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# 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.

Updated Nov 12, 2026

## Key points

- High incidence: southern China, Southeast Asia, North Africa, Inuit populations.
- Risk factors: EBV, nitrosamine-rich salted fish and fermented foods, genetic susceptibility, smoking.
- Nonkeratinising (formerly 'lymphoepithelioma'): syncytial large cells with vesicular nuclei and prominent nucleoli among abundant lymphocytes; EBER positive.
- Presents with a neck mass (cervical node metastasis) in most patients, nasal obstruction, epistaxis, serous otitis media from Eustachian tube block.
- Serum EBV antibodies and plasma EBV DNA help diagnosis and monitoring; radiotherapy is the main treatment.

## 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](https://durgical.com/en/conditions/nasopharyngeal-carcinoma/) | 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.

## Memory aid

No keratin, no problem with radiation: nonkeratinising NPC melts with radiotherapy.

## 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.

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## Connections

## Related 4

- [Oncogenic viruses and H. pylori: the table to know](https://durgical.com/en/general-pathology/oncogenic-viruses-and-h-pylori-the-table-to-know/)
- [Head and neck squamous cell carcinoma](https://durgical.com/en/general-pathology/head-and-neck-squamous-cell-carcinoma/)
- [Sinonasal tumours](https://durgical.com/en/general-pathology/sinonasal-tumours/)
- [The ear: otitis media, cholesteatoma, otosclerosis and ear tumours](https://durgical.com/en/general-pathology/the-ear-otitis-media-cholesteatoma-otosclerosis-and-ear-tumours/)

## Related conditions 2

- [Nasopharyngeal carcinoma](https://durgical.com/en/conditions/nasopharyngeal-carcinoma/)
- [Cervical lymphadenopathy](https://durgical.com/en/conditions/cervical-lymphadenopathy/)

## Microorganisms 1

- [Epstein–Barr virus](https://durgical.com/en/microbiology/epstein-barr-virus/)

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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](https://medlineplus.gov/headandneckcancer.html) (MedlinePlus, US National Library of Medicine, 2025); [Throat Cancer](https://medlineplus.gov/throatcancer.html) (MedlinePlus, US National Library of Medicine, 2025).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/nasopharyngeal-carcinoma-ebv-keratinizing-and-nonkeratinizing-types/