Pathology · patient case question
Which agent is most commonly implicated in carcinoma at this site?
Patient case: A lump behind the tonsil
demo: 56-year-old male
chief: A painless lump in the right side of the neck that he first noticed two months ago.
history: Never smoked. Modest alcohol intake. Reports multiple lifetime sexual partners.
meds: None.
findings: A firm, non-tender 3 cm level II cervical node on the right. Examination of the oropharynx shows an ulcerated, slightly raised lesion of the right tonsil. Elsewhere the mucosa is unremarkable.
Show answer and explanation
Correct answer: A. Human papillomavirus type 16
- A. Correct. HPV-16 accounts for the large majority of oropharyngeal squamous cell carcinomas, which arise in the tonsillar crypts and base of tongue. The E6 and E7 oncoproteins inactivate p53 and retinoblastoma protein. The typical patient is younger, a non-smoker, and presents with nodal disease from a small primary, exactly as here.
- B. HIV increases the incidence of Kaposi sarcoma, non-Hodgkin lymphoma and cervical carcinoma through immunosuppression, but it is not the direct oncogenic driver of tonsillar carcinoma.
- C. Epstein-Barr virus is the virus of nasopharyngeal carcinoma, Burkitt lymphoma and oral hairy leukoplakia, and the nasopharynx is a different site from the oropharynx.
- D. Herpes simplex type 1 causes primary herpetic gingivostomatitis and recurrent herpes labialis. It has no established causal role in this carcinoma.