Nasal cavity, paranasal sinuses, nasopharynx
Nasopharyngeal carcinoma
Keratinizing squamous cell carcinoma

Topic Completed: 1 January 2014

Minor changes: 3 March 2020

Copyright: 2004-2020,, Inc.

PubMed Search: Keratinizing squamous cell carcinoma nasal

Rifat Mannan, M.D.
Songyang Yuan, M.D., Ph.D.
Page views in 2019: 5,176
Page views in 2020 to date: 4,248
Cite this page: Mannan A.A.S.R. Keratinizing squamous cell carcinoma. website. Accessed August 14th, 2020.
Definition / general
  • Variant of nasopharyngeal carcinoma (NPC) exhibiting microscopic evidence of keratinization
  • Represents about 25% of all nasopharyngeal carcinoma
  • More common in men
  • Usual age at presentation is decades 4 - 6
  • Lateral wall of nasopharynx (fossa of Rosenmüller) is most common site, followed by superior posterior wall
  • Cervical lymph node metastasis is common
  • Weak association with EBV compared to other subtypes of nasopharyngeal carcinoma
  • HPV may play a pathogenetic role
  • Can arise de novo or as a radiation associated carcinoma occurring many years after radiation therapy for nonkeratinizing nasopharyngeal carcinoma (Hum Pathol 2000;31:227)
Clinical features
  • Similar to other subtypes of nasopharyngeal carcinoma:
    • Asymptomatic cervical neck mass is usually localized to the posterior cervical triangle
    • Nasal obstruction, nasal discharge, epistaxis, pain, serous otitis media, otalgia, hearing loss and headache are other presentations
  • Higher incidence of locally advanced tumor (Am J Otolaryngol 1995;16:103) but lower incidence of lymphatic (Otolaryngol Clin North Am 1985;18:479) or distant spread as compared to other subtypes
Prognostic factors
  • Overall 5 year survival is 20 - 40%
  • Clinical stage is the most important prognostic factor
  • Keratinizing NPC has a poorer 5 year survival rate due to higher incidence of deaths secondary to local disease and nodal metastases
  • Supervoltage radiotherapy (65 → 70 Gy) is treatment of choice for all histological subtypes
  • Surgery is reserved for patients who fail radiation therapy
Gross description
  • Varies from mucosal bulge to an infiltrative mass lesion
Microscopic (histologic) description
  • Invasive carcinoma demonstrating obvious squamous differentiation as intercellular bridges and keratinization
  • Can grade as well differentiated, moderately differentiated or poorly differentiated
  • Desmoplastic response is typically associated with invasive tumor
Microscopic (histologic) images

Contributed by Dr. Songyang Yuan

Well differentiated keratinizing squamous cell carcinoma

Positive stains
Back to top