. The number of intracellular or extracellular keratinizations is much less than that in highly differentiated squamous cell carcinoma.

. The number of intracellular or extracellular keratinizations is much less than that in highly differentiated squamous cell carcinoma. . There are varying numbers of lymphocytic infiltrates within the cancer nests, and a variable amount of plasma cells around the nests. The stromal changes are similar to those in low-grade differentiated squamous cell carcinoma, but different from highly differentiated squamous cell carcinoma. S Low-grade differentiated squamous cell carcinoma: Under light microscopy, a certain number of cancer cells can also be seen, with intercellular bridges or intracellular keratinization, but the quantity is small. The nuclei of the cancer cells are deeply stained. The nucleoli are enlarged and often show some basophilic eosin staining. The boundary between the cancer nests and the stroma is relatively clear, but it can also be intermingled with the stroma. There are varying numbers of lymphocytic infiltrates within the cancer nests, and the stroma can present in various types, such as lymphocyte-rich infiltration type, granulation tissue type, fibrotic type, and native tissue type. Regardless of the type of stroma, there is always a variable amount of plasma cell infiltration. (3) Adenocarcinoma: Nasopharyngeal adenocarcinoma originates from glandular structures. ① Highly differentiated adenocarcinoma: The boundary between the cancer parenchyma and the stroma is clear, and the cancer nests are quite distinct. Some cancer cells are arranged in acinar patterns; some are arranged in tall columnar duct-like structures; some exhibit adenoid cystic or cribriform carcinomas; others are simple adenocarcinomas. ② Moderately differentiated adenocarcinoma: This refers to adenocarcinomas in which a certain number of clear glandular lumens can be observed, but they are accompanied by some undifferentiated cancer structures. These are often the result of further transformation from the aforementioned highly differentiated adenocarcinomas, so they still retain traces of highly differentiated adenocarcinomas. ③ Low-grade differentiated adenocarcinoma: Clear glandular lumen structures can be seen in the cancer tissue, but they are very few. Most of the cancer tissue presents undifferentiated cancer structures. The tumor cells appear foamy with abundant cytoplasm, and Alcian blue staining is weakly negative. (4) Pseudonuclear cell carcinoma: Nasopharyngeal cancers in which most of the cancer cell nuclei exhibit vacuolar changes can be called pseudonuclear cell carcinomas. Due to its relatively special morphology and better prognosis after radiotherapy, it is classified as an independent type. The so-called vacuolar change of the nucleus means that the nucleus is large and round, elliptical, or spindle-shaped. The nuclear area is more than three times that of a lymphocyte nucleus. The chromatin inside the nucleus is relatively sparse, making the nucleus appear vacuolar; the chromatin adheres unevenly to the inner surface of the nuclear membrane, resulting in uneven thickness, with the thinnest parts even resembling defects in the nuclear membrane. To diagnose nasopharyngeal pseudonuclear cell carcinoma, at least 75% of the cancer cell nuclei must show vacuolar changes in the section, while the remaining less than 25% of the cancer cells can be low-grade squamous cell carcinoma or undifferentiated carcinoma. The standard for diagnosing pseudonuclear cell carcinoma is set at having more than 75% of cancer cells with vacuolar changes because only in this way can its unique biological characteristics be demonstrated, namely the better prognosis after radiotherapy. (5) Undifferentiated carcinoma: Cancer cells are distributed rather diffusely and often intermingle with the stroma. The cells are medium-sized or slightly small, short fusiform, elliptical, or irregular in shape, with little cytoplasm and slight basophilia. The nuclear chromatin increases, appearing granular or clumpy, and sometimes nucleoli can be seen. II. Diagnosis and Treatment (---) Clinical Diagnosis Clinically, patients presenting with retractile epistaxis, unilateral tinnitus, hearing loss, ear fullness, unexplained cervical lymphadenopathy, facial numbness, diplopia, tongue deviation, tongue muscle atrophy, headache, and other symptoms should undergo careful nasopharyngoscopy and clinical examination to enable early detection of nasopharyngeal carcinoma. Posterior rhinoscopy involves examining the nasopharyngeal cavity through the posterior nasal passage to observe whether there are any masses or abnormal changes such as erosion, ulcers, bleeding, and necrosis on the nasopharyngeal mucosa, and biopsies can be taken via posterior rhinoscopy. Anterior rhinoscopy allows observation of whether there are any masses, bleeding, or necrotic debris in the nasal passages, thereby ruling out nasal obstruction caused by inferior turbinate hypertrophy or deviated nasal septum. Fiberoptic nasopharyngoscopy provides a clear view of lesions in both the nasal cavity and the nasopharynx. CT scans can clearly show involvement of the nasopharynx, soft tissue spaces in the pharynx, infratemporal fossa, pterygopalatine fossa, and paranasal sinuses, thus giving CT high qualitative and locational diagnostic value for nasopharyngeal carcinoma. MRI can clearly display all layers of the skull, cerebral sulci, gyri, gray matter, white matter, ventricles, cerebrospinal fluid pathways, blood vessels, etc., and SE method can produce T1 and T2 extended high-intensity images, which can be used to diagnose nasopharyngeal carcinoma, maxillary sinus pain, and other conditions, as well as to show the relationship between the tumor and surrounding tissues. Angiography reveals vascular tortuosity and separation, vascular dilation and narrowing, tumor-associated vessels, tumor staining, early venous appearance, and ectopic blood supply. (2) Western Medical Treatment Treatment for nasopharyngeal carcinoma includes radiotherapy, surgical treatment, chemotherapy, immunotherapy, and other methods. Radiotherapy is widely recognized as the first-line treatment for nasopharyngeal carcinoma. Most cases of nasopharyngeal carcinoma are low-grade squamous cell carcinomas, which are highly sensitive to radiotherapy. Radical radiotherapy can be used for early and middle-stage cases, while palliative radiotherapy is appropriately combined for advanced cases. Chemotherapy has certain short-term efficacy for nasopharyngeal carcinoma, and patients in the middle and late stages often receive concurrent chemoradiotherapy, such as neoadjuvant chemotherapy, concurrent chemoradiotherapy, adjuvant chemotherapy, and for advanced cases with distant metastases, chemotherapy is the mainstay. Common chemotherapy regimens include PF, CF+5-FU+DDP, with an effectiveness rate of about 90%. Other regimens include PFB, PMB, PFA, CBF, CAB, etc. Surgical treatment is only suitable for cases that are insensitive to radiotherapy (highly differentiated) or for residual or recurrent cases after radiotherapy.

1. Radiotherapy Radiotherapy is the primary treatment for nasopharyngeal carcinoma, usually employing combined face-and-neck irradiation. Stage I and II patients receive simple external irradiation; stages III and IV use a comprehensive treatment model of radiotherapy plus chemotherapy; for advanced patients, palliative radiotherapy mainly based on chemotherapy is adopted. Two-dimensional radiotherapy (2D-RT) and three-dimensional radiotherapy (3D-RT) are traditional radiotherapy techniques for nasopharyngeal carcinoma, but their tumor control rates are not high and they have serious long-term toxic side effects. Intensity-modulated radiation therapy (IMRT) has gradually become the standard radiotherapy technique for nasopharyngeal carcinoma, with a local control rate of about 93% and an overall survival rate of about 80% five years after IMRT.
2. Chemotherapy In concurrent chemotherapy, cisplatin is the main drug, and the cumulative dose of DDP needs to reach 200 mg/m². Research shows that nedaplatin or carboplatin can replace cisplatin in concurrent chemotherapy. Adjuvant chemotherapy is administered after radiotherapy, with common regimens including PF regimen or long-term low-dose oral capecitabine (625 mg/m² twice daily). Induction chemotherapy is given before radiotherapy, with common regimens including TPF regimen, TP regimen, GP regimen, PF regimen, DDP+EPI+PTX regimen, etc.
3. Targeted Therapy Epidermal growth factor receptor (EGFR) is expressed in 80%–90% of nasopharyngeal carcinomas, and nimotuzumab and cetuximab have shown good short-term efficacy and tolerability.
4. Immunotherapy PD-1/PD-L1 inhibitor combination therapy with chemotherapy can achieve an effectiveness rate of over 90% for nasopharyngeal carcinoma, with nivolumab, pembrolizumab, camrelizumab, sintilimab, and other drugs all demonstrating good efficacy.
5. Surgical Treatment Surgical treatment is rarely used in nasopharyngeal carcinoma, usually serving as a rescue measure for residual or recurrent cases.
6. Interventional Treatment Interventional treatment for nasopharyngeal carcinoma mainly involves intravascular infusion chemotherapy or infusion chemotherapy embolization. Repeated angiography, microcatheter superselective procedures, and related treatments are crucial for preventing complications.
7. Other With the rapid development of technology, in addition to the above-mentioned treatment methods, particle implantation technology and other approaches have also shown certain efficacy in treating nasopharyngeal carcinoma and other tumors, and can be used according to relevant chapters, specific circumstances, and patient conditions. III. Professor Pei Zhengxue’s Thinking Method Professor Pei Zhengxue believes that the onset of this disease is due to external invasion of the six pathogenic factors, or emotional stagnation leading to qi blockage, or dietary imbalance and phlegm-food stagnation, resulting in abnormal circulation of qi and blood and dysfunction of the internal organs, which then leads to phlegm-qi condensation, qi stagnation and blood reversal, and concomitant fire accumulation, ultimately causing the disease. In the early stages, the disease is often caused by external invasion of the six pathogenic factors and lung deficiency in dispersing and descending, or emotional stagnation and depression-induced qi stagnation, with syndromes mainly characterized by excess pathogenic factors. Qi stagnation transforms into fire, liver-gallbladder fire toxicity rises upward, leading to severe liver qi stagnation and fire; liver qi stagnation damages the spleen and stomach, or if the person already has a weak spleen and stomach constitution, or during radiotherapy when the stomach loses harmony and the spleen loses function, phlegm-dampness stagnates, at which point the syndrome is mostly deficiency with excess, a mixture of deficiency and excess. In the later stages, deficiency becomes the main issue, especially after radiotherapy when yin fluids are mostly depleted, manifesting as qi and yin deficiency, or liver and kidney deficiency. Treatment emphasizes combining disease and syndrome, tailoring treatment to the syndrome, and primarily using Chinese herbal medicine to tonify the body and consolidate the foundation after radiotherapy and chemotherapy. Common prescriptions include Zilong Xiaoliu Tang, Tongqiao Huoxue Tang, Maiwei Dihuang Tang, Yangyin Qingfei Tang, and Lanzhou formula adjusted according to the syndrome. IV. Traditional Chinese Medicine Syndrome Differentiation and Prescriptions 1. Pathogenic Heat in the Lung Symptoms: nasal congestion, blood in the nasal discharge, sometimes dry nose, hot breath from the nose, headache, cough, neck mass. Tongue is red, coating is thin yellow, pulse is floating and rapid or slippery and rapid. Treatment should focus on dispersing lung heat, eliminating phlegm, and resolving nodules. Prescription: Mahuang Guizhi Heji, Fangfeng Tongsheng San, Kang'ai Wuwei Xiaodu Yin with modifications: Mahuang 10 g, Guizhi 10 g, Xingren 10 g, Sheng Shigao 30 g (decocted first), Gancao 6 g, Chuanxiong 10 g, Baizhi 6 g, Xixin 3 g, Qianghuo 12 g, Duohuo 12 g, Fangfeng 12 g, Yinhua 15 g, Lianqiao 15 g, Jiegeng 15 g, Niubangzi 10 g, Zaoshu 15 g, Baihua She Shecao 15 g, Banzhilian 15 g, Caohetou 15 g, Xiakucao 15 g, Haizao 10 g, Kunbu 10 g, Sanleng 10 g, Sheng Muli 30 g (decocted first), Zhebei 15 g, Yejuhua 10 g, Shandougen 15 g. Decoct in water and take one dose per day. Modifications: For chills and fever, add Bohe and Jingjie; for severe cough, add Xingren.