1. Epithelial Dysplastic Features of Lymphoepithelioma (Nasopharyngeal Carcinoma) Dr Muhammad Mudassar Prof. Dr Anwar-ul-Haque PIMS, Islamabad

2. Introduction Nasopharyngeal carcinoma is a leading cause of death in South Asia. Nasopharyngeal carcinoma is a leading cause of death in South Asia. Keratinizing and non keratinizing type. Keratinizing and non keratinizing type. Non keratinizing further divided into differentiated and undifferentiated variety. Non keratinizing further divided into differentiated and undifferentiated variety. Prominent inflammatory infiltrate rich in lymphocytes is accompanied in un- differentiated variety, hence the name “Lymphoepithelioma”. Prominent inflammatory infiltrate rich in lymphocytes is accompanied in un- differentiated variety, hence the name “Lymphoepithelioma”.

3. Lymphoepithelioma

5. Introduction – cont. Closely resembles with malignant lymphoma. Closely resembles with malignant lymphoma. Very tricky to differentiate between one another. Very tricky to differentiate between one another. Immunohistochemistry and other expensive investigations Immunohistochemistry and other expensive investigations Overlying epithelium reveals dysplasia and carcinoma in situ. Overlying epithelium reveals dysplasia and carcinoma in situ. With or without continuity with the underlying tumor. With or without continuity with the underlying tumor. Great diagnostic help and make immunological studies unnecessary and superfluous. Great diagnostic help and make immunological studies unnecessary and superfluous.

6. Objective To elaborate the spectrum of dysplasia in the overlying epithelium of Lymphoepithelioma that can inevitably help to diagnose it and differentiates it from malignant lymphoma. To elaborate the spectrum of dysplasia in the overlying epithelium of Lymphoepithelioma that can inevitably help to diagnose it and differentiates it from malignant lymphoma.

7. Material and Methods Descriptive retrospective study Descriptive retrospective study From January 2004 to date From January 2004 to date Pathology department, PIMS, Islamabad. Pathology department, PIMS, Islamabad. Inclusion criterion; Diagnosed cases of Lymphoepithelioma (Nasopharyngeal carcinoma). Inclusion criterion; Diagnosed cases of Lymphoepithelioma (Nasopharyngeal carcinoma). Exclusion;1. nasopharyngeal CA of clear cut keratinizing squamous cell variety. Exclusion;1. nasopharyngeal CA of clear cut keratinizing squamous cell variety.

8. Materials and Methods– cont. Some cases not showing epithelium. Some cases not showing epithelium. Deeper cuts. Deeper cuts. A total of 23 cases fulfill the criterion A total of 23 cases fulfill the criterion They were sorted out and examined by consultant pathologist at PIMS. They were sorted out and examined by consultant pathologist at PIMS. Three variables ; dysplasia of overlying epithelium, invasion, and dysplasia in glands. Three variables ; dysplasia of overlying epithelium, invasion, and dysplasia in glands.

9. Materials and Methods– cont. Dysplasia recorded as mild, moderate, severe, and carcinoma in situ. Dysplasia recorded as mild, moderate, severe, and carcinoma in situ. Invasion as no, micro and macro. Invasion as no, micro and macro. Their microscopic features were noted down and results analyzed with the help of SPSS ver. 10. Their microscopic features were noted down and results analyzed with the help of SPSS ver. 10.

10. Results Dysplasia In epithe. Total =23 Mild1Moderate3Severe8CIS11 Invasion No inv 15Micro6Macro2 Dysplasia in glands Total =23 Not seen 15 No dysplasia 4DysplasiaPresent4

25. Discussion Lymphoepithelioma is very tricky because of its resemblance with malignant lymphoma. Lymphoepithelioma is very tricky because of its resemblance with malignant lymphoma. Results clearly show that 100 % of tumors were showing dysplasia, no matter how small that may be. Results clearly show that 100 % of tumors were showing dysplasia, no matter how small that may be. 82 % of all cases were either CIS or having Severe dysplasia. 82 % of all cases were either CIS or having Severe dysplasia. Invasion also is seen in 43% of cases. Invasion also is seen in 43% of cases. Even glands( 4/8 ) showing dysplasia. Even glands( 4/8 ) showing dysplasia. Depicts that underlying tumor is epithelial in origin and not lymphoid. Depicts that underlying tumor is epithelial in origin and not lymphoid.

26. Discussion– cont. Pathologist overlook the epithelium and its dysplasia. Pathologist overlook the epithelium and its dysplasia. Immune markers are advised to clear the diagnosis. Immune markers are advised to clear the diagnosis. Increases the economic burden. Increases the economic burden. All Epithelial tumors should be assessed for the dysplasia in overlying epithelium. All Epithelial tumors should be assessed for the dysplasia in overlying epithelium. Future studies. Future studies.

27. Conclusion Nasopharyngeal tumor is almost always showing dysplasia of overlying epithelium and some invasion, along with main tumor underneath. This can clearly establish the epithelial nature of tumor and avoid unnecessary investigations. Nasopharyngeal tumor is almost always showing dysplasia of overlying epithelium and some invasion, along with main tumor underneath. This can clearly establish the epithelial nature of tumor and avoid unnecessary investigations.

28. Thanks a lot