Contributed by Melissa Halpern, M.D and Leon E Barnes, MD
Published on line in September 2002
The patient is an 87-year-old female who presented with recurrent epistaxis. A CT scan at an outside institution showed a large nasopharyngeal mass. Her past medical history was noncontributory. A biopsy was performed, and the glass slides and paraffin block were received in consultation.
The histologic sections showed fragments of hypercellular tissue admixed with blood clot (Figure 1). Examination of the hypercellular areas revealed loosely cohesive enlarged cells with scant to moderate amounts of eosinophilic cytoplasm (Figures 2, 3 and 4). The nuclei were enlarged and moderately pleomorphic, with irregular nuclear membranes. The chromatin was finely clumped and numerous typical and atypical mitotic figures were identified (Figure 3). Prominent central red nucleoli of varying shapes were seen (Figure 4). These cells were accompanied by a mild infiltrate of small round lymphocytes. Focally, intact respiratory epithelium was identified.
The neoplastic cells stained positive with immunohistochemical stains for S-100 protein (Figure 5) and tyrosinase (Figure 6). The cells were negative for cytokeratin (AE1/AE3 and CAM 5.2), synaptophysin, smooth muscle actin, p63, myogenin, mucicarmine, and lymphoid markers (leukocyte common antigen, CD20, CD3, CD30, kappa and lambda).