EBV-associated nasopharyngeal carcinoma (NPC) is most commonly of which WHO histological type and where does it most frequently drain lymphatically first?

• A WHO type III (undifferentiated/non-keratinizing); retropharyngeal (node of Rouvière) and then level II cervical nodes ✓
• B WHO type I (keratinizing SCC); ipsilateral parotid nodes
• C WHO type II (non-keratinizing differentiated); submandibular nodes level I
• D WHO type III; level V posterior cervical triangle nodes first

Explanation

WHO type III (undifferentiated carcinoma, formerly called lymphoepithelioma) is the most common subtype of NPC, strongly associated with EBV, and is most prevalent in Southeast Asia and southern China. It is highly radiosensitive and chemosensitive. The primary lymphatic drainage from the nasopharynx is to the retropharyngeal nodes (node of Rouvière in the lateral retropharyngeal space) and then to ipsilateral level II cervical nodes. Bilateral nodal disease and contralateral level V involvement are common at presentation.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.