Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-24T18:24:59.487Z Has data issue: false hasContentIssue false
  • English
  • Français

Isolated pituitary fossa metastasis from a primary tonsillar squamous cell carcinoma: case report

Published online by Cambridge University Press:  01 April 2020

H Merchant ,
D S Rye  and
J A Smith
H Merchant*
Affiliation:
University of Exeter Medical School, Royal Devon and Exeter NHS Foundation Trust, UK
D S Rye
Affiliation:
University of Exeter Medical School, Royal Devon and Exeter NHS Foundation Trust, UK
J A Smith
Affiliation:
Department of Otolaryngology, Royal Devon and Exeter NHS Foundation Trust, UK
*
Author for correspondence: Mr Haider Merchant, 2 Garthside, Church Road, RichmondTW10 5JA, UK E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

This paper presents a case of an isolated pituitary fossa metastasis on a background of a previously treated tonsillar squamous cell carcinoma.

Case report

A 64-year-old male, diagnosed with a primary p16-negative squamous cell carcinoma in the right tonsil, was treated with a course of chemoradiotherapy with curative intent. Positron emission tomography/computed tomography, performed at six months post-treatment, revealed a good local response and no distant metastases. The patient was placed on routine follow up at two-monthly intervals. Two months into follow up, he presented with a right-sided oculomotor nerve palsy and partial Horner's syndrome. Imaging and biopsy revealed a pituitary fossa metastasis (p16-negative squamous cell carcinoma), and a further positron emission tomography/computed tomography visualised this lesion. He was deemed unsuitable for further intervention and underwent palliative radiotherapy for symptom control.

Conclusion

This case represents the first reported isolated pituitary fossa metastasis from a tonsillar squamous cell carcinoma. A high degree of clinical suspicion is recommended, along with a low threshold for biopsy and a cautioned use of positron emission tomography/computed tomography, when investigating such patients.

Keywords

Pituitary NeoplasmsPositron Emission Tomography Computed TomographySquamous Cell CarcinomaSella TurcicaOculomotor Nerve DiseasesTonsillar Neoplasms
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 4 , April 2020 , pp. 369 - 371
Copyright
Copyright © JLO (1984) Limited, 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Mr H Merchant takes responsibility for the integrity of the content of the paper

Presented as a poster at the Association of Surgeons in Training annual conference, 22–24 March 2019, Belfast, Northern Ireland, UK.

References

Weatherspoon, DJ, Chattopadhyay, A, Boroumand, S, Garcia, I. Oral cavity and oropharyngeal cancer incidence trends and disparities in the United States: 2000–2010. Cancer Epidemiol 2015;39:497–504CrossRefGoogle ScholarPubMed
Seiden, AM, Tami, TA, Pensak, ML, Cotton, RT, Gluckman, JL. Otolaryngology: The Essentials. Stuttgart: Theime Medical Publishers, 2002Google Scholar
de Bree, R, Mehta, DM, Snow, GB, Quak, JJ. Intracranial metastases in patients with squamous cell carcinoma of the head and neck. Otolaryngol Head Neck Surg 2001;124:217–21CrossRefGoogle ScholarPubMed
Barrett, TF, Gill, CM, Miles, BA, Iloreta, AMC, Bakst, RL, Fowkes, M et al. Brain metastasis from squamous cell carcinoma of the head and neck: a review of the literature in the genomic era. Neurosurg Focus 2018;44:E11CrossRefGoogle ScholarPubMed
Dobelbower, MC, Nabell, L, Markert, J, Carroll, W, Said-Al-Naief, N, Meredith, R. Cancer of the tonsil presenting as central nervous system metastasis: a case report. Head Neck 2009;3:127–30CrossRefGoogle Scholar
Altay, T, Krisht, KM, Couldwell, WT. Sellar and parasellar metastatic tumors. Int J Surg Oncol 2012;2012:647256Google ScholarPubMed
Marchese-Ragona, R, Ferraro, SM, Marioni, G, Staffieri, C, Manara, R, Restivo, DA et al. Abducent nerve paralysis: first clinical sign of clivus metastasis from tonsillar carcinoma. Acta Otolaryngol 2008;128:713–16CrossRefGoogle ScholarPubMed
Lin, CY, Huang, WK, Chung, FT, Chang, HK. Prognostic factors in cancer patients with symptomatic pituitary metastasis: a clinical case study. Anticancer Res 2015;35:983–7Google ScholarPubMed
Valassi, E, Biller, BMK, Klibanski, A, Swearingen, B. Clinical features of nonpituitary sellar lesions in a large surgical series. Clin Endocrinol (Oxf) 2010;73:798–807CrossRefGoogle Scholar
Al-Aridi, R, El Sibai, K, Fu, P, Khan, M, Selman, WR, Arafah, BM. Clinical and biochemical characteristic features of metastatic cancer to the sella turcica: an analytical review. Pituitary 2013;17:575–87CrossRefGoogle Scholar
Aaberg, TM Jr, Kay, M, Sternau, L. Metastatic tumors to the pituitary. Am J Ophthalmol 1995;16:779–85CrossRefGoogle Scholar
Goulart, CR, Upadhyay, S, Ditzel Filho, LFS, Beer-Furlan, A, Carrau, RL, Prevedello, LM et al. Newly diagnosed sellar tumors in patients with cancer: a diagnostic challenge and management dilemma. World Neurosurg 2017;106:254–65CrossRefGoogle ScholarPubMed
Tantiwongkosi, B, Yu, F, Kanard, A, Miller, FR. Role of (18)F-FDG PET/CT in pre and post treatment evaluation in head and neck carcinoma. World J Radiol 2014;6:177–91CrossRefGoogle ScholarPubMed
Kitajima, K, Nakamoto, Y, Okizuka, H, Onishi, Y, Senda, M, Suganuma, N et al. Accuracy of whole-body FDG-PET/CT for detecting brain metastases from non-central nervous system tumors. Ann Nucl Med 2008;22:595–602CrossRefGoogle ScholarPubMed
Bochev, P, Klisarova, A, Kaprelyan, A, Chaushev, B, Dancheva, Z. Brain metastases detectability of routine whole body 18F-FDG PET and low dose CT scanning in 2502 asymptomatic patients with solid extracranial tumors. Hell J Nucl Med 2012;15:125–9Google ScholarPubMed
Lee, HY, Lee, KS, Kim, BT, Cho, YS, Lee, EJ, Yi, CA et al. Diagnostic efficacy of PET/CT plus brain MR imaging for detection of extrathoracic metastases in patients with lung adenocarcinoma. J Korean Med Sci 2009;24:1132–8CrossRefGoogle ScholarPubMed
Galldiks, N, Langen, KJ, Albert, NL, Chamberlain, M, Soffietti, R, Kim, MM et al. PET imaging in patients with brain metastasis--report of the RANO/PET group. Neuro Oncol 2019;21:585–95CrossRefGoogle ScholarPubMed
Kida, K, Terada, T, Uwa, N, Omori, Y, Fujii, T, Tomita, Y et al. Relationship between p16 expression and prognosis in patients with oropharyngeal cancer undergoing surgery. In Vivo 2018;32:927–35CrossRefGoogle ScholarPubMed
Weinberger, PM, Yu, Z, Haffty, BG, Kowalski, D, Harigopal, M, Sasaki, C et al. Prognostic significance of p16 protein levels in oropharyngeal squamous cell cancer. Clin Cancer Res 2004;10:5684–91CrossRefGoogle ScholarPubMed
Fischer, CA, Zlobec, I, Green, E, Probst, S, Storck, C, Lugli, A et al. Is the improved prognosis of p16 positive oropharyngeal squamous cell carcinoma dependent of the treatment modality? Int J Cancer 2010;126:1256–62Google ScholarPubMed