Shoulder Pain Due to Humeral Metastasis: Unusual Presentation of Nasopharyngeal Carcinoma

Nasopharyngeal carcinoma is the most common head and neck malignancy arising from the mucosal lining epithelium of the nasopharynx, the commonest presentation being a unilateral neck mass. While bone, liver and lung metastases are well-documented, the presentation with shoulder pain is unusual. We present an unusual case of a 16-year-old male with persistent shoulder pain not resolved with physiotherapy. A month later, a growing neck mass was reported. MRI shoulder revealed an aggressive bone lesion in the proximal humerus. MRI head and neck revealed a nasopharyngeal mass with right deep cervical lymphadenopathy. Biopsy of the humeral mass revealed undifferentiated nasopharyngeal cancer.