Squamous cell carcinoma (SCC) of the Pyriform sinus with multiple metachronous brain metastases, a case report
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CASE REPORT
Open Access
Squamous cell carcinoma (SCC) of the Pyriform sinus with multiple metachronous brain metastases, a case report Agostino Cristaudo1* , Antonio Stefanelli1, Stefano Ursino2, Durim Delishaj3, Davide Baldaccini2, Alessandra Gonnelli2 and Fabiola Paiar2
Abstract Background: Distant Metastases from Head and Neck Squamous cell carcinomas are uncommon (9–11%) and they are usually found in the lung and less frequently in the liver, kidney and adrenals. Central nervous system (CNS) metastases are extremely rare (2–8%), and they are described mainly in patients who already have extracranial metastases. So there’s scarcity of data about their optimal management . Methods and results: A patient presented CNS metastases after having been successfully treated with induction chemotherapy and definitive radiotherapy for a pyriform sinus carcinoma. The patient’s work up, treatment and outcome are described. Conclusions: CNS metastases from Head and Neck carcinomas are exceptionally rare. Nevertheless, clinicians should be alert of neurological symptoms in these patients, in order to set up a timely assessment and treatment. Secondarily, given the rarity of this condition, additional research on this topic is warranted in order to improve therapeutic strategies and outcomes of such patients. Keywords: Head and neck carcinoma, Brain, Metastases, Radiotherapy
Main Text This is the case study of a 52 - year - old Caucasian woman with hypothyroidism, strong smoker (68 pack/ years) and with a history of heavy alcohol consumption and anxious-depressive syndrome. During routine follow up for hypothyroidism an enlarged neck node was found. A Fine Needle Aspiration Cytology (FNAC) was performed with the diagnosis of metastasis from squamous cell carcinoma. A Computed Tomography (CT) scan identified at least 3 right laterocervical lymphadenopathies and a thickening of the contiguous area of the hypopharynx and of the nasopharynx. A subsequent FluorodeoxyglucosePositron Emission Tomography/Computed Tomography (FDG-PET-CT) documented hypercaptation in the laterocervical lymphadenopathies and in the right laryngeal * Correspondence: [email protected]; [email protected] 1 Department of Radiotherapy, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro, 44124 Ferrara, Cona, Italy Full list of author information is available at the end of the article
ventricle, showing no hypercaptation in the nasopharynx. An esophagogastroscopy didn’t show any suspicious finding, while an otolaryngology consult documented a neoplastic lesion in the right pyriform synus, which underwent biopsy resulting a Grade 2 squamous cell carcinoma. The nasopharynx was negative. The proposed clinical stage was cT2 cN2b. The patient therefore underwent 3 cycles of neoadjuvant chemotherapy (Docetaxel, Cisplatin and 5-Fluorouracil, TPF) and then she was treated with definitive RT. A dose of 54 Gy in 2 Gy fractions was administered to the laterocervical nodes (Levels from II to V, bilaterally), while the tumor in the right pyriform
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