Nasopharyngeal carcinoma presenting with external auditory canal neoplasms or periauricular masses as initial manifestations

To investigate the clinicopathological characteristics of nasopharyngeal carcinoma (NPC) presenting with external auditory canal neoplasms or periauricular masses as initial manifestations in seven cases. A retrospective analysis was performed on seven patients with NPC who initially presented with external auditory canal neoplasms or periauricular masses. Clinicopathological features, immunophenotypes, diagnostic approaches, differential diagnoses, treatment strategies, and prognostic outcomes were evaluated. The cohort included four males and three females, aged 46–65 years (mean age, 52 years). Two patients presented with external auditory canal neoplasms, while five presented with periauricular masses, all with a documented history of NPC. Histomorphological and immunohistochemical features of the auricular lesions were consistent with those of the primary nasopharyngeal tumors. All cases were classified as non-keratinizing squamous cell carcinoma. Immunohistochemically, tumor cells were positive for CKpan, CK5/6, P63, and P40, with a Ki-67 proliferation index ranging from 60% to 90%. Nasopharyngeal squamous cell carcinoma manifesting initially as external auditory canal neoplasms or periauricular masses is rare. Clinicians and pathologists should consider the possibility of NPC involvement or metastasis when encountering such presentations, particularly in middle-aged and older patients. An accurate diagnosis requires integration of histomorphology, immunophenotyping, and biopsy of the primary nasopharyngeal lesion.