Nasopharyngeal Carcinoma Presenting as Deep Neck Abscess

Objective: Nasopharyngeal carcinoma (NPC) is endemic in South East Asia and is the fifth most common cancer in Singapore. The most common presenting symptom is cervical nodal metastasis. There have been only 2 reports of NPC presenting as deep neck abscesses. We present our experience with 4 patients.

Method: Retrospective review of the archives of patients admitted for deep neck abscesses from 2 tertiary hospitals from November 2006 to September 2010 revealed 4 patients with a nasopharynx primary.

Results: The 4 patients consist of 3 males and 1 female with a mean age of 50 years (range, 32-63 years). All patients presented with fever and a painful fluctuant neck mass. Incision and drainage was performed in 2 patients who did not improve symptomatically from intravenous antibiotics. Computer tomography (CT) showed deep neck abscess in all patients and a nasopharyngeal primary only in 2 patients. Repeat physical examination showed nasopharyngeal mucosa irregularity in these patients and biopsy performed showed undifferentiated NPC. Three patients were stage 4 NPC while 1 patient was stage 2.

Conclusion: The nasopharynx should be carefully examined in patients presenting with deep neck abscess even with normal CT findings, especially in countries where NPC is endemic. Deep neck abscess may be the initial presentation of NPC.