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Fig. 2.10 Nasopharyngeal nonkeratinizing carcinoma, undifferentiated subtype. A So-called lymphoepithelial carcinoma, characterized by lymphoid cells apparently breaking up the tumour into tiny aggregates, rendering it difficult to appreciate the epithelial nature of the neoplasm. B This case comprises spindly cells with dark-staining nuclei and inconspicuous nucleoli. C Among the carcinoma cells with vesicular nuclei, there can be tumour cels with a shrunken appearance and dark-staining nuclei. D Some examples show many amyloid globules among the tumour cells. Some globules are intracellular, and displace the nucleus of the tumour cells to one pole.

Fig. 2.10 Nasopharyngeal nonkeratinizing carcinoma, undifferentiated subtype. A So-called lymphoepithelial carcinoma, characterized by lymphoid cells apparently breaking up the tumour into tiny aggregates, rendering it difficult to appreciate the epithelial nature of the neoplasm. B This case comprises spindly cells with dark-staining nuclei and inconspicuous nucleoli. C Among the carcinoma cells with vesicular nuclei, there can be tumour cels with a shrunken appearance and dark-staining nuclei. D Some examples show many amyloid globules among the tumour cells. Some globules are intracellular, and displace the nucleus of the tumour cells to one pole.

may appear shrunken, with dark smudged nuclei and dense amphophilic or eosinophilic cytoplasm; it is unclear whether such changes reflect a degenerative phenomenon in a subpopulation of tumour cells, or a biopsy artefact. There can be Pagetoid spread of the carcinoma into the surface or crypt epithelium. In approximately one-tenth of cases, there are interspersed spherical amyloid globules {2084}. The amyloid globules are usually smaller than a tumour cell, and can be present intracellularly (sometimes causing indentation of the tumour cell nucleus), scattered among the carcinoma cells, or in the adjacent stroma. They are derived from keratins, and are probably of tumour origin. In the uncommon papillary variant, there are papillary fronds comprising delicate stromal cores covered by stratified tumour cells morphologically no different from those of the usual nonkeratinizing nasopharyngeal carcinoma. Rare cases can show cyto-

Table 2.04 Frequency of histological subtypes of nasopharyngeal carcinoma.

Current WHO

High incidence population

Intermediate

Low incidence

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