Low grade nasopharyngeal papillary adenocarcinoma managed by endoscopic excision in a teenager

Background Low grade nasopharyngeal papillary adenocarcinoma (LGNPPA) is an exceptionally rare epithelial malignancy of the nasopharynx that can mimic other benign and malignant nasopharyngeal tumors, leading to diagnostic challenges and delayed management. Due to indolent clinical behavior, accurate histopathological and immunohistochemical evaluation is essential for proper treatment planning. Case presentation An 18-year female presented with five-year history of recurrent epistaxis, nasal obstruction, mucoid rhinorrhea, and hyponasal speech. Endoscopic examination revealed a multilobulated nasopharyngeal mass, and imaging findings suggested a vascular tumor. The patient underwent endoscopic excision of the lesion. Histopathological examinations demonstrated papillary glandular architecture consistent with LGNPPA and immunohistochemistry excluded metastatic disease. The postoperative course was uneventful and no recurrence or metastasis was observed during eight months of follow-up. Conclusion The case shows that LGNPPA can present with long-standing nasal symptoms and may be clinically mistaken for other nasopharyngeal tumors. The discrepancy between preoperative clinical impression and postoperative pathological diagnosis underscores the importance of histopathological analysis and tailored surgical management for this rare neoplasm. Eight months follow-up shows no recurrence or metastasis; longer follow-up typically ≥ 2 years is recommended to confirm outcomes. Early intervention and complete endoscopic excision can lead to excellent clinical outcomes.