Nasopharyngeal carcinoma (NPC) arises from the epithelium of the nasopharynx and is a rare tumor in most parts of the world, including the United States. Neck swelling, nasal obstruction, and epistaxis are the most common presenting symptoms. The etiology of NPC is multifactorial and includes genetic susceptibility, exposure to carcinogens, and prior infection with the Epstein-Barr virus (EBV). We report a case of a 16-year-old African-American male who presented with hemoptysis and a 3-month history of a neck mass. Diagnostic evaluation identified a nasopharyngeal mass that upon biopsy was shown to be an undifferentiated nasopharyngeal carcinoma with immunohistochemical stains markedly positive for EBV. Recent studies have further elucidated the role of EBV in the pathogenesis of NPC and have demonstrated the utility of EBV studies in staging, prognosis, and post-therapeutic monitoring.