This young patient presented with a right-sided neck mass.   Ultrasound-guided biopsy confirmed a nasopharyngeal nodal metastases and a subsequent ENT assessment and biopsy confirmed this as the primary.  It is not uncommon to see nodal disease large in volume compared to the nasopharyngeal primary as in this case.

Radiologically the nasopharyngeal carcinoma was T1,N3a,M0.

Chemotherapy was undertaken with the follow-up MRI one year later demonstrates complete radiological regression of the previous extension of metastatic nodal disease and the primary nasopharyngeal tumor.