Oncogenic viruses — MCQs

Question 11: A 55-year-old Chinese man presents to the office with a complaint of progressive unilateral nasal obstruction for 10 months. Though he was able to tolerate his symptoms at the beginning, he can’t breathe properly through the obstructed nostril anymore. Also, a bloody nasal discharge has started recently through the occluded nostril. He also complains of double vision during the past 2 months but did not pay attention to it until now. Past medical history is insignificant except for occasional sore throats. His vitals include: blood pressure of 120/88 mm Hg, respiratory rate of 14/min, pulse of 88/min, temperature 37.0°C (98.6°F). Blood analysis shows: Hemoglobin 15 g/dL Hematocrit 46% Leukocyte count 15000/mm3 Neutrophils 72% Lymphocytes 25% Monocytes 3% Mean corpuscular volume 95 fL Platelet count 350,000/mm3 Which of the following viral etiology is most likely associated with the development of this patient’s condition?

• A. Human T lymphotropic virus type I
• B. Hepatitis B virus
• C. HIV
• D. Epstein-Barr virus (Correct Answer)
• E. Human papillomavirus

Explanation: ***Epstein-Barr virus*** - The patient's symptoms of **unilateral nasal obstruction**, **bloody nasal discharge**, and **diplopia** (double vision) are highly suggestive of **nasopharyngeal carcinoma (NPC)**. - **Epstein-Barr virus (EBV)** is strongly associated with NPC, particularly in endemic regions like Southeast Asia, which includes China, the patient's ethnicity. *Human T lymphotropic virus type I* - **HTLV-1** is primarily associated with **Adult T-cell Leukemia/Lymphoma** and **HTLV-1-associated myelopathy/tropical spastic paraparesis**. - It does not typically present with sinonasal malignancy symptoms like unilateral nasal obstruction and bloody discharge. *Hepatitis B virus* - **Hepatitis B virus (HBV)** is a major risk factor for **hepatocellular carcinoma (HCC)** and can cause various liver diseases. - HBV is not linked to nasopharyngeal carcinoma or the specific symptoms presented in this patient. *HIV* - **HIV** primarily causes **immunosuppression**, leading to opportunistic infections and certain cancers like **Kaposi's sarcoma**, **non-Hodgkin lymphoma**, and **cervical cancer**. - While HIV can increase the risk of some cancers, it is not directly associated with nasopharyngeal carcinoma as a primary viral etiology. *Human papillomavirus* - **Human papillomavirus (HPV)** is a well-known cause of **cervical cancer**, **anogenital cancers**, and a subset of **oropharyngeal squamous cell carcinomas**. - HPV is not a common viral etiology for nasopharyngeal carcinoma, which is more strongly linked to EBV.