The diagnosis based on the clinical history is most likely a case of Nasopharyngeal carcinoma.
History of China is also important (endemic in that region).
Usually arises from fossa of rosenmuller in nasopharyngeal wall.
First presentation is by painless cervical lymphadenopathy.
Other clinical manifestations:
Unilateral nasal discharge, nosebleeds, impaired nasal breathing (due to obstruction)
Obstruction of the Eustachian tube: recurrent otitis media (may be accompanied by effusion); conductive hearing loss, tinnitus
Infiltration of caudal cranial nerves → Garcin syndrome
Associated with EBV infection.
Positive staining for cytokeratin assures it’s epithelial origin and LCA negativity rules out possibilities of lymphoma.