Sinonasal or Nasopharyngeal Undifferentiated Carcinoma ?: Diagnostic Pitfall and The Role of EBV and HPV Examination

Wahyu Tri Widayati(1*), Ery Kus Dwianingsih(2), Bustanul Ardianto(3), Didik Setyo Heriyanto(4), Sagung Rai Indrasari(5), Camelia Herdini(6), . Irianiwati(7)

(1) Universitas Gadjah Mada
(*) Corresponding Author




Undifferentiated carcinoma of the head and neck is frequently observed in nasopharynx, however it may also occur in oropharynx, salivary gland and sinonasal. Overlapping lesions in those regions create difficulty in determining the origin of the tumor. Thus, it causes diagnostic pitfall not only for pathologists, but also for clinicians.

Case Description

A 40 year old man, presented with nasal obstruction, epistaxis, diplopia, and headache for a yearand showed nasal cavity sinistra and nasopharynx masses on CT-scan. Lymph node enlargement was not detected. First biopsy was performed and histopathologically diagnosed as nasopharyngeal undifferentiated carcinoma(NPC), extended into nasal cavity. Chemo-radiation protocol for NPC was conducted, and showing uncomplete response. Second biopsy was done, and reviewed with the first biopsy result. The tumour was arranged in solid, syncytial and trabecular pattern, with vesicular nuclei, prominent nucleoli, and lack of lymphoplasmacytic infiltrat. Immunohistochemistry (IHC) analysis of p16, EBNA1 and LMP1 were negative. PCR analysis of HPV-18 was positive, while EBV detection showed negative result.

Discussion and conclusion

General association of EBV with NPC suggests that the presence of latent EBV infection can serve as a positive marker for NPC. Therefore, in this case, the EBV negativity and strong HPV association led to diagnosis of SNUC. The distinction of SNUC or from NPC was important for appropriate management and therapy.


Keyword : Undifferentiated carcinoma, sinonasal carcinoma, nasopharyngeal carcinoma

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