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P2651 - A Unique Presentation of Concurrent Duodenal and Peritoneal Metastasis From Head and Neck Cancer

Tuesday, October 29

10:30 AM - 4:00 PM

Location: Exhibit Halls 3 and 4 (Street Level)

Presenting Author(s)

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.

CT scan image of the abdomen (left) showing new omental carcinomatosis (red arrows) and ascites (yellow arrow) when compared to a CT scan done three months prior (right).

Nodular, erythematous, friable lesion of the duodenum (Image A, top right corner) during EGD, later found to be a metastatic lesion from the primary HNSCC. A close-up view of the metastatic lesion (B) illustrates how it occupies approximately one third of the circumference of the lumen. A distinct change in appearance can be appreciated with the lesion being more erythematous, friable, and containing punctate hemorrhages when compared to the surrounding normal mucosa.

Biopsy images from the post-auricular nodule during the patient's HNSCC workup (A-D) as well histological images from the duodenal biopsy (E-H). Image A and E portray an H&E stain (10X magnification) showing poorly differentiated squamous cell carcinoma. Images B and F illustrate an H&E stain (20X magnification) showing keratinization (arrow). Image C shows a diffusely positive P63 staining pattern from the post-auricular nodule (20X magnification). Image D shows diffusely positive P16 staining (cytoplasmic and nuclear) from the post-auricular nodule (20X magnification). On image G, areas of positive P63 staining can be found on the duodenal biopsy (10X magnification). Image H clearly shows areas of positive p16 staining on the duodenal biopsy (10X magnification).

Disclosures:

Ahmed Ahmed indicated no relevant financial relationships.

Umair Nasir indicated no relevant financial relationships.

Paul Delle Donna indicated no relevant financial relationships.

Shahida Ahmed indicated no relevant financial relationships.

Christopher Lenza indicated no relevant financial relationships.

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.