Nasal-Tip Metastasis on 18F-FDG PET/CT Scan in a Patient With Squamous Lung Carcinoma

Clown Nose: A Rare Hypopharyngeal Cancer Metastasis

Cutaneous metastases from squamous cell carcinomas of the head and neck region are uncommon, and their location at the nasal tip is exceptionally rare. A patient, previously treated with surgery and chemoradiation for a hypopharyngeal squamous cell carcinoma, developed several red nodular skin lesions at the nasal tip. Biopsy revealed cutaneous metastasis from the primary tumor. This manifestation was previously described as a "clown nose," given their appearance and location. Skin lesions should raise suspicion of malignancy, despite their location at uncommon places, particularly in patients with previous diagnosed cancer. Clinicians must be aware that metastases from head and neck cancer can present as a "clown nose."

Non-Small Cell Lung Cancer Presenting as Anterior Nasal Mass and Epistaxis

Lung malignancy presentation with an uncommon metastatic site is a diagnostic challenge and often associated with poor prognosis. Nasal cavity is a rare metastatic site for any type of lung cancer. We report an unusual case of poorly differentiated adenosquamous carcinoma of the lung with widespread metastasis presenting as a right vestibular nasal mass with epistaxis. A 76-year-old male patient with chronic obstructive pulmonary disease and 80 pack-year smoking history presented with spontaneous epistaxis. He reported a new rapidly growing right-sided nasal vestibular mass first noticed 2 weeks prior. Physical examination showed fleshy mass with crusting in right nasal vestibule along with a left nasal domus mass. Imaging revealed an ovoid mass in the right anterior nostril and a large mass in the right upper lobe of the lung (RULL) along with thoracic vertebral sclerotic metastasis and large left frontal lobe hemorrhagic lesion with severe vasogenic edema. Positron emission tomography scan showed large right upper lobe mass and suspected to be the primary malignancy along with widespread metastasis. Biopsy of the nasal lesion revealed poorly differentiated non-small cell carcinoma with squamous and glandular features. The diagnosis of very poorly differentiated adenosquamous carcinoma of the lung with widespread metastasis was made. In conclusion, unusual metastatic sites with unknown primary lesions require a thorough diagnostic workup involving biopsy and extensive imaging. Lung cancer with unusual metastatic sites is inherently aggressive and associated with poor prognosis. Multidisciplinary treatment modalities should be employed keeping in view the functional status and comorbidities of the patient.

FDG PET/CT in Isolated Nasal Cavity Metastasis From Squamous Cell Lung Cancer

ABSTRACT

Nasal cavity metastasis is rare. We present FDG PET/CT findings in a case with isolated nasal cavity metastasis from squamous cell lung cancer. The nasal cavity tumor invaded the nasal septum and hard palate and showed intense inhomogeneous activity, mimicking a primary malignancy. Knowledge of the atypical manifestations of metastatic lung cancer will be helpful for correct diagnosis.

Detection of Nasal Solitary Extramedullary Plasmacytoma on 18F-FDG PET/CT Imaging

ABSTRACT

A 46-year-old man presented with a 3-month history of epistaxis. CT and MRI scan showed a soft tissue mass in the left nasal cavity. An excisional biopsy of the mass revealed extramedullary plasmacytoma. 18F-FDG PET/CT showed intense activity in the region of the left nasal cavity but no other FDG-avid lesions. Additional workups did not reveal any evidence of systematic disease. Based on these findings, the patient was diagnosed as having solitary nasal extramedullary plasmacytoma. He received the local radiation therapy. During the 3-month follow-up, his symptom was relieved.