Lymphoepithelioma (World Health Organization type 3, undifferentiated carcinoma of the nasopharyngeal type) is an extremely rare cancer in the laryngohypopharyngeal regions. We found reports of only 6 such tumors in the English language medical literature; 1 of the 6 was from our institution. We report four additional cases seen at the Mayo Clinic. Radiotherapy controlled disease at the primary site in three of the four cases. The neoplasm has a propensity for early, widespread dissemination. Three of our four patients died of extensive visceral and nodal metastases. One patient has survived eight years without a recurrence.