Distant Multilevel Spinal Metastasis Secondary to Hypopharyngeal Squamous Cell Carcinoma

Authors

R Parker Kirby
Sarah Kim
Lama M Abdurrahman
Alexander Kietzman
James Doan
David Hernandez

Publication Date

7-1-2024

Journal

Cureus

DOI

10.7759/cureus.64715

PMID

39156392

PMCID

PMC11328829

PubMedCentral® Posted Date

7-17-2024

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

head and neck cancer pathology, otolaryngology-head & neck surgeons, head and neck surgery with free flap reconstruction, spinal metastasis, head and neck squamous cell carcinoma (hnscc)

Abstract

Head and neck squamous cell carcinomas account for most head and neck malignancies. While multi-modality treatment may be offered for locally advanced cancer, distant metastasis still occurs in a significant number of patients. This paper aims to present a rare case of a patient who developed bony metastases in the cervical spine from a primary hypopharyngeal malignancy status post-laryngopharyngectomy. We report a case of a male patient presenting with acute-on-chronic hypercapnic and hypoxic respiratory failure with two months of dysphagia and weight loss. On arrival, a barium swallow revealed mucosal irregularity of the upper thoracic esophagus as well as narrowing and stenosis. A direct laryngoscopy with biopsy revealed squamous cell carcinoma of the hypopharynx. CT neck and chest were obtained for staging. He underwent a total laryngopharyngectomy, bilateral neck dissections, and a free flap. His final staging was pT4aN2c cM0. Three months post-admission, during inpatient radiation therapy, the patient reported midline neck pain with focal bone tenderness, and an MRI was obtained of his cervical and thoracic spine with a report concerning spinal metastasis.A subsequent bone biopsy showed findings consistent with osseous metastasis from a primary hypopharyngeal squamous cell carcinoma. After multidisciplinary goals of care discussions, the patient ultimately decided to be discharged to inpatient hospice. This report highlights a rare case of hypopharyngeal carcinoma metastasis to the cervical spine. Despite its rarity and poor prognosis, such a metastasis should be considered in the differential diagnosis of patients with a history of hypopharyngeal squamous cell carcinoma and localizing symptoms.