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CASE 21

CASE 21. 46 year old man with a papillary lesion of nasopharynx. CK 5/6. Ki-67. LAM. LAM. EBER. Diagnosis. Papillary nasopharyngeal carcinoma, non-keratinizing type undifferentiated, predominantly in-situ with areas of probable superficial invasion. Nasopharyngeal Carcinoma.

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CASE 21

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  1. CASE 21 46 year old man with a papillary lesion of nasopharynx.

  2. CK 5/6

  3. Ki-67

  4. LAM

  5. LAM

  6. EBER

  7. Diagnosis Papillary nasopharyngeal carcinoma, non-keratinizing type undifferentiated, predominantly in-situ with areas of probable superficial invasion.

  8. Nasopharyngeal Carcinoma “A carcinoma arising in the nasopharyngeal mucosa that shows light microscopic or ultrastructural evidence of squamous differentiation. It encompasses squamous cell carcinoma (differentiated or undifferentiated) and basaloid-squamous carcinoma. Adenocarcinoma and salivary gland carcinoma are excluded.”

  9. Nasopharyngeal Carcinoma • Distinctive geographic and ethnic distribution • Relatively rare tumor worldwide • 65,000 new cases per year • 0.6% of all cancers

  10. NPC - Etiology • Race • Genetics • HLA • Multiple chromosomal changes (loss of material short arm of C-3) • First degree relative with NPC

  11. NPC – Etiology Increased Risk Decreased Risk HLA –A2 HLA –A11 HLA –B14 HLA –B13 HLA –B46 HLA –B22

  12. NPC - Etiology 3. Environment A. Salted fish – nitrosamines B. Cigarette smoking C. Formaldehyde exposure D. Occupational exposure to wood dust E. Alcohol F. Crowded conditions

  13. NPC - Etiology 4. Viruses A. EBV – nonkeratinizing B. ?HPV – keratinizing 5. Miscellaneous A. Chronic rhinosinusitis

  14. NPC – Clinical Features • Peak incidence 30-50 yrs. • Some regions 2 peaks (10-20 and 40-60 yrs.) • M:F 2-3:1

  15. NPC – Clinical Features • Symptoms: cervical mass, serous otitis, epistaxis, nasal obstruction • 10-20% cranial nerve dysfunction • 60-85% positive nodes, 35-45% bilateral • Less than 5% distant mets

  16. NPC – Distribution of 437 Cases • 78% lateral wall – equally distributed between rt. and lt. sides • 12% central • 5% occult • 5% too large to determine Skinner DW, et al. Ann Otol Rhinol Laryngol 100:544, 1991

  17. Nasopharyngeal Carcinoma*(N=209) 74.0% Exophytic 14.4% Infiltrative 6.7% Ulcerative 4.8% Unknown *Dickson, RI, Laryngoscope 91:33, 1981

  18. WHO (1978) • Squamous cell carcinoma • Non-Keratinizing carcinoma • Undifferentiated carcinoma

  19. WHO (1991) • Squamous cell carcinoma 2. Non-Keratinizing carcinoma A. Differentiated non-keratinizing carcinoma B. Undifferentiated carcinoma

  20. WHO (2005) • Squamous cell carcinoma • Non-keratinizing carcinoma A. Differentiated non-keratinizing carcinoma B. Undifferentiated carcinoma 3. Basaloid squamous carcinoma

  21. K

  22. WHO-III EBER

  23. K

  24. NPC

  25. 92%

  26. NPC – Squamous Cell Carcinoma 25% of all NPCs in U.S. Weak relationship to EBV Tends to remain localized Variable response to X-ray 20-40% 5-year survival

  27. NPC – Non-Keratinizing Carcinomas 75% of all NPCs in U.S. Strong relationship with EBV Tend to disseminate Good response to x-ray 65% 5-year survival

  28. Incidence of EBER-1 in 140 NPC* Type % WHO I (N=5) 80 WHO II (N=73) 97.3 WHO III (N=62) 96.8 Tsai S-T, et al, Cancer 77:231, 1996

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