Cytological Features of Undifferentiated Nasopharyngeal Carcinomas (12 Cases Diagnosed Cytologically From Lymph Node Metastases)

Öz

Aim: Nasopharyngeal carcinomas (NPCs) are often diagnosed through fine-needle aspiration biopsy (FNAB) samples from metastatic lymph nodes. The differential diagnosis of cervical mass lesions includes a broad spectrum of lesions, which can complicate the diagnostic process. This study aims to analyze the clinical and cytological features of 12 cases of undifferentiated nonkeratinizing NPC diagnosed from metastases and identify key morphological findings that may aid diagnosis. Method: This retrospective study included 12 cases of nasopharyngeal carcinoma diagnosed via fine-needle aspiration (FNA) in our department between 2021 and 2024. All cases were histologically classified as undifferentiated-type nasopharyngeal carcinoma. Clinical data of the cases were retrieved from the hospital information management system. Cytology smears were retrieved from the archives and re-evaluated in terms of cytomorphological characteristics. Results: Eight of the cases were male, and four were female. Their ages ranged from 23 to 80 years. All smears were cellular. In half of the cases (6 cases), the tumor cells formed cohesive clusters, whereas in 5 cases, the cells displayed loose cohesion. In 7 cases, the tumor cells exhibited large nuclei, with pleomorphism in 10 cases. In half of the cases, the nuclei were oval-shaped, followed by oval-to-round nuclei in four cases. Naked nuclei were observed in most cases (9/12). Nucleoli were prominent in 8 cases. In 10 cases, the cytoplasm was scant with indistinct borders. Conclusions: The cytologic diagnosis of NPC is complex and requires a multifaceted approach. FNA of cervical lymph nodes is a valuable diagnostic tool, but careful interpretation is crucial. The presence of cells exhibiting a mixed pattern—forming clusters as well as appearing isolated cells—characterized by large pleomorphic nuclei, prominent nucleoli, and scant cytoplasm, particularly in samples obtained from cervical lymph nodes, constitutes a significant clue in cytological diagnosis.

Anahtar Kelimeler

• Nasopharyngeal carcinomas
• fine-needle aspiration (FNA)
• cytology

Andiferansiye Nazofarenks Karsinomlarının Sitolojik Özellikleri (Lenf Nodu Metastazlarından Sitolojik Olarak Tanı Alan 12 Olgu)

Öz

Amaç: Nazofarenks karsinomları (NFK), sıklıkla metastatik lenf nodlarından alınan ince iğne aspirasyon biyopsisi (İİAB) örnekleri ile tanı almaktadır. Servikal kitle lezyonlarının ayırıcı tanısı, geniş bir spektrumu içermekte olup, bu durum tanı sürecini karmaşık hale getirebilmektedir. Bu çalışmanın amacı, metastazlardan tanı alan 12 undiferansiye nonkeratinize NFK olgusunun klinik ve sitolojik özelliklerini analiz etmek ve tanıya yardımcı olabilecek temel morfolojik bulguları belirlemektir. Yöntem: Bu retrospektif çalışmaya, 2021-2024 yılları arasında bölümümüzde ince iğne aspirasyonu (İİA) ile tanı alan 12 nazofarenks karsinomu olgusu dahil edilmiştir. Tüm olgular histolojik olarak undiferansiye tip nazofarenks karsinomu olarak sınıflandırılmıştır. Olgulara ait klinik veriler, hastane bilgi yönetim sisteminden elde edilmiştir. Arşivlerden temin edilen sitoloji yaymaları, sitomorfolojik özellikler açısından yeniden değerlendirilmiştir. Bulgular: Çalışmaya dahil edilen 12 olgunun 8’i erkek, 4’ü kadın olup yaşları 23 ile 80 arasında değişmektedir. Tüm sitoloji yaymaları hücre içeriği açısından yeterliydi. Olguların yarısında (6 olgu) tümör hücreleri koherent kümeler oluştururken, 5 olguda hücreler düşük kohezyon göstermiştir. Tümör hücreleri 7 olguda büyük çekirdekler sergilemiş olup, 10 olguda çekirdek pleomorfizmi saptanmıştır. Çekirdekler, olguların yarısında oval şekilli, dört olguda ise oval-yuvarlak olarak gözlenmiştir. Olguların büyük bir kısmında (9/12) çıplak çekirdekler izlenmiştir. Nükleoller 8 olguda belirgin olarak değerlendirilmiştir. Sitoplazma 10 olguda belirgin sınırları olmayan ve yetersiz miktarda olarak saptanmıştır. Sonuç: NFK'nin sitolojik tanısı karmaşık olup çok yönlü bir değerlendirme gerektirmektedir. Servikal lenf nodlarından yapılan İİAB, değerli bir tanı yöntemi olmakla birlikte dikkatli yorumlanması gereklidir. Servikal lenf nodlarından elde edilen örneklerde, kümeler oluşturan ve aynı zamanda izole hücreler şeklinde dağılım gösteren, büyük pleomorfik çekirdekler, belirgin nükleoller ve az sitoplazma içeren hücrelerin varlığı, sitolojik tanıda önemli bir ipucu sunmaktadır.

Anahtar Kelimeler

• Nazofarenks karsinomu
• ince iğne aspirasyonu (İİA)
• sitoloji

Kaynakça

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