Metastatic melanoma to the palatine tonsil with a favourable prognosis

Urothelial carcinoma with tonsillar metastasis in a dog

Given its unusual lymphatic drainage system, the tonsil is a rare site of metastasis, with few reports in the human and veterinary literature. Prognosis in cases of tonsillar metastasis is reportedly poor. We describe here a unique case of urinary bladder urothelial carcinoma (UC) with metastasis to the tonsil in an 11-y-old, spayed female, mixed-breed dog. At presentation, the patient had a history of a growing neck mass and increasing lethargy, hyporexia, weight loss, drooling, and diarrhea for 2 wk. A carcinoma was diagnosed by cytology. Given the poor prognosis, the patient was euthanized. Postmortem examination revealed masses in the inguinal region, cranioventral neck region including tonsil, and urinary bladder. Histologically, the masses were composed of large polyhedral cells arranged in dense sheets and nests with occasional large, clear, intracytoplasmic vacuoles. Neoplastic cells were multifocally positive for uroplakin III and cytokeratin 8/18 by immunohistochemistry. UC with metastasis to tonsil and lymph nodes was diagnosed.

Canine tonsillar neoplasia and tonsillar metastasis from various primary neoplasms

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.

Delayed Metastatic Melanoma to the Pharyngeal Tonsil in an African American Female

Background: Metastatic melanoma to the mucosa of the upper aerodigestive tract is extremely rare, accounting for <0.6% of known metastasis to the head and neck region. We present a case of delayed metastatic melanoma to the pharyngeal tonsil. Case Report: A 57-year-old African American female presented for evaluation of a rapidly enlarging unilateral tonsil mass. Three years prior to presentation, she had undergone primary resection of and systemic therapy for cutaneous melanoma on the sole of her right foot. Tonsillectomy confirmed the diagnosis of metastatic melanoma. Because of the poor prognosis of the disease, the patient was referred for palliative chemotherapy but died shortly after beginning treatment. Conclusion: Metastatic melanoma is a rare disease in African Americans, and the presence of metastatic lesions is a significant prognostic indicator for long-term patient survival. Meticulous head and neck examinations should be performed during the follow-up period, and any pigmented lesion should have a high suspicion for metastasis in any patient with a history of cutaneous melanoma.

Cutaneous Melanoma with Tonsillar Metastasis

Metastases to the tonsillar fossa due to hematogenous dissemination is an extremely rare phenomenon associated with advanced-stage disease and poor prognosis. In the present report we describe a case of cutaneous melanoma with a metastasis to the tonsil approximately 4 years after the initial diagnosis of the primary disease treated with palliative radiation therapy.

Metastasis to the oral soft tissues: A review of 412 cases

The present review article analyzes the characteristics of metastases to the oral soft tissues from 1937 to 2015. An extensive literature search was performed. All variables such as age, gender, and primary and secondary tumor sites were analyzed. Metastases to the major salivary glands were not included in this review. In general, there were 412 metastatic lesions developed in the oral soft tissues. The male-to-female ratio was approximately 1.8:1. The mean age of the patients at diagnosis was 58. The lung was the most common primary site and the gingiva was the most common metastatic site. The greater part of the histological examination yielded adenocarcinoma. The diagnosis of a metastatic lesion in the oral cavity is a challenge to the clinicians due to the lack of pathognomonic signs and symptoms. Oral metastases usually occur in the advanced stages of cancers, and the interval between appearance and death is usually short. The oral soft tissue metastasis can be easily recognized compared to the metastasis of jawbones. Early detection of oral lesions is important in the case of being the first sign of a malignancy in other parts of body.

A case of rectal adenocarcinoma presented with palatine tonsil metastasis

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.

Metastatic melanoma to the upper aerodigestive tract: a systematic review of the literature

This study is a systematic review of the literature that was performed to clarify the natural history and treatment outcomes of upper aerodigestive tract metastases from cutaneous melanoma. A search of the MEDLINE database was undertaken from 1950 to 2013 to identify relevant manuscripts for this review. Article inclusion required cases with documentation of previous cutaneous melanoma primary lesions, adequate survival data, and description of metastatic treatment. Individual patient data were extracted from source articles for analysis of survival outcomes. A systematic search revealed 34 relevant articles with 37 cases for inclusion. Metastases were identified throughout the upper aerodigestive tract with a predilection for the oropharynx, larynx, and oral cavity. Treatment outcomes were estimated with the Kaplan-Meier method, with survival of 37% and 16% at 1 and 5 years, respectively. As expected from previous reports, 73% presented with disseminated disease burden with almost universally poor prognosis despite locoregional or systemic therapy. Conversely, a group of patients with limited metastatic burden had improved treatment response with a 1-year survival of 90%, denoting a hazard ratio of 9.7332 (95% confidence interval, 4.5-21.1) for disseminated disease in comparison. Upper aerodigestive tract metastases of melanoma thus are rare clinical entities that in general present in the setting of disseminated disease and evidently necessitate a focus on palliation. In contrast, for those with a limited metastatic burden, aggressive multimodality therapy including complete metastectomy can produce a significant survival advantage.

Tonsilar metastases of melanoma in an older person

We presented a rare case of metastasis of melanoma in palatine tonsils alerting healthcare professionals to this diagnose in black oral lesions.

Tonsil metastasis from cutaneous melanoma: first clinical sign of recurrence after complete lymph node dissection

BACKGROUND

The development of melanoma metastasis to the palatine tonsil is a very rare event, generally associated with advanced-stage disease and poor prognosis.

CASE PRESENTATION

A 29-year-old man presented with a melanoma metastasis to the right palatine tonsil 6 months after the surgical excision of an ulcerated nodular melanoma (tumor thickness 1.8 mm, Clark level IV) on the left shoulder. A metastatic sentinel lymph node had been removed from the left axilla, and a subsequent complete lymph node dissection had disclosed no further metastatic lymph nodes. Although staging tests had revealed multiple visceral metastases, a palliative tonsillectomy was performed. The patient died of metastases 5 months later.

CONCLUSION

The case presentation suggests that careful examination of the head and neck should be part of the routine follow-up visit in all melanoma patients.

Metastatic tumors to the oral and maxillofacial region: a retrospective study of 19 cases in West China and review of the Chinese and English literature

PURPOSE

The aim of this article was to obtain an overview of metastatic tumors to the oral and maxillofacial (OMF) region, especially the differences in the constituent ratios of primary cancers between the United States and China.

PATIENTS AND METHODS

Clinical findings of 19 cases encountered in West China Hospital of Stomatology were summarized and the English and Chinese literature were reviewed and analyzed. The main clinical features of OMF metastases were summarized, with an emphasis on primary cancers' constituents.

RESULTS

The lung, breast, kidney, liver, and prostate were the top 5 common primary sites of cancer. However, there was a significant difference in the primary cancers' constituents between United States and China (P < .001). The breast, kidney, prostate cancers, and melanoma of skin were more frequent primary cancers in United States than in China, whereas that of the lung, thyroid, liver, esophagus, and the stomach were more common in China than in United States. The proportions of the OMF metastatic lesions originating in the lung, kidney, liver, thyroid, and esophagus in all OMF metastatic tumors were higher than the corresponding primary cancers' prevalent proportions.

CONCLUSIONS

The frequency of developing OMF metastasis is not always consistent with primary cancers' prevalence, which suggests that different cancers have different potentiality to develop OMF metastasis. Cancers of the kidney, liver, lung, thyroid, and esophagus were more likely to spread to the OMF region. In general screening of primary cancer, it would be helpful to take into account the metastatic potentiality of different cancers and primary cancers' prevalence in different countries in the case of occult primary.

Metastatic tumours to the oral cavity - pathogenesis and analysis of 673 cases

The oral region is an uncommon site for metastatic tumour cell colonization and is usually evidence of a wide spread disease. In 25% of cases, oral metastases were found to be the first sign of the metastatic spread and in 23% it was the first indication of an undiscovered malignancy at a distant site. The jawbones, particularly the mandible, were more frequently affected than the oral soft tissues (2:1). In the oral soft tissues, the attached gingiva was the most commonly affected site (54%). The major primary sites presenting oral metastases were the lung, kidney, liver, and prostate for men, breast, female genital organs (FGO), kidney, and colo-rectum for women. The primary site differs according to oral site colonization, in men the lung was the most common primary site affecting both the jawbones and oral mucosa (22% and 31.3%, respectively) followed by the prostate gland in the jawbones (11%) and kidney in the oral soft tissues (14%). In women, the breast was the most common primary tumour affecting the jawbones and soft tissues (41% and 24.3%, respectively), followed by the adrenal and female genital organs (FGO) in the jawbones (7.7%) and FGO in the soft tissues (14.8%). The clinical presentation of the metastatic lesions differ between the various sites in the oral region. In the jawbones most patients complain of swelling, pain and paresthesia which developed in a relative short period. Early manifestation of the gingival metastases resembled a hyperplastic or reactive lesion, such as pyogenic granuloma, peripheral giant cell granuloma, or fibrous epulis. Because of its rarity, the diagnosis of a metastatic lesion in the oral region is challenging, both to the clinician and to the pathologist, in recognizing that a lesion is metastatic and in determining the site of origin. The clinical presentation of a metastatic lesion in the oral cavity can be deceiving leading to a misdiagnosis of a benign process, therefore, in any case where the clinical presentation is unusual especially in patients with a known malignant disease a biopsy is mandatory.

[Metastasis in the palatine tonsil as the first sign of a gastric adenocarcinoma]

Gastric adenocarcinomas rarely give rise to metastases in the palatine tonsils; twelve such cases have been published. In two of them the tonsillar tumour was the first sign of the disease. We present a patient with a tumour of the palatine tonsil and cervical lymph node involvement who was diagnosed as having an adenocarcinoma of "signet ring" cells in the histopathology and cytology studies. Finding such cells directed us to the stomach in our search for the primary.

Tonsillar metastasis revealing signet-ring cell carcinoma of the rectum

A 45-year-old man presented with a tonsillar tumor and rectal syndrome. Histology specimens revealed signet-cell adenocarcinoma of both the tonsils and rectum. The clinical course was rapidly degenerated with multiple metastases in the skin and bones. Tonsil metastasis is rare and generally develops from primary gastric or colorectal cancer, predominantly poorly-differentiated or signet-ring cell adenocarcinomas.

Malignant tumors of the oral cavity and oropharynx: clinical, pathologic, and radiologic evaluation

Carcinomas of the oral cavity and oropharynx constitute approximately 2% to 5% of head and neck cancers. Alcohol abuse and tobacco chewing, including chewing Shamma, predispose individuals to the development of cancer in the oral cavity. CT and MR imaging are best suited in the evaluation of cancer of the oral cavity and oropharynx. CT in the axial and coronal planes with 3- to 5-mm sections is the primary modality and is best in the evaluation of bony erosion of the mandible and maxilla. Furthermore, lymph node metastases in the neck are optimally evaluated by contrast CT with 5-mm axial sections. MR imaging is preferred for soft tissue assessment because of the greater contrast resolution. It is therefore the first modality in the assessment of tongue carcinomas, oropharyngeal cancer, and tonsillar lesions. The MR examination should be performed with thin-section imaging, applying T1, T2, and T1-GD-DTPA in the axial and coronal planes, with sagittal sections added for paramidline lesions involving the tongue, lips, anterior floor of the mouth, subdivided according to anatomic locations. The local spread, lymph node metastases, prognosis, and therapeutic approaches vary with the location of the lesion represented by a carcinoma either squamous or undifferentiated in 90% of cases. Some malignant lesions may mimic a benign tumor, such as the adenoid cystic or mucoepidermoid carcinoma. Histopathologic diagnosis is therefore necessary for the final diagnosis before treatment by surgery or radiotherapy. PET scanning is indicated in the following instances: in search of an unknown primary tumor in patients who have a neck mass secondary to carcinoma, if a recurrent carcinoma may be present, when there are metastatic N0 lymph nodes in the neck, or where CT is inconclusive for metastatic lymph nodes in the neck.