# Multimodal management of solitary axillary lymph node metastasis from a recurrent nasopharyngeal undifferentiated carcinoma: a case report and review of the literature

## TL;DR

A rare case of axillary lymph node recurrence in a patient with nasopharyngeal cancer was successfully treated with surgery, chemotherapy, and radiotherapy.

## Contribution

This is the second reported case of isolated axillary lymph node recurrence in undifferentiated nasopharyngeal carcinoma after remission.

## Key findings

- Axillary lymph node dissection, chemotherapy, and radiotherapy led to 12 months of disease-free survival.
- The case highlights a rare metastasis pattern in nasopharyngeal cancer.
- Long-term follow-up with thorough investigations is emphasized for nasopharyngeal cancer patients.

## Abstract

Undifferentiated Nasopharyngeal carcinoma (UNPC) exhibits the highest loco-regional cervical lymph node recurrence among head and neck epithelial malignancies. Axillary lymph node recurrence in NPC is uncommon.

A 44-year-old male presented with two-month history of painless swelling of the right axilla. He was diagnosed with stage IVB UNPC three years and eight months previously and had undergone neoadjuvant chemotherapy, and concurrent chemo-radiotherapy. Biopsy of the axillary swelling revealed metastatic UNPC. The patient was treated with axillary lymph node dissection followed by chemotherapy, and right axillary radiotherapy. Currently, the patient has been disease free for 12 months.

To our knowledge, this is the second reported case of UNPC with isolated axillary lymph node recurrence after remission, treated with axillary lymph node dissection, chemotherapy, and radiotherapy. This case highlights a rare pattern of metastasis and underscores the need for thorough investigations and imaging in the long-term follow-up of NPC.