BACKGROUND: Nasopharyngeal carcinoma is one of the rare forms of cancer globally which has a high incidence in select geographic and ethnic populations. The current study aims to assess the clinical presentation, imaging patterns and radiologypathology correlation of nasopharyngeal carcinoma.METHODS: This is a retrospective analysis of 80 patients with newly diagnosed nasopharyngeal carcinoma who came to Tikur Anbessa Specialized Hospital from January 2016 to August 2017. The patients’ history, physical examination, abdominopelvic ultrasound, chest x-ray, computed tomography scan and biopsy reports were reviewed from their medical record. Patients who had previous history of treatment for nasopharyngeal carcinoma, those who did not have biopsy and those without imaging were excluded from the study.RESULTS: This study showed that 61(81.3%) patients had neck swelling as the initial clinical symptom, and the average time of presentation of symptoms was 6(IQR 8) months. On the other hand, 56(70.0%) were diagnosed with non-keratinizing undifferentiated nasopharyngeal carcinoma while 15(3.8%) had keratinizing nasopharyngeal carcinoma. Sixty-nine (86.3%) patients had nodal metastasis; 22.5% had invasion into the paranasal sinuses; 47.5% had T4 with T1, T2 and T3 being 18.8%, 17.5% and 7.5% stage respectively at time of diagnosis. Ninety percent of the cases had a diagnosis of nasopharyngeal carcinoma on imaging, but 10% were given alternative diagnosis.CONCLUSION: Non-keratinizing undifferentiated type was the commonest histologic subtype in this study which is also recognized as the commonest one in endemic countries. A significant number did not have a specific histologic WHO type on pathology report which could in turn affect the management and assessment of risk factors.