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

Large right sided NPC with skull base invasion accounts for the patient's symptoms.

The sites of the nasopharynx include: vault, lateral and posterior walls, superior surface of soft palate.

Staging:

T4- extensive tumor invasion in this case into the middle cranial fossa, infratemporal fossa and masticator space. T4 staging also applies if tumor involves cranial nerves, the brain, hypopharynx or orbit. 

 N1- unilateral metastasis in lymph node above the supraclavicular fossa <6cm.

The mass was biopsied and histology revealed a well differentiated keratinizing type NPC.