Small Bowel Metastasis from Squamous Cell Carcinoma of the Larynx. A Case Report

Squamous Cell Carcinoma of Duodenum Secondary to Metastasis From Recurrent Head and Neck Cancer: A Case Report and Literature Review

This report describes a case involving the diagnosis and treatment of squamous cell carcinoma (SCC) of the duodenum, which was found to be a metastatic lesion originating from recurrent head and neck cancer (HNC) in a 74-year-old female patient. The patient had a past medical history of gastroesophageal reflux disease (GERD), tonsillar SCC, and recurrent HNC. She presented with symptoms of burning, tingling, and numbness of the throat and left side of the tongue. Upon examination with an esophagogastroduodenoscopy, an ulcerated hard area mass was detected in the third portion of the duodenum. Biopsy results confirmed the mass to be a metastatic poorly differentiated SCC. The incidence of head and neck squamous cell carcinoma (HNSCC) metastasis to the duodenum is rare, likely due to the unique anatomic location and the lack of lymphatic drainage in the area. The patient was treated with a combination of paclitaxel, carboplatin, and pembrolizumab. This case underscores the significance of considering unusual sites of metastasis in HNSCC patients and utilizing advanced imaging modalities and immunotherapy to detect and treat these locations effectively.

Uncommon metastasis of laryngeal cancer to small bowel causing intestinal obstruction treated by laparoscopic approach

Metastatic laryngeal cancer to the small bowel is extremely rare. Management of small bowel obstruction used to constitute a relative contraindication for the use of laparoscopic modality. We are reporting a case of an elderly man known to have laryngeal cancer who presented with small bowel obstruction due to metastatic deposit to the small bowel. The condition was successfully treated by laparoscopic assisted approach. A review of the natural history of advanced laryngeal cancer, common and uncommon sites of metastasis, and the rare presentation as small bowel obstruction is illustrated in this review.

Carcinoma of the larynx, metastatic to illeum, presents as ruptured appendicitis: case report and literature review

Objectives

Metastasis of laryngeal squamous cell carcinoma (SCC) to the intra-abdominal gastrointestinal tract is exceedingly rare. The objectives of this case report are to describe a case involving a perforated metastasis of a laryngeal SCC to the ileum and to review the literature pertaining to other similar cases.

Methods

A review of patient’s chart and a review of the English literature involving malignant SCC of the larynx with metastasis to the small bowel.

Results

We describe the case of a 58-year-old man who had failed induction chemotherapy and underwent a laryngopharyngectomy with bilateral neck dissection and pectoralis major flap for a T4N2c laryngeal SCC. Subsequently, the patient was treated with postoperative radiation and cituximab.

The patient went on to present with symptoms consistent with a ruptured appendix, supported by ultrasound imaging. The patient was taken to the operating room where a right hemicolectomy was performed. Pathological gross examination confirmed a 4 cm transmural perforation in the terminal ileum. Microscopy demonstrated deposits of metastatic squamous cell carcinoma in the surrounding smooth muscle. Metastatic carcinoma was also found in a separate nodule from the abdominal wall. The patient had an uncomplicated post-operative period, and survived several months thereafter.

Conclusions

Metastasis of laryngeal SCC to the small bowel with perforation is exceedingly rare, but possible. These patients may be successfully managed with resection.

Comprehensive review of small bowel metastasis from head and neck squamous cell carcinoma

Secondary tumours of small intestine account for 10% of all small bowel cancers. The most common sites of primary tumour metastasizing to small bowel are uterus, cervix, colon, lung, breast and melanoma. The majority of these metastatic tumours come from adenocarcinoma primaries; squamous cell carcinoma constitutes a very small proportion of all metastatic small intestinal lesions. Metastasis to small bowel by head and neck squamous cell carcinoma is extremely rare and carries an unfavourable prognosis. Owing to the limited number of published studies, its characteristic features, clinical presentation and outcomes are poorly described. This work aims at specifying these characteristics by reviewing, compiling, analysing and reporting all published cases in the published literature on small bowel metastasis secondary to head and neck squamous cell carcinoma. To the best of our knowledge, this is the first comprehensive review article on the small intestinal metastasis from head and neck squamous cell carcinoma.

[Small bowel metastases from head and neck cancers]

AIM OF THE STUDY

Small bowel metastases represent less than 10% of malignant tumours of the small bowel. Among primitive cancers with small bowel metastases, head and neck cancers are exceptional. The aim of the study was to evaluate clinical and evolutive characteristics of patients with small bowel metastases from head and neck cancers.

PATIENTS AND METHODS

Analyse of a reported case and bibliographic study by asking the Medline database and gathering anamnestic, clinical and evolutive data from observations of small bowel metastases from head and neck cancers.

RESULTS

We report the case of a 63 years-old male patient with a small bowel metastasis from a head and neck cancer. Nine other observations have been published in the international literature. Analysis of this 10 patient-series shows that small bowel metastases of head and neck cancers occur rather in old male patients (mean age: 71 years). They are usually discovered after primitive cancer diagnosis, always because of occlusive, perforative or bleeding complications. Jejunal metastases are rather complicated by perforation whereas ileal ones rather induce occlusion or digestive bleeding. Discovering a small bowel metastasis in the context of head and neck cancer is highly indicative of a poor prognosis. In these 10 patients, deaths occurred within the 8 months following the diagnosis, because of postoperative complication or neoplastic evolution.

CONCLUSIONS

Small bowel metastases from head and neck cancers usually occur as emergent complications. They are indicative of an advanced disease and the prognosis is extremely poor. The aim of the management is to afford the best quality of life as possible.

An unusual case of laryngeal carcinoma metastasizing to the small intestine

An unusual case of laryngeal carcinoma metastasizing to the small intestine is reported. The patient was admitted to our hospital due to hoarseness, sore throat and dyspnoea. Pathological examination on the laryngeal mass revealed it to be moderately differentiated squamous cell carcinoma, staged as T4N0M0. A total laryngectomy and right modified neck dissection were performed. Over two years after the operation a small intestinal tumour was found, with a resultant resection of the ileum and sigmoid colon. An infiltration of the cell nests of squamous cell carcinoma were present at the submucosal regions of the ileum. These findings indicated that the laryngeal cancer had already metastasized to the small intestine at the time of the initial treatment.