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Kazunari Nakao, MD; Tadashi Yuge, MD; Masato Mochiki, MD; Ken-ichi Nibu, MD; Masashi Sugasawa, MD

Arch Otolaryngol Head Neck Surg. 2003;129:338-340.

Background  Nasopharyngeal carcinoma is often associated with neck lymph node (LN) metastases, which in many cases is the only manifestation of this disease. The submucosal and infiltrative characteristics of nasopharyngeal carcinoma make this type of cancer difficult to diagnose. Nasopharyngeal carcinoma has also been reported to be strongly associated with the Epstein-Barr virus.

Methods  We examined 36 nasopharyngeal carcinomas (from 30 primary sites and from 6 metastasized LNs), 13 metastasized LNs of other head and neck cancers, and 12 primary unknown neck metastases using an in situ hybridization technique.

Results  In the nasopharyngeal carcinomas, in situ hybridization with an Epstein-Barr virus–encoded small RNA identified the Epstein-Barr virus in 20 (67%) of the 30 primary sites and in 3 (50%) of the 6 metastasized LNs. Epstein-Barr virus was not detected in metastasized LNs of other head and neck cancers, but was detected in 1 of the primary unknown neck metastases.

Conclusion  In situ hybridization using a digoxigenin-labeled Epstein-Barr virus–encoded small RNA probe is useful for the differential diagnosis of metastasized LNs when the primary site is unknown.

From the Departments of Otolaryngology–Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo (Drs Nakao, Yuge, Mochiki, and Sugasawa), and Kobe University Graduate School of Medicine, Kobe (Dr Nibu), Japan.

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