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Lung squamous cell carcinoma metastasizing to the nasopharynx following bronchoscopy intervention therapies: a case report.

Hu JB, Jin M, Chen EG, Sun XN - World J Surg Oncol (2014)

Bottom Line: The lesion was considered metastatic from lung cancer on the basis of clinical and histological clues.The exact mechanism of lung cancer metastasis to the nasopharynx in this case remains unclear because either implantation or hematogenous and lymphatic spread is possible.The early detection of a silent nasopharyngeal metastasis is important to choosing from among the multiple treatment options available.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiation Oncology, Sir Run Run Shaw Hospital of Zhejiang University Medical School, No, 3 Qingchun East Road, 310016 Hangzhou, Zhejiang Province, China. sunxiaonan@hotmail.com.

ABSTRACT
Metastatic carcinoma to the nasopharynx is extremely rare, and few cases have been reported in the literature. In the present report, we describe the case of a patient with a mass in the nasopharynx found by bronchoscopy. Our patient was a 61-year-old man receiving multiple bronchoscopy intervention therapies for advanced lung squamous cell carcinoma (SCC), which was histopathologically confirmed. The SCC metastasized to the nasopharynx following the bronchoscopy intervention therapies. The lesion was considered metastatic from lung cancer on the basis of clinical and histological clues. The exact mechanism of lung cancer metastasis to the nasopharynx in this case remains unclear because either implantation or hematogenous and lymphatic spread is possible. A thorough head and neck examination should be undertaken during bronchoscopic evaluation, especially in patients receiving bronchoscopy intervention therapies. The early detection of a silent nasopharyngeal metastasis is important to choosing from among the multiple treatment options available.

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Histopathological specimen images. Nasopharynx specimen (A) showing squamous cell carcinoma with morphology similar to that of the primary lesion of the trachea (B).
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Figure 3: Histopathological specimen images. Nasopharynx specimen (A) showing squamous cell carcinoma with morphology similar to that of the primary lesion of the trachea (B).

Mentions: A 61-year-old man who was a heavy cigarette smokerpresented to our department with a mass in the nasopharynx found by bronchoscopy. He had been diagnosed with SCC of the left lower lung by bronchoscopic biopsy 2 years earlier. He was staged with T4N0M0 disease after systemic evaluation at that time. Thereafter he received a presumed curative left pneumonectomy, which revealed moderately differentiated SCC with no lymph node metastases and a clear bronchial resection margin. He was given four cycles of adjuvant chemotherapy with regular doses of gemcitabine and cisplatin. His disease had remained stable for 1 year until 6 months before his presentation to our hospital.We founda recurrent mass in the end of his trachea by chest computed tomography and bronchoscopy (Figure 1), and, on the basis of a bronchoscopic biopsy, we confirmed the mass to be a well- to moderately differentiated SCC. To alleviate the patient’s symptoms of respiratory obstruction, tumor removal was carried out through bronchoscopy intervention therapies, including argon knife, electric snare, cryotherapy and hot biopsy forceps. His symptoms were relieved after these procedures. However, his symptoms recurred 1.5 months later. A similar mass was found again in the end of the trachea, with the same pathological result confirmed by biopsy. The second-course tumor removal through bronchoscopy intervention therapy was carried out, followed by one course of conformal external beam radiation to the tumor bed at a dose of 6,600 cGy in 33 fractions. Three months after the completion of radiotherapy, a cauliflower-like mass in the torus tubarius of the nasopharynx was found during a routine follow-up bronchoscopic evaluation. Biopsy of the nasopharyngeal mass confirmed it to be SCC. The patient was referred to our department for further evaluation. Serum tests of antibodies to Epstein-Barr virus (EBV) were negative. Magnetic resonance imaging revealed a solitary mass in the torus tubarius of the nasopharynx without paranasopharyngeal space involvement (Figure 2). Owing to the patient’s advanced disease and poor general condition, palliative removal of the lesion in the nasopharynx was carried out through bronchoscopy intervention therapy. Histopathological examinationof hematoxylin and eosin–stained sections of the nasopharyngeal lesion revealed typical SCC composed of large, eosinophilic cells with distinct cell borders, keratinization and the formation of small horn pearls. The histopathological morphology of the nasopharyngeal lesion was similar to that of the primary tumor of the trachea (Figure 3). To identify the origin of the lesions, samples of nasopharyngeal and tracheal masses were analyzed for EBV infection status by the technique of EBV-encoded RNA in situ hybridization (EBER-ISH). EBER-ISH tests of both lesionswere negative. The patient received an additional five cycles of chemotherapy with regular doses of taxotere and cisplatin. He remained disease-free at his 6-month follow-up examination.


Lung squamous cell carcinoma metastasizing to the nasopharynx following bronchoscopy intervention therapies: a case report.

Hu JB, Jin M, Chen EG, Sun XN - World J Surg Oncol (2014)

Histopathological specimen images. Nasopharynx specimen (A) showing squamous cell carcinoma with morphology similar to that of the primary lesion of the trachea (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4230632&req=5

Figure 3: Histopathological specimen images. Nasopharynx specimen (A) showing squamous cell carcinoma with morphology similar to that of the primary lesion of the trachea (B).
Mentions: A 61-year-old man who was a heavy cigarette smokerpresented to our department with a mass in the nasopharynx found by bronchoscopy. He had been diagnosed with SCC of the left lower lung by bronchoscopic biopsy 2 years earlier. He was staged with T4N0M0 disease after systemic evaluation at that time. Thereafter he received a presumed curative left pneumonectomy, which revealed moderately differentiated SCC with no lymph node metastases and a clear bronchial resection margin. He was given four cycles of adjuvant chemotherapy with regular doses of gemcitabine and cisplatin. His disease had remained stable for 1 year until 6 months before his presentation to our hospital.We founda recurrent mass in the end of his trachea by chest computed tomography and bronchoscopy (Figure 1), and, on the basis of a bronchoscopic biopsy, we confirmed the mass to be a well- to moderately differentiated SCC. To alleviate the patient’s symptoms of respiratory obstruction, tumor removal was carried out through bronchoscopy intervention therapies, including argon knife, electric snare, cryotherapy and hot biopsy forceps. His symptoms were relieved after these procedures. However, his symptoms recurred 1.5 months later. A similar mass was found again in the end of the trachea, with the same pathological result confirmed by biopsy. The second-course tumor removal through bronchoscopy intervention therapy was carried out, followed by one course of conformal external beam radiation to the tumor bed at a dose of 6,600 cGy in 33 fractions. Three months after the completion of radiotherapy, a cauliflower-like mass in the torus tubarius of the nasopharynx was found during a routine follow-up bronchoscopic evaluation. Biopsy of the nasopharyngeal mass confirmed it to be SCC. The patient was referred to our department for further evaluation. Serum tests of antibodies to Epstein-Barr virus (EBV) were negative. Magnetic resonance imaging revealed a solitary mass in the torus tubarius of the nasopharynx without paranasopharyngeal space involvement (Figure 2). Owing to the patient’s advanced disease and poor general condition, palliative removal of the lesion in the nasopharynx was carried out through bronchoscopy intervention therapy. Histopathological examinationof hematoxylin and eosin–stained sections of the nasopharyngeal lesion revealed typical SCC composed of large, eosinophilic cells with distinct cell borders, keratinization and the formation of small horn pearls. The histopathological morphology of the nasopharyngeal lesion was similar to that of the primary tumor of the trachea (Figure 3). To identify the origin of the lesions, samples of nasopharyngeal and tracheal masses were analyzed for EBV infection status by the technique of EBV-encoded RNA in situ hybridization (EBER-ISH). EBER-ISH tests of both lesionswere negative. The patient received an additional five cycles of chemotherapy with regular doses of taxotere and cisplatin. He remained disease-free at his 6-month follow-up examination.

Bottom Line: The lesion was considered metastatic from lung cancer on the basis of clinical and histological clues.The exact mechanism of lung cancer metastasis to the nasopharynx in this case remains unclear because either implantation or hematogenous and lymphatic spread is possible.The early detection of a silent nasopharyngeal metastasis is important to choosing from among the multiple treatment options available.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiation Oncology, Sir Run Run Shaw Hospital of Zhejiang University Medical School, No, 3 Qingchun East Road, 310016 Hangzhou, Zhejiang Province, China. sunxiaonan@hotmail.com.

ABSTRACT
Metastatic carcinoma to the nasopharynx is extremely rare, and few cases have been reported in the literature. In the present report, we describe the case of a patient with a mass in the nasopharynx found by bronchoscopy. Our patient was a 61-year-old man receiving multiple bronchoscopy intervention therapies for advanced lung squamous cell carcinoma (SCC), which was histopathologically confirmed. The SCC metastasized to the nasopharynx following the bronchoscopy intervention therapies. The lesion was considered metastatic from lung cancer on the basis of clinical and histological clues. The exact mechanism of lung cancer metastasis to the nasopharynx in this case remains unclear because either implantation or hematogenous and lymphatic spread is possible. A thorough head and neck examination should be undertaken during bronchoscopic evaluation, especially in patients receiving bronchoscopy intervention therapies. The early detection of a silent nasopharyngeal metastasis is important to choosing from among the multiple treatment options available.

Show MeSH
Related in: MedlinePlus