Exploring the rare: An uncommon presentation of metastatic nasopharyngeal carcinoma

Histologically Proven Bronchial Involvement in a Long-Term NPC Survivor

Abstract

Background: Endobronchial metastasis (EBM) from nasopharyngeal carcinoma (NPC) is an exceptionally rare clinical entity, often mimicking primary bronchogenic carcinoma and posing significant diagnostic challenges. Histopathological confirmation is essential for accurate differentiation and appropriate management.

Case Presentation: We report the case of a 30-year-old male previously treated for T3N1M0 NPC with concurrent chemoradiation in 2014. Eight years post-treatment, he presented with persistent cough and shortness of breath. Imaging revealed a necrotic hilar mass, and bronchoscopy confirmed EBM consistent with NPC origin. The patient was managed with systemic chemotherapy followed by palliative external beam radiation therapy (EBRT) to the bronchial and mediastinal regions. Post-treatment PET-CT demonstrated complete metabolic response.

Discussion: This case highlights the importance of considering EBM in NPC patients presenting with unexplained respiratory symptoms, even years after primary treatment. Histological and immunohistochemical evaluation remains the cornerstone of diagnosis. Given the rarity and complexity of such presentations, multidisciplinary team (MDT) involvement is critical for individualized treatment planning and optimal outcomes.

Conclusion: EBM from NPC is a rare but clinically significant manifestation. Timely diagnosis, MDT-based management, and tailored therapeutic strategies—including radiation—can lead to meaningful clinical responses in select cases.