LYMPH NODE METASTASIS AS A SOLE PRESENTATION OF NASOPHARYNGEAL CARCINOMA

Abstract

Introduction: Nasopharyngeal carcinoma (NPC) is a distinct head and neck malignancy with unique epidemiological and biological characteristics. In many cases, NPC initially presents with cervical lymph node metastasis before the identification of the primary tumor. Rarely, lymph node metastasis may be the sole initial clinical manifestation, leading to diagnostic delay and clinical challenges.

Objective: To highlight the clinic pathological features of patients presenting with cervical lymph node metastasis as the only initial presentation of Nasopharyngeal carcinoma.

Materials and Methods: This observational study was conducted in the Department of ENT and Head and Neck Surgery at Ayub teaching Hospital MTI, Abbottabad., and included 30 patients presenting with isolated cervical lymphadenopathy subsequently diagnosed as nasopharyngeal carcinoma (NPC). Patients underwent detailed clinical examination, contrast-enhanced CT/MRI of the head and neck, nasopharyngoscopy, and histopathological evaluation of lymph node and nasopharyngeal biopsy specimens. Immunohistochemistry and Epstein–Barr virus (EBV)-encoded RNA testing were performed where indicated. Demographic, clinical, radiological, and pathological findings were analyzed using descriptive statistical methods.

Results: Most patients presented with painless, firm cervical lymph nodes, predominantly in the upper deep cervical chain. In several cases, the nasopharyngeal primary tumor was clinically occult and detected only on imaging or endoscopic evaluation. Histopathology confirmed non-keratinizing undifferentiated carcinoma in the majority of cases. Epstein–Barr virus (EBV)-associated markers were positive in most patients. Delayed identification of the primary site was associated with advanced nodal stage at presentation.

Conclusion: Cervical lymph node metastasis may represent the sole presenting feature of NPC. A high index of suspicion, especially in endemic regions, is essential for early diagnosis. Comprehensive evaluation of unexplained cervical lymphadenopathy should always include assessment of the nasopharynx to avoid diagnostic delay and improve outcomes.