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Delayed Distant Metastasis of Tonsillar Squamous Cell Carcinoma Origin- A Case Report

Hermann Simo, Louis De Las Casas, Vasuki Anandan, Michal Preis and Reginald Baugh

Introduction: The incidence of distant metastases from head and neck Squamous Cell Carcinoma (SCC) is reportedly low; reports of distant metastases from tonsil carcinoma are rare. 85% of distant metastases of SCC in head and neck cancers usually become apparent within two years of primary diagnosis, but can take up to five years before diagnosis.

Background: Metastases from tonsillar cancers are uncommon, with less than 1% reported to go to subcutaneous tissues. Metastases are reported to occur within 1-48 months after initial treatment.

Methods and results: A case report is presented of a patient seen with an isolated temporal scalp Squamous Cell Carcinoma (SCC) lesion 8 years after treatment for a tonsillar SCC and negative annual PET scans thereafter. The comparative immunehistochemical study and in situ hybridization done between the scalp tumor and the previous tonsil tumor eight years earlier, showed similarities, thus suggesting a metastasis from the tonsil tumor.

Conclusions: A tonsillar SCC metastasis presenting as a temporal scalp lesion 8 years after primary tumor treatment and locoregional control achievement is a uniquely rare event. The case highlights the need for a method to identify and track tumor cell lineage, and the need for better understanding of cancer stem cells role in head and neck SCC.