Nasopharyngeal carcinoma: EBV, keratinizing and nonkeratinizing types
- Lesion
A cancer of the nasopharynx closely tied to Epstein–Barr virus and to certain regions. It often first shows as a lump in the neck.
What it is
Nasopharyngeal carcinoma is a squamous carcinoma of the nasopharyngeal mucosa with a distinctive geographic distribution, close relation to lymphoid tissue and association with EBV. It is classified as keratinising, nonkeratinising or basaloid squamous carcinoma. The nonkeratinising type, almost always EBV-positive and full of lymphocytes, is very radiosensitive and has a far better prognosis than the keratinising type.
Structure
- Primary is often small or hidden in the lateral recess (fossa of Rosenmüller).
- Nonkeratinising: sheets and syncytial clusters of large cells with indistinct borders and large nucleoli, infiltrated by T lymphocytes.
- Keratinising: like well-differentiated squamous carcinoma elsewhere, with keratin pearls.
- EBV detected by EBER in situ hybridisation or LMP-1 immunostaining in tumour cells.
Step by step
- EBV infects nasopharyngeal epithelium in genetically susceptible people.
- Dietary nitrosamines and other carcinogens add DNA damage.
- Latent EBV proteins (LMP-1) activate NF-κB and growth pathways and help the cells evade immunity.
- Tumour cells attract lymphocytes, giving the lymphoepithelial appearance.
- Early spread to retropharyngeal and cervical nodes; local invasion of the skull base and cranial nerves.
Nasopharyngeal carcinoma subtypes
| Feature | Nonkeratinising | Keratinising |
|---|---|---|
| Histology | Syncytial cells, lymphocyte-rich | Keratin pearls, well differentiated |
| EBV | Almost always | Less consistent |
| Radiosensitivity | High | Low |
| Prognosis | Good | Poor |
Markers
- EBER
- LMP-1
- p40
- Plasma EBV DNA
Clinical notes
- Unilateral serous otitis media in an adult should prompt examination of the nasopharynx.
- Five-year survival is high for nonkeratinising tumours but poor for keratinising ones, reflecting radiosensitivity.
- Checkpoint inhibitors are used for recurrent or metastatic disease.
Test yourself
Think of the answer, then tap the question to see it.
Which virus is associated with nonkeratinising nasopharyngeal carcinoma?
Epstein–Barr virus.
What is the most common first sign of nasopharyngeal carcinoma?
A painless neck mass from cervical lymph node metastasis.
Why might an adult with nasopharyngeal carcinoma present with hearing loss in one ear?
The tumour blocks the Eustachian tube, causing serous otitis media.
Connections
Microorganisms1
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Head and Neck Cancer (MedlinePlus, US National Library of Medicine, 2025); Throat Cancer (MedlinePlus, US National Library of Medicine, 2025).
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Representative model, for educational purposes only.