Clin Exp Otorhinolaryngol.  2013 Mar;6(1):48-51.

Exclusive Endoscopic Resection of Nasopharyngeal Papillary Adenocarcinoma via Combined Transnasal and Transoral Approach

• Ryu J
• Park WS
• Jung YS

Abstract

Low grade nasopharyngeal papillary adenocarcinoma (LGNPPA) is an extremely rare variant of nasopharyngeal cancer, which exhibits distinct clinicopathological characteristics. Surgical resection has been regarded as the principal treatment. For this, transpalatal or transfacial approach has been classically used for exposure of the field. Up for now, there has been no report on applying endoscopic approach for this disease, which could be an effective alternative to minimize possible morbidities of palatotomy or maxillotomy. Endoscopic approach can be justified considering narrow extent and indolent behavior of LGNPPA. We report a patient with LGNPPA, which was successfully resected exclusively by endoscopic visualization. Our case exhibited narrow-based exophytic features with compatible immunopathologic profiles of LGNPPA. Exclusive endoscopic resection can be effective and less-morbid modality for this rare disease as in this case.

Keyword

Nasopharyngeal neoplasms; Papillary adenocarcinoma; Endoscopy; Immunohistochemistry

MeSH Terms

Adenocarcinoma, Papillary
Endoscopy
Humans
Immunohistochemistry
Nasopharyngeal Neoplasms
Rare Diseases

Figure

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  Fig. 1 A broad tumor occluding most of the nasopharyngeal cavity is shown with (A) a transoral nasopharyngoscopic view under soft palate retraction with a nelaton catheter under general anesthesia taken just before surgical exploration. The exophytic tumor occluded almost the entire nasopharyngeal cavity. (B) Computed tomography showing a 2.8×2.4 cm-sized pedunculated tumor without any submucosal infiltration. The location of the stalk was estimated to be confined around the nasopharyngeal vault and the posterior end of the nasal septum (arrow) without any adjacent invasion to parapharyngeal structures. (C) 18-FDG-positron emission tomography showing only mild 18-FDG uptake (standardized uptake value, 2.55) confined to the nasopharyngeal area. (D) Transoral nasopharyngoscopic finding 1 year after surgery. A focal fibrotic scar was observed in the area around the previously existing stalk (arrows). No recurrence was observed. FDG, fluorodeoxyglucose.

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  Fig. 2 (A) Low power view (×40) showing typical papillary growth pattern of glandular epithelial cells, which is usually seen in papillary thyroid carcinoma. (B) A thin fibrovascular core was visible without calcified psammoma bodies. The cells lining these structures had bland, round-to-oval, nuclei without mitotic figures (H&E, ×200). Immunohistochemistry disclosed (C) positivity for thyroid transcription factor-1 (×200) but (D) negativity for thyroglobulin (×200).

Reference

1. Wenig BM, Hyams VJ, Heffner DK. Nasopharyngeal papillary adenocarcinoma: a clinicopathologic study of a low-grade carcinoma. Am J Surg Pathol. 1988; 12. 12(12):946–953. PMID: 2462370.

2. van Hasselt CA, Ng HK. Papillary adenocarcinoma of the nasopharynx. J Laryngol Otol. 1991; 10. 105(10):853–854. PMID: 1753201.

3. Nojeg MM, Jalaludin MA, Jayalakshmi P. Papillary adenocarcinoma of the nasopharynx: case report and review of the literature. Med J Malaysia. 1998; 3. 53(1):104–106. PMID: 10968147.

4. Wang CP, Chang YL, Chen CT, Yang TH, Lou PJ. Photodynamic therapy with topical 5-aminolevulinic acid as a post-operative adjuvant therapy for an incompletely resected primary nasopharyngeal papillary adenocarcinoma: a case report. Lasers Surg Med. 2006; 6. 38(5):435–438. PMID: 16470845.

5. Fu CH, Chang KP, Ueng SH, Wu CC, Hao SP. Primary thyroid-like papillary adenocarcinoma of the nasopharynx. Auris Nasus Larynx. 2008; 12. 35(4):579–582. PMID: 18201851.

6. Bejarano PA, Nikiforov YE, Swenson ES, Biddinger PW. Thyroid transcription factor-1, thyroglobulin, cytokeratin 7, and cytokeratin 20 in thyroid neoplasms. Appl Immunohistochem Mol Morphol. 2000; 9. 8(3):189–194. PMID: 10981870.