Localized amyloidosis in nasopharyngeal carcinoma diagnosed by fine needleaspiration and electron microscopy - A case report

BACKGROUND: The association of amyloidosis and tumors is well known, but on ly rarely has it been found in the nasopharynx. Moreover, only a single cas e of tumor-associated amyloidosis in the nasopharynx has been diagnosed by exfoliative cytology and reported in the English-language literature. We de scribe a case of localized amyloidosis in metastatic nasopharyngeal carcino ma diagnosed by fine needle aspiration and confirmed by histology and elect ron microscopy. CASE: Bilateral neck enlargement appeared six months before consultation in a 57-year-old man. Both masses were resected, and during exploration of th e nasopharynx, several blind biopsies were taken. Smears from the fine need le aspirate showed malignant epithelial cells, consistent with metastatic c arcinoma, and Congo red stain showed the presence of amyloid. Histologic ex amination of the resected cervical masses and nasopharyngeal biopsies confi rmed the diagnosis of nasopharyngeal carcinoma, nonkeratinizing variant wit h amyloid, and metastases in two lymph nodes. Electron microscopic examinat ion of a lymph node showed extracellular, ribbonlike amyloid deposits as we ll as masses of amorphous amyloid, apparently intracellular. CONCLUSION: The origin of this form of amyloidosis is unclear in this patie nt since he had no other known etiologic factors for the condition. Increas ed awareness of the potential association of these two conditions and the u se of fine needle aspiration may reveal a higher frequency than hitherto re ported.