Epstein-Barr virus-positive small cell neuroendocrine carcinoma of the nasopharynx

Epstein–Barr virus (EBV)-positive small cell neuroendocrine carcinoma (SCNEC) is a highly aggressive epithelial malignancy most frequently arising in the lung, with its occurrence in the nasopharynx being exceedingly uncommon. Despite having distinctive morphological and immunophenotypic characteristics, limited familiarity with this entity may result in misdiagnosis as other small round cell tumors or poorly differentiated carcinomas, thereby influencing therapeutic decisions. A 62-year-old male presented with a one-year history of right-sided epistaxis and a three-month history of nasal obstruction. Physical examination revealed a firm, pink, mulberry-shaped mass exhibiting surface necrosis and obstructing the right nasal cavity. Imaging studies identified a space-occupying lesion within the right nasal cavity, accompanied by obstructive sinusitis. Histopathological analysis of a biopsy specimen from the lesion confirmed the diagnosis of EBV-positive SCNEC. No evidence of recurrence was observed during a six-month postoperative follow-up period. EBV-positive SCNEC represents a rare and aggressive malignancy with nonspecific clinical manifestations. Definitive diagnosis depends on histopathological evaluation supported by immunohistochemical detection of neuroendocrine markers, including Syn, CgA, and CD56. This report highlights an unusual instance of SCNEC originating in the nasopharynx, emphasizing the importance of awareness among clinicians and pathologists to facilitate accurate diagnosis and timely intervention in atypical locations.