DOI: https://doi.org/10.36347/sjmcr.2026.v14i04.028

Pages: 704-707

Background: Nasopharyngeal carcinoma (NPC), particularly the undifferentiated subtype (UCNT), is a head and neck malignancy strongly associated with Epstein-Barr virus and characterized by a high propensity for cervical lymph node metastasis. Rarely, patients present with cervical lymphadenopathy without an identifiable primary tumor, representing an occult form of NPC. Case Presentation: We report the case of a 64-year-old woman presenting with a progressively enlarging right submandibular mass. Clinical examination revealed a firm, painless lymph node measuring approximately 4 cm, associated with multiple right lateral cervical lymphadenopathies. Nasopharyngoscopy was normal. Contrast-enhanced CT and MRI demonstrated a 46 mm lesion in the right submandibular space infiltrating the submandibular gland and adjacent muscles, with associated lymphadenopathy. Histopathological examination of a lymph node biopsy, supported by immunohistochemistry, revealed metastatic undifferentiated carcinoma consistent with nasopharyngeal origin. Staging cervico-thoracic CT showed no distant metastases. The patient received concomitant chemoradiotherapy. Conclusion: This case highlights a rare presentation of occult UCNT in an older patient, revealed by submandibular lymph node metastasis. It emphasizes the importance of considering NPC in atypical presentations and supports the role of cervical lymph node biopsy and multimodal imaging in establishing the diagnosis and guiding treatment. Early recognition remains essential for optimal management.