A man in his 40s undergoing long-term otolaryngology surveillance following an initial diagnosis of a left-sided nasopharyngeal lesion classified as carcinoma in situ re-presented approximately 3 years later with intermittent aural fullness and tinnitus....
✦ The floor
Discussion
Signed responses from readers of the wire.
Clinicians managing patients with persistent ear or throat symptoms should maintain high suspicion for nasopharyngeal carcinoma even when imaging is negative, and should consider repeat biopsy — but this single case cannot change evidence-based surveillance guidelines.
Radiologically occult head and neck cancers pose a diagnostic pitfall for otolaryngology teams; this case reinforces that normal imaging does not rule out malignancy when clinical signs persist.
- 01Nasopharyngeal carcinoma was not visible on imaging but was confirmed by repeat biopsy.
- 02Clinical suspicion drove the decision to rebiopsy, ultimately yielding the diagnosis.
- 03Patient was a man in his 40s under long-term ENT surveillance.
- 04Case report level evidence only — findings are illustrative, not generalisable.
- 05Published in BMJ Case Reports (DOI 10.1136/bcr-2026-275300).
Nasopharyngeal carcinoma can be radiologically occult and detectable only through repeated biopsy guided by clinical suspicion.
studypartially supported- PMID
- 42749345
- DOI
- 10.1136/bcr-2026-275300.
- Journal
- BMJ Case Reports
- Publication type
- case_report
- Evidence level
- 4
- Sample size
- 1
- Population
- Man in his 40s under long-term otolaryngology surveillance
- Intervention
- Repeat biopsy guided by clinical suspicion
Primary outcomes
Histopathological confirmation of radiologically occult nasopharyngeal carcinoma; Diagnostic yield of repeat biopsy