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Case Report

Early stage squamous cell carcinoma of the tonsil presenting with
multiple organ metastases including skin and brain after successful
local treatment

Susovan Banerjee , Dipankar Kundu , Mukti Mukherjee , Pradip Kumar Maiti 1
1
1
2
1 Department of Radiotherapy, NRS Medical College, Kolkata 700014, West Bengal, India.
2 Department of Surgery, NRS Medical College, Kolkata 700014, West Bengal, India.
Correspondence to: Dr. Susovan Banerjee, Department of Radiotherapy, NRS Medical College, Kolkata 700014, West Bengal, India.
E-mail: drsusovan@gmail.com

ABSTRACT
Early stage carcinoma of the tonsil is curable, and the incidence of systemic metastasis is very low and central nervous system
involvement is very rare. A patient diagnosed with early stage tonsillar carcinoma treated with chemoradiation was followed by
brachytherapy boost. One and half years after completion of treatment, the patient presented with disseminated metastasis to the
skin, lung, liver, bone, and brain. He had all favorable prognostic parameters except being a young adult.

Key words: Brain metastasis, distant metastasis, early stage cancer tonsil, skin metastasis

Introduction proliferative growth of 3 cm diameter at left tonsil;
involving the anterior and posterior pillar and encroaching
Early stage carcinoma of the tonsil is curable with a to the soft palate and lateral pharyngeal wall. The
very low incidence of distant metastasis. Advanced valleculae and epiglottis were free. The histopathological
stage carcinoma of the oropharynx has a probability report of the tonsillar fossa biopsy indicated moderately
[1]
of distant metastasis from 15% to 20%. Considering differentiated, infi ltrating squamous cell carcinoma.
all stages and sub-sites of head and neck cancer, the Contrast-enhanced computed tomography scan of the
incidence of distant metastasis is reported to be of about head and neck revealed 3.1 cm × 2.2 cm sized mass at
10-15%. Evidence of distant metastasis in early stage the left tonsillar fossa. In the neck, there was no evidence
[2]
disease is not available in the literature. We diagnosed of lymph node metastasis. Ultrasonography (USG) of
a case of early stage carcinoma tonsil that had been the abdomen and pelvis was normal except for mild
treated effectively with concurrent chemoradiotherapy fatty changes in the liver. Chest skiagram was normal.
followed by brachytherapy boost. The patient had locally Hence, the patient was diagnosed as a case of carcinoma
controlled disease but developed multiple visceral tonsil cT N M and was planned for radical therapy. He
2
0
0
metastases through hematogeneous dissemination within was treated with external beam radiotherapy (EBRT)
a few months of treatment completion. of 6 MeV photon with conventional bilateral portal
plan, 50 Gy in 25 fractions, along with 5 cycles of
Case Report concurrent chemotherapy with cisplatinum (65 mg).
A 34-year-old Indian male with a history of being a Thereafter, a boost radiation by interstitial high-dose-rate
chronic smoker and alcoholic presented with complaints brachytherapy of 20 Gy/5 fractions to residual tumor and
of dysphagia, foreign body sensation during deglutition tonsillar fossa was given.
of 3 months duration. On physical examination, the After completion of treatment, the patient was asked to
patient appeared to be in a good performance and visit the follow-up (FU) for clinical evaluation every
adequate nutritional status. Clinical examination revealed 3 months. The 1st year of FU was unremarkable. At the
a proliferative growth at left tonsil without evidence of FU visit at 18 months, he presented with a recent history
any palpable neck nodes. Direct laryngoscope revealed of dry cough for more than 1 week. Chest skiagram
showed only pneumonitic changes at the lung bases.
Access this article online He was managed conservatively and responded well.
At the FU of 20 months, the patient was suffering from
Quick Response Code: backache which has progressed over a short period in
Website:
www.jcmtjournal.com spite of taking analgesics. Digital X-ray of the lumbar
sacral (LS) spine revealed no obvious fi ndings. However,
within a few weeks, the pain increased severely, and the
DOI:
10.4103/2394-4722.152761 patient was unable to walk or stand without support.
Clinically he had a severe tenderness over the lumbar

Journal of Cancer Metastasis and Treatment ¦ Volume 1 ¦ Issue 1 ¦ April 15, 2015 ¦ 31