Hidden Behind the Headache: A Rare Case Report of Childhood Nasopharyngeal Cancer

CASE REPORT
Danu Yudistira, Sagung Rai Indrasari, Camelia Herdini, Nurul Annisa Shafira Maheswari

 
For citation: Yudistira D, Indrasari SR, Herdini C, Maheswari NAS. Hidden Behind the Headache: A Rare Case Report of Childhood Nasopharyngeal Cancer. International Journal of Biomedicine. 2026;16(1):111-115. doi:10.21103/Article16(1)_CR2
 
Originally published March 5, 2026

Abstract: 

Nasopharyngeal carcinoma is a rare malignancy in children, representing less than one percent of pediatric cancers, with incidence varying across regions. A fourteen-year-old boy presented with one month of right nasal obstruction, ear fullness, hearing loss, and progressive headache. Physical examination revealed a 20 x 20 mm mass at the level II of the neck.  Anterior rhinoscopy revealed mucosal discharge and a friable mass occupying the right nasal cavity. The left nasal cavity showed inferior turbinate hypertrophy, livid mucosa, and mucous secretion, with a mass appearance suggestive of contralateral compression. Contrast-enhanced MSCT revealed a bilateral solid nasopharyngeal mass (3.75 × 3.71 × 4.27 cm) with post-contrast enhancement, extending into the sphenoid sinus and associated with destruction of the right sphenoid and temporal bones. Because early symptoms are nonspecific, the diagnosis of nasopharyngeal carcinoma in children is often delayed. Early recognition and evaluation are essential to reduce morbidity and improve clinical outcomes.

Keywords: 
nasopharyngeal carcinoma • pediatric • symptoms • epidemiology
References: 
  1. Chang ET, Adami HO. The enigmatic epidemiology of nasopharyngeal carcinoma. Cancer Epidemiol Biomarkers Prev. 2006 Oct;15(10):1765-77. doi: 10.1158/1055-9965.EPI-06-0353. PMID: 17035381.
  2. de Martel C, Ferlay J, Franceschi S, Vignat J, Bray F, Forman D, Plummer M. Global burden of cancers attributable to infections in 2008: a review and synthetic analysis. Lancet Oncol. 2012 Jun;13(6):607-15. doi: 10.1016/S1470-2045(12)70137-7. Epub 2012 May 9. PMID: 22575588.
  3. Ben-Ami T. Nasopharyngeal Carcinoma in Children, Current Treatment Approach. J Pediatr Hematol Oncol. 2024 Apr 1;46(3):117-124. doi: 10.1097/MPH.0000000000002848. Epub 2024 Mar 5. PMID: 38447121; PMCID: PMC10956687.
  4. Claude L, Jouglar E, Duverge L, Orbach D. Update in pediatric nasopharyngeal undifferentiated carcinoma. Br J Radiol. 2019 Oct;92(1102):20190107. doi: 10.1259/bjr.20190107. Epub 2019 Jul 31. PMID: 31322911; PMCID: PMC6774591.
  5. Gong T, Liu Y, Jie H, Liang M, Wu W, Lu J. Retrospective analysis of clinical features and prognosis of nasopharyngeal carcinoma in children and adolescents. Front Pediatr. 2022 Sep 16;10:939435. doi: 10.3389/fped.2022.939435. PMID: 36186630; PMCID: PMC9523006.
  6. Person L, Lacour B, Faure L, Guissou S, Poulalhon C, Orbach D, Goujon S, Berger C, Clavel J, Desandes E. Childhood head and neck cancer in France: Incidence, survival and trends from 2000 to 2015. Int J Pediatr Otorhinolaryngol. 2021 Nov;150:110858. doi: 10.1016/j.ijporl.2021.110858. Epub 2021 Aug 3. PMID: 34388659.
  7. Casanova M, Bisogno G, Gandola L, Cecchetto G, Di Cataldo A, Basso E, Indolfi P, D'Angelo P, Favini F, Collini P, Potepan P, Ferrari A; Rare Tumors in Pediatric Age Group. A prospective protocol for nasopharyngeal carcinoma in children and adolescents: the Italian Rare Tumors in Pediatric Age (TREP) project. Cancer. 2012 May 15;118(10):2718-25. doi: 10.1002/cncr.26528. Epub 2011 Sep 14. PMID: 21918965.
  8. Lei S, Chen L, Ji P, Li K, Li Q, Huang C, Wang G, Ma J, Guo R, Tang L. Global burdens of nasopharyngeal carcinoma in children and young adults and predictions to 2040. Oral Oncol. 2024 Aug;155:106891. doi: 10.1016/j.oraloncology.2024.106891. Epub 2024 Jun 14. PMID: 38878356.
  9. Chang ET, Ye W, Zeng YX, Adami HO. The Evolving Epidemiology of Nasopharyngeal Carcinoma. Cancer Epidemiol Biomarkers Prev. 2021 Jun;30(6):1035-1047. doi: 10.1158/1055-9965.EPI-20-1702. Epub 2021 Apr 13. PMID: 33849968.
  10. Pastore G, De Salvo GL, Bisogno G, Dama E, Inserra A, Cecchetto G, Ferrari A; TREP Group; CSD of Epidemiology Biostatistics, AIEOP. Evaluating access to pediatric cancer care centers of children and adolescents with rare tumors in Italy: the TREP project. Pediatr Blood Cancer. 2009 Aug;53(2):152-5. doi: 10.1002/pbc.22049. PMID: 19353626.
  11. Bray F, Haugen M, Moger TA, Tretli S, Aalen OO, Grotmol T. Age-incidence curves of nasopharyngeal carcinoma worldwide: bimodality in low-risk populations and aetiologic implications. Cancer Epidemiol Biomarkers Prev. 2008 Sep;17(9):2356-65. doi: 10.1158/1055-9965.EPI-08-0461. PMID: 18768504.
  12. Guo X, Cui J, Yuan X, Gao Z, Yu G, Wu H, Kou C. Long-term trends of nasopharyngeal carcinoma mortality in China from 2006 to 2020 by region and sex: an age-period-cohort analysis. BMC Public Health. 2023 Oct 20;23(1):2057. doi: 10.1186/s12889-023-16892-1. PMID: 37864181; PMCID: PMC10588046.
  13. Dourthe ME, Bolle S, Temam S, Jouin A, Claude L, Reguerre Y, Defachelles AS, Orbach D, Fresneau B. Childhood Nasopharyngeal Carcinoma: State-of-the-Art, and Questions for the Future. J Pediatr Hematol Oncol. 2018 Mar;40(2):85-92. doi: 10.1097/MPH.0000000000001054. PMID: 29300240.
  14. European Reference Network. Consensus Recommendations for Nasopharyngeal carcinoma in children and adolescents. Available from: https://siope.eu/media/documents/escp-nasopharyngeal-carcinoma-in-children-and-adolescents.pdf
  15. Chen YP, Chan ATC, Le QT, Blanchard P, Sun Y, Ma J. Nasopharyngeal carcinoma. Lancet. 2019 Jul 6;394(10192):64-80. doi: 10.1016/S0140-6736(19)30956-0. Epub 2019 Jun 6. PMID: 31178151.
  16. Cheuk DK, Billups CA, Martin MG, Roland CR, Ribeiro RC, Krasin MJ, Rodriguez-Galindo C. Prognostic factors and long-term outcomes of childhood nasopharyngeal carcinoma. Cancer. 2011 Jan 1;117(1):197-206. doi: 10.1002/cncr.25376. Epub 2010 Aug 24. PMID: 20737561; PMCID: PMC2994981.
  17. Richards MK, Dahl JP, Gow K, Goldin AB, Doski J, Goldfarb M, Nuchtern J, Langer M, Beierle EA, Vasudevan S, Hawkins DS, Parikh SR. Factors Associated With Mortality in Pediatric vs Adult Nasopharyngeal Carcinoma. JAMA Otolaryngol Head Neck Surg. 2016 Mar;142(3):217-22. doi: 10.1001/jamaoto.2015.3217. PMID: 26769566.
  18. Sahai P, Mohanti BK, Sharma A, Thakar A, Bhasker S, Kakkar A, Sharma MC, Upadhyay AD. Clinical outcome and morbidity in pediatric patients with nasopharyngeal cancer treated with chemoradiotherapy. Pediatr Blood Cancer. 2017 Feb;64(2):259-266. doi: 10.1002/pbc.26240. Epub 2016 Sep 29. PMID: 27681956.
  19. Ayan I, Kaytan E, Ayan N. Childhood nasopharyngeal carcinoma: from biology to treatment. Lancet Oncol. 2003 Jan;4(1):13-21. doi: 10.1016/s1470-2045(03)00956-2. PMID: 12517535.
  20. Qiu WZ, Peng XS, Xia HQ, Huang PY, Guo X, Cao KJ. A retrospective study comparing the outcomes and toxicities of intensity-modulated radiotherapy versus two-dimensional conventional radiotherapy for the treatment of children and adolescent nasopharyngeal carcinoma. J Cancer Res Clin Oncol. 2017 Aug;143(8):1563-1572. doi: 10.1007/s00432-017-2401-y. Epub 2017 Mar 25. PMID: 28342002; PMCID: PMC5504129.
  21. Mohandas A, Marcus C, Kang H, Truong MT, Subramaniam RM. FDG PET/CT in the management of nasopharyngeal carcinoma. AJR Am J Roentgenol. 2014 Aug;203(2):W146-57. doi: 10.2214/AJR.13.12420. PMID: 25055290.
  22. King AD, Vlantis AC, Bhatia KS, Zee BC, Woo JK, Tse GM, Chan AT, Ahuja AT. Primary nasopharyngeal carcinoma: diagnostic accuracy of MR imaging versus that of endoscopy and endoscopic biopsy. Radiology. 2011 Feb;258(2):531-7. doi: 10.1148/radiol.10101241. Epub 2010 Dec 3. PMID: 21131580.
  23. King AD, Teo P, Lam WW, Leung SF, Metreweli C. Paranasopharyngeal space involvement in nasopharyngeal cancer: detection by CT and MRI. Clin Oncol (R Coll Radiol). 2000;12(6):397-402. doi: 10.1053/clon.2000.9199. PMID: 11202093.
  24. Cheuk DK, Sabin ND, Hossain M, Wozniak A, Naik M, Rodriguez-Galindo C, Krasin MJ, Shulkin BL. PET/CT for staging and follow-up of pediatric nasopharyngeal carcinoma. Eur J Nucl Med Mol Imaging. 2012 Jul;39(7):1097-106. doi: 10.1007/s00259-012-2091-2. Epub 2012 Apr 25. PMID: 22532252; PMCID: PMC3531235.
  25. Zhang SX, Han PH, Zhang GQ, Wang RH, Ge YB, Ren ZG, Li JS, Fu WH. Comparison of SPECT/CT, MRI and CT in diagnosis of skull base bone invasion in nasopharyngeal carcinoma. Biomed Mater Eng. 2014;24(1):1117-24. doi: 10.3233/BME-130911. PMID: 24212004.
  26. Shen G, Zhang W, Jia Z, Li J, Wang Q, Deng H. Meta-analysis of diagnostic value of 18F-FDG PET or PET/CT for detecting lymph node and distant metastases in patients with nasopharyngeal carcinoma. Br J Radiol. 2014 Dec;87(1044):20140296. doi: 10.1259/bjr.20140296. Epub 2014 Oct 28. PMID: 25348201; PMCID: PMC4243207.
  27. Chua ML, Ong SC, Wee JT, Ng DC, Gao F, Tan TW, Fong KW, Chua ET, Khoo JB, Low JS. Comparison of 4 modalities for distant metastasis staging in endemic nasopharyngeal carcinoma. Head Neck. 2009 Mar;31(3):346-54. doi: 10.1002/hed.20974. PMID: 18972431.
  28. Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, Meyer L, Gress DM, Byrd DR, Winchester DP. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin. 2017 Mar;67(2):93-99. doi: 10.3322/caac.21388. Epub 2017 Jan 17. PMID: 28094848.
  29. King AD, Woo JKS, Ai QY, Chan JSM, Lam WKJ, Tse IOL, Bhatia KS, Zee BCY, Hui EP, Ma BBY, Chiu RWK, van Hasselt AC, Chan ATC, Lo YMD, Chan KCA. Complementary roles of MRI and endoscopic examination in the early detection of nasopharyngeal carcinoma. Ann Oncol. 2019 Jun 1;30(6):977-982. doi: 10.1093/annonc/mdz106. PMID: 30912815.
  30. Ogun GO, Olusanya AA, Akinmoladun VI, Adeyemo AA, Ogunkeyede SA, Daniel A, Awosusi BL, Fatunla EO, Fasunla AJ, Onakoya PA, Adeosun AA, Nwaorgu OG. Nasopharyngeal carcinoma in Ibadan, Nigeria: a clinicopathologic study. Pan Afr Med J. 2020 Jun 9;36:82. doi: 10.11604/pamj.2020.36.82.19657. PMID: 32774641; PMCID: PMC7392876.
  31. Liu W, Tang Y, Gao L, Huang X, Luo J, Zhang S, Wang K, Qu Y, Xiao J, Xu G, Yi J. Nasopharyngeal carcinoma in children and adolescents - a single institution experience of 158 patients. Radiat Oncol. 2014 Dec 5;9:274. doi: 10.1186/s13014-014-0274-7. PMID: 25477058; PMCID: PMC4264314.
  32. Young LS, Dawson CW. Epstein-Barr virus and nasopharyngeal carcinoma. Chin J Cancer. 2014 Dec;33(12):581-90. doi: 10.5732/cjc.014.10197. Epub 2014 Nov 21. PMID: 25418193; PMCID: PMC4308653.
  33. Pathmanathan R, Prasad U, Chandrika G, Sadler R, Flynn K, Raab-Traub N. Undifferentiated, nonkeratinizing, and squamous cell carcinoma of the nasopharynx. Variants of Epstein-Barr virus-infected neoplasia. Am J Pathol. 1995 Jun;146(6):1355-67. PMID: 7778675; PMCID: PMC1870892.

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Received December 10, 2025.
Accepted January 20, 2026.
©2026 International Medical Research and Development Corporation.