The most common primary tumours metastasising to the breast include melanoma, lymphoma, lung cancer and ovarian cancer, while metastases from head and neck cancer are rare. Metastases from undifferentiated nasopharyngeal carcinoma cancers are extremely rare, and only 3 well-documented cases have been reported in the English literature. We report a fourth case of breast metastases from nasopharyngeal carcinoma confirmed by in situ hybridization, focusing on clinical data as well as radiologic and pathologic features.