Whole-organ histopathological study of recurrent nasopharyngeal carcinoma

Authors

  • Jimmy Y. W. Chan MD, MS,

    Corresponding author
    1. Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hong Kong, China
    • Send correspondence to Jimmy Yu Wai Chan, MD, MS, Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China. E-mail: chanjyw@gmail.com

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  • Stanley T. S. Wong BSc, PhD,

    1. Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hong Kong, China
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  • William I. Wei MD, MS

    1. Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hong Kong, China
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  • This work was supported by the Hong Kong University Grants Committee Area of Excellence scheme.

  • The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

To study the histopathological features of recurrent nasopharyngeal carcinoma and the accuracy of preoperative magnetic resonance imaging (MRI).

Study Design

Prospective.

Methods

Whole-organ study of nasopharyngectomy specimens.

Results

Between 2006 and 2009, 50 specimens were obtained after maxillary swing nasopharyngectomy and sent for whole-organ study. The tumors arose from the fossa of Rosenmüller (68%), posterior wall (18%), or roof of the nasopharynx (14%), and the majority (72%) took the form of an ulcerative tumor. The T-classifications of the recurrent tumors were: T1, 24%; T2, 48%; and T3, 28%. All the tumors appeared as islands of cancer cells separated by lymphoplasmacytic infiltrate and fibrosis. The tumor size measured by MRI correlated closely with that measured histologically, especially for the depth of invasion and parapharyngeal extension. For tumors with parapharyngeal extension, removal of the pharyngobasilar fascia was essential to ensure a clear margin on the surface of the petrosal internal carotid artery. None of the tumors showed invasion of the Eustachian tube.

Conclusions

Contrast MRI is accurate in assessing the local extent of recurrent nasopharyngeal carcinoma. During nasopharyngectomy, a radial resection margin of 15 mm should be taken with the underlying medial pterygoid muscle. For tumors with parapharyngeal extension, the pharyngobasilar fascia should be resected en bloc with the specimen.

Level of Evidence

N/A Laryngoscope, 124:446–450, 2014

Ancillary