Metastasis of pulmonary adenocarcinoma to the palatine tonsil

Abstract

Lung cancer rarely metastasizes to the palatine tonsil. There have only been a few cases that have reported on palatine tonsillar metastases of pulmonary adenocarcinoma. In the majority of these cases the primary diagnosis is a small cell lung cancer. The present case report resents an unusual case of a 66-year-old woman with a multiple metastasized lung adenocarcinoma, which was finally detected by tonsillectomy. The present case report and review of the literature revealed the importance of complete and systematic tumor staging, including the examination of the oral cavity in case of lung cancer and that the evident tentative diagnosis is not always the right one.

How Can We Best Manage Patients With Oligometastatic Disease In Head And Neck Cancer?

“…It is known that metastases prefer sites of trauma, and lung cancer patients undergo bronchoscopic procedures either for diagnostic purposes with biopsies or interventional therapeutic purposes with debulking. There is a risk of damage particularly to the oropharynx and the tonsils, and this has been reported in literature (68,74) with patients developing tonsillar metastases after rigid bronchoscopies. In fact, this has been shown in other conditions too, particularly with port-site metastases secondary to instruments in laparoscopic surgery and percutaneous endoscopic gastrostomy sites.…”

“…Lung cancer has a tendency to metastasise to the liver, brain, bones and adrenal glands. Small cell and adenocarcinomas tend to metastasise to the brain preferentially, while liver metastases almost never arise from adenocarcinomas exclusively (68). Lung cancer oligometastatic disease to the head and neck is rare but has been reported in literature.…”

“…The lymphatic route is thought to be of relevance in lung cancer due to pattern of distribution of oligometastatic sites, with the parotid gland and tonsils being very common. The concept of retrograde lymphatic flow to the head and neck is one that is explored in literature (68,76,78). It suggests that as a result of involvement of cervical lymph nodes, there is a higher downstream pressure in the lymph vessels which then causes an inversion of flow.…”

“…This particularly applied to tonsillar metastases. Some advocate for a tonsillectomy in view of a biopsy regardless (68), and the mechanism of tonsillar spread as a form of direct implantation post-bronchoscopy favours it being an isolated lesion without any further tissue involvement. However, whether this translates into direct overall survival benefit is difficult to see with the low number of cases in literature.…”

Urothelial carcinoma with tonsillar metastasis in a dog

“…9 The typical route of cancer cell spread to the tonsils is unknown, but current theories include retrograde lymphatic and hematogenous spread. 15 In humans, types of neoplasia with tonsillar metastasis include melanoma, breast neoplasia, gastrointestinal neoplasia, and lung neoplasia. 8,12,14 Reports of metastases to the tonsil originating from the urogenital system include renal cell neoplasia and seminoma.…”