Difference between revisions of "Sinonasal undifferentiated carcinoma"
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Sinonasal_undifferentiated_carcinoma_-_high_mag.jpg | |||
| Width = | |||
| Caption = SNUC. [[H&E stain]]. | |||
| Synonyms = | |||
| Micro = tumour with variable architecture (nested, trabecular or lobular), small-to-moderate cytoplasm, +/-distinct nucleoli, cell size variable (small to large); glandular and squamous differentiation are absent by definition | |||
| Subtypes = | |||
| LMDDx = poorly differentiated [[squamous cell carcinoma of the head and neck]], [[small cell carcinoma]], [[SMARCB1-deficient sinonasal carcinoma]], [[SMARCA4-deficient sinonasal carcinoma]], [[nasopharyngeal carcinoma]], others | |||
| Stains = | |||
| IHC = pankeratin +ve, [[EMA]] +ve, [[CK7]] +ve, [[CK5/6]] -ve, NSE +ve/-ve, chromogranin A -ve, synaptophysin -ve, [[p63]] +ve/-ve | |||
| EM = | |||
| Molecular = [[EBER]] -ve | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Site = [[head and neck pathology|head and neck]] | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = rare | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = poor | |||
| Other = | |||
| ClinDDx = other head and neck tumours | |||
| Tx = | |||
}} | |||
'''Sinonasal undifferentiated carcinoma''', abbreviated '''SNUC''', is a rare epithelial malignancy of the [[head and neck pathology|head and neck]]. | '''Sinonasal undifferentiated carcinoma''', abbreviated '''SNUC''', is a rare epithelial malignancy of the [[head and neck pathology|head and neck]]. | ||
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*Glandular and squamous differentiation are absent by definition.<ref name=pmid11904342/> | *Glandular and squamous differentiation are absent by definition.<ref name=pmid11904342/> | ||
DDx: | |||
*www: | *Poorly differentiated [[squamous cell carcinoma of the head and neck]]. | ||
*[[Small cell carcinoma]]. | |||
*[[SMARCB1-deficient sinonasal carcinoma]].<ref name=pmid25007146>{{Cite journal | last1 = Bishop | first1 = JA. | last2 = Antonescu | first2 = CR. | last3 = Westra | first3 = WH. | title = SMARCB1 (INI-1)-deficient carcinomas of the sinonasal tract. | journal = Am J Surg Pathol | volume = 38 | issue = 9 | pages = 1282-9 | month = Sep | year = 2014 | doi = 10.1097/PAS.0000000000000285 | PMID = 25007146 }}</ref> | |||
*[[SMARCA4-deficient sinonasal carcinoma]].<ref name=pmid34871352>{{cite journal |authors=Kakkar A, Ashraf SF, Rathor A, Adhya AK, Mani S, Sikka K, Jain D |title=SMARCA4/BRG1-Deficient Sinonasal Carcinoma |journal=Arch Pathol Lab Med |volume=146 |issue=9 |pages=1122–1130 |date=September 2022 |pmid=34871352 |doi=10.5858/arpa.2021-0001-OA |url=}}</ref> | |||
*[[Nasopharyngeal carcinoma]]. | |||
*Other tumours, especially [[small round blue cell tumours]] and [[lymphoma]]. | |||
===Images=== | |||
www: | |||
*[http://www.nature.com/modpathol/journal/v15/n3/fig_tab/3880522f7.html SNUC (nature.com)].<ref name=pmid11904342>{{Cite journal | last1 = Mills | first1 = SE. | title = Neuroectodermal neoplasms of the head and neck with emphasis on neuroendocrine carcinomas. | journal = Mod Pathol | volume = 15 | issue = 3 | pages = 264-78 | month = Mar | year = 2002 | doi = 10.1038/modpathol.3880522 | PMID = 11904342 | URL = http://dx.doi.org/10.1038/modpathol.3880522 }}</ref> | |||
*[http://www.pathologypics.com/PictView.aspx?ID=244 SNUC (pathologypics.com)]. | |||
*[http://www.pathologypics.com/PictView.aspx?ID=249 SNUC (pathologypics.com)]. | |||
<gallery> | |||
Image:Sinonasal_undifferentiated_carcinoma_-_low_mag.jpg | SNUC - low mag. (WC) | |||
Image:Sinonasal_undifferentiated_carcinoma_-_high_mag.jpg | SNUC - high mag. (WC) | |||
Image:Sinonasal_undifferentiated_carcinoma_-_very_high_mag.jpg | SNUC - very high mag. (WC) | |||
</gallery> | |||
==IHC== | ==IHC== | ||
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*Pankeratin +ve. | *Pankeratin +ve. | ||
*[[EMA]] +ve. | *[[EMA]] +ve. | ||
*CK7 +ve. | *[[CK7]] +ve. | ||
*CK5/6 -ve. | *[[CK5/6]] -ve. | ||
Others: | Others: | ||
Line 39: | Line 79: | ||
*Synaptophysin -ve. | *Synaptophysin -ve. | ||
*p63 +ve/-ve.<ref name=pmid21805120>{{Cite journal | last1 = Wadsworth | first1 = B. | last2 = Bumpous | first2 = JM. | last3 = Martin | first3 = AW. | last4 = Nowacki | first4 = MR. | last5 = Jenson | first5 = AB. | last6 = Farghaly | first6 = H. | title = Expression of p16 in sinonasal undifferentiated carcinoma (SNUC) without associated human papillomavirus (HPV). | journal = Head Neck Pathol | volume = 5 | issue = 4 | pages = 349-54 | month = Dec | year = 2011 | doi = 10.1007/s12105-011-0285-8 | PMID = 21805120 | PMC = 3210220 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3210220/ }}</ref> | *p63 +ve/-ve.<ref name=pmid21805120>{{Cite journal | last1 = Wadsworth | first1 = B. | last2 = Bumpous | first2 = JM. | last3 = Martin | first3 = AW. | last4 = Nowacki | first4 = MR. | last5 = Jenson | first5 = AB. | last6 = Farghaly | first6 = H. | title = Expression of p16 in sinonasal undifferentiated carcinoma (SNUC) without associated human papillomavirus (HPV). | journal = Head Neck Pathol | volume = 5 | issue = 4 | pages = 349-54 | month = Dec | year = 2011 | doi = 10.1007/s12105-011-0285-8 | PMID = 21805120 | PMC = 3210220 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3210220/ }}</ref> | ||
*SMARCB1 ([[INI1]]) +ve (nuclear staining present). | |||
**Nuclear staining lost in [[SMARCB1-deficient sinonasal carcinoma]]. | |||
===Comparison between different sinonasal carcinomas=== | |||
Based on a modest size study, keratins can useful for subclassifying sinonasal carcinomas:<ref name=pmid12459626>{{cite journal |authors=Franchi A, Moroni M, Massi D, Paglierani M, Santucci M |title=Sinonasal undifferentiated carcinoma, nasopharyngeal-type undifferentiated carcinoma, and keratinizing and nonkeratinizing squamous cell carcinoma express different cytokeratin patterns |journal=Am J Surg Pathol |volume=26 |issue=12 |pages=1597–604 |date=December 2002 |pmid=12459626 |doi=10.1097/00000478-200212000-00007 |url=}}</ref> | |||
{| class="wikitable sortable" | |||
! Diagnosis | |||
! CK4 | |||
! CK5/6 | |||
! CK7 | |||
! CK13 | |||
! CK14 | |||
! CK19 | |||
|- | |||
| Sinonasal undifferentiated carcinoma (SNUC) | |||
| +0% | |||
| +0% | |||
| +50% | |||
| +0% | |||
| +0% | |||
| +50% | |||
|- | |||
| Nasopharyngeal-type undifferentiated carcinoma (NPTC) | |||
| +0% | |||
| +80% | |||
| +0% | |||
| +80% | |||
| +0% | |||
| +100% | |||
|- | |||
| Nonkeratinizing squamous cell carcinoma (NKSCC) | |||
| +0% | |||
| +90% | |||
| +0% | |||
| +80% | |||
| +80% | |||
| +90% | |||
|- | |||
|Squamous cell carcinoma (keratainizing) | |||
| +30% | |||
| +90% | |||
| +60% | |||
| +90% | |||
| +80% | |||
| +90% | |||
|- | |||
|} | |||
==Molecular== | |||
*EBER -ve.<ref name=pmid11176064>{{cite journal |authors=Cerilli LA, Holst VA, Brandwein MS, Stoler MH, Mills SE |title=Sinonasal undifferentiated carcinoma: immunohistochemical profile and lack of EBV association |journal=Am J Surg Pathol |volume=25 |issue=2 |pages=156–63 |date=February 2001 |pmid=11176064 |doi=10.1097/00000478-200102000-00003 |url=}}</ref> | |||
==See also== | ==See also== |
Latest revision as of 18:07, 20 December 2023
Sinonasal undifferentiated carcinoma | |
---|---|
Diagnosis in short | |
SNUC. H&E stain. | |
| |
LM | tumour with variable architecture (nested, trabecular or lobular), small-to-moderate cytoplasm, +/-distinct nucleoli, cell size variable (small to large); glandular and squamous differentiation are absent by definition |
LM DDx | poorly differentiated squamous cell carcinoma of the head and neck, small cell carcinoma, SMARCB1-deficient sinonasal carcinoma, SMARCA4-deficient sinonasal carcinoma, nasopharyngeal carcinoma, others |
IHC | pankeratin +ve, EMA +ve, CK7 +ve, CK5/6 -ve, NSE +ve/-ve, chromogranin A -ve, synaptophysin -ve, p63 +ve/-ve |
Molecular | EBER -ve |
Site | head and neck |
| |
Prevalence | rare |
Prognosis | poor |
Clin. DDx | other head and neck tumours |
Sinonasal undifferentiated carcinoma, abbreviated SNUC, is a rare epithelial malignancy of the head and neck.
General
- Aggressive/poor prognosis.
Microscopic
Features:[3]
- Architecture: nested, trabecular or lobular.
- Distinct cellular borders.
- Small-to-moderate cytoplasm.
- +/-Distinct nucleoli.
- Tumour cell size variable (small to large).
Note:
- Glandular and squamous differentiation are absent by definition.[4]
DDx:
- Poorly differentiated squamous cell carcinoma of the head and neck.
- Small cell carcinoma.
- SMARCB1-deficient sinonasal carcinoma.[5]
- SMARCA4-deficient sinonasal carcinoma.[6]
- Nasopharyngeal carcinoma.
- Other tumours, especially small round blue cell tumours and lymphoma.
Images
www:
IHC
Features:[3]
Others:
- NSE +ve/-ve.
- Chromogranin A -ve.
- Synaptophysin -ve.
- p63 +ve/-ve.[7]
- SMARCB1 (INI1) +ve (nuclear staining present).
- Nuclear staining lost in SMARCB1-deficient sinonasal carcinoma.
Comparison between different sinonasal carcinomas
Based on a modest size study, keratins can useful for subclassifying sinonasal carcinomas:[8]
Diagnosis | CK4 | CK5/6 | CK7 | CK13 | CK14 | CK19 |
---|---|---|---|---|---|---|
Sinonasal undifferentiated carcinoma (SNUC) | +0% | +0% | +50% | +0% | +0% | +50% |
Nasopharyngeal-type undifferentiated carcinoma (NPTC) | +0% | +80% | +0% | +80% | +0% | +100% |
Nonkeratinizing squamous cell carcinoma (NKSCC) | +0% | +90% | +0% | +80% | +80% | +90% |
Squamous cell carcinoma (keratainizing) | +30% | +90% | +60% | +90% | +80% | +90% |
Molecular
- EBER -ve.[9]
See also
References
- ↑ Pitman, KT.; Costantino, PD.; Lassen, LF. (1995). "Sinonasal undifferentiated carcinoma: current trends in treatment.". Skull Base Surg 5 (4): 269-72. PMC 1656535. PMID 17170968. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1656535/.
- ↑ Al-Mamgani, A.; van Rooij, P.; Mehilal, R.; Tans, L.; Levendag, PC. (Apr 2012). "Combined-modality treatment improved outcome in sinonasal undifferentiated carcinoma: single-institutional experience of 21 patients and review of the literature.". Eur Arch Otorhinolaryngol. doi:10.1007/s00405-012-2008-5. PMID 22476411.
- ↑ 3.0 3.1 Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 38. ISBN 978-0781765275.
- ↑ 4.0 4.1 Mills, SE. (Mar 2002). "Neuroectodermal neoplasms of the head and neck with emphasis on neuroendocrine carcinomas.". Mod Pathol 15 (3): 264-78. doi:10.1038/modpathol.3880522. PMID 11904342.
- ↑ Bishop, JA.; Antonescu, CR.; Westra, WH. (Sep 2014). "SMARCB1 (INI-1)-deficient carcinomas of the sinonasal tract.". Am J Surg Pathol 38 (9): 1282-9. doi:10.1097/PAS.0000000000000285. PMID 25007146.
- ↑ Kakkar A, Ashraf SF, Rathor A, Adhya AK, Mani S, Sikka K, Jain D (September 2022). "SMARCA4/BRG1-Deficient Sinonasal Carcinoma". Arch Pathol Lab Med 146 (9): 1122–1130. doi:10.5858/arpa.2021-0001-OA. PMID 34871352.
- ↑ Wadsworth, B.; Bumpous, JM.; Martin, AW.; Nowacki, MR.; Jenson, AB.; Farghaly, H. (Dec 2011). "Expression of p16 in sinonasal undifferentiated carcinoma (SNUC) without associated human papillomavirus (HPV).". Head Neck Pathol 5 (4): 349-54. doi:10.1007/s12105-011-0285-8. PMC 3210220. PMID 21805120. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3210220/.
- ↑ Franchi A, Moroni M, Massi D, Paglierani M, Santucci M (December 2002). "Sinonasal undifferentiated carcinoma, nasopharyngeal-type undifferentiated carcinoma, and keratinizing and nonkeratinizing squamous cell carcinoma express different cytokeratin patterns". Am J Surg Pathol 26 (12): 1597–604. doi:10.1097/00000478-200212000-00007. PMID 12459626.
- ↑ Cerilli LA, Holst VA, Brandwein MS, Stoler MH, Mills SE (February 2001). "Sinonasal undifferentiated carcinoma: immunohistochemical profile and lack of EBV association". Am J Surg Pathol 25 (2): 156–63. doi:10.1097/00000478-200102000-00003. PMID 11176064.