Review Question - QID 106142

The patient presents with multiple episodes of epistaxis and trouble hearing in the context of his Asian origin and undifferentiated cells seen on biopsy. This is significant for undifferentiated nasopharyngeal carcinoma and is associated closely with Epstein Barr Virus (EBV) infection along with smoking.

Most cases of nasopharyngeal cancer are found in patients of Asian origin (typically Southern China). There is a significant association between nasopharyngeal cancer and Asian origin, smoking, and ingestion of salt-preserved foods. The clinical presentation often involves a cervical mass due to metastatic spread from the lymph nodes. Additional features include epistaxis, serous otitis media due to eustachian tube occlusion, nasal obstruction, tinnitus, headache, and parasthesias in the distribution of the trigeminal nerve due to tumor impingement.

Her stated EBV is associated with nasopharyngeal carcinoma along with Hodgkin's disease, Burkitt's lymphoma, lymphoproliferative disease in the post-transplant setting, and T-cell lymphoma due to it's latent nature. The risk for EBV associated nasopharyngeal carcinoma is 80 times higher in a Southern Chinese patient compared to a person from North America or Western Europe.

Qu et al. found, through a retrospective analysis, that female nonsmokers who were diagnosed early had higher survival compared to their counterparts. Survival was not affected by alcohol ingestion, lesion location, lesion type, or radiotherapy patten.

Figure A shows undifferentiated cells extracted from the nasopharynx signifying nasopharyngeal carcinoma, undifferentiated type.

Incorrect Answers
Answer 1: HHV-8 is associated with Kaposi's Sarcoma that has a vascular, bruise like appearance.
Answer 3: H. Pylori is associated with Gastric carcinoma (GALT).
Answer 4: Clonorchis sinensis is assocaited with cholangiocarcinoma.
Answer 5: Alcohol intake in large amounts is associated with hepatic cirrhosis which puts patients at an increased risk of hepatic cancers.