 Corresponding author: Athina Zarachi Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece. Copyright © 2021 Author[s] retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution Liscense 4.0. Persistent otitis media with effusion: An unusual type of nasopharyngeal adenocarcinoma Athina Zarachi 1, * , Zoi Evangelou 2 , Angelos Liontos 3 , Stefania Gkoura 4 , Alkistis Tsikou 1 , Ioannis Kastanioudakis 1 and Ioannis Komnos 1 1 Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece. 2 Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece. 3 Faculty of Medicine, Department of Internal Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece. 4 Department of Oncology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece. International Journal of Science and Research Archive, 2021, 03[02], 113–117 Publication history: Received on 22 August 2021; revised on 26 September 2021; accepted on 28 September 2021 Article DOI: https://doi.org/10.30574/ijsra.2021.3.2.0145 Abstract We present the case of a 41-year-old male patient that examined in the outpatient ENT Department of our hospital, reported a persistent otitis media for about six months. Despite medical therapy, his symptom did not improve. The suspicious of a nasopharyngeal mass was raised and the rhino endoscopy revealed a mucosal projection in the left fossa of the Rosenmuller. Computed tomography (CT) of temporal bone pneumatization showed a left mastoid cell occupation and a small projection in the left fossa of the Rosenmuller. The histological examination result of a biopsy of the lession that prepared under local anesthesia, revealed nasopharyngeal adenoid cystic carcinoma. Magnetic resonance imaging indicated the extent of the tumor. The positron emission tomography/computed tomography (PET/CT) scan staged the patient and concluded the diagnosis. The patient underwent both surgery and radiotherapy and addressed oncologists and radiotherapists for further treatment. The patient was diagnosed with lung and kidney metastasis. Adenoid cystic carcinoma is a rare type of adenocarcinoma with ominous prognosis. We always have to raise the suspicious of nasopharyngeal carcinoma, in patients with persistent otological symptoms, that do not improve despite therapy. Keywords: Adenocarcinoma; Adenic cystic carcinoma; Nasopharynx; otitis media; Effusion; Otalgia; Persistent symptoms 1. Introduction Nasopharyngeal carcinoma (NPC) occurs in the epithelial lining of the nasopharynx, and has a variety of subtypes, pathologically. The majority of NPC cases involve squamous cell carcinoma [NPSC], while additional pathological types of NPC include adenocarcinoma, lymphoma and sarcomas, constituting less than 5% of all NPC cases[1, 2]. Specifically, nasopharyngeal adenocarcinoma (NPAC) is histologically characterised by the presence of a glandular structure and production of mucus, and reported to occupy 0.48% in all types of NPC. According to classification by the World Health Organization, NPAC can be divided into common type and salivary gland type cases. Subtypes of nasopharyngeal salivary gland-type adenocarcinoma include the mucoepidermoid adenocarcinoma, the adenoid cystic adenocarcinoma , the polymorphous low-grade adenocarcinoma and the malignant mixed tumor, that come from different cell population and appear different prognosis[3-6]. Nasopharyngeal adenoid cystic carcinoma (NACC) is a rare tumor that represents approximately 1% of all carcinomas of the head and neck. NACC tends to be locally aggressive, demonstrate perineural invasion and appears ominous prognosis[7-10]. Except the type of nasopharyngeal carcinoma, overall