Atypical metastasis of p16(+) tonsillar squamous cell carcinoma to the pleura: A case report

Publication date: Available online 19 July 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Claude Charles LeRose, Carlos Antonio Ramirez

Abstract

Incidence rates and patterns of distant metastasis of head and neck malignancies are well documented in the literature, such that focused management strategies are routinely practiced in anticipation of their likely behavior. Head and neck tumors are known to most commonly metastasize to the lungs, skeletal system, and liver, generally within two years of definitive treatment and in the context of poor locoregional control of the primary lesion. Recent studies have shown, however, that HPV(+) oropharyngeal squamous cell carcinoma (SCCa) tumors display different patterns of distant metastases than those traditionally described for head and neck HPV(-) SCCa tumors. This finding has significant implications for how patients treated for these cancers should be surveilled after therapy. This report describes a case of p16(+) tonsillar SCCa with metastasis to a highly unusual secondary site in the pleura to demonstrate an example of the unconventional patterns of distant metastases reported for HPV(+) oropharyngeal SCCa in the recent literature. The report aims to provide a more thorough understanding of this case by discussing the pathogenesis of metastatic spread to the pleura and the clinical progression generally observed in patients with secondary pleural malignancy. The report goes on to then investigate how behaviors of distant metastases exhibited by HPV(+) oropharyngeal SCCa differ from those of more conventionally described head and neck HPV(-) SCCa and the implications this has for strategies of post-treatment surveillance of these tumors going forward.

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