Background: Adenoid tissue rarely persists in adolescence and adulthood period, It rarely represents a malignant process. Nasopharyngeal mass lesions may vary from simple adenoid hyperplasia to other benign and malignant lesions.

Materials and methods: A retrospective study done on sixty- six patients presented with a nasopharyngeal mass lesion to our institute in Dhofar, Sultanate of Oman where nasopharyngeal biopsy was done in all cases to differentiate benign from malignant lesions.

Results: The majority of the cases included in the study 60/66 (90.9%) represented benign lesions. The six cases with malignancy showed highly significant correlation with neck mass, ear pain, unilateral otitis media with effusion and suspicious appearance on endoscopy. Advanced age showed a highly significant difference between the malignant and non- malignant groups.

Conclusion: Nasopharyngeal biopsy should be reserved only to cases where associated (sinister features) exist along with the presence of nasopharyngeal mass.

Keywords: Adenoid hyperplasia; malignant; neck mass; otitis media.