Abstract

Dr. Preetam Mandawat, *Dr. Parul Agarwal, Dr. Ishita Nagda and Dr. Ridam Jain

ABSTRACT

Background: Nasopharyngeal carcinoma (NPC) is a malignant tumor arising from the epithelial lining of the nasopharynx, most commonly presenting as undifferentiated carcinoma. A hallmark of NPC is early and frequent metastasis to cervical lymph nodes, often presenting before primary site symptoms, making diagnosis challenging. Case Presentation: We report the case of a 45-year-old female who presented with a persistent, painless left postauricular swelling for over one year.  Clinical examination revealed a firm, non-tender mass suggestive of lymphadenopathy. Radiological imaging identified multiple cervical lymph nodes with necrotic centers and a suspicious lesion in the left nasopharynx. Fine needle aspiration cytology from the swelling revealed features of metastatic undifferentiated carcinoma. A tru-cut biopsy from a cervical lymph node confirmed the diagnosis, supported by immunohistochemistry findings: pancytokeratin, EMA, p63, and EBV-LMP-1 were positive, while LCA and HMB-45 were negative. These results were consistent with metastatic nonkeratinizing squamous cell carcinoma, undifferentiated subtype (NPC). The patient was treated with chemotherapy and showed a favorable clinical response. Discussion: This case highlights the diagnostic difficulty posed by NPC presenting solely as cervical lymphadenopathy, without nasopharyngeal symptoms. NPC is strongly associated with Epstein-Barr virus (EBV) infection, which aids in its identification through immunohistochemical markers. Proper radiological evaluation and an accurate panel of IHC markers are crucial for distinguishing NPC from other causes of cervical lymphadenopathy, such as lymphoma. Conclusion: A high index of suspicion, combined with thorough imaging, cytopathology, and IHC analysis, is essential for the early diagnosis and appropriate management of NPC.