A 64-year-old man comes to the office due to a month of slowly progressive left-sided neck swelling. The swelling is not painful or erythematous. He has also had persistent nasal congestion, frequent epistaxis, and headaches. The patient has a history of rhinosinusitis and attributes his current symptoms to another episode of infection. He has been taking over-the-counter decongestants and antihistamines, but these have not provided relief. He has no other medical problems. The patient takes daily multivitamins and occasionally uses nonsteroidal anti-inflammatory medications for aches and pains. He immigrated to the United States from China 15 years ago. Vital signs are within normal limits. Several enlarged and hard cervical lymph nodes are present. Nasopharyngoscopy reveals a mass in the posterior nasal cavity, and biopsy demonstrates poorly differentiated carcinoma. Which of the following is most strongly associated with this patient's current condition?

Question

A 64-year-old man comes to the office due to a month of slowly progressive left-sided neck swelling.  The swelling is not painful or erythematous.  He has also had persistent nasal congestion, frequent epistaxis, and headaches.  The patient has a history of rhinosinusitis and attributes his current symptoms to another episode of infection.  He has been taking over-the-counter decongestants and antihistamines, but these have not provided relief.  He has no other medical problems.  The patient takes daily multivitamins and occasionally uses nonsteroidal anti-inflammatory medications for aches and pains.  He immigrated to the United States from China 15 years ago.  Vital signs are within normal limits.  Several enlarged and hard cervical lymph nodes are present.  Nasopharyngoscopy reveals a mass in the posterior nasal cavity, and biopsy demonstrates poorly differentiated carcinoma.  Which of the following is most strongly associated with this patient's current condition?

Quizplus · Accepted Answer

11ec25c8_d8c3_7e3e_bc81_19447a912c84_MD0003_00 This patient has nasopharyngeal carcinoma (NPC), which is associated with the reactivation of Epstein-Barr virus (EBV). Tumors typically express EBV DNA, and EBV assays are often used to monitor treatment response and disease relapse. NPC is rare in the United States but is endemic to southern China (and parts of Africa and the Middle East). Risk is thought to be higher in these locations due to diet (salt-cured food, early exposure to salted fish) and genetic predisposition. NPC tumors obstruct the nasopharynx and invade adjacent tissues, often resulting in nasal congestion with epistaxis, headache, cranial nerve palsies (eg, facial numbness), and/or serous otitis media (eustachian tube obstruction). Early metastatic spread to the cervical lymph nodes may cause a nontender neck mass (as in this patient). (Choice A) Aflatoxin B₁ is a mycotoxin that often contaminates agricultural products and is associated with an increased risk of hepatocellular carcinoma, not NPC. (Choice C) Nonsteroidal anti-inflammatory drugs (NSAIDs) are often associated with bleeding (gastrointestinal) and renal injury. Although NSAIDs may increase the risk of epistaxis, they are not a cause of NPC. (Choice D) Recurrent bacterial sinusitis may result in nasal polyposis. This may manifest with nasal congestion and thick rhinorrhea. Recurrent sinusitis is not typically associated with NPC. (Choice E) Some forms of vitamin A (eg, beta carotene) in excess may increase the risk of lung cancer in smokers, but there is no association with NPC. Educational objective: Nasopharyngeal carcinoma is associated with the reactivation of Epstein-Barr virus and occurs most commonly in those from Asia (particularly southern China) and parts of Africa and the Middle East. Manifestations include nasal congestion with epistaxis, headaches, cranial nerve palsies, and otitis media. Early spread to the cervical lymph nodes is common.

A 64-Year-Old Man Comes to the Office Due to a Month