||
| Line 18: | Line 55: | ||
***Abundant dense eosinophilic cytoplasm. | ***Abundant dense eosinophilic cytoplasm. | ||
***Central nuclei +/- small/indistinct nucleoli. | ***Central nuclei +/- small/indistinct nucleoli. | ||
Note: | |||
*May be keratinizing or nonkeratinizing<ref name=pmid10594290>{{Cite journal | last1 = Wenig | first1 = BM. | title = Nasopharyngeal carcinoma. | journal = Ann Diagn Pathol | volume = 3 | issue = 6 | pages = 374-85 | month = Dec | year = 1999 | doi = 10.1053/ADPA00300374 | PMID = 10594290 }}</ref> and the distinction is important - see classification below. | |||
DDx: | |||
*[[HPV-associated head and neck squamous cell carcinoma]]. | |||
*[[Squamous cell carcinoma of the head and neck]]. | |||
*[[Sinonasal undifferentiated carcinoma]] (SNUC). | |||
===Images=== | ===Images=== | ||
====Case 1==== | |||
<gallery> | |||
Image: Nasopharyngeal carcinoma -- extremely low mag.jpg | NPC - very low mag. (WC) | |||
Image: Nasopharyngeal carcinoma -- very low mag.jpg | NPC - very low mag. (WC) | |||
Image: Nasopharyngeal carcinoma -- low mag.jpg | NPC - low mag. (WC) | |||
Image: Nasopharyngeal carcinoma -- intermed mag.jpg | NPC - intermed. mag. (WC) | |||
Image: Nasopharyngeal carcinoma -- high mag.jpg | NPC - high mag. (WC) | |||
Image: Nasopharyngeal carcinoma - alt -- high mag.jpg | NPC - high mag. (WC) | |||
Image: Nasopharyngeal carcinoma -- very high mag.jpg | NPC - very high mag. (WC) | |||
</gallery> | |||
====Case 2==== | |||
<gallery> | <gallery> | ||
Image:Lymphoepithelioma_met_to_LN_6.jpg | Nasopharyngeal carcinoma - in a LN - intermed. mag. (WC) | Image:Lymphoepithelioma_met_to_LN_6.jpg | Nasopharyngeal carcinoma - in a LN - intermed. mag. (WC) | ||
</gallery> | </gallery> | ||
====www==== | |||
*[http://en.wikipedia.org/wiki/File:Lymphoepithelioma_met_to_LN_4.jpg Nasopharyngeal carcinoma - in a LN - low mag. (WP)]. | |||
*[http://en.wikipedia.org/wiki/File:Lymphoepithelioma_met_to_LN_2.jpg Nasopharyngeal carcinoma - in a LN - high mag. (WP)]. | |||
===Histologic subclassification=== | ===Histologic subclassification=== | ||
World Health Classification (2005) for NPC:<ref name=Ref_WMSP39>{{Ref WMSP|39}}</ref> | World Health Classification (2005) for NPC:<ref name=Ref_WMSP39>{{Ref WMSP|39}}</ref> | ||
| Line 68: | Line 127: | ||
==IHC== | ==IHC== | ||
*p16 -ve.<ref name=pmid9546345>{{cite journal |author=Gulley ML, Nicholls JM, Schneider BG, Amin MB, Ro JY, Geradts J |title=Nasopharyngeal carcinomas frequently lack the p16/MTS1 tumor suppressor protein but consistently express the retinoblastoma gene product |journal=Am. J. Pathol. |volume=152 |issue=4 |pages=865–9 |year=1998 |month=April |pmid=9546345 |pmc=1858242 |doi= |url=}}</ref> | *p16 -ve.<ref name=pmid9546345>{{cite journal |author=Gulley ML, Nicholls JM, Schneider BG, Amin MB, Ro JY, Geradts J |title=Nasopharyngeal carcinomas frequently lack the p16/MTS1 tumor suppressor protein but consistently express the retinoblastoma gene product |journal=Am. J. Pathol. |volume=152 |issue=4 |pages=865–9 |year=1998 |month=April |pmid=9546345 |pmc=1858242 |doi= |url=}}</ref> | ||
*LMP-1 (EBV-LMP) +ve/-ve. | |||
**''Not'' [[Sensitivity|sensitive]]; only positive in 40-45% of cases in a series of 30 cases.<ref name=pmid11913680>{{Cite journal | last1 = Plaza | first1 = G. | last2 = Manzanal | first2 = AI. | last3 = Fogué | first3 = L. | last4 = Santón | first4 = A. | last5 = Martínez-Montero | first5 = JC. | last6 = Bellas | first6 = C. | title = Association of Epstein-Barr virus and nasopharyngeal carcinoma in Caucasian patients. | journal = Ann Otol Rhinol Laryngol | volume = 111 | issue = 3 Pt 1 | pages = 210-6 | month = Mar | year = 2002 | doi = 10.1177/000348940211100304 | PMID = 11913680 }}</ref> | |||
Notes: | Notes: | ||
*[[HPV-associated head and neck squamous cell carcinoma]]s are p16 +ve.<ref name=pmid21484924>{{Cite journal | last1 = Singhi | first1 = AD. | last2 = Califano | first2 = J. | last3 = Westra | first3 = WH. | title = High-risk human papillomavirus in nasopharyngeal carcinoma. | journal = Head Neck | volume = 34 | issue = 2 | pages = 213-8 | month = Feb | year = 2012 | doi = 10.1002/hed.21714 | PMID = 21484924 }}</ref> | *[[HPV-associated head and neck squamous cell carcinoma]]s are p16 +ve.<ref name=pmid21484924>{{Cite journal | last1 = Singhi | first1 = AD. | last2 = Califano | first2 = J. | last3 = Westra | first3 = WH. | title = High-risk human papillomavirus in nasopharyngeal carcinoma. | journal = Head Neck | volume = 34 | issue = 2 | pages = 213-8 | month = Feb | year = 2012 | doi = 10.1002/hed.21714 | PMID = 21484924 }}</ref> | ||
==Molecular== | |||
*[[EBER]] +ve.<ref name=pmid11913680/> | |||
===Images=== | |||
<gallery> | |||
Image: Nasopharyngeal carcinoma - EBER -- very low mag.jpg | NPC - EBER - very low mag. (WC) | |||
Image: Nasopharyngeal carcinoma - EBER -- low mag.jpg | NPC - EBER - low mag. (WC) | |||
Image: Nasopharyngeal carcinoma - EBER -- high mag.jpg | NPC - EBER - high mag. (WC) | |||
</gallery> | |||
==See also== | ==See also== | ||
Latest revision as of 17:10, 4 October 2021
| Nasopharyngeal carcinoma | |
|---|---|
| Diagnosis in short | |
 Nasopharyngeal carcinoma. H&E stain. | |
|
| |
| Synonyms | nasopharyngeal-type undifferentiated carcinoma, non-keratining nasopharyngeal carcinoma undifferentiated type |
|
| |
| LM | Cohesive typical (squamoid) cells (abundant dense eosinophilic cytoplasm, central nuclei +/- small/indistinct nucleoli), prominent lymphoid component |
| Subtypes | keratinizing SCC; nonkeratinizing carcinoma, differentiated; nonkeratinizing carcinoma, undifferentiated; basaloid SCC |
| LM DDx | HPV-associated head and neck squamous cell carcinoma, squamous cell carcinoma of the head and neck, sinonasal undifferentiated carcinoma (SNUC) |
| IHC | p16 -ve, LMP-1 -ve/+ve |
| Molecular | EBER +ve |
| Site | nasopharynx - see head and neck |
|
| |
| Signs | neck mass |
| Prevalence | uncommon in West |
Nasopharyngeal carcinoma, abbreviated NPC, is malignant epithelial tumour of the head and neck closely related to squamous cell carcinoma.
General
- "Nasopharyngeal carcinoma" is the name of an entity - it is not a descriptive term.
- Strong association with Epstein-Barr virus (EBV).
- Moderate risk increase for smokers.[1]
- Uncommon in the Western World[2] - endemic in the East.
Clinical:
- Neck mass - most common presentation.[2]
Note:
- A morphologically identical tumour elsewhere is called lymphoepithelioma-like carcinoma.
Gross
- Nasopharynx - as the name would suggest.
- Nasal cavity involvement - common in early disease.[3]
Microscopic
Features:[4]
- Prominent lymphoid component - key feature.
- Features of squamous cell carcinoma:
- Cohesive cells with:
- Abundant dense eosinophilic cytoplasm.
- Central nuclei +/- small/indistinct nucleoli.
- Cohesive cells with:
Note:
- May be keratinizing or nonkeratinizing[5] and the distinction is important - see classification below.
DDx:
- HPV-associated head and neck squamous cell carcinoma.
- Squamous cell carcinoma of the head and neck.
- Sinonasal undifferentiated carcinoma (SNUC).
Images
Case 1
NPC - very low mag. (WC)
NPC - very low mag. (WC)
NPC - low mag. (WC)
NPC - intermed. mag. (WC)
NPC - high mag. (WC)
NPC - high mag. (WC)
NPC - very high mag. (WC)
Case 2
Nasopharyngeal carcinoma - in a LN - intermed. mag. (WC)
www
- Nasopharyngeal carcinoma - in a LN - low mag. (WP).
- Nasopharyngeal carcinoma - in a LN - high mag. (WP).
Histologic subclassification
World Health Classification (2005) for NPC:[6]
| Type | Histology | Description | EBV | Prevalence | Prognosis |
|---|---|---|---|---|---|
| 1 | keratinizing SCC | graded poorly-well-diff. | -ve | ? | bad |
| 2a | nonkeratinizing carcinoma, differentiated | well def. cell borders & tumour nest borders, mimics appearance of UCC | +ve | ? | good |
| 2b | nonkeratinizing carcinoma, undifferentiated | sheets/syncytial, vescicular nuclei, prominent nucleoli, pink cytoplasm | ? | most common | ? |
| 3 | basaloid SCC | mimics BCC - see basaloid SCC | ? | least common | ? |
How to remember KNUB:
- Keratinizing, Non-keratinizing diff., non-keratinizing Undiff., Basaloid SCC.
IHC
- p16 -ve.[7]
- LMP-1 (EBV-LMP) +ve/-ve.
Notes:
Molecular
Images
NPC - EBER - very low mag. (WC)
NPC - EBER - low mag. (WC)
NPC - EBER - high mag. (WC)
See also
References
- ↑ Xue, WQ.; Qin, HD.; Ruan, HL.; Shugart, YY.; Jia, WH. (Aug 2013). "Quantitative association of tobacco smoking with the risk of nasopharyngeal carcinoma: a comprehensive meta-analysis of studies conducted between 1979 and 2011.". Am J Epidemiol 178 (3): 325-38. doi:10.1093/aje/kws479. PMID 23785114.
- ↑ 2.0 2.1 Colaco, RJ.; Betts, G.; Donne, A.; Swindell, R.; Yap, BK.; Sykes, AJ.; Slevin, NJ.; Homer, JJ. et al. (Mar 2013). "Nasopharyngeal carcinoma: a retrospective review of demographics, treatment and patient outcome in a single centre.". Clin Oncol (R Coll Radiol) 25 (3): 171-7. doi:10.1016/j.clon.2012.10.006. PMID 23337060.
- ↑ Abdel Khalek Abdel Razek, A.; King, A. (Jan 2012). "MRI and CT of nasopharyngeal carcinoma.". AJR Am J Roentgenol 198 (1): 11-8. doi:10.2214/AJR.11.6954. PMID 22194474.
- ↑ Klatt, Edward C. (2006). Robbins and Cotran Atlas of Pathology (1st ed.). Saunders. pp. 145. ISBN 978-1416002741.
- ↑ Wenig, BM. (Dec 1999). "Nasopharyngeal carcinoma.". Ann Diagn Pathol 3 (6): 374-85. doi:10.1053/ADPA00300374. PMID 10594290.
- ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 39. ISBN 978-0781765275.
- ↑ Gulley ML, Nicholls JM, Schneider BG, Amin MB, Ro JY, Geradts J (April 1998). "Nasopharyngeal carcinomas frequently lack the p16/MTS1 tumor suppressor protein but consistently express the retinoblastoma gene product". Am. J. Pathol. 152 (4): 865–9. PMC 1858242. PMID 9546345. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1858242/.
- ↑ 8.0 8.1 Plaza, G.; Manzanal, AI.; Fogué, L.; Santón, A.; Martínez-Montero, JC.; Bellas, C. (Mar 2002). "Association of Epstein-Barr virus and nasopharyngeal carcinoma in Caucasian patients.". Ann Otol Rhinol Laryngol 111 (3 Pt 1): 210-6. doi:10.1177/000348940211100304. PMID 11913680.
- ↑ Singhi, AD.; Califano, J.; Westra, WH. (Feb 2012). "High-risk human papillomavirus in nasopharyngeal carcinoma.". Head Neck 34 (2): 213-8. doi:10.1002/hed.21714. PMID 21484924.