Bronchial adenocarcinoma presenting as a lingual tonsillar metastasis

Expectoration of tonsillar metastasis of pulmonary pleomorphic carcinoma after pseudoprogression: A case report

Pulmonary pleomorphic carcinoma is a rare malignant tumor that grows rapidly and has a poor prognosis. Although no effective treatments have so far been established, immune checkpoint inhibitors (ICIs) have shown clinical improvement in some cases of pleomorphic carcinoma. However, pseudoprogression is a major concern for treatment of this carcinoma using ICIs. Here, we report the case of a 61‐year‐old man who was diagnosed with large cell carcinoma of the lung with brain metastases. Systemic chemotherapy comprising carboplatin and pemetrexed was administered as a first‐line therapy; however, disease progression was observed. A tonsillar lesion grew rapidly after the administration of nivolumab as a second‐line therapy. Tracheostomy was planned to avoid suffocation, but the patient naturally expectorated the tumor. Pathological examination revealed that it was a palatine tonsillar metastasis of pulmonary pleomorphic carcinoma with infiltration of CD8+/CD4‐ lymphocytes and necrosis. The primary lesion expanded after nivolumab administration and shrank with no additional nivolumab administration. We therefore concluded that pseudoprogression caused expectoration of the tonsillar metastasis. Hence, ICIs can cause serious adverse events due to pseudoprogression.

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.

Distribution and prognosis of uncommon metastases from non-small cell lung cancer

BACKGROUND

According to the literature and our experience, the most common sites of non-small cell lung cancer (NSCLC) metastases include the brain, bone, liver, adrenal glands, contralateral lung and distant lymph nodes. Metastases to other organs are relatively rare. There have been numerous case reports and a few small case series of uncommon metastases derived from NSCLC.

METHODS

We defined all organs except the common metastatic sites mentioned above as uncommon sites of metastasis. Patients with uncommon metastases among 2,872 consecutive NSCLC patients with stage IV disease at the Guangdong Lung Cancer Institute (GLCI) from 2006 to 2012 were included in this study. The diagnosis of uncommon metastases was based on pathology or imaging studies.

RESULTS

Uncommon metastases were diagnosed in 193 cases at anatomical sites such as the soft tissue, kidney, pancreas, spleen, peritoneum, intestine, bone marrow, eye, ovary, thyroid, heart, breast, tonsil and nasal cavity. Uncommon metastases were identified as independent poor prognostic factors through a multivariate analysis with a HR (hazard ratio) of 1.29 [95% confidence interval (CI) 1.09-1.52, P < 0.01]. Those patients who received systemic therapy plus local treatment had a better survival rate than did those who received systemic therapy only (P < 0.01); all patients received best supportive care.

CONCLUSIONS

Metastases to the above mentioned sites are infrequent. The presentation of uncommon metastases tends to indicate a poor outcome, and selected patients may benefit from local treatment.

Successfully treated lingual tonsillar metastasis from bronchial adenocarcinoma

Tonsillar metastasis from neoplasms, including lung cancer, are extremely rare, and the prognosis for patients with tonsillar metastases is rather poor. We herein describe a case of long-term survival following radiation for lingual tonsillar metastasis from a bronchial adenocarcinoma. A 39-year-old male was diagnosed with adenocarcinoma of the right lung and was surgically treated. Four months after surgery, a mass arising from the lingual tonsil was noted at the root of the tongue and was pathologically diagnosed as metastasis from lung cancer. In addition, a computed tomography scan revealed a jugular lymphadenopathy, which was considered to be a metastasis from the tonsillar tumor. The tonsillar mass and jugular lymphadenopathy disappeared after external radiotherapy (50 Gy). The patient is alive without recurrence more than 8 years after treatment for tonsillar metastasis. This is the first report of successfully treated tonsillar metastasis from a malignant tumor.

Tonsillar metastasis from malignant pulmonary carcinoid tumour

Tumour metastases to the tonsil are rare and are usually due to spread from malignant melanoma and carcinomas of the breast, lung, kidney or stomach. We describe the clinical and histological findings of a tonsillar metastasis from a malignant pulmonary carcinoid tumour, an occurrence not previously reported.

Tonsillar metastasis from adenocarcinoma of the stomach

Metastatic carcinoma of the tonsil is rare with only some 100 cases having been reported in the literature, of which nine have resulted from stomach carcinoma. Tonsillar metastases rarely become apparent before the diagnosis of the primary neoplasm. We describe here the clinical and histopathological findings of a case of unilateral palatine tonsil metastasis as the first sign of a signet-ring cell carcinoma of the stomach. This has not been reported previously.

Palatine tonsillar metastasis from carcinoma of the colon

Metastatic carcinoma of the palatine tonsil is rare, with only 92 cases reported in the world literature. We report a case of tonsillar metastasis from the colon. This is an unusual case not only because it is the first case report of tonsillar metastasis from this site but also because the tonsillar secondary is the first sign of the primary disease.

Clinical manifestations of lung cancer

The initial clinical manifestations of lung cancer are diverse and may occur with or without symptoms. Manifestations of pulmonary malignant lesions are produced by local growth or invasion, metastatic disease, or paraneoplastic processes. Patterns of local invasion such as Pancoast's syndrome or the superior vena cava syndrome are relatively uncommon but well recognized. Metastatic lung cancer can involve almost any anatomic area by hematogenous, lymphatic, or, occasionally, interalveolar dissemination. Complications related to malnutrition, infection, electrolyte disturbances, and coexisting diseases influence the initial manifestations. Although individual tumor cell types are associated with characteristic features, no constellation of findings is pathognomonic for a specific histologic variant. Because successful treatment of pulmonary carcinoma depends on early detection, awareness of the typical clinical manifestations is important.

A case of Merkel-cell carcinoma metastatic to the tonsil

Metastatic tumours are rare in the tonsil. We describe a 69-year-old male patient who had previously undergone a resection of a Merkel-cell tumour of the left forearm and subsequently presented with a left tonsillar tumour. Biopsy revealed a metastatic Merkel-cell carcinoma. Our patient is the first described case of Merkel-cell carcinoma metastasizing to the tonsil. The clinical and histopathological picture of this rare tumour is presented, along with a review of literature.

Bilateral tonsillar metastasis of gastric adenocarcinoma

The occurrence of metastatic tumors in the tonsils, although rare, must be considered in the differential diagnosis of tonsillar lesions. In particular, the review of the literature reports only 7 cases of tonsillar metastasis of gastric carcinoma. The authors describe a case of adenocarcinoma involving bilaterally the palatine tonsils and the lingual tonsil, in a patient previously operated due to gastric adenocarcinoma. The clinical appearance of the lesion could be also consistent with lymphoproliferative or infectious diseases. The clinical and pathologic differential diagnosis of this peculiar case is discussed, together with a brief review of the literature.