RESUMO
ABSTRACT: Malignant basaloid neoplasms of the skin are frequent, and their accurate diagnosis holds paramount importance for treatment and prognosis. However, these neoplasms can present diagnostic challenges because of their extensive differential diagnosis, which encompasses cutaneous metastasis among many other possibilities. We present a case of a 74-year-old man with a history of p16-positive palatine tonsil squamous cell carcinoma (SCC) treated with surgery and adjuvant radiation with no prior evidence of recurrence who presented to the dermatologist with 2 chin papules. The initial histopathologic evaluation of these lesions showed poorly differentiated malignant basaloid neoplasms. Subsequently, these biopsies were compared with the previous biopsies from his tonsil and lymph node, which showed similar findings including positive p16 staining and positive molecular testing for human papillomavirus-16, confirming the diagnosis of cutaneous metastasis from his previously diagnosed human papillomavirus-related tonsil SCC. Additional imaging studies found metastases to internal organs including the brain, and he was started on chemotherapy, immunotherapy, and radiation therapy. Cutaneous metastases from tonsil SCC are exceedingly rare, and only 5 cases have been described. Furthermore, this is the first case confirming the presence of high-risk human papillomavirus by molecular studies within the cutaneous metastases. The presented case underscores the importance of recognizing this unusual manifestation of tonsil SCC metastatic to the skin along with a good clinical patient history, ensuring accurate and prompt diagnosis and treatment of this condition.
Assuntos
Carcinoma de Células Escamosas , Neoplasias Cutâneas , Neoplasias Tonsilares , Humanos , Masculino , Idoso , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/secundário , Neoplasias Cutâneas/virologia , Neoplasias Tonsilares/virologia , Neoplasias Tonsilares/patologia , Neoplasias Tonsilares/secundário , Neoplasias Tonsilares/terapia , Diagnóstico Diferencial , Carcinoma de Células Escamosas/virologia , Carcinoma de Células Escamosas/secundário , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/terapia , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/virologia , Papillomavirus Humano 16/isolamento & purificação , Papillomavirus Humano 16/genética , Biomarcadores Tumorais/análiseRESUMO
Tonsillar squamous cell carcinoma is a subtype of head and neck cancer that rarely metastasizes to the colorectal system. Colonic metastasis secondary to primary tonsillar squamous cell carcinoma is a very rare clinical occurrence with unclear pathogenesis. Palliative chemo-radiation and surgery are recommended for this rare condition, which is generally seen in advanced stages. Here, we aimed to report a case of a 70-year male who underwent palliative surgery due to the symptoms of mechanical bowel obstruction as a result of colonic metastasis of tonsillar carcinoma and review the relevant literature. Key Words: Tonsillar carcinoma, Colon, Metastasis.
Assuntos
Carcinoma de Células Escamosas , Neoplasias de Cabeça e Pescoço , Neoplasias Tonsilares , Carcinoma de Células Escamosas/patologia , Colo , Humanos , Masculino , Neoplasias Tonsilares/patologia , Neoplasias Tonsilares/secundárioRESUMO
Pulmonary pleomorphic carcinoma is a rare malignant tumor that grows rapidly and has a poor prognosis. Although no effective treatments have so far been established, immune checkpoint inhibitors (ICIs) have shown clinical improvement in some cases of pleomorphic carcinoma. However, pseudoprogression is a major concern for treatment of this carcinoma using ICIs. Here, we report the case of a 61-year-old man who was diagnosed with large cell carcinoma of the lung with brain metastases. Systemic chemotherapy comprising carboplatin and pemetrexed was administered as a first-line therapy; however, disease progression was observed. A tonsillar lesion grew rapidly after the administration of nivolumab as a second-line therapy. Tracheostomy was planned to avoid suffocation, but the patient naturally expectorated the tumor. Pathological examination revealed that it was a palatine tonsillar metastasis of pulmonary pleomorphic carcinoma with infiltration of CD8+/CD4- lymphocytes and necrosis. The primary lesion expanded after nivolumab administration and shrank with no additional nivolumab administration. We therefore concluded that pseudoprogression caused expectoration of the tonsillar metastasis. Hence, ICIs can cause serious adverse events due to pseudoprogression.
Assuntos
Neoplasias Pulmonares/complicações , Neoplasias Tonsilares/secundário , Progressão da Doença , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Metástase NeoplásicaRESUMO
A man in his mid 70s was referred to head and neck outpatients with bulky tissue in the left tonsillar fossa. He had previously been treated for oligometastatic renal clear cell carcinoma (diagnosed over 15 years prior to disease recurrence) by tonsillectomy and adjuvant radiotherapy (years from primary treatment), followed by trans-oral laser surgery to his oropharyngeal recurrence 3 years later. Examination under anaesthetic and biopsy confirmed further recurrence of disease in the left tonsillar fossa, with parapharyngeal extension, which has not been previously reported in the literature. After discussion in the head and neck and urology multi-disciplinary teams meeting, the patient was offered trans-oral robotic-assisted surgery (TORS) for local control and prevention of progression of a fungating oropharyngeal mass. TORS partial pharyngectomy and left buccal artery myomucosal flap reconstruction were successfully carried out, with preservation of some swallow function.
Assuntos
Carcinoma de Células Renais/secundário , Carcinoma de Células Renais/cirurgia , Neoplasias Renais/patologia , Faringectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Retalhos Cirúrgicos , Neoplasias Tonsilares/secundário , Neoplasias Tonsilares/cirurgia , Idoso , Humanos , Terapia a Laser , Masculino , Margens de Excisão , Recidiva Local de Neoplasia/cirurgia , Neoplasias Orofaríngeas/secundário , Neoplasias Orofaríngeas/cirurgia , Radioterapia Adjuvante , TonsilectomiaRESUMO
Here, we report the case of a 54-year-old man with a history of squamous cell carcinoma (SCC) of the lung, who developed bilateral neuroendocrine carcinoma (NEC) of the palatine tonsils. Faced with this atypical situation, another biopsy of the lung lesion was performed, revealing NEC histology patterns. This article describes the first case of metastasis to the bilateral palatine tonsils from the NEC component of a mixed NEC/SCC of the lung, highlighting the importance of reconsidering the diagnosis of the primary tumor histology, particularly in lung cancer with the possible presence of mixed tumor after phenotype transdifferentiation of the primary tumor. KEY POINTS: SIGNIFICANT FINDINGS OF THE STUDY: Mixed lung carcinoma can be revealed after the presence of neuroendocrine carcinoma metastasis. WHAT THIS STUDY ADDS: Bilateral neuroendocrine carcinoma of the palatine tonsils should be considered as metastases, particularly in the presence of lung cancer with a poor response to treatment.
Assuntos
Neoplasias Pulmonares/complicações , Tumores Neuroendócrinos/complicações , Tonsila Palatina/fisiopatologia , Neoplasias Tonsilares/secundário , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Tumores Neuroendócrinos/patologiaRESUMO
A 54-year-old woman with smoking history who was diagnosed with invasive adenocarcinoma of the rectosigmoid colon with subsequent surgical resection and chemotherapy was presented. The patient developed local recurrence and pulmonary metastases that required further chemotherapy and surgical resection. During follow-up, the patient had F-FDG PET/CT scan showing asymmetric hypermetabolic tonsils with activity greater on the right compared with the left. The patient underwent bilateral tonsillectomy, and pathology revealed moderately to poorly differentiated adenocarcinoma in the right tonsil, consistent with metastasis from known colonic primary.
Assuntos
Neoplasias do Colo/diagnóstico por imagem , Neoplasias do Colo/patologia , Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias Tonsilares/secundário , Feminino , Humanos , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Neoplasias Tonsilares/diagnóstico por imagemRESUMO
Tonsillar metastasis from distant primary tumours has not been described in dogs, and reports are rare in humans. The aims of this study were to determine whether tumour metastasis occurs to the canine palatine tonsils and evaluate whether afferent lymphatics drain to the palatine tonsils via skull indirect computed tomography lymphangiography (ICTL). Retrospective review of the diagnostic laboratory tonsillar histopathology submissions was performed. ICTL studies (n = 53) were retrospectively reviewed by a single radiologist. Of 882 total tonsil histopathology samples, 492 (56%) were considered neoplastic, with 8% of them benign. Of the primary malignant neoplasms of the tonsil, squamous cell carcinoma (55%), lymphoma (17%) and melanoma (12%) were most common. Tonsillar metastasis was confirmed in 41 cases; histopathologic evaluation revealed melanoma (25), carcinoma (10), hemangiosarcoma (2) and one each of fibrosarcoma, malignant histiocytosis, basal cell tumour and undifferentiated sarcoma. A total of 53 tonsillar melanoma cases were identified, of which 25 represented metastasis from a known distant primary tumour and 28 were solely tonsillar, with 9 of these cases having concurrent lymph node metastasis. No ICTL cases had lymphatic contrast drainage to the palatine tonsil. The palatine tonsil is an important site of metastasis for a variety of primary tumour types from many locations. ICTL did not reveal lymphatics draining to the palatine tonsil, which is highly supportive of hematogenous route of metastasis to the tonsil. Tonsillar metastasis may be more common than previously thought. It is recommended to perform a thorough oral examination, including the tonsils, for all oral tumours and melanoma cases.
Assuntos
Doenças do Cão/epidemiologia , Doenças do Cão/patologia , Neoplasias/veterinária , Neoplasias Tonsilares/veterinária , Animais , Colorado/epidemiologia , Cães , Neoplasias/epidemiologia , Neoplasias/patologia , Tonsila Palatina/patologia , Estudos Retrospectivos , Neoplasias Tonsilares/patologia , Neoplasias Tonsilares/secundárioRESUMO
Neuroendocrine cervical carcinoma (NECC) is a rare type of cervical cancer, with high tendency of lymphatic and distant metastasis and poor prognosis. Herein, we reported a rare case of relapsed NECC metastasizing to palatine tonsil and subcutaneous adipose tissue in multiple regions, which reflects the aggressive biological behavior of NECC.
Assuntos
Carcinoma Neuroendócrino/patologia , Neoplasias Tonsilares/secundário , Neoplasias do Colo do Útero/patologia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Neuroendócrino/tratamento farmacológico , Cisplatino/uso terapêutico , Evolução Fatal , Feminino , Humanos , Paclitaxel/uso terapêutico , Neoplasias Tonsilares/diagnóstico , Neoplasias Tonsilares/tratamento farmacológicoRESUMO
RATIONALE: Palatine tonsil is an extremely rare site for metastatic disease, accounting for 0.8% of malignant tonsillar neoplasms. To the best of our knowledge, this is the first report of metastatic adenocarcinoma in the tonsil treated with wide excision and targeted therapy, with no local recurrence 6 months postoperatively. PATIENT CONCERNS: A 75-year-old man presented hemoptysis and mild productive cough for 2 weeks. DIAGNOSES: Palatine tonsil metastasis from lung adenocarcinoma, pT2bN0M1b, stage IVA, was confirmed. INTERVENTIONS: Wide excision of primary lung tumor and metastatic tonsil carcinoma has been performed, and the patient was undergoing targeted therapy with the epidermal growth factor receptor inhibitor afatinib. OUTCOMES: There was no local recurrence in the oropharynx 6 months postoperatively. LESSONS: We aim at highlighting the importance of a thorough evaluation for suspicion of tonsillar enlargement, which might be a sign of a primary malignancy elsewhere.
Assuntos
Adenocarcinoma/secundário , Neoplasias Pulmonares/patologia , Tonsila Palatina/patologia , Neoplasias Tonsilares/secundário , Adenocarcinoma/patologia , Idoso , Humanos , Masculino , Neoplasias Tonsilares/patologiaRESUMO
BACKGROUND: This systematic review and meta-analysis aims to evaluate the effectiveness of palatine tonsillectomy in patients with cervical metastasis from squamous cell carcinoma of unknown primary (SCCUP) origin. METHODS: A systematic review including studies that encompassed palatine tonsillectomy in the SSCUP diagnostic evaluation was conducted. A single arm meta-analysis was then made to obtain the overall identification rate of tonsillectomy. RESULTS: Fourteen studies were included, comprising 673 patients who underwent 416 palatine tonsillectomies, 338 preformed during examination under anesthesia (EUA) and 78 managed with transoral robotic surgery (TORS). A total of 140 occult tonsillar malignancies were identified; of these, 124 (89%) were ipsilateral, 2 (1%) contralateral, and 14 (10%) synchronous bilateral. Meta-analysis of 11 studies showed an overall detection rate of tonsillectomy of 0.34 (99% confidence interval 0.23-0.46). CONCLUSION: Palatine tonsillectomy is a valuable diagnostic tool in the management of patients with head and neck SCCUP. Bilaterality of tonsillectomy should be taken into consideration.
Assuntos
Neoplasias de Cabeça e Pescoço/secundário , Neoplasias Primárias Desconhecidas/diagnóstico , Carcinoma de Células Escamosas de Cabeça e Pescoço/secundário , Neoplasias Tonsilares/secundário , Neoplasias Tonsilares/cirurgia , Idoso , Intervalo Livre de Doença , Feminino , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Tonsila Palatina/patologia , Tonsila Palatina/cirurgia , Prognóstico , Medição de Risco , Papel (figurativo) , Carcinoma de Células Escamosas de Cabeça e Pescoço/mortalidade , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia , Análise de Sobrevida , Neoplasias Tonsilares/mortalidade , Tonsilectomia/métodos , Resultado do TratamentoRESUMO
Malignant melanoma (MM) has a high potential of lymphatic and hematogeneous spread, and metastatic disease is always incurable with a high mortality. We present a rare phenomenon of MM metastasizing to the palatine tonsil.
Assuntos
Melanoma/tratamento farmacológico , Neoplasias Tonsilares/tratamento farmacológico , Idoso , Humanos , Masculino , Melanoma/patologia , Melanoma/cirurgia , Metástase Neoplásica , Neoplasias Tonsilares/patologia , Neoplasias Tonsilares/secundário , Neoplasias Tonsilares/cirurgiaAssuntos
Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/secundário , Neoplasias Tonsilares/secundário , Biomarcadores Tumorais/análise , Biópsia , Neoplasias da Mama/tratamento farmacológico , Carcinoma Ductal de Mama/tratamento farmacológico , Carcinoma Ductal de Mama/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Tonsilares/tratamento farmacológico , Neoplasias Tonsilares/patologiaRESUMO
RATIONALE: Lung cancer has the highest mortality of all malignant tumors and is becoming the leading cause of death in China. Surgical resection is the best treatment for early non-small-cell lung carcinoma. But postoperative tumor recurrence is very common. Brain, bone and liver are the most common metastatic sites of lung cancer. PATIENT CONCERNS: A 59-year-old woman was admitted to our hospital finding a lung nodule in physical examination. No other obvious symptoms were obsessed in this patient. No remarkable abnormality was detected in preoperative laboratory tests and physical examination. DIAGNOSES: A ground-glass nodule was detected on the left inferior lobe in the imaging examination. No metastases were detected before the surgery and early-stage lung cancer was supposed. INTERVENTION: This patient underwent a radical resection of lung cancer successfully and enjoyed a peaceful postoperative rehabilitation. OUTCOMES: Although pathological diagnosed confirmed early stage lung adenocarcinoma (T1N0M0). The patient had tumor recurrence 7 months after operation. Gene sequencing confirmed the G719S mutation in exon 18 of the EGFR gene and target therapy, chemotherapy and radiotherapy were all given to this patient successively, but they were all unresponsive. The patient died 26 months after surgery. LESSONS: We herein first report G719S mutation in lung adenocarcinoma with tonsillar metastasis. Generally, the tumor responded poorly to treatment and progressed quickly, which didn't achieve the desired effect. G719S mutant is supposed to be the cause of poor responsive to treatment.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/patologia , Genes erbB-1/genética , Neoplasias Pulmonares/patologia , Neoplasias Tonsilares/secundário , Carcinoma Pulmonar de Células não Pequenas/genética , Carcinoma Pulmonar de Células não Pequenas/terapia , China , Feminino , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/terapia , Pessoa de Meia-Idade , Neoplasias Tonsilares/genética , Neoplasias Tonsilares/terapiaRESUMO
BACKGROUND: Tonsillar metastasis is very rare and accounts for only 0.8% of tonsillar tumors. And phyllodes tumor of the breast with tonsillar metastasis is very rare. CASE PRESENTATION: A 57-year-old Japanese woman received surgery (partial mastectomy) of malignant phyllodes tumor. Seven months after initial surgery, pharyngeal pain, swelling, and a feeling of dyspnea developed, and tumor was found in the left palatine tonsil. Computed tomography for further evaluation showed a tonsillar lesion with contrast enhancement, and tonsillar metastasis was suspected. The metastatic lung tumors had not progressed. Laryngoscopic biopsy showed a tonsillar metastasis from the malignant phyllodes tumor. Despite the diagnosis of malignant phyllodes tumor with tonsillar and pulmonary metastases, the patient refused further treatment and died about 1 month later. CONCLUSIONS: A patient with a malignant phyllodes tumor of the breast and tonsillar metastasis was reported, along with a discussion of the relevant literature of this very rare pattern of metastasis.
Assuntos
Neoplasias da Mama/patologia , Tumor Filoide/patologia , Neoplasias Tonsilares/secundário , Mama/patologia , Neoplasias da Mama/diagnóstico por imagem , Evolução Fatal , Feminino , Humanos , Japão , Metástase Linfática , Pessoa de Meia-Idade , Metástase Neoplásica , Tumor Filoide/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Neoplasias Tonsilares/diagnóstico por imagemAssuntos
Carcinoma de Células Pequenas/diagnóstico por imagem , Carcinoma de Células Pequenas/secundário , Fluordesoxiglucose F18 , Neoplasias Pulmonares/patologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Compostos Radiofarmacêuticos , Neoplasias Tonsilares/diagnóstico por imagem , Neoplasias Tonsilares/secundário , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
We present the case of a 47-year-old man with a history of Epstein-Barr-virus-positive nasopharyngeal carcino- ma who developed a metastasis to the palatine tonsil. To the best of our knowledge, this is the first reported case of an intratonsillar metastasis of a nasopharyngeal carcinoma. The aim of this report is to emphasize the importance of vigilant surveillance in patients with nasopharyngeal carcinoma. This case also demonstrates that an atypical metastatic pattern can raise suspicion of a local disease recurrence.
Assuntos
Carcinoma/secundário , Infecções por Vírus Epstein-Barr/complicações , Neoplasias Nasofaríngeas/patologia , Neoplasias Tonsilares/secundário , Carcinoma/complicações , Carcinoma/patologia , Carcinoma/virologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Carcinoma Nasofaríngeo , Neoplasias Nasofaríngeas/complicações , Neoplasias Nasofaríngeas/diagnóstico por imagem , Neoplasias Nasofaríngeas/virologia , Neoplasias Tonsilares/complicações , Neoplasias Tonsilares/patologia , Neoplasias Tonsilares/virologiaRESUMO
The most common metastatic sites of colorectal cancer are liver, lung, peritoneum and lymph nodes. Metastasis of colorectal carcinoma to palatine tonsil is rarely seen. To our knowledge, only 11 patients were documented in English literature. Atypical metastases can sometimes lead to misdiagnosis. Precise diagnosis of atypical metastases requires a careful physical examination, good imaging method and comprehensive pathological evaluation. Here, we report a case of rectal adenocarcinoma presented with palatine tonsil metastasis.