Transnasal–Transoral Endoscopic Surgery Followed by Radiotherapy for Nasopharyngeal Spindle Cell Carcinoma

Spindle cell carcinoma (SpCC) is a rare and aggressive variant of squamous cell carcinoma characterized by the coexistence of epithelial and mesenchymal components, accounting for <1% of all head and neck malignancies. Nasopharyngeal SpCC is extremely rare, and its optimal management remains unclear, particularly in patients who cannot tolerate extensive surgery. An 80-year-old man presenting with right-sided ear fullness was diagnosed with nasopharyngeal SpCC (T1N0M0). Imaging revealed a submucosal tumor on the posterior wall of the nasopharynx that was in contact with the right Eustachian tube. The patient also had severe chronic kidney disease; therefore, conventional open approaches requiring prolonged operative time and significant surgical stress were considered unsuitable. Therefore, a combined transnasal-transoral endoscopic approach was selected to achieve maximal tumor reduction while minimizing surgical invasiveness. This approach provides a wide and complementary surgical view of the nasopharynx, enabling precise dissection of tumor margins extending cranially and caudally beyond the soft palate. Intraoperatively, the Eustachian tube was clearly visualized and confirmed to be intact. Histopathological examination revealed SpCC with a positive surgical margin on the posterior nasopharyngeal wall. Postoperative radiotherapy was administered to the surgical bed with positive margins. The patient achieved disease-free survival for >3 years after surgery, with stable perioperative renal function. This case highlights the advantages of the transnasal-transoral endoscopic approach in providing adequate visualization and access to the nasopharynx while reducing surgical morbidity. The combination of maximal cytoreductive endoscopic surgery and postoperative radiotherapy may represent an effective and less invasive treatment option for nasopharyngeal SpCC, particularly in patients with significant comorbidities.