Thyroid-Like Low-Grade Nasopharyngeal Papillary Adenocarcinoma

Am J Clin Pathol. 2019 Oct 7;152(5):582-589. doi: 10.1093/ajcp/aqz082.

Abstract

Objectives: Thyroid-like low-grade nasopharyngeal papillary adenocarcinoma (TLLGNPPA) is a relatively rare nasopharyngeal tumor. We performed morphological characterization, immunohistochemical profiling, and investigated gene mutations. We also provide clinical follow-up data and brief review of the literature.

Methods: Immunohistochemistry was used to evaluate the expression of TTF-1, CK19, CK7, EMA, TG, Pax-8, CK5/6, S100, and Ki-67. Additionally, in situ hybridization was utilized to identify the presence of EBV. We investigated mutations in hot-spot exons of KRAS/NRAS/BRAF to rule out common mutations seen in thyroid tumors.

Results: Histopathologic examination of four cases identified tumors that were mainly occupied by papillary architectures. One case had a predominantly glandular structure. The tumors expressed TTF-1 and CK19, while TG and Pax-8 were negative. S100 was moderately expressed focally in three cases.

Conclusions: While TLLGNPPA displays a morphological resemblance to papillary thyroid carcinoma (PTC), it is vital to differentiate nasopharyngeal metastasis from PTC for appropriate treatment.

Keywords: Clinicopathologic features; Genetic mutations; Nasopharyngeal papillary adenocarcinoma; Thyroid-like.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adenocarcinoma, Papillary / genetics
  • Adenocarcinoma, Papillary / pathology*
  • Adenocarcinoma, Papillary / surgery
  • Adult
  • Biomarkers, Tumor / analysis
  • DNA-Binding Proteins / analysis
  • Diagnosis, Differential
  • Female
  • Humans
  • Immunohistochemistry
  • Male
  • Mutation / genetics
  • Nasopharyngeal Neoplasms / genetics
  • Nasopharyngeal Neoplasms / pathology*
  • Nasopharyngeal Neoplasms / surgery
  • S100 Proteins / analysis
  • Thyroid Cancer, Papillary*
  • Tomography, X-Ray Computed
  • Transcription Factors / analysis

Substances

  • Biomarkers, Tumor
  • DNA-Binding Proteins
  • S100 Proteins
  • TTF1 protein, human
  • Transcription Factors