A 69-year-old man presented with painful swelling of several finger tips over a period of 2 months that interfered with activities of daily life and had not responded to topical or oral antibiotics prescribed by his primary care physician. The patient was diagnosed with locoregionally advanced laryngeal squamous cell carcinoma 18 months before this presentation, which was initially treated with total laryngectomy and postoperative concurrent chemoradiotherapy but had recurred with lung metastases. On examination, the patient had hard, erythematous, and tender swelling of several finger pulps in both hands (Fig 1A, arrows), most pronounced in the third finger of both hands. There was no fluctuation or warmth. A 3-cm erythematous mass was also present in the left thigh (Fig 1B). Cytologic examination from a fine-needle aspiration of an involved digit confirmed metastatic squamous cell carcinoma (Fig 2A, diff quick stain; Fig 2B, papanicolaou stain).The patient expired as a result of myocardial infarction before initiation of palliative chemotherapy.
DiscussionSquamous cell carcinoma of the head and neck has a predilection for cervical lymph node metastasis, and hematogenous spread is less frequent. With improvements in locoregional disease control associated with modern therapies, however, the reported rate of distant recurrence appears to have risen. 1 Although the lung is the most common site for distant recurrence, metastases to un-usual sites including intracardiac, kidney, small intestines, and muscles have also been reported. [2][3][4][5] There is a single report of laryngeal cancer metastasis to the thumb used for digital occlusion during tracheoesophageal speech in a laryngectomized patient with lung metastases. 6 The authors attributed the metastasis to direct implantation from contact with contaminated pulmonary secretions via the tracheostomy. In our case, hematologic metastasis is suspected as several fingers of both hands were involved, in addition to the lesion on the thigh. This clinical observation was associated with rapid patient demise.
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