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Year : 2019  |  Volume : 12  |  Issue : 2  |  Page : 103-104  

Rare presentation of squamous cell carcinoma: A case report

Department of Pathology, Sri Devaraj Urs Medical College, Kolar, Karnataka, India

Date of Web Publication25-Mar-2019

Correspondence Address:
Subhashish Das
Department of Pathology, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_67_18

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How to cite this article:
Das S. Rare presentation of squamous cell carcinoma: A case report. Med J DY Patil Vidyapeeth 2019;12:103-4

How to cite this URL:
Das S. Rare presentation of squamous cell carcinoma: A case report. Med J DY Patil Vidyapeeth [serial online] 2019 [cited 2020 Aug 11];12:103-4. Available from: http://www.mjdrdypv.org/text.asp?2019/12/2/103/254781

[In response to: Anila K R, Kainical C T, Koshy SM, Nair P S. Head-and-neck squamous cell carcinoma metastasizing to femur-pathological confirmation of a rare site of metastasis of a common cancer. Med J DY Patil Vidyapeeth 2019;12:75-7]

Bone metastases from squamous cell carcinoma of the head and neck is an extremely rare clinical entity, but should be seriously considered because the increasing duration of survival of head-and-neck cancer patients increases the probability of late bones metastases. Efforts must be made to identify the frequency, clinical presentation, and clinical course of metastatic disease to bone from head-and-neck primaries.[1],[2]

Distant bone metastases are infrequent, but should be considered a possibility in any patient with a concurrent or past diagnosis of head-and-neck carcinoma. The very short time from discovery of bone dissemination to death in most of these patients should be taken into consideration when contemplating operative intervention. Two-third of head-and-neck cancers present in an advanced local and nodal stage, leading to poor results, with chances of distant metastasis also increasing.[3],[4],[5]

The development of newer radiotherapy techniques and availability of better chemotherapy drugs used concurrently have led to better control of such cancers. In fact, better control of local disease may lead to an increased incidence of distant metastasis, affecting survival. Bone metastases depend on the primary site of involvement, T and N stage, and control of the nodal disease. It has been shown that patients presenting with advanced nodal disease show a higher incidence of distant metastasis especially when there is extensive soft tissue or jugular vein involvement in the neck.[6],[7]

Studies by Bhandari, A strong correlation was seen between clinical nodal disease and pathologically involved lymph nodal status. Patients with clinically palpable lymph nodal (N1–N3) disease were operated and histologically had three or more lymph nodes showing metastases with extracapsular spread and/or lymphovascular invasion were more prone to develop distant metastasis.[1]

Axial skeleton is the most common site of bone metastasis in our cases, involving spine, pelvis, and ribs, with lumbar spine being the most common. In the appendicular skeleton, the proximal femur and humerus are mainly involved. Siegel et al., observe 1% head and neck cancer patients developed bone metastasis, mainly involving pelvic bones, femur, humerus, ribs, and thoracic vertebra. These lesions were mainly osteolytic, with moth-eaten or permeated borders. Similar observation was also noted by Bhandari, who also found that the flat parietal bones of skull, ribs, and sacrum, and long bones such as shaft of femur and radius were involved. Osteolytic lesions usually appeared within 3–12 months of completion of the primary treatment. The prognosis of carcinoma buccal mucosa patients who develop bone metastasis is usually poor with a median survival about 8 months.[1],[2],[6],[7]

The exact metastasis pathogenesis remains unknown. However, a probability of subclinical seeding of malignant cells before the eradication of the primary tumor should be considered.

In locally advance cases of head-and-neck cancer, a bone scan should be done before definitive treatment to avoid unnecessary local treatment and start systemic treatment earlier to improve survival.[2]

We conclude by emphasizing the fact that newer diagnostic regimens and more thorough work-up at diagnosis have improved our understanding of squamous cell carcinoma, and consequently, locoregional control of cancer above the clavicles has increased. However, the overall disease-free survival rate has not improved, and the incidence of distant metastases and second primary tumors has increased. Risk factors for hematogenous spread include higher tumor stage, size of the primary lesion (T4), tumor grade, and the lesion site. Bhandari diagnosed four cases of squamous cell carcinoma of the buccal mucosa which had metastasized to bones. All patients were young, had T4 disease and Grade I-II squamous cell carcinoma, and were using chewing tobacco. The cause of such frequent metastases cannot be proved; however, subclinical seeding of malignant cells before the eradication of the primary tumor is probable contributory with advanced local and nodal disease with the high-grade tumor. A pretreatment bone scan should be performed in locoregionally advanced buccal mucosa carcinomas at the time of diagnosis to define the treatment plan.[1],[2],[3],[8]

  References Top

Bhandari V. Incidence of bone metastasis in squamous cell carcinoma of the buccal mucosa. J Cancer Metastasis Treat 2015;1:27-30.  Back to cited text no. 1
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Siegel JE, Weinstein MC, Russell LB, Gold MR. Recommendations for reporting cost-effectiveness analyses. Panel on cost-effectiveness in health and medicine. JAMA 1996;276:1339-41.  Back to cited text no. 2
Talmi YP, Cotlear D, Waller A, Horowitz Z, Adunski A, Roth Y, et al. Distant metastases in terminal head and neck cancer patients. J Laryngol Otol 1997;111:454-8.  Back to cited text no. 3
Al-Othman MO, Morris CG, Hinerman RW, Amdur RJ, Mendenhall WM. Distant metastases after definitive radiotherapy for squamous cell carcinoma of the head and neck. Head Neck 2003;25:629-33.  Back to cited text no. 4
León X, Quer M, Orús C, del Prado Venegas M, López M. Distant metastases in head and neck cancer patients who achieved loco-regional control. Head Neck 2000;22:680-6.  Back to cited text no. 5
Marioni G, Blandamura S, Calgaro N, Ferraro SM, Stramare R, Staffieri A, et al. Distant muscular (gluteus maximus muscle) metastasis from laryngeal squamous cell carcinoma. Acta Otolaryngol 2005;125:678-82.  Back to cited text no. 6
Calhoun KH, Fulmer P, Weiss R, Hokanson JA. Distant metastases from head and neck squamous cell carcinomas. Laryngoscope 1994;104:1199-205.  Back to cited text no. 7
Ferlito A, Shaha AR, Silver CE, Rinaldo A, Mondin V. Incidence and sites of distant metastases from head and neck cancer. ORL J Otorhinolaryngol Relat Spec 2001;63:202-7.  Back to cited text no. 8


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