Exploration of Medicine

Table 3. Summary of key diagnostic test results.

Test/Finding	Result	Normal range	Interpretation/Relevance
CT neck (Sep 2020)	Nasopharyngeal mass 30 × 17 mm; bilateral cervical adenopathy (max. 4 cm)	—	Staging workup; primary tumour delineation
18F-FDG PET-CT (Sep 2020)	Hypermetabolic activity in the nasopharynx + bilateral cervical nodes	No pathological uptake	Stage IVA confirmed (cT2N3M0)
Nasopharyngeal biopsy (Sep 2020)	Non-keratinising SCC, WHO type II, Regaud pattern	—	Histological diagnosis
Immunohistochemistry (Sep 2020)	p40+; CK7−, CK20−, TTF-1−, PSA−	—	Squamous lineage confirmed; exclusion of other primary tumours
EBER-ISH (Sep 2020)	Strongly positive	Negative	EBV-driven NPC (WHO type II/III)
Plasma EBV DNA (May 2023)	76.4 copies/mL	Undetectable (< 1 copy/mL)	Consistent with tumour recurrence
Skin biopsy (May 2023)	Recurrent non-keratinising NPC, same immunophenotype as primary	—	Histological confirmation of cutaneous metastases (lethalides)
PD-L1 CPS (May 2023)	70	< 1 (negative)	High expression; rationale for pembrolizumab use; predictive value limited at individual level
Plasma EBV DNA (Dec 2023)	Undetectable	Undetectable	Response to 1st-line salvage chemotherapy confirmed
Plasma EBV DNA (Feb 2024)	Low-positive (rising)	Undetectable	Biochemical relapse ~6–8 wks before radiological evidence of PD
CT (Oct 2024)	Extensive locoregional spread; new axillary, mediastinal, retrocrural adenopathy	Stable/Responding	Confirmed PD on 3rd-line therapy; correlated with EBV DNA 13,000 copies/mL
Plasma EBV DNA (Jun 2025)	252 copies/mL (nadir on 5th-line)	Undetectable	Biochemical correlate of partial response to carboplatin–paclitaxel

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EBER-ISH: Epstein–Barr encoding region in situ hybridisation; EBV: Epstein–Barr virus; CPS: combined positive score; CT: computed tomography; NPC: nasopharyngeal carcinoma; PD: progressive disease; PET-CT: positron emission tomography-computed tomography; CK: cytokeratin; PD-L1: programmed death-ligand 1; PSA: prostate-specific antigen; TTF-1: thyroid transcription factor-1; WHO: World Health Organization; SCC: squamous cell carcinoma.

Declarations

Acknowledgments

We sincerely acknowledge all the patients and their families, whose trust and participation have been the driving force behind this research.

Author contributions

CGR: Conceptualization, Data curation, Methodology, Investigation, Writing—original draft, Writing—review & editing. SCC: Data curation, Validation, Methodology, Investigation, Writing—review & editing. MPK: Data curation, Validation, Methodology, Software. ARR: Methodology, Validation, Writing—review & editing. OJGCM: Validation, Writing—review & editing. SJCS: Validation, Writing—review & editing. BCO: Data curation, Visualization, Investigation, Methodology, Supervision, Writing—original draft, Writing—review & editing. LCG: Conceptualization, Data curation, Validation, Methodology, Investigation, Supervision, Writing—original draft, Writing—review & editing. All authors read and approved the final version of the manuscript.

Conflicts of interest

Luis Cabezón-Gutiérrez declares the following conflicts of interest: Advisory roles: AstraZeneca, Roche, Eisai, and Bristol-Myers Squibb. Speaker’s bureau/honoraria: Roche, AstraZeneca, Bristol-Myers Squibb, Merck Serono, Grünenthal, Pfizer and Eisai. Travel, accommodation, and expenses (Conferences): Merck, Servier. Magda Palka-Kotlowska declares: Advisory roles: GlaxoSmithKline and Esteve. Speaker’s bureau/honoraria: Pfizer, Gilead, Daiichi Sankyo, GlaxoSmithKline, AstraZeneca, and Novartis. Sara Custodio-Cabello declares: Speaker’s bureau / Honoraria: Fresenius, Abbott, Astellas. Claudia García-Ruíz, Otto José Guillermo Chacón-Medina, Samuel Jesús Castañeda-Sánchez, Beatriz Chacón-Ovejero and Adriana Rosero-Rodriguez declare no conflicts of interest.

Ethical approval

Ethical approval for this case report was not required, as it has been exempted in accordance with institutional regulations governing retrospective single-patient reports. This study was conducted in accordance with the ethical principles of the Declaration of Helsinki.

Consent to participate

Written informed consent for participation in this case report was obtained from the patient’s next of kin (family members), given that the patient is deceased.

Consent to publication

Written informed consent for publication of this case report, including accompanying clinical images, was obtained from the patient’s next of kin (family members), given that the patient is deceased.

Availability of data and materials

The data that support the findings of this case report are not publicly available due to patient privacy and confidentiality restrictions, but are available from the corresponding author upon reasonable request and subject to institutional approval.

Funding

Not applicable.

Copyright

Publisher’s note

Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.

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