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a systematic review and meta-analysis on the detection of p16(INK4a), human papillomavirus (HPV), and Ebstein-Barr virus (EBV). Am J Otolaryngol . 2021;42(1):102762. https://doi. org/10.1016/j.amjoto.2020.102762 1737. Ruuskanen M, Irjala H, Minn H, et al. Epstein-Barr virus and human papillomaviruses as favorable prognostic factors in nasopharyngeal carcinoma: a nationwide study in Fin land. Head Neck . 2019;41(2):349-357. https://doi.org/10.1002/ hed.25450 1738. Jiang W, Chamberlain PD, Garden AS, et al. Prognostic value of p16 expression in Epstein-Barr virus-positive nasopharyn geal carcinomas. Head Neck . 2016;38(Suppl. 1):E1459-E1466. https://doi.org/10.1002/hed.24258 1739. Atighechi S, Ahmadpour Baghdadabad MR, Mirvakili SA, et al. Human papilloma virus and nasopharyngeal carcinoma: pathology, prognosis, recurrence and mortality of the disease. ExpOncol . 2014;36(3):215-216. 1740. Stenmark MH, McHugh JB, Schipper M, et al. Nonendemic HPV-positive nasopharyngeal carcinoma: association with poor prognosis. Int J Radiat Oncol Biol Phys . 2014;88(3):580 588. https://doi.org/10.1016/j.ijrobp.2013.11.246 1741. Newton E, Valenzuela D, Foley J, Thamboo A, Prisman E. Outcomes for the treatment of locoregional recurrent nasopharyngeal cancer: systematic review and pooled analy sis. HeadNeck . 2021;43(12):3979-3995. https://doi.org/10.1002/ hed.26836 1742. Zhang B, Li Y, Weng J, et al. Efficacy and safety of endoscopic nasopharyngectomy combined with low-dose radiotherapy for primary T1-2 nasopharyngeal carcinoma. Technol Cancer Res Treat . 2021;20:15330338211011976. https://doi.org/10.1177/ 15330338211011975 1743. Thamboo A, Patel VS, Hwang PH. 5-year outcomes of salvage endoscopic nasopharyngectomy for recurrent nasopharyn geal carcinoma. J Otolaryngol Head Neck Surg . 2021;50(1):12. https://doi.org/10.1186/s40463-020-00482-x 1744. Li W, Lu H, Wang H, et al. Salvage endoscopic nasopha ryngectomy in recurrent nasopharyngeal carcinoma: prog nostic factors and treatment outcomes. Am J Rhinol Allergy . 2021;35(4):458-466. https://doi.org/10.1177/1945892420964054 1745. Wang ZQ, Xie YL, Liu YP, et al. Endoscopic nasopha ryngectomy combined with internal carotid artery pretreat ment for recurrent nasopharyngeal carcinoma. Otolaryngol Head Neck Surg . 2022;166(3):490-497. https://doi.org/10.1177/ 01945998211011076 1746. Wong EHC, Liew YT, Loong SP, Prepageran N. Five-year survival data on the role of endoscopic endonasal nasopharyn gectomy in advanced recurrent rT3 and rT4 nasopharyngeal carcinoma. Ann Otol Rhinol Laryngol . 2020;129(3):287-293. https://doi.org/10.1177/0003489419887410 1747. Tang IP, Ngui LX, Ramachandran K, et al. A 4-year review of surgical and oncological outcomes of endo scopic endonasal transpterygoid nasopharyngectomy in sal vaging locally recurrent nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol . 2019;276(9):2475-2482. https://doi.org/ 10.1007/s00405-019-05522-5 1748. Liu J, Yu H, Sun X, et al. Salvage endoscopic nasopharyn gectomy for local recurrent or residual nasopharyngeal car cinoma: a 10-year experience. Int J Clin Oncol . 2017;22(5):834 842. https://doi.org/10.1007/s10147-017-1143-9

adenocarcinoma presenting as snoring in a 49 year-old male. Diagn Histopathol . 2013;19(9):350-353. https://doi.org/10.1016/j.mpdhp.2013.06.016 1724. Wu PY, Huang CC, Chen HK, Chien CY. Adult thyroid like low-grade nasopharyngeal papillary adenocarcinoma with thyroid transcription factor-1 expression. Otolaryngol Head Neck Surg . 2007;137(5):837-838. https://doi.org/10.1016/ j.otohns.2007.06.725 1725. Fu CH, Chang KP, Ueng SH, Wu CC, Hao SP. Primary thyroid-like papillary adenocarcinoma of the nasopharynx. Auris Nasus Larynx . 2008;35(4):579-582. https://doi.org/10. 1016/j.anl.2007.10.009 1726. Ohe C, Sakaida N, Tadokoro C, et al. Thyroid-like low grade nasopharyngeal papillary adenocarcinoma: report of two cases. Pathol Int . 2010;60(2):107-111. https://doi.org/10. 1111/j.1440-1827.2009.02480.x 1727. Sillings CN, Weathers DR, Delgaudio JM. Thyroid-like pap illary adenocarcinoma of the nasopharynx: a case report in a 19-year-old male. Oral Surg Oral Med Oral Pathol Oral Radiol Endod . 2010;110(3):e25-e28. https://doi.org/10.1016/j. tripleo.2010.04.029 1728. Petersson F, Pang B, Loke D, Hao L, Yan B. Biphasic low-grade nasopharyngeal papillary adenocarcinoma with a prominent spindle cell component: report of a case localized to the posterior nasal septum. Head Neck Pathol . 2011;5(3):306-313. https://doi.org/10.1007/s12105-011-0252-4 1729. Guo ZM, Liu WW, He JH. A retrospective cohort study of nasopharyngeal adenocarcinoma: a rare histological type of nasopharyngeal cancer. Clin Otolaryngol . 2009;34(4):322-327. https://doi.org/10.1111/j.1749-4486.2009.01952.x 1730. Booth JR, Unsal AA, Tadros S, Byrd JK, Kountakis SE. Salivary gland cancers of the nasopharynx: a population-based analysis of 383 cases. Otolaryngol Head Neck Surg . 2019;161(3):442-449. https://doi.org/10.1177/0194599819849923 1731. Ryu J, Park WS, Jung YS. Exclusive endoscopic resection of nasopharyngeal papillary adenocarcinoma via combined transnasal and transoral approach. Clin Exp Otorhinolaryngol . 2013;6(1):48-51. https://doi.org/10.3342/ceo.2013.6.1.48 1732. Unsaler S, Basaran B, Aslan I, Yilmazbayhan D. Endonasal endoscopic nasopharyngectomy for the treatment of nasopha ryngeal papillary adenocarcinoma: report of a rare case. Int J Pediatr Otorhinolaryngol . 2018;104:51-53. https://doi.org/10. 1016/j.ijporl.2017.10.041 1733. Stepan KO, Mazul AL, Skillington SA, et al. The prognostic significance of race in nasopharyngeal carcinoma by histolog ical subtype. HeadNeck . 2021;43(6):1797-1811. https://doi.org/ 10.1002/hed.26639 1734. Zang J, Li C, Xu M, et al. Induction chemotherapy followed by concurrent chemoradiotherapy is benefit for advanced stage nasopharyngeal carcinoma with different nonkeratiniz ing carcinoma subtypes. Sci Rep . 2018;8(1):13318. https://doi. org/10.1038/s41598-018-31050-z 1735. Isayeva T, Li Y, Maswahu D, Brandwein-Gensler M. Human papillomavirus in non-oropharyngeal head and neck can cers: a systematic literature review. Head Neck Pathol . 2012;6(Suppl. 1):S104-S120. https://doi.org/10.1007/s12105 012-0368-1 1736. Tham T, Machado R, Russo DP, Herman SW, Teegala S, Costantino P. Viral markers in nasopharyngeal carcinoma: