Metastatic basal cell carcinoma of the head and neck

Metastases are occasionally associated with cutaneous squamous cell carcinoma but only rarely with basal cell carcinoma. There are approximately 200 cases of metastases from basal cell carcinoma reported in the world literature. We describe 6 additional cases. All of our patients demonstrated recurrence at the primary site before they developed their metastases. Metastases presented in subcutaneous tissue, cervical lymph nodes, bone, and lung between 1.5 and 14 years after initial treatment of the primary lesion. The long interval seen in these patients between the initial treatment of the primary and the development of metastases underscores the need for long-term follow-up in what is often thought to be a nonaggressive, nonmetastasizing malignancy.     

Metastatic carcinoma of the neck from unknown primary sites

Encountering a metastatic carcinoma of the neck from an unknown primary site is not unusual, despite intensive examinations of the entire body. In previous reports, the pathological diagnosis of these carcinomas was usually squamous cell carcinomas and rarely adenocarcinoma. We treated eight patients with metastatic carcinoma of the neck from unknown primary sites, including 4 cases of squamous cell carcinoma, 2 cases of adenocarcinoma, one case of small cell carcinoma, and one case of clear cell carcinoma, during a 10-year period from January 1992 to December 2001. We clinically examined these eight cases, and focusing on the two cases of metastatic cervical adenocarcinoma from unknown primary sites. The 8 cases consisted of 5 cases of N2 and 3 cases of N3 disease. Three of the 5 N2 patients underwent a neck dissection, but all three of the N3 cases were judged to be inoperable. Disease-free survival was achieved in all 3 patients who underwent surgery. In this paper, we review 36 reports on metastatic carcinomas of the neck from unknown primary sites and statistically analyze 1454 cases. Pathologically, the majority of them (81.1%) were squamous cell carcinoma; adenocarcinomas accounted for only 7.6% of the cases. Notably, 65.0% of the patients with cervical metastatic adenocarcinomas were confirmed to have primary lesions outside the head and neck region. The prognosis of primary unknown metastatic cervical adenocarcinoma is reportedly poor, and the optimal treatment is still unclear, although surgery is recommended for primary unknown metastatic cervical squamous cell carcinoma. However, we suggest that intensive treatment, including surgery, radiotherapy, and chemotherapy, of metastatic lesions of the neck may play a key role in improving patient prognosis.     

Metastatic renal cell carcinoma to the head and neck

OBJECTIVES: The objectives of the study were to present four cases of renal cell carcinoma (RCC) metastatic to the head and neck, to recognize the appearance on radiographic studies, to understand the importance of preoperative embolization, and to review the results of treatment. STUDY DESIGN: Retrospective review of patients diagnosed with metastatic RCC to the head and neck. METHODS: The records of four patients diagnosed with metastatic RCC at a tertiary medical center over a 5-year period from 1996 to 2001 were reviewed and analyzed for demographic and outcomes data. RESULTS: Metastatic RCC to the head and neck was seen in the following locations: nasal cavity, lower lip, hard palate, tongue, and maxillary sinus. Presenting signs were loose upper molars, dysphagia, nasal obstruction, lower lip lesion, recurrent epistaxis, and foul nasal drainage. Histological studies confirmed metastasis of RCC in all four patients. Treatment consisted of preoperative radiation therapy, embolization, and local excision with adjunct chemotherapy. CONCLUSIONS: Metastatic RCC to the head and neck is rare but can have serious consequences if not recognized before biopsy. We present several treatment options with local excision as the primary mode of treatment.     

Metastatic head and neck squamous cell carcinoma to the brain.

BACKGROUND: To evaluate the natural history of patients with metastatic squamous cell carcinoma (SCCA) of the head and neck to the brain. METHODS: A retrospective review of patients with brain metastases treated over a 20-year period identified five that had a head and neck SCCA primary. RESULTS: Five cases of patients with SCCA of the head and neck that developed brain metastases are presented in detail. CONCLUSION: In patients with aggressive disease, large infiltrative lesions, and in late survivors with initially advanced disease, metastasis to the brain should be considered. Perineural metastasis appears to be the most common mode of spread of head and neck SCCA to the brain. Pain, paresis, or paresthesias in the distribution of cranial nerves or other neurological symptoms should alert the otolaryngologist to neural or central nervous system involvement in patients with SCCA of the head and neck. Surgery with or without post-operative whole brain radiation therapy is the mainstay of treatment in most patients. Stereotactic radiosurgery may play a major role in treating brain metastases from head and neck primary tumors.     

Metastatic meningioma in the neck

Although meningiomas represent 15 per cent of tumours of the central nervous system, they rarely metastasize. A case is presented in which metastasis to a cervical lymph node occurred, together with local recurrence, nine years after initial diagnosis and treatment. This case serves to illustrate that malignant meningioma is a rare cause of a neck mass.     

Metastatic squamous cell carcinoma in the neck invading the facial canal--a case report

The results of histopathologic examination of the temporal bone of a 71-year-old woman with squamous cell carcinoma of the tonsil and ipsilateral facial palsy are presented. The right temporal bone was directly involved by metastatic spread of the primary lesion to the right upper cervical lymph nodes. Tumor cells had invaded the canal of the facial nerve, the chorda tympani nerve, and the stapedius muscle, as well as the air cells in the mastoid region. However, although tumor cells had infiltrated the facial canal to a considerable distance from the metastatic tumor mass, the facial nerve had not been infiltrated. Slight degeneration of the facial nerve, however, was observed and appeared to have been caused by compression by the tumor.     

颈部转移性Merkel细胞癌1例并文献复习

目的 探讨Merkel细胞癌的临床表现及诊疗方法。方法 回顾性分析1例颈部转移性Merkel细胞癌患者的临床资料并复习相关文献进行总结。结果 对患者采取术中肿物扩大切除+淋巴结清扫+患侧锁骨上动脉岛状瓣移植。术后随访1年患者恢复良好,未见局部复发及远处转移征象。结论 Merkel细胞癌具有局部复发率、淋巴结转移率高的特点,目前肿瘤切除仍是Merkel细胞癌治疗的一线选择,依据肿瘤侵袭范围选择个体化的治疗方案尤为关键。     

Metastatic thymoma to the head and neck

Malignant thymoma is a mediastinal tumor which spreads primarily by local invasion. Spread to regional lymph nodes and distant organs is variable. The most common sites of metastasis in the head and neck region are the supraclavicular nodes and the brain. Cervical lymph node metastasis as the presenting symptom of malignant thymoma has not yet been reported in the otolaryngologic literature. We present three cases of metastatic thymoma to the neck from a series of 28 thymomas, ten of which were malignant. The clinical presentation, histopathological features, therapy, and prognosis of malignant thymomas are discussed.     

Metastatic carcinoma in the neck: a clinical,radiological, scintigraphic and pathological study

Metastatic carcinoma in the neck: a clinical, radiological, scintigraphic and pathological study This study was undertaken to compare clinical evaluation of the neck with ^99mTc(v) DMSA planar scintigraphy and computerized tomography (CT) in patients with head and neck carcinoma. Twenty-six patients were studied and in all but one the neck was previously untreated. A total of 31 neck dissections were performed and the specimens examined histopathologically. CT was approximately as accurate (71%) as clinical examination (68%) and more accurate than ^99mTc(v) DMSA planar scintigraphy (48%) in predicting which necks contained metastatic carcinoma. Overall, 13% of necks had their staging correctly changed by ^99mTcCv) DMSA scintigraphy compared with 10% for CT. Although scintigraphy upstaged 13% of clinically N₀ necks compared to 6% for CT, it was less sensitive and specific than either clinical examination or CT. Tc(v) DMSA planar scintigraphy has no role to play in the investigation of patients with metastatic carcinoma to include the clinically N₀ neck.     

Metastatic carcinoma in the neck: a clinical, radiological, scintigraphic and pathological study.

This study was undertaken to compare clinical evaluation of the neck with 99mTc(v) DMSA planar scintigraphy and computerized tomography (CT) in patients with head and neck carcinoma. Twenty-six patients were studied and in all but one the neck was previously untreated. A total of 31 neck dissections were performed and the specimens examined histopathologically. CT was approximately as accurate (71%) as clinical examination (68%) and more accurate than 99mTc(v) DMSA planar scintigraphy (48%) in predicting which necks contained metastatic carcinoma. Overall, 13% of necks had their staging correctly changed by 99mTc(v) DMSA scintigraphy compared with 10% for CT. Although scintigraphy upstaged 13% of clinically N0 necks compared to 6% for CT, it was less sensitive and specific than either clinical examination or CT. 99mTc(v) DMSA planar scintigraphy has no role to play in the investigation of patients with metastatic carcinoma to include the clinically N0 neck.     

Metastatic carcinoma to the temporal bone

We present a case report of a woman with adenocarcinoma of the breast and metastasis to the temporal bone. The diagnosis of metastasis to the temporal bone may be difficult to make, for the symptoms and findings may mimic those of chronic infection. A high-resolution computed tomography scan is mandatory for complete investigation.     

Metastatic sweat gland carcinoma

Only 48 cases of metastatic sweat gland carcinoma have been published. Our case report is of an elderly lady with a sweat gland carcinoma of the scalp with metastatic disease in the neck. She was treated with radical neck dissection and wide local excision. Follow-up of three years has revealed no recurrence. The most common location of sweat gland carcinoma is on the scalp. The diagnosis of malignant non-metastatic sweat gland carcinoma is difficult because there are no definite histologic criteria for diagnosing these tumors. Of the tumors that metastasize, most involve the regional lymph nodes. The differentiation between apocrine and eccrine metastatic sweat gland carcinoma is quite difficult and the criteria are not adequate to be of practical use. Sweat gland tumors may remain the same size for many years and then show a rapid period of growth followed by metastasis. Most metastases are in the regional lymph nodes, however, systemic disease does occur. Wide local excision of the primary tumor with resection of the involved regional lymph nodes is the recommended initial treatment. Prognosis of metastatic sweat gland carcinoma is poor although a few cases may have rather long survivals.     

Metastatic basal cell carcinoma

Objective

The purpose of this study is to review our series of metastatic basal cell carcinomas of the head and neck.

Study Design

A retrospective review was conducted for this study.

Methods

All cases of documented metastatic basal cell carcinomas arising from a primary within the head and neck region and presenting for treatment to one of the authors (Y.D.) were included in this review.

Results

Nine patients were available for review. Five patients had extension to but not transgression of the base of skull. Sites for metastatic disease included 4 lungs and 5 parotid glands. All metastatic lesions were treated with surgical excision, and 6 also received postoperative radiation therapy. No patient deaths from disease have been noted at an average follow-up of 4.7 years (range, 3-8.5 years). No evidence of further metastatic disease has been noted in any of these patients on follow-up.

Conclusions

Metastatic basal cell carcinoma arising from a head and neck primary is a rare entity. However, initial involvement of the skull base and/or dura by a basal cell carcinoma appears to warrant a complete metastatic workup and metastatic surveillance. When metastatic disease is discovered, it appears to be well treated by surgical resection with/without adjunctive radiation therapy. We do not favor chemotherapy for resectable basal cell carcinomas.     

Metastatic squamous cell carcinoma of the lip

Squamous cell carcinoma of the lip is a common lesion that is not always acknowledged as a potentially lethal disease. We reviewed the cases of 27 patients with metastatic squamous cell carcinoma of the lip. Our data confirm that patients in an older age group are at greater risk for development of metastases than the general population of patients with squamous cell carcinoma of the lip. We also found a universally grave prognosis for patients who exhibit fixation of tumor to the mandible or erosion of the mandible. We were unable to confirm a greater risk for development of metastases among more advanced (T3 and T4) lesions. A number of our patients had T1 and T2 primary lesions. We also could not establish a relationship between a patient's delay before seeking medical assistance and subsequent development of metastases.