We describe the treatment course and imaging correlations in a patient with a unique case of undifferentiated nasopharyngeal carcinoma with axillary lymph node involvement as a component of failure following chemoradiotherapy. To our knowledge, this is the only such case reported in the literature. A preliminary diagnosis of axillary node involvement was based on both positron-emission tomography and computed tomography; these findings were subsequently confirmed by pathologic review following dissection of the node. This case represents a rare presentation of a recurrent nasopharyngeal carcinoma and illustrates the importance of a comprehensive physical examination and correlation with imaging modalities when following these patients over time.
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