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Carcinoma of buccal mucosa with metastasis to thigh
Oral Oncology xxx (2016) xxx–xxx
Contents lists available at ScienceDirect
Oral Oncology journal homepage: www.elsevier.com/locate/oraloncology
Letter to the editor Carcinoma of buccal mucosa with metastasis to thigh
Dear Editor, Squamous cell carcinoma of the oral cavity ranks as the twelfth most common cancer in the world and the eighth most frequent in males. In USA, cancers of oral cavity comprises approximately 3% of all cancers, the most common sub site for oral cavity carcinomas being the tongue followed by floor of mouth among all Head and Neck squamous cell carcinoma (HNSCC). Buccal mucosa is the most common oral cancer in men and the third most common oral cancer in women in India; and accounts for up to one-third of all tobacco-related cancers. This higher rate of buccal mucosa involvement in India is likely related to the widespread practice of betel nut chewing, in addition to tobacco and alcohol. Other suspected etiologic agents include human papilloma virus, poor oral hygiene and chronic irritation [1]. Head and neck malignancy most commonly metastasize to the regional lymph node. Common sites of distant metastasis are lung, mediastinal lymph node, bone and liver. Primary buccal mucosa malignancies rarely metastasize to distant sites [2]. Case report
Fig. 1. Intraoral postoperative photograph.
A 29 year man was reported at our department with complain of nodule in the medial aspect of right thigh since 15 days which is slowly increasing in size and he gives history of carcinoma right buccal mucosa, which was treated with right modified radical neck dissection, segmental mandibulectomy, wide local excision of buccal mucosa and reconstruction with pectoralis major myocutaneous flap. Histological findings confirmed squamous cell carcinoma of the right buccal mucosa and multiple nodal metastases without extra capsular spread therefore adjuvant radiotherapy was given one and half year back. Patient was put on follow-up and was locally control of disease on primary site (Fig. 1). In last follow-up 3 4 cm nodule palpated in the medial aspect of right thigh (Fig 2). Computed tomography (CT) scan demonstrated (Fig. 3) the presence of metastatic lesion to the right medial part of the thigh. True cut biopsy was done to confirm diagnosis and which came to be metastatic squamous cell carcinoma. PET scan was advised to patient but due to financial constraints and non availability in this region it could not be done however CT and USG were done to rule out metastasis in other region. Discussion Newer surgical techniques and an improved understanding of HNSCC have improved the control of cancer but overall survival rate has not improved significantly [3]. The occurrence of http://dx.doi.org/10.1016/j.oraloncology.2016.12.024 1368-8375/Ó 2016 Elsevier Ltd. All rights reserved.
Fig. 2. Metastasis lesion on medial aspect of thigh.
2
Letter to the editor / Oral Oncology xxx (2016) xxx–xxx
Funding source None Conflict of interest The authors have no conflict of interest to declare. References
Fig. 3. Axial computed tomography scan shows metastasis lesion medial aspect of thigh.
metastases is correlated with the stage of the primary tumor, the nodal involvement at diagnosis, and the development of relapse on the primary site. In fact, patients with clinically palpable neck disease (N1–N3), histological evidence of metastatic nodal disease, extra capsular spread, and three or more positive lymph nodes are at greater risk of developing failure at distant sites [4]. Primary tumors of HNSCC with advanced disease have been reported to metastasize most frequently to the lung (66%) bone (22%), liver (10%), skin, mediastinum, and bone marrow [5]. Previous studies showed that bone is the second common site of distant spread, with reported frequencies ranging from 17% to 31%, but in case of loco regional control, the incidence decreases to 12%, due to low frequency of bone metastases and the high percentage of equivocal findings, bone scintigraphy is not routinely performed for staging HNSCC, and screening for distant metastases at sites other than the lungs is usually not recommended [6]. Loco regional control and survival rates may be greater with surgical excision with post-operative concurrent chemotherapy and radiation than with treatment with either modality alone [7]. Distant metastases are uncommon in buccal carcinoma. Pichi et al. reported carcinoma of the buccal mucosa metastasizing to the Talus [8]. Study conducted by Mathew et al. in which they had reported that distant metastasis to bones from buccal mucosa is extremely rare and were they could find only one report [9]. Bhandari in his study reported that in the last five years, there center diagnosed four cases of squamous cell carcinoma of the buccal mucosa which had metastasized to bones [10].
[1] Suhag Maj Virendra et al. Carcinoma buccal mucosa with metastasis to left adrenal. MIAn 2011;67(1). [2] Bhandari Virendra. Incidence of bone metastasis in squamous cell carcinoma of the buccal mucosa. J Cancer Meta Treat 2015;1(1). [3] Ferlito A, Shaha AR, Silver CE, Rinaldo A, Mondin V. Incidence and sites of distant metastases from head and neck cancer. ORL J Otorhinolaryngol Relat Spec 2001;63:202–7. [4] Pichi B, Marchesi P, Manciocco V, Ruscito P, Pellini R, Cristalli G, et al. Carcinoma of the buccal mucosa metastasizing to the talus. Journal of Craniofacial Surgery 2009;20(4):1142–5. doi: http://dx.doi.org/10.1097/ SCS.0b013e3181abb469. [5] Alvi A, Jhonson JT. Development of distant metastasis after treatment of advanced-stage head and neck cancer. Head Neck 1997;19:500–5. [6] Basu D, Siegel BA, Mc Donald DJ, et al. Detection of occult bone metastases from head and neck squamous cell carcinoma. Arch Otolaryngol Head Neck Surg 2007;133:801Y805. [7] Lin D, Bucci MK, Eisele DW, Wang SI. Squamous cell carcinoma of the buccal mucosa: a retrospective anaIyais of 22 cases. Ear, NOlIe Throat J 2008;87:582–6. [8] Manon RR, Myers lN, Khuntia D, Harari PM. Oral cavity cancer. In: Wazer DE, Freeman C, Prosnitz LR, editors. Perez and Brady’s principles and practice of radiation oncology. CD: Lippincott Williams & Wilkins; 2008. p. 891–912. [9] Mathew BS, Jayasree K, Madhavan J, Nair MK, Rajan B. Skeletal metastases and bone marrow infiltration from squamous cell carcinoma of the buccal mucosa. Oral Oncol 1997;33:454–5. [10] Kotwall C, Sako K, Razack MS, Rao U, Bakamjian V, Shedd DP. Metastatic patterns in squamous cell cancer of the head and neck. Am J Surg 1987;154:439–42.
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Gunjan Agrawal Ashutosh Gupta Vivek Chaudhary Regional Cancer Center, PTJNM Medical College, Raipur, Chhattisgarh 492001, India ⇑ Corresponding author. E-mail addresses: [email protected] (G. Agrawal), [email protected] (A. Gupta), [email protected] (V. Chaudhary) Available online xxxx
Contents lists available at ScienceDirect
Oral Oncology journal homepage: www.elsevier.com/locate/oraloncology
Letter to the editor Carcinoma of buccal mucosa with metastasis to thigh
Dear Editor, Squamous cell carcinoma of the oral cavity ranks as the twelfth most common cancer in the world and the eighth most frequent in males. In USA, cancers of oral cavity comprises approximately 3% of all cancers, the most common sub site for oral cavity carcinomas being the tongue followed by floor of mouth among all Head and Neck squamous cell carcinoma (HNSCC). Buccal mucosa is the most common oral cancer in men and the third most common oral cancer in women in India; and accounts for up to one-third of all tobacco-related cancers. This higher rate of buccal mucosa involvement in India is likely related to the widespread practice of betel nut chewing, in addition to tobacco and alcohol. Other suspected etiologic agents include human papilloma virus, poor oral hygiene and chronic irritation [1]. Head and neck malignancy most commonly metastasize to the regional lymph node. Common sites of distant metastasis are lung, mediastinal lymph node, bone and liver. Primary buccal mucosa malignancies rarely metastasize to distant sites [2]. Case report
Fig. 1. Intraoral postoperative photograph.
A 29 year man was reported at our department with complain of nodule in the medial aspect of right thigh since 15 days which is slowly increasing in size and he gives history of carcinoma right buccal mucosa, which was treated with right modified radical neck dissection, segmental mandibulectomy, wide local excision of buccal mucosa and reconstruction with pectoralis major myocutaneous flap. Histological findings confirmed squamous cell carcinoma of the right buccal mucosa and multiple nodal metastases without extra capsular spread therefore adjuvant radiotherapy was given one and half year back. Patient was put on follow-up and was locally control of disease on primary site (Fig. 1). In last follow-up 3 4 cm nodule palpated in the medial aspect of right thigh (Fig 2). Computed tomography (CT) scan demonstrated (Fig. 3) the presence of metastatic lesion to the right medial part of the thigh. True cut biopsy was done to confirm diagnosis and which came to be metastatic squamous cell carcinoma. PET scan was advised to patient but due to financial constraints and non availability in this region it could not be done however CT and USG were done to rule out metastasis in other region. Discussion Newer surgical techniques and an improved understanding of HNSCC have improved the control of cancer but overall survival rate has not improved significantly [3]. The occurrence of http://dx.doi.org/10.1016/j.oraloncology.2016.12.024 1368-8375/Ó 2016 Elsevier Ltd. All rights reserved.
Fig. 2. Metastasis lesion on medial aspect of thigh.
2
Letter to the editor / Oral Oncology xxx (2016) xxx–xxx
Funding source None Conflict of interest The authors have no conflict of interest to declare. References
Fig. 3. Axial computed tomography scan shows metastasis lesion medial aspect of thigh.
metastases is correlated with the stage of the primary tumor, the nodal involvement at diagnosis, and the development of relapse on the primary site. In fact, patients with clinically palpable neck disease (N1–N3), histological evidence of metastatic nodal disease, extra capsular spread, and three or more positive lymph nodes are at greater risk of developing failure at distant sites [4]. Primary tumors of HNSCC with advanced disease have been reported to metastasize most frequently to the lung (66%) bone (22%), liver (10%), skin, mediastinum, and bone marrow [5]. Previous studies showed that bone is the second common site of distant spread, with reported frequencies ranging from 17% to 31%, but in case of loco regional control, the incidence decreases to 12%, due to low frequency of bone metastases and the high percentage of equivocal findings, bone scintigraphy is not routinely performed for staging HNSCC, and screening for distant metastases at sites other than the lungs is usually not recommended [6]. Loco regional control and survival rates may be greater with surgical excision with post-operative concurrent chemotherapy and radiation than with treatment with either modality alone [7]. Distant metastases are uncommon in buccal carcinoma. Pichi et al. reported carcinoma of the buccal mucosa metastasizing to the Talus [8]. Study conducted by Mathew et al. in which they had reported that distant metastasis to bones from buccal mucosa is extremely rare and were they could find only one report [9]. Bhandari in his study reported that in the last five years, there center diagnosed four cases of squamous cell carcinoma of the buccal mucosa which had metastasized to bones [10].
[1] Suhag Maj Virendra et al. Carcinoma buccal mucosa with metastasis to left adrenal. MIAn 2011;67(1). [2] Bhandari Virendra. Incidence of bone metastasis in squamous cell carcinoma of the buccal mucosa. J Cancer Meta Treat 2015;1(1). [3] Ferlito A, Shaha AR, Silver CE, Rinaldo A, Mondin V. Incidence and sites of distant metastases from head and neck cancer. ORL J Otorhinolaryngol Relat Spec 2001;63:202–7. [4] Pichi B, Marchesi P, Manciocco V, Ruscito P, Pellini R, Cristalli G, et al. Carcinoma of the buccal mucosa metastasizing to the talus. Journal of Craniofacial Surgery 2009;20(4):1142–5. doi: http://dx.doi.org/10.1097/ SCS.0b013e3181abb469. [5] Alvi A, Jhonson JT. Development of distant metastasis after treatment of advanced-stage head and neck cancer. Head Neck 1997;19:500–5. [6] Basu D, Siegel BA, Mc Donald DJ, et al. Detection of occult bone metastases from head and neck squamous cell carcinoma. Arch Otolaryngol Head Neck Surg 2007;133:801Y805. [7] Lin D, Bucci MK, Eisele DW, Wang SI. Squamous cell carcinoma of the buccal mucosa: a retrospective anaIyais of 22 cases. Ear, NOlIe Throat J 2008;87:582–6. [8] Manon RR, Myers lN, Khuntia D, Harari PM. Oral cavity cancer. In: Wazer DE, Freeman C, Prosnitz LR, editors. Perez and Brady’s principles and practice of radiation oncology. CD: Lippincott Williams & Wilkins; 2008. p. 891–912. [9] Mathew BS, Jayasree K, Madhavan J, Nair MK, Rajan B. Skeletal metastases and bone marrow infiltration from squamous cell carcinoma of the buccal mucosa. Oral Oncol 1997;33:454–5. [10] Kotwall C, Sako K, Razack MS, Rao U, Bakamjian V, Shedd DP. Metastatic patterns in squamous cell cancer of the head and neck. Am J Surg 1987;154:439–42.
⇑
Gunjan Agrawal Ashutosh Gupta Vivek Chaudhary Regional Cancer Center, PTJNM Medical College, Raipur, Chhattisgarh 492001, India ⇑ Corresponding author. E-mail addresses: [email protected] (G. Agrawal), [email protected] (A. Gupta), [email protected] (V. Chaudhary) Available online xxxx