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Review
. 2016 Mar;10(1):75-84.
doi: 10.1007/s12105-016-0695-8. Epub 2016 Feb 1.

An Update on Sinonasal Round Cell Undifferentiated Tumors

Alessandro Franchi  1
Affiliations
Review

An Update on Sinonasal Round Cell Undifferentiated Tumors

Alessandro Franchi. Head Neck Pathol. 2016 Mar.

Abstract

The sinonasal cavities host a wide variety of undifferentiated malignancies with round cell morphology, including neoplasms of epithelial, mesenchymal, neuroectodermal, and hematolymphoid lineage. The differential diagnosis may be difficult, especially in small biopsy material, due to overlapping morphology, but their correct classification is clinically relevant. The aim of this review is to provide practical guidelines for the differential diagnosis of these malignancies, with emphasis on recently described entities and special reference to the role of ancillary techniques.

Keywords: Diagnosis; Immunohistochemistry; Molecular biology; Nasal cavity; Paranasal sinuses; Undifferentiated tumors.

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Figures

Fig. 1
Fig. 1
Sinonasal undifferentiated carcinoma. a The tumor consists of a proliferation of undifferentiated round cells, with a high nuclear/cytoplasmic ratio. Mitotic figures and apoptotic bodies are present. Tumor cells are positive for cytokeratin 8 (b)
Fig. 2
Fig. 2
Small cell neuroendocrine carcinoma of the maxillary sinus (a). The tumor is composed of closely packed cells with inconspicuous cytoplasm and nuclei with dense chromatin. In sinonasal large cell neuroendocrine carcinoma, neoplastic cells have larger nuclei with prominent nucleoli (b). These malignancies are positive for cytokeratins, often with a dot-like paranuclear pattern (c) and synaptophysin (d)
Fig. 3
Fig. 3
Basaloid squamous cell carcinoma with comedo necrosis
Fig. 4
Fig. 4
HPV-related carcinoma with adenoid cystic-like features presents areas of solid growth of basaloid cells (a) and cribriform areas (b). P16 is diffusely positive (c), and high risk HPV can be detected by in situ hybridization (d)
Fig. 5
Fig. 5
Sinonasal melanoma presenting with round cell undifferentiated morphology (a). The tumor is positive for HMB45 (b)
Fig. 6
Fig. 6
High grade olfactory neuroblastoma is characterized by a solid growth pattern, moderate pleomorphism (a), and presence of necrosis (b). The tumor is positive for synaptophysin (c), while cytokeratin AE1/AE3 is negative (d). Positive non-neoplastic epithelium is visible on the left
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