Synchronous nasopharyngeal carcinoma (NPC) with meningioma in the anterior and middle base of the skull. A 45-year old man (patient 21) presented with hearing impairment in the right ear and dizziness for 10 days. The magnetic resonance (MR) scan demonstrated a homogeneously enhanced mass involving the sphenoidal sinus, anterior skull base and right middle skull base (arrow heads in a, b and c: contrast-enhanced MR). A lesion in the left lateral side of the nasopharynx (arrows in a and b: coronal contrast-enhanced MR) was also identified. Endoscopic biopsy of the nasopharyngeal lesion (arrows in d: endoscopic view) and sphenoidal mass was performed. Histological examination revealed the diagnosis of NPC with strong positive immunohistochemisty staining for P63 and CK in the nasopharynx (e: hematoxylin and eosin staining, ×200) and meningioma immunopositive for epithelial membrane antigen (EMA) and vimentin but negative for CK and Epstein-Barr virus-encoded RNA in situ hybridization (EBER ISH) in the sphenoidal sinus (f: hematoxylin and eosin staining, ×200).