PMC7710863_01
Tumor appearance on nasopharyngeal endoscopy and magnetic resonance imaging (MRI). Endoscopic findings of the nasopharyngeal tumor viewed from the right (A) and left (B) nasal cavities at the first visit to the previous hospital are shown. A pedunculated polypoid tumor originating from the posterior edge of the nasal septum was found in the epipharynx. Horizontal views of plain T1-weighted (C) and T2-weighted magnetic resonance imaging (D) of the head showed a tumor of ~20 mm in diameter located in the epipharynx originating from the posterior edge of the nasal septum without invasive or destructive findings (white arrows). T1- and T2-weighted images showed the same or slightly higher intensities compared to that of the nasal concha. Preoperative (E) and postoperative (F) endoscopic findings of the nasopharyngeal tumor viewed from the right nasal cavity in our hospital. In the preoperative view, the main portion of tumor had disappeared and only the pedunculated portion remained (E). The tumor was endoscopically resected with a 5-mm safety margin (F).
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F1
An inspection of the nasal cavity with a soft fiberscope revealed a pedunculated polypoid tumor of ~20 mm in diameter on the posterior edge of nasal septum (Figures 1A,B). Magnetic resonance imaging (MRI) revealed a 20-mm tumor located in the epipharynx that originated from the posterior edge of the nasal septum, and T1- and T2-weighted images showed the same or slightly higher intensities compared to that of the nasal concha (Figures 1C,D). On the first inspection of the nasopharynx in our hospital, the main part of the tumor had disappeared and only the pedunculated portion of the tumor remained (Figure 1E). In this operation, the tumor was completely excised with a surgical margin of ~5 mm using a needle electrode knife and was removed together with the periosteum from the vomer (Figure 1F).
Histopathological features of TL-LGNPPA. (A) Histological examination revealed a papillary structure with fibrovascular cores lined by cuboidal to columnar stratified cells with round to oval vesicular nuclei and eosinophilic cytoplasm. Psammoma bodies were not seen. The tumor showed invasive growth into the underlying fibrous connective tissue. (H&E staining, x 20). (B) An increase in nuclear chromatin and mild nuclear atypia were found, but no nuclear polymorphism was detected. Some cells had clear chromatin; however, the nuclear groove and nuclear pseudoinclusion were absent. No mitotic figures were found, and necrosis was not identified (H&E staining, x 40). (C) A streaming pattern lining of the tumor cells was also found in some areas (H&E staining, x 40).
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F2
A histologic examination revealed a papillary structure with hyalinized fibrovascular cores lined by cuboidal to columnar stratified cells with round to oval vesicular nuclei and eosinophilic cytoplasm (Figure 2A). No mitotic figures were found and there was no necrosis (Figure 2B). A streaming pattern lining of the tumor cells with small round to oval nuclei (i.e., spindle cell component) was also found in some areas (Figure 2C). The tumor showed invasive growth into the underlying fibrous connective tissue (Figure 2A).
Immunohistochemical features of TL-LGNPPA. (A) Positive staining for cytokeratin (CK) AE1/AE3 (x 20). (B) Positive staining for vimentin (x 20). (C) Positive nuclear staining for thyroid tissue factor-1 (TTF-1) (x 20). (D) Negative staining for smooth muscle actin (SMA) (x 20). (E) Negative staining for S100 (x 20). (F) Negative staining for thyroglobulin (x 20).
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F3
AE1/AE3 (Figure 3A), CK7, CK19, epithelial membrane antigen (EMA), vimentin (Figure 3B), and thyroid tissue factor-1 (TTF-1) (Figure 3C) but negative for CK5/6, CK20, smooth muscle actin (SMA) (Figure 3D), calponin, p63, glial fibrillary acidic protein (GFAP), S100 (Figure 3E), CDX2, CEA, PAX8, CD10, DOG1, GATA3, SOX10, GCDFP-15, and thyroglobulin (Figure 3F). A pathological diagnosis of LGNPPA with