Nasopharyngeal Carcinoma with an Unusual Metastatic Presentation

Nasopharyngeal carcinoma usually presents with regional lymphadenopathy and involvement of lymph nodes follows a particular pattern. Parotid lymph node involvement is a rare phenomenon in nasopharyngeal carcinoma. The occurrence of parotid lymph node involvement has been reported in various studies and is approximately 1%. Here we present a case of a 55-year-old male, a case of nasopharyngeal carcinoma whose nasopharyngeal biopsy and scans were negative. Patient had recurrent level II node which was subjected to fine needle aspiration cytology (FNAC) and trucut biopsy which was suggestive of basal cell adenocarcinoma features favouring salivary gland primary. The patient underwent left-sided parotidectomy with lymph node dissection. On examination of the specimen one lymph node was positive for p16 and p40 which was suggestive of Epstein Barr aetiology. Then Epstien-Barr encoded RNA in situ hybridization (EBER ISH) was done which was in favour of Epstien Barr etiology. The patient was treated as a case of nasopharyngeal carcinoma with Epstein Barr virus (EBV) positive metastatic neck node. The patient then received external beam radiotherapy concurrent with cisplatin and is on follow up and doing well.