Difference between revisions of "Sinonasal undifferentiated carcinoma"

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#redirect [[Head_and_neck_pathology#Sinonasal_undifferentiated_carcinoma]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Sinonasal_undifferentiated_carcinoma_-_high_mag.jpg
| Width      =
| Caption    = SNUC. [[H&E stain]].
| Synonyms  =
| Micro      = tumour with variable architecture (nested, trabecular or lobular), small-to-moderate cytoplasm, +/-distinct nucleoli, cell size variable (small to large); glandular and squamous differentiation are absent by definition
| Subtypes  =
| LMDDx      = poorly differentiated [[squamous cell carcinoma of the head and neck]], [[small cell carcinoma]], [[SMARCB1-deficient sinonasal carcinoma]], [[SMARCA4-deficient sinonasal carcinoma]], [[nasopharyngeal carcinoma]], others
| Stains    =
| IHC        = pankeratin +ve, [[EMA]] +ve, [[CK7]] +ve, [[CK5/6]] -ve, NSE +ve/-ve, chromogranin A -ve, synaptophysin -ve, [[p63]] +ve/-ve
| EM        =
| Molecular  = [[EBER]] -ve
| IF        =
| Gross      =
| Grossing  =
| Site      = [[head and neck pathology|head and neck]]
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence = rare
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = poor
| Other      =
| ClinDDx    = other head and neck tumours
| Tx        =
}}
'''Sinonasal undifferentiated carcinoma''', abbreviated '''SNUC''', is a rare epithelial malignancy of the [[head and neck pathology|head and neck]].


==General==
*Aggressive/poor prognosis.
**In the past, survival was measured in months.<ref name=pmid17170968>{{Cite journal  | last1 = Pitman | first1 = KT. | last2 = Costantino | first2 = PD. | last3 = Lassen | first3 = LF. | title = Sinonasal undifferentiated carcinoma: current trends in treatment. | journal = Skull Base Surg | volume = 5 | issue = 4 | pages = 269-72 | month =  | year = 1995 | doi =  | PMID = 17170968 | PMC = 1656535 | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1656535/ }}</ref>
**With (aggressive) combined modality treatment, the overall five-year survival is approximately 75%.<ref name=pmid22476411>{{Cite journal  | last1 = Al-Mamgani | first1 = A. | last2 = van Rooij | first2 = P. | last3 = Mehilal | first3 = R. | last4 = Tans | first4 = L. | last5 = Levendag | first5 = PC. | title = Combined-modality treatment improved outcome in sinonasal undifferentiated carcinoma: single-institutional experience of 21 patients and review of the literature. | journal = Eur Arch Otorhinolaryngol | volume =  | issue =  | pages =  | month = Apr | year = 2012 | doi = 10.1007/s00405-012-2008-5 | PMID = 22476411 }}</ref>
==Microscopic==
Features:<ref name=Ref_WMSP38>{{Ref WMSP|38}}</ref>
*Architecture: nested, trabecular or lobular.
*Distinct cellular borders.
*Small-to-moderate cytoplasm.
*+/-Distinct nucleoli.
*Tumour cell size variable (small to large).
Note:
*Glandular and squamous differentiation are absent by definition.<ref name=pmid11904342/>
DDx:
*Poorly differentiated [[squamous cell carcinoma of the head and neck]].
*[[Small cell carcinoma]].
*[[SMARCB1-deficient sinonasal carcinoma]].<ref name=pmid25007146>{{Cite journal  | last1 = Bishop | first1 = JA. | last2 = Antonescu | first2 = CR. | last3 = Westra | first3 = WH. | title = SMARCB1 (INI-1)-deficient carcinomas of the sinonasal tract. | journal = Am J Surg Pathol | volume = 38 | issue = 9 | pages = 1282-9 | month = Sep | year = 2014 | doi = 10.1097/PAS.0000000000000285 | PMID = 25007146 }}</ref>
*[[SMARCA4-deficient sinonasal carcinoma]].<ref name=pmid34871352>{{cite journal |authors=Kakkar A, Ashraf SF, Rathor A, Adhya AK, Mani S, Sikka K, Jain D |title=SMARCA4/BRG1-Deficient Sinonasal Carcinoma |journal=Arch Pathol Lab Med |volume=146 |issue=9 |pages=1122–1130 |date=September 2022 |pmid=34871352 |doi=10.5858/arpa.2021-0001-OA |url=}}</ref>
*[[Nasopharyngeal carcinoma]].
*Other tumours, especially [[small round blue cell tumours]] and [[lymphoma]].
===Images===
www:
*[http://www.nature.com/modpathol/journal/v15/n3/fig_tab/3880522f7.html SNUC (nature.com)].<ref name=pmid11904342>{{Cite journal  | last1 = Mills | first1 = SE. | title = Neuroectodermal neoplasms of the head and neck with emphasis on neuroendocrine carcinomas. | journal = Mod Pathol | volume = 15 | issue = 3 | pages = 264-78 | month = Mar | year = 2002 | doi = 10.1038/modpathol.3880522 | PMID = 11904342 | URL = http://dx.doi.org/10.1038/modpathol.3880522 }}</ref>
*[http://www.pathologypics.com/PictView.aspx?ID=244 SNUC (pathologypics.com)].
*[http://www.pathologypics.com/PictView.aspx?ID=249 SNUC (pathologypics.com)].
<gallery>
Image:Sinonasal_undifferentiated_carcinoma_-_low_mag.jpg | SNUC - low mag. (WC)
Image:Sinonasal_undifferentiated_carcinoma_-_high_mag.jpg | SNUC - high mag. (WC)
Image:Sinonasal_undifferentiated_carcinoma_-_very_high_mag.jpg | SNUC - very high mag. (WC)
</gallery>
==IHC==
Features:<ref name=Ref_WMSP38>{{Ref WMSP|38}}</ref>
*Pankeratin +ve.
*[[EMA]] +ve.
*[[CK7]] +ve.
*[[CK5/6]] -ve.
Others:
*NSE +ve/-ve.
*Chromogranin A -ve.
*Synaptophysin -ve.
*p63 +ve/-ve.<ref name=pmid21805120>{{Cite journal  | last1 = Wadsworth | first1 = B. | last2 = Bumpous | first2 = JM. | last3 = Martin | first3 = AW. | last4 = Nowacki | first4 = MR. | last5 = Jenson | first5 = AB. | last6 = Farghaly | first6 = H. | title = Expression of p16 in sinonasal undifferentiated carcinoma (SNUC) without associated human papillomavirus (HPV). | journal = Head Neck Pathol | volume = 5 | issue = 4 | pages = 349-54 | month = Dec | year = 2011 | doi = 10.1007/s12105-011-0285-8 | PMID = 21805120 | PMC = 3210220 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3210220/ }}</ref>
*SMARCB1 ([[INI1]]) +ve (nuclear staining present).
**Nuclear staining lost in [[SMARCB1-deficient sinonasal carcinoma]].
===Comparison between different sinonasal carcinomas===
Based on a modest size study, keratins can useful for subclassifying sinonasal carcinomas:<ref name=pmid12459626>{{cite journal |authors=Franchi A, Moroni M, Massi D, Paglierani M, Santucci M |title=Sinonasal undifferentiated carcinoma, nasopharyngeal-type undifferentiated carcinoma, and keratinizing and nonkeratinizing squamous cell carcinoma express different cytokeratin patterns |journal=Am J Surg Pathol |volume=26 |issue=12 |pages=1597–604 |date=December 2002 |pmid=12459626 |doi=10.1097/00000478-200212000-00007 |url=}}</ref>
{| class="wikitable sortable"
! Diagnosis
! CK4
! CK5/6
! CK7
! CK13
! CK14
! CK19
|-
| Sinonasal undifferentiated carcinoma (SNUC)
| +0%
| +0%
| +50%
| +0%
| +0%
| +50%
|-
| Nasopharyngeal-type undifferentiated carcinoma (NPTC)
| +0%
| +80%
| +0%
| +80%
| +0%
| +100%
|-
| Nonkeratinizing squamous cell carcinoma (NKSCC)
| +0%
| +90%
| +0%
| +80%
| +80%
| +90%
|-
|Squamous cell carcinoma (keratainizing)
| +30%
| +90%
| +60%
| +90%
| +80%
| +90%
|-
|}
==Molecular==
*EBER -ve.<ref name=pmid11176064>{{cite journal |authors=Cerilli LA, Holst VA, Brandwein MS, Stoler MH, Mills SE |title=Sinonasal undifferentiated carcinoma: immunohistochemical profile and lack of EBV association |journal=Am J Surg Pathol |volume=25 |issue=2 |pages=156–63 |date=February 2001 |pmid=11176064 |doi=10.1097/00000478-200102000-00003 |url=}}</ref>
==See also==
*[[Head and neck pathology]].
*[[Squamous cell carcinoma of the head and neck]].
==References==
{{Reflist|2}}
[[Category:Head and neck pathology]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]

Latest revision as of 18:07, 20 December 2023

Sinonasal undifferentiated carcinoma
Diagnosis in short

SNUC. H&E stain.
LM tumour with variable architecture (nested, trabecular or lobular), small-to-moderate cytoplasm, +/-distinct nucleoli, cell size variable (small to large); glandular and squamous differentiation are absent by definition
LM DDx poorly differentiated squamous cell carcinoma of the head and neck, small cell carcinoma, SMARCB1-deficient sinonasal carcinoma, SMARCA4-deficient sinonasal carcinoma, nasopharyngeal carcinoma, others
IHC pankeratin +ve, EMA +ve, CK7 +ve, CK5/6 -ve, NSE +ve/-ve, chromogranin A -ve, synaptophysin -ve, p63 +ve/-ve
Molecular EBER -ve
Site head and neck
Prevalence rare
Prognosis poor
Clin. DDx other head and neck tumours

Sinonasal undifferentiated carcinoma, abbreviated SNUC, is a rare epithelial malignancy of the head and neck.

General

  • Aggressive/poor prognosis.
    • In the past, survival was measured in months.[1]
    • With (aggressive) combined modality treatment, the overall five-year survival is approximately 75%.[2]

Microscopic

Features:[3]

  • Architecture: nested, trabecular or lobular.
  • Distinct cellular borders.
  • Small-to-moderate cytoplasm.
  • +/-Distinct nucleoli.
  • Tumour cell size variable (small to large).

Note:

  • Glandular and squamous differentiation are absent by definition.[4]

DDx:

Images

www:

  • SNUC - low mag. (WC)

  • SNUC - high mag. (WC)

  • SNUC - very high mag. (WC)

IHC

Features:[3]

Others:

Comparison between different sinonasal carcinomas

Based on a modest size study, keratins can useful for subclassifying sinonasal carcinomas:[8]

Diagnosis CK4 CK5/6 CK7 CK13 CK14 CK19
Sinonasal undifferentiated carcinoma (SNUC) +0% +0% +50% +0% +0% +50%
Nasopharyngeal-type undifferentiated carcinoma (NPTC) +0% +80% +0% +80% +0% +100%
Nonkeratinizing squamous cell carcinoma (NKSCC) +0% +90% +0% +80% +80% +90%
Squamous cell carcinoma (keratainizing) +30% +90% +60% +90% +80% +90%

Molecular

See also

References

  1. ↑ Pitman, KT.; Costantino, PD.; Lassen, LF. (1995). "Sinonasal undifferentiated carcinoma: current trends in treatment.". Skull Base Surg 5 (4): 269-72. PMC 1656535. PMID 17170968. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1656535/.
  2. ↑ Al-Mamgani, A.; van Rooij, P.; Mehilal, R.; Tans, L.; Levendag, PC. (Apr 2012). "Combined-modality treatment improved outcome in sinonasal undifferentiated carcinoma: single-institutional experience of 21 patients and review of the literature.". Eur Arch Otorhinolaryngol. doi:10.1007/s00405-012-2008-5. PMID 22476411.
  3. ↑ 3.0 3.1 Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 38. ISBN 978-0781765275.
  4. ↑ 4.0 4.1 Mills, SE. (Mar 2002). "Neuroectodermal neoplasms of the head and neck with emphasis on neuroendocrine carcinomas.". Mod Pathol 15 (3): 264-78. doi:10.1038/modpathol.3880522. PMID 11904342.
  5. ↑ Bishop, JA.; Antonescu, CR.; Westra, WH. (Sep 2014). "SMARCB1 (INI-1)-deficient carcinomas of the sinonasal tract.". Am J Surg Pathol 38 (9): 1282-9. doi:10.1097/PAS.0000000000000285. PMID 25007146.
  6. ↑ Kakkar A, Ashraf SF, Rathor A, Adhya AK, Mani S, Sikka K, Jain D (September 2022). "SMARCA4/BRG1-Deficient Sinonasal Carcinoma". Arch Pathol Lab Med 146 (9): 1122–1130. doi:10.5858/arpa.2021-0001-OA. PMID 34871352.
  7. ↑ Wadsworth, B.; Bumpous, JM.; Martin, AW.; Nowacki, MR.; Jenson, AB.; Farghaly, H. (Dec 2011). "Expression of p16 in sinonasal undifferentiated carcinoma (SNUC) without associated human papillomavirus (HPV).". Head Neck Pathol 5 (4): 349-54. doi:10.1007/s12105-011-0285-8. PMC 3210220. PMID 21805120. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3210220/.
  8. ↑ Franchi A, Moroni M, Massi D, Paglierani M, Santucci M (December 2002). "Sinonasal undifferentiated carcinoma, nasopharyngeal-type undifferentiated carcinoma, and keratinizing and nonkeratinizing squamous cell carcinoma express different cytokeratin patterns". Am J Surg Pathol 26 (12): 1597–604. doi:10.1097/00000478-200212000-00007. PMID 12459626.
  9. ↑ Cerilli LA, Holst VA, Brandwein MS, Stoler MH, Mills SE (February 2001). "Sinonasal undifferentiated carcinoma: immunohistochemical profile and lack of EBV association". Am J Surg Pathol 25 (2): 156–63. doi:10.1097/00000478-200102000-00003. PMID 11176064.
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