Difference between revisions of "Nasopharyngeal carcinoma"

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{{ Infobox diagnosis
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Name      = {{PAGENAME}}
| Image      =  
| Image      = Nasopharyngeal carcinoma - alt -- high mag.jpg
| Width      =
| Width      =
| Caption    =  
| Caption    = Nasopharyngeal carcinoma. [[H&E stain]].
| Synonyms  =
| Synonyms  = nasopharyngeal-type undifferentiated carcinoma, non-keratining nasopharyngeal carcinoma undifferentiated type
| Micro      =
| Micro      = Cohesive typical (squamoid) cells (abundant dense eosinophilic cytoplasm, central nuclei +/- small/indistinct nucleoli), prominent lymphoid component
| Subtypes  =
| Subtypes  = keratinizing SCC; nonkeratinizing carcinoma, differentiated; nonkeratinizing carcinoma, undifferentiated; basaloid SCC
| LMDDx      =
| LMDDx      = [[HPV-associated head and neck squamous cell carcinoma]], [[squamous cell carcinoma of the head and neck]], [[sinonasal undifferentiated carcinoma]] (SNUC)
| Stains    =
| Stains    =
| IHC        = EBER +ve, p16 -ve
| IHC        = p16 -ve, LMP-1 -ve/+ve
| EM        =
| EM        =
| Molecular  =
| Molecular  = [[EBER]] +ve
| IF        =
| IF        =
| Gross      =
| Gross      =
| Grossing  =
| Grossing  =
| Site      = [[head and neck pathology|head and neck]]
| Site      = nasopharynx - see ''[[head and neck pathology|head and neck]]''
| Assdx      =
| Assdx      =
| Syndromes  =
| Syndromes  =
| Clinicalhx =
| Clinicalhx =
| Signs      =
| Signs      = neck mass
| Symptoms  =
| Symptoms  =
| Prevalence =
| Prevalence = uncommon in West
| Bloodwork  =
| Bloodwork  =
| Rads      =
| Rads      =
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*"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:
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==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 49: 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:
DDx:
*[[HPV-associated head and neck squamous cell carcinomas]].
*[[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:
====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_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)].
*[http://en.wikipedia.org/wiki/File:Lymphoepithelioma_met_to_LN_2.jpg Nasopharyngeal carcinoma - in a LN - high mag. (WP)].
Line 104: Line 127:


==IHC==
==IHC==
*EBER +ve.
*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, abbreviated NPC, is malignant epithelial tumour of the head and neck closely related to squamous cell carcinoma.

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

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:

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.

Note:

  • May be keratinizing or nonkeratinizing[5] and the distinction is important - see classification below.

DDx:

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

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.
    • Not sensitive; only positive in 40-45% of cases in a series of 30 cases.[8]

Notes:

Molecular

Images

  • NPC - EBER - very low mag. (WC)

  • NPC - EBER - low mag. (WC)

  • NPC - EBER - high mag. (WC)

See also

References

  1. ↑ 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. ↑ 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.
  3. ↑ 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.
  4. ↑ Klatt, Edward C. (2006). Robbins and Cotran Atlas of Pathology (1st ed.). Saunders. pp. 145. ISBN 978-1416002741.
  5. ↑ Wenig, BM. (Dec 1999). "Nasopharyngeal carcinoma.". Ann Diagn Pathol 3 (6): 374-85. doi:10.1053/ADPA00300374. PMID 10594290.
  6. ↑ 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.
  7. ↑ 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. ↑ 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.
  9. ↑ 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.
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