Neuroendocrine tumours are rare and aggressive heterogenous histologic group of tumours with a wide spectrum of differentiation. They are divided into 3 categories according to its grade, clinical behaviours and prognosis; well-differentiated or low-grade, moderately differentiated or intermediate-grade, and poorly differentiated or high-grade based on the 2017 World Health Organisation Classification for Head and Neck Tumours. They commonly originate at larynx, with only 4% arising from the hypopharynx. Experience regarding diagnosis and treatment of hypopharyngeal NEC cancer are scarce and are mostly consisted of case studies or small case series. Here, we report a rare case of hypopharyngeal small cell type NEC malignancy and discuss the clinical manifestation, pathway to diagnosis and treatment.