Pathology

Nasopharyngeal carcinoma is a lymphoepithelioma comprising lymphoid elements admixed with malignant epithelial cells identical to those of a poorly differentiated squamous cell carcinoma. The epithelial cells, not the lymphoid elements, are considered neoplastic.

Biopsy is necessary to differentiate nasopharyngeal carcinoma from other nasopharyngeal malignancies, such as:

• lymphoma - including Burkitt's lymphoma
• sarcoma - rhabdomyosarcoma, sarcomas from fibrous, cartilaginous, or osseous tissues surrounding the nasopharynx
• adenocarcinoma
• tumours from salivary tissues - such as adenoid cystic adenocarcinoma

Spread may occur:

• directly:
  • anteriorly, i.e. nasally
  • inferiorly, i.e. pharyngeal
  • superiorly, i.e. sphenoidal
  • posteriorly, i.e. region of first cervical vertebra
  • laterally, i.e. parotid gland; IX, X, XI, XII cranial nerves
• lymphatic - to the upper deep cervical lymph nodes
• haematogenous - to the spinal column, lung and liver

Lymphatic spread tends to occur earliest.