Abstract

Nasopharyngeal carcinoma is the most frequent tumor type arising in the nasopharynx. Lymph node metastases are predominantly seen at diagnosis in lymphnode regions of neck. Nasopharynx carcinoma presenting with distant lymphadenopathy (LAP) rather than a prominent nasopharyngeal mass is not common.We describe a 48-year old man admitted to the hospital with cervical and right axillary mass. In physical examination, he had a 3x2cm right axillary lymphadenopathy (LAP) and bilaterally cervical LAPs. An exisional cervical LAP biopsy histopathology revealed undifferentiated carcinoma metastasis. On radiological evaluation, he had bilaterally cervical LAPs and nasopharyngeal thickening and bone metastasis on his right humerus. He was considered as metastatic undifferentiated carcinoma with highly probable primary as nasopharynx carcinoma. He was given chemotherapy. He achieved near complete response. After 4 months of follow-up, he had again second line therapy with near complete remission. In follow-up period, he developed right axillary LAP (3x2,1cm). An exisional biopsy of the right axillary LAP was performed to rule out other etiologies, such as lymphoproliferative disease. Histopathology had similar histopathological properties with the first cervical biopsy giving rise to thought of keratinizing nasopharynx carcinoma metastasis.Axillary LAP might occur rarely in nasopharynx carcinoma. Secondary primary tumors should be also kept in mind while evaluating the cancer patients with an unexpected relapsing pattern especially in those followed-up with remission for a while. Evaluation of the second biopsy material with the first one seems to be helpful in these patients.