Excessive epithelioid cell granulomatous reaction associated with a lymphoepithelial carcinoma (Schmincke-Regaud)

We report on a 56-year-old man in whom histologic examination of "granulation tissue" from the right lower meatus of the nose revealed the presence of an undifferentiated nasopharyngeal carcinoma of the lymphoepithelial type (Schmincke-Regaud). The diagnosis was supported by serologic detection of antibodies against the Epstein-Barr virus. Approximately 3 weeks after the first excision, biopsy material was taken from the epipharynx. Histologically a marked epithelioid cell granulomatous reaction was found. As an unusual feature, granulomas were not located between tumor cell complexes, but rather contained tumor remnants in their center. At tissue site all transitions from well preserved to completely necrotic tumor cells were discernible. This unusual reaction probably represents a strong, favorable immunologic response against the neoplasm.