Nasopharyngeal carcinoma: Difference between revisions

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~~#redirect~~ [[~~Head_and_neck_pathology#Nasopharyngeal_carcinoma~~]]

{{ 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]].

==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]].<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:

*A morphologically identical tumour elsewhere is called ''[[lymphoepithelioma-like carcinoma]]''.

==Gross==

*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==

Features:<ref name=Ref_Klatt145>{{Ref Klatt|145}}</ref>

*Prominent lymphoid component - '''key feature'''.

*Features of squamous cell carcinoma:

**Cohesive cells with:

***Abundant dense eosinophilic cytoplasm.

***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===

====Case 1====

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====

Image:Lymphoepithelioma_met_to_LN_6.jpg | Nasopharyngeal carcinoma - in a LN - intermed. mag. (WC)

</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===

World Health Classification (2005) for NPC:<ref name=Ref_WMSP39>{{Ref WMSP|39}}</ref>

{| class="wikitable"

! 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'':

*'''K'''eratinizing, '''N'''on-keratinizing diff., non-keratinizing '''U'''ndiff., '''B'''asaloid SCC.

==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>

*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:

*[[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===

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==

*[[Head and neck pathology]].

==References==

[[Category:Head and neck pathology]]

[[Category:Diagnosis]]

@@ Line 1: / Line 1: @@
-#redirect [[Head_and_neck_pathology#Nasopharyngeal_carcinoma]]
+{{ 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]].
+==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]].<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:
+*A morphologically identical tumour elsewhere is called ''[[lymphoepithelioma-like carcinoma]]''.
+==Gross==
+*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==
+Features:<ref name=Ref_Klatt145>{{Ref Klatt|145}}</ref>
+*Prominent lymphoid component - '''key feature'''.
+*Features of squamous cell carcinoma:
+**Cohesive cells with:
+***Abundant dense eosinophilic cytoplasm.
+***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===
+====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>
+Image:Lymphoepithelioma_met_to_LN_6.jpg | Nasopharyngeal carcinoma - in a LN - intermed. mag. (WC)
+</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===
+World Health Classification (2005) for NPC:<ref name=Ref_WMSP39>{{Ref WMSP|39}}</ref>
+{| class="wikitable"
+! 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'':
+*'''K'''eratinizing, '''N'''on-keratinizing diff., non-keratinizing '''U'''ndiff., '''B'''asaloid SCC.
+==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>
+*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:
+*[[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==
+*[[Head and neck pathology]].
+==References==
+{{Reflist|2}}
+[[Category:Head and neck pathology]]
+[[Category:Diagnosis]]

Nasopharyngeal carcinoma: Difference between revisions

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