Nasal cavity, paranasal sinuses, nasopharynx
Nasopharyngeal carcinoma
General

Author: Nat Pernick, M.D. (see Authors page)

Revised: 18 May 2018, last major update November 2004

Copyright: (c) 2004-2018, PathologyOutlines.com, Inc.

PubMed Search: Nasopharyngeal carcinoma[TI] pathology[TIAB] full text[sb]

Cite this page: Pernick, N. Nasopharyngeal carcinoma - general. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/nasalnasopharyngealgeneral.html. Accessed September 22nd, 2018.
Definition / general
  • Demographics vary greatly by region
  • United States: rare, incidence of 0.4 per 100,000 in whites
  • Africa: common; #1 childhood cancer; associated with EBV
  • South China: most common cancer in adults (18% of cancers in Hong Kong, 21.4 per 100,000 in Hong Kong, see table below), rare in children
  • 70% male
  • Strongly associated with EBV infection for undifferentiated and nonkeratinizing subtypes
  • Other risk factors: consumption of salt preserved fish containing carcinogenic nitrosamines, family history, specific HLA class I genotypes, tobacco smoking, chronic respiratory tract conditions and low consumption of fresh fruits and vegetables (Cancer Epidemiol Biomarkers Prev 2006;15:1765)
Diagrams / tables

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Age standardized incidence rates

Diagnosis
  • Blind biopsies, particularly in fossa of Rosenmüller, are recommended if diagnosis is suspected (70% sensitive)
  • Tumors arising from fossa of Rosenmüller frequently extend to paranasopharyngeal space, then along trigeminal nerve
  • Often metastasizes to regional nodes; common presentation is unilateral cervical lymphadenopathy; 25% have bilateral nodal metastases
  • May have distant metastases to bones
  • After radiation therapy, risk of 0.4% of subsequent carcinoma in nasal cavity of nasopharynx; differentiate from recurrence based on > 5 year delay, different histology, EBV- (Hum Pathol 2000;31:227)
Laboratory
  • IgG against early EBV antigen is suggestive but has 30% false positives
  • IgA against viral capsid antigen has 9 - 18% false positives
Prognostic factors
  • Good prognostic factors: younger age, lower stage, ipsilateral metastases, metastases limited to upper neck, no involvement of cranial nerves, orbit or intracranial structures; nonkeratinizing subtypes
Treatment
  • Immunotherapy (interferon), radiation therapy, chemotherapy
Gross description
  • May not be identifiable tumor
Microscopic (histologic) description
Positive stains
Electron microscopy description
  • Tonofilaments and complex desmosomes