Ahmed Ahmed, DO
Newark, New Jersey
Ahmed Ahmed, DO1, Umair M. Nasir, DO1, Paul Delle Donna, DO1, Shahida Ahmed, MD2, Christopher Lenza, DO3
1Rutgers New Jersey Medical School, Newark, NJ; 2East Orange VA Hospital, Newark, NJ; 3East Orange VA Hospital, East Orange, NJ
Introduction: It is very rare for head and neck squamous cell carcinoma (HNSCC) to metastasize to the duodenum or the peritoneum. Only a few cases have been reported for each metastatic site, however, there have been no reported cases of concurrent duodenal and peritoneal metastasis (PM) from HNSCC. Such a presentation enhances the literature on HNSCC and illustrates the need for further studies to understand the mechanism of HNSCC metastasis.
Case Description/Methods: 68-year-old male with history of HNSCC presented with worsening nausea, postprandial vomiting, and abdominal pain for over 2 months. 3 months prior he was worked up for several postauricular lumps, with computerized tomography (CT) scan showing a supraglottic mass and excisional biopsy of a nodule confirming metastatic HNSCC. Imaging upon admission showed new peritoneal carcinomatosis and worsening diffuse lymphadenopathy (LAD). Esophagogastroduodenoscopy (EGD) showed a large nodular lesion occupying one third of the lumen circumference. Like the neck nodule, biopsies of the mass showed metastatic, poorly differentiated SCC that was strongly positive for p63 and p16. The patient was not deemed a candidate for chemotherapy due to poor prognosis and poor functional status and was eventually discharged on home hospice.
Discussion: We hereby described the first case of concurrent duodenal and peritoneal metastasis from a HNSCC, with both being independently rare sites of metastasis. The patient’s history of chronic tobacco use increased his risk of SCC. Chemotherapy and peritoneal excision, in certain cases, have shown to be a viable treatment option and have a beneficial impact on survival and quality of life. In select cases of obstruction, palliative stenting can be an option to improve quality of life. Due to rapid disease progression and the patient’s poor functional status, these treatment options were deemed not feasible. There are many speculated mechanisms regarding intestinal and PM such as direct extension, tumor rupture or trauma leading to seeding of the peritoneum, hematogenous dissemination, and even via the lymphatics. In our case, the patient did not have any abdominal surgeries and had multiple metastatic sites, including the duodenum, making hematogenous or lymphatic spread more likely. In any case, further studies are needed to understand the mechanism involved in HNSCC metastasis.
Waksasaki T, et al. A case of peritoneal metastasis during treatment for hypopharyngeal squamous cell carcinoma. World J Surg Oncol. 2016;14:265.
Citation: Ahmed Ahmed, DO; Umair M. Nasir, DO; Paul Delle Donna, DO; Shahida Ahmed, MD; Christopher Lenza, DO. P2651 - A UNIQUE PRESENTATION OF CONCURRENT DUODENAL AND PERITONEAL METASTASIS FROM HEAD AND NECK CANCER. Program No. P2651. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.