Persistent otitis media with effusion - an unusual type of nasopharyngeal adenocarcinoma

We present the case of a 41-year-old male patient that examined in the outpatient ENT Department of our hospital, reported a persistent otitis media for about six months. Despite medical therapy, his symptom did not improve. The suspicious of a nasopharyngeal mass was raised and the rhino endoscopy revealed a mucosal projection in the left fossa of the Rosenmuller. Computed tomography (CT) of temporal bone pneumatization showed a left mastoid cell occupation and a small projection in the left fossa of the Rosenmuller. The histological examination result of a biopsy of the lession that prepared under local anesthesia, revealed nasopharyngeal adenoid cystic carcinoma. Magnetic resonance imaging indicated the extent of the tumor. The positron emission tomography/computed tomography (PET/CT) scan staged the patient and concluded the diagnosis. The patient underwent both surgery and radiotherapy and addressed oncologists and radiotherapists for further treatment. The patient was diagnosed with lung and kidney metastasis. Adenoid cystic carcinoma is a rare type of adenocarcinoma with ominous prognosis. We always have to raise the suspicious of nasopharyngeal carcinoma, in patients with persistent otological symptoms, that do not improve despite therapy.