A rare presentation recurrent nasopharyngeal carcinoma with axillary lymph node metastasis

Introduction: Nasopharyngeal carcinoma (NPC) has the highest rate of local and regional cervical lymph node recurrence amongst other head and neck epithelial malignant tumour. Distant recurrence is less common and usually occurs in bone, liver and lung. Recurrent NPC to axillary lymph node is rare. Case report: A 44-year-old male presented with two-month history of painless right axillary swelling. He was diagnosed with nasopharyngeal carcinoma (NPC) stage IVA (T2N3M0) two years prior to presentation and had underwent neoadjuvant chemotherapy with 5-Fluorouracil and Cisplatin, and concurrent chemo-radiotherapy (CCRT) of total 70 Gy over 35 sessions with Cisplatin. He was on regular monthly surveillance reviews, with no signs of recurrence. Fine Needle Aspiration Cytology (FNAC) of the axillary swelling was reported as metastatic NPC and Positron Emission Tomography/ Com-puted tomography (PET-CT) scan showed foci of high FDG hypermetabolism at right axillary lymph node confirming the diagnosis of recurrent NPC. Conclusion: Recurrence usually occurs in the first two years after completion of treatment. Patients with an overall TNM stage IV or N3, high pre-treatment or persistently detectable post-treatment plasma EBV DNA (pEBV DNA) load are at greatest risk. Management of recurrent NPC depends on local, regional or distant recurrence. Both PET scan and pEBV DNA load can be used for relapse detection. The man-agement for each recurrent NPC case is unique and should be determined by a multidisciplinary team, local expertise and facilities. Knowledge of potential sites of recurrence is essential to both physicians and patients for early detection.