EBV-Associated Non-keratinizing Nasopharyngeal Carcinoma with Prominent Spindled Cell and Whorling Patterns: A Previously Unreported Histological Variant in a Patient Presenting with Dermatomyositis

A case of non-keratinizing, EBV-positive (chromogenic EBER-in situ hybridization), carcinoma with a hitherto undescribed nodular whorling architecture is presented. The patient is a 55 year old male with 2 months history of dermatomyositis who was diagnosed with T1N0M0 non-keratinizing nasopharyngeal carcinoma. The patient received radiotherapy with complete response. The tumor cells predominantly displayed spindle cell morphology, strongly expressed low-molecular weight cytokeratins (AE1-3), p63 and p40. There was no evidence of recurrence or disease progression on follow-up after 16 months which included post treatment biopsy, MRI and PET-CT scans.