A Unique Presentation of Concurrent Duodenal and Peritoneal Metastasis From Head and Neck Cancer

Abstract

Metastatic disease to the duodenum or peritoneum from a primary head and neck carcinoma is an extremely rare presentation. We report the case of a 68-year-old male with a history of head and neck squamous cell carcinoma (HNSCC) who presented with worsening nausea, abdominal pain, postprandial vomiting, and early satiety for over two months. Prior to this presentation, he was evaluated for several postauricular lumps, with computerized tomography (CT) scan showing a supraglottic mass and an excisional biopsy of a postauricular nodule confirming metastatic HNSCC. A CT scan of the chest, abdomen, and pelvis during the admission showed worsening lymphadenopathy in the mediastinum and hilar regions, as well as new ascites and peritoneal lesions. Esophagogastroduodenoscopy showed a large erythematous nodular lesion in the second portion of the duodenum occupying approximately one-third of the lumen circumference. Similar to the previously worked up nodule, histology from the duodenal mass biopsies showed metastatic poorly differentiated squamous cell carcinoma that was strongly positive for p63 and p16. Thus, we report the first case of concurrent duodenal and peritoneal metastasis from an HNSCC.

Distant metastasis at the time of presentation of head and neck squamous cell carcinoma: a retrospective chart review from a tertiary cancer care centre

“…14,18 The other common sites of distant metastasis include the liver and bone, but rarely does head and neck SCC also present with isolated metastatic lesions in the stomach, duodenum, or peritoneum. 14,[21][22][23] There are several challenges concerning the choice of investigation that is sensitive as well as cost-effective for detecting the distant metastasis in head and neck SCC. [13][14][15] The routine use of computed tomography of the thorax to screen for the most likely site of distant metastasis is not cost-effective in all cases of head and neck SCC, particularly in low-and medium-income countries.…”

“…14,18 The other common sites of distant metastasis include the liver and bone, but rarely does head and neck SCC also present with isolated metastatic lesions in the stomach, duodenum, or peritoneum. 14,21–23…”

Squamous Cell Carcinoma of Duodenum Secondary to Metastasis From Recurrent Head and Neck Cancer: A Case Report and Literature Review

“…The literature shows that HNSCC typically metastasizes to the lung, followed by the bone and liver [3][4][5]. Metastasis to the GI tract, particularly the duodenum, is a rare phenomenon with limited documented cases available [6,7]. A comprehensive literature search was conducted on PubMed and Google Scholar utilizing key terms such as "small bowel metastasis," "duodenal metastasis in head-and-neck cancers," "head-and-neck squamous cell carcinoma," and "HSNCC."…”

“…Furthermore, the reference lists of relevant articles were thoroughly examined, and any additional pertinent works were added to the review. Overall, 17 cases that met the inclusion and exclusion criteria were identified, with this case report being the 18th (Table 1) [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. Of these reported cases, only six were identified as duodenal metastases, while the remaining cases consisted of eight ileal metastases, three While the pathophysiology of duodenal metastasis from HNSCC is not well understood, multiple mechanisms have been identified by which metastases can spread to the small intestine.…”

“…Although it is a rare occurrence, HNSCC can spread to the GI tract and small intestine. Specifically, there have been only a few reported cases of HNSCC metastasizing to the duodenum, emphasizing the rarity of this condition [ 6 , 7 ]. This case report aims to detail the presentation, diagnosis, and management of a patient with SCC of the duodenum, which was secondary to metastasis from recurrent head and neck cancer (HNC).…”