<![CDATA[Mock22 Nasopharangeal carcinoma]]>Stem
Diabetic middle-aged Chinese male with an ulcer in the nasopharynx. Recently received chemo and radiotherapy.

In simple words define frozen section?

It's a pathological laboratory procedure to perform rapid microscopic analysis of a specimen.

Can you explain more the steps?

The surgeon takes a small piece from a tissue or tumour and send it for analysis
The pathologist freezes it and section it and immediately cut it
The section will be stained and reported immediately when the results come out

If you are scrubbed in surgery and waiting for the results of frozen section. How they will tell you the results?

By telephone.

Risk factors for nasopharyngeal carcinoma?

Non-modifiable (constitutional)
Gender: more in males
Family history
Race / Ethnicity: more common in southern China, Singapore, Vietnam• Infection with EBV
Modifiable
Tobacco and alcohol use
Diet: consumption of salted fish containing volatile nitrosamines

Define carcinoma?

Type of cancer that develops from epithelial cells.

What are other non-epithelial tumours can be here?

Lymphoma (usually non-Hodgkin)
Rhabdomyosarcoma
Angiofibroma

If palpable lymph nodes, how to assess? / What simple pathological investigation assist in assessing the nodal status?

I will start by FNAC, then I may need also to do excisional biopsy

What is Cytology vs histology? What is the main difference between cytology and histology?

Cytology is the study of cellular structure and function
Histology is the study of tissue under the microscope

How can IHC confirm this is carcinoma?

Cytokeratin: This marker is typically expressed in squamous cell carcinomas but not in adenocarcinomas.
p63 and p40: commonly expressed in squamous cell carcinomas. Their specificity for squamous differentiation makes them useful in distinguishing squamous cell carcinoma from adenocarcinoma

What are steps are needed for the malignant tumours to spread from nasopharynx to the cervical lymph nodes? / How do malignant cells reach lymph nodes?

Cancer cells and the secrete growth factors which are taken up by the lymphatic capillaries and transported towards the LN.
These growth factors induce lymph-angiogenesis thereby promoting LN metastasis
Also, primary tumours release immunomodulatory molecules which lead to immunosuppression

How does radiotherapy act against malignant tumours?

Direct: Deliver high energy to tumour's DNA causing direct damage to the DNA
Indirect: by the generation of free radicals causing further cell damage.

Scale of radiation dose? / What the SI unit measurement is commonly used in measurement of radiation dose?

Gray

If swab grows hyphae, what do you think it is?

Fungal infection mainly Candida

If this patient has an infection and a swab showed fungal infection; From the stem what is the predisposing factors to this infection?

Diabetic
Immunosuppressant from chemotherapy
Dead tissue from the pharynx due to radiotherapy ulceration which is more prone to fungal infection.

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