Case submitted by Dr Smita Deb and A/Prof Pramit Phal.

Staging:

T4- tumor has intracranial extension plus invasion of the masticator space and cranial nerves.  

N2- bilateral metastasis in lymph nodes <6cm above the supraclavicular fossa.

Histology of the nasopharyngeal mass which was biopsied from both sides confirmed undifferentiated non-keratinizing NPC. USS +/- FNA of the lymph nodes could confirm metastasis.