Ovarian Metastasis from EBV-Associated Undifferentiated Nasopharyngeal Carcinoma: An Exceptionally Rare Occurrence

Nasopharyngeal carcinoma (NPC) commonly metastasizes to bone, lung, and liver, whereas ovarian involvement is exceptionally rare, with only one previously reported case. Recognizing such atypical spread is clinically important, as differentiating metastatic NPC from primary ovarian tumors directly affects patient management.

A 44-year-old woman with Epstein-Barr virus (EBV)-associated, non-keratinizing undifferentiated NPC presented with metastatic disease at diagnosis, including liver and bone metastases. Positron-emission tomography/computed tomography showed bilateral adnexal uptake from the outset, although this finding was initially considered clinically insignificant. After initial response to gemcitabine-cisplatin and subsequent radiotherapy for locoregional recurrence, the patient developed recurrent liver metastasis and persistent adnexal lesions. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed following new gynecological symptoms. Histopathology of the ovaries revealed metastatic undifferentiated carcinoma with diffuse EBV-encoded RNA positivity, confirming ovarian metastasis from NPC. The patient later developed leptomeningeal spread and was transitioned to supportive care.

To our knowledge, this represents the second reported case of ovarian metastasis from NPC. The tumor exhibited EBV-related undifferentiated histology and concurrent liver metastasis, suggesting a potential pattern of dissemination, although conclusions are limited by rarity. This report highlights the need to consider metastatic NPC in the differential diagnosis of adnexal masses and underscores the diagnostic value of EBV-based testing.