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Presented by William Westra, M.D. and prepared by Walter Klein, M.D.
Case 6: Nasopharynx biopsy from a 59 year-old man with bulky cervical adenopathy.
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Week 169: Case 6
Nasopharynx biopsy from a 59 year-old man with bulky cervical adenopathy.images/klein/011904case6fig1.jpg
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images/klein/011904case6fig5.jpgCorrect
Answer: Sinonasal carcinoma, undifferentiated type
Histology: The background shows mostly a dense lymphoid infiltrate of small round lymphocytes. At higher power, the lymphocytes are intimately admixed with larger cells occurring singly or as small clusters. These larger atypical cells have uniform nuclei with prominent eosinophilic nucleoli, and syncitial cytoplasm (i.e. cytoplasmic borders are not seen). Immunohistochemical studies were performed. The large atypical cells were found to be immunoreactive for AE1:AE3; and they were not immunoreactive for CD20, S100 or HMB-45.
Discussion: Nasopharyngeal undifferentiated carcinoma occurs over a very broad range of ages. In fact, is the only type of head and neck carcinoma that can effects children with any frequency. These tumors have a predilection to metastasize to regional lymph nodes even during early stages of tumor growth. The clinical presentation of bulky cervical adenopathy in the absence of an obvious nasopharyngeal mass is quite typical.
Nasopharyngeal undifferentiated carcinoma is an undifferentiated carcinoma that is histologically recognized by: 1) a prominent reactive lymphoplasmacytoid infiltrate, 2) prominent eosinophilic nucleoli, and indistinct cell borders. The carcinoma is often so intensely permeated by the inflammatory infiltrate that it the tumor cells are either entirely overlooked or confused with lymphoma. The distinction between lymphoma and nasopharyngeal undifferentiated carcinoma has been greatly facilitated by sensitive and specific markers for both epithelial and lymphoid differentiation. For prognostic reasons, the undifferentiated type of nasopharyngeal carcinoma should be distinguished from the differentiated types (both keratinizing and non-keratinizing) of nasopharyngeal carcinoma. Non-keratinizing nasopharyngeal carcinoma does not occur in children, and it demonstrates the light microscopic features of squamous cell carcinoma including a “pavement stone” arrangement of the tumor cells with cell borders.
The diagnosis of undifferentiated nasopharyngeal carcinoma carries prognostic implications that are both good and bad. The good news is that these tumors tend to be exquisitely sensitive to radiation. The bad news is that these tumors tend to present at advanced stages when conventional chemoradiation therapy is less effective.
Incorrect
Answer: Sinonasal carcinoma, undifferentiated type
Histology: The background shows mostly a dense lymphoid infiltrate of small round lymphocytes. At higher power, the lymphocytes are intimately admixed with larger cells occurring singly or as small clusters. These larger atypical cells have uniform nuclei with prominent eosinophilic nucleoli, and syncitial cytoplasm (i.e. cytoplasmic borders are not seen). Immunohistochemical studies were performed. The large atypical cells were found to be immunoreactive for AE1:AE3; and they were not immunoreactive for CD20, S100 or HMB-45.
Discussion: Nasopharyngeal undifferentiated carcinoma occurs over a very broad range of ages. In fact, is the only type of head and neck carcinoma that can effects children with any frequency. These tumors have a predilection to metastasize to regional lymph nodes even during early stages of tumor growth. The clinical presentation of bulky cervical adenopathy in the absence of an obvious nasopharyngeal mass is quite typical.
Nasopharyngeal undifferentiated carcinoma is an undifferentiated carcinoma that is histologically recognized by: 1) a prominent reactive lymphoplasmacytoid infiltrate, 2) prominent eosinophilic nucleoli, and indistinct cell borders. The carcinoma is often so intensely permeated by the inflammatory infiltrate that it the tumor cells are either entirely overlooked or confused with lymphoma. The distinction between lymphoma and nasopharyngeal undifferentiated carcinoma has been greatly facilitated by sensitive and specific markers for both epithelial and lymphoid differentiation. For prognostic reasons, the undifferentiated type of nasopharyngeal carcinoma should be distinguished from the differentiated types (both keratinizing and non-keratinizing) of nasopharyngeal carcinoma. Non-keratinizing nasopharyngeal carcinoma does not occur in children, and it demonstrates the light microscopic features of squamous cell carcinoma including a “pavement stone” arrangement of the tumor cells with cell borders.
The diagnosis of undifferentiated nasopharyngeal carcinoma carries prognostic implications that are both good and bad. The good news is that these tumors tend to be exquisitely sensitive to radiation. The bad news is that these tumors tend to present at advanced stages when conventional chemoradiation therapy is less effective.
