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Nasopharyngeal carcinoma

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Clinical features

  • Demographics
    • Africa: associated with EBV; common in children
    • South China: most common cancer in adults; rare in children
    • US: rare in adults and children
  • Associated with HBV infection and repeated exposure
  • Presentation as a lymph node metastasis is frequent
  • Other sites of  metastasis: bone, bone marrow, liver and lungs

Fig 104a –  Nasopharyngeal carcinoma – Sheets of undifferentiated epithelial cells, with high nuclear/cytoplasmic ratio, vesicular nuclei and prominent nucleoli (H&E)

  • Sheets and clusters of undifferentiated epithelial cells
  • Vesicular nuclei and prominent nucleoli
  • Sparse eosinophilic cytoplasm
  • Inflammatory cells: lymphocytes (often T lymphocytes) and plasma cells


  • Keratins: positive
  • EMA: positive
  • EBV: positive
  • EBER: positive
  • CD23: positive in some cases
  • CD30: positive (in rare cases)
  • CEA: variable
  • S-100 protein: variable

Genetic studies

  • Over expression of p53

Differential diagnosis

  • Large cell lymphoma
    • EMA: useless for the differential diagnosis with large cell lymphoma
    • CD30: useless for the differential diagnosis with large cell lymphoma
  • Hodgkin’s disease
    • Sternberg-Reed cells
    • CD15: positive

Main points

  • Treatment: radiation therapy
  • Good prognostic factors: younger age, lower stage, metastases limited to the upper neck and no involvement of central nerve system