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Pathology · patient case question

Which HPV type is most responsible for squamous cell carcinoma of the tonsil?

Patient case: Child with lymphadenopathy and petechiae

Patient: Child

Chief complaint: Sore throat, fatigue and swollen glands.

Background: Several weeks of malaise.

Current findings: Generalised lymphadenopathy and palatal petechiae.

  1. HPV 16
  2. HPV 32
  3. HPV 11
  4. HPV 6
Show answer and explanation

Correct answer: A. HPV 16

  • A. CORRECT. HPV 16 is the dominant high-risk type in OROPHARYNGEAL squamous cell carcinoma, particularly of the tonsil and base of tongue. HPV-positive oropharyngeal carcinoma is a distinct entity, occurring in younger non-smokers and carrying a considerably better prognosis than HPV-negative disease.
  • B. HPV 32 is associated with focal epithelial hyperplasia (Heck disease), which is benign.
  • C. HPV 11 is likewise low-risk, causing genital warts and respiratory papillomatosis.
  • D. HPV 6 is a low-risk type causing condyloma acuminatum.

Note: Note the distinction the exam tests: HPV drives OROPHARYNGEAL cancer (tonsil, base of tongue). Cancer of the ORAL CAVITY proper remains predominantly tobacco and alcohol related.

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