Low-Grade Nasopharyngeal Papillary Adenocarcinoma: A Review of 28 Patients in a Single Institution

Yuting Lai,¹ Wanpeng Li,¹ Changwen Zhai,² Xiaole Song,¹ Jingyi Yang,¹ Xicai Sun,¹ Dehui Wang<sup>1

1</sup>Department of Otolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, 200031, People’s Republic of China; ²Department of Clinical Pathology, Eye and ENT Hospital of Fudan University, Shanghai, 200031, People’s Republic of China

Correspondence: Dehui Wang; Xicai Sun
Department of Otolaryngology, Eye and ENT Hospital of Fudan University, No. 83 Fenyang Road, Shanghai, 200031, People’s Republic of China
Tel +86 13701852008
; +86 13681751601
Fax +86 21 64377151
Email wangdehuient@sina.com; laryngeal@163.com

Purpose: Low-grade nasopharyngeal papillary adenocarcinoma (LGNPPA) is a rare nasopharyngeal tumor. This study aimed to analyze the clinical and histopathological features of the disease, and to share our experience of its treatment.
Patients and Methods: We collected demographic data, clinical symptoms, tumor location, pathological features, immunohistochemical results, treatments, and outcomes of 28 patients with pathologically confirmed LGNPPA between 2009 and 2019.
Results: The median age of the 28 patients was 41.5 years, with a female: male ratio of 1.5:1 (17 females, 11 males). The most common symptom was blood-stained rhinorrhea. The neoplasms were located on the roof of the nasopharynx (RON) in 13 patients, the posterior margin of the nasal septum (PMONP) in 12 patients, the lateral wall of the nasopharynx in one case, and both the RON and PMONP in two patients. Fourteen patients were diagnosed with thyroid-like LGNPPA. Immunohistochemically, the tumors were uniformly positive for cytokeratin 7, cytokeratin 8, vimentin, epithelial membrane antigen, and pan-cytokeratin, and negative for thyroglobulin. Twenty-three patients underwent pure endoscopic surgery, three patients underwent preoperative radiotherapy, and two patients underwent radiotherapy postoperatively. All patients were alive without evidence of lymphatic or distant metastases in the follow-up period (range: 7 to 121 months). Two patients (7%, 2/28) experienced disease recurrence.
Conclusion: LGNPPA is an indolent tumor with an excellent prognosis. Endonasal endoscopic excision was an effective treatment. It is important to distinguish thyroid-like LGNPPA from metastatic papillary thyroid carcinoma because these diseases have similar microscopic features but different prognoses.

Keywords: nasopharyngeal adenocarcinoma, thyroid transcription factor-1, endoscopic surgery, papillary thyroid carcinoma