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involvement (number, level of neck node involved) and 2. León X, Quer M, Orús C, del Prado Venegas M, López M.
site of the primary tumor (P < 0.001). Among other Distant metastases in head and neck cancer patients who
factors, T stage of the primary tumor, histopathological achieved loco-regional control. Head Neck 2000;22:680-6.
grade of tumor, response to treatment, and young age 3. Chen J, Pappas L, Moeller JH, Rankin J, Sharma PK,
are also mentioned but with varying signifi cance in Bentz BG, Fang LC, Hayes JK, Shrieve DC, Hitchcock YJ.
Treatment of oropharyngeal squamous cell carcinoma
different studies. In this context, this case had features with external beam radiation combined with interstitial
of favorable prognostic group (stage cT N M , tonsil, brachytherapy. Head Neck 2007;29:362-9.
0
2
0
moderately differentiated squamous cell carcinoma, 4. Ferlito A, Shaha AR, Silver CE, Rinaldo A, Mondin V.
excellent loco-regional control) but except for young Incidence and sites of distant metastases from head and neck
age. Similar cases need to be reported and documented cancer. ORL J Otorhinolaryngol Relat Spec 2001;63:202-7.
so that more aggressive FU can be advised in this group 5. Goodwin WJ. Distant metastases from oropharyngeal cancer.
of patients. ORL J Otorhinolaryngol Relat Spec 2001;63:222-3.
6. Djalilian HR, Tekin M, Hall WA, Adams GL. Metastatic
The reasons for this unusual presentation of such head and neck squamous cell carcinoma to the brain.
widespread metastasis in a patient with apparently good Auris Nasus Larynx 2002;29:47-54.
prognostic factors is not known. However, we came 7. Price KA, Cohen EE. Current treatment options for metastatic
across two very interesting reports while preparing this head and neck cancer. Curr Treat Options Oncol 2012;13:35-46.
case report. In a study on prostate cancer patients treated 8. Garavello W, Ciardo A, Spreafi co R, Gaini RM. Risk factors
for distant metastases in head and neck squamous cell
by brachytherapy, the authors concern that the cells carcinoma. Arch Otolaryngol Head Neck Surg 2006;132:762-6.
liberated at the time of brachytherapy increases the risk 9. Siddiqua A, Chendil D, Rowland R, Meigooni AS,
of metastatic deposits and may results in a systemic Kudrimoti M, Mohiuddin M, Ahmed MM. Increased
failure, as measured by serum prostate-specifi c antigen expression of PSA mRNA during brachytherapy in peripheral
[9]
levels. Similar observation had been made in case of blood of patients with prostate cancer. Urology 2002;60:270-5.
[10]
a glioblastoma multiforme is treated by brachytherapy. 10. Houston SC, Crocker IR, Brat DJ, Olson JJ. Extraneural
There are no further evidences in this regards, but those metastatic glioblastoma after interstitial brachytherapy.
Int J Radiat Oncol Biol Phys 2000;48:831-6.
interesting incidences need to be reviewed in the context
of our case to fi nd out the rarest possibility of any such
mechanism.
How to cite this article: Banerjee S, Kundu D, Mukherjee M, Maiti PK.
Early stage squamous cell carcinoma of the tonsil presenting with
References multiple organ metastases including skin and brain after successful
local treatment. J Cancer Metastasis Treat 2015;1:31-3.
1. Dobelbower MC, Nabell L, Markert J, Carroll W, Said-Al-Naief N,
Meredith R. Cancer of the tonsil presenting as central nervous Received: 08-08-2014; Accepted: 15-11-2014.
system metastasis: A case report. Head Neck 2009;31:127-30. Source of Support: Nil, Confl ict of Interest: None declared.

Journal of Cancer Metastasis and Treatment ¦ Volume 1 ¦ Issue 1 ¦ April 15, 2015 ¦ 33