Leukemoid reaction as a paraneoplastic syndrome in hypopharyngeal squamous cell carcinoma with cutaneous metastasis: an exceedingly rare occurrence

Abstract

SUMMARYHead and neck squamous cell carcinoma is considered a locoregional disease, with a distinct chance of metastasis, however, skin is an unusual site. Haematological paraneoplastic syndromes are even rarer, and may be the only presenting feature in these malignancies, producing diagnostic confusion. Cutaneous metastasis, in addition to signifying poor response to treatment and prognosis, can cause diagnostic difficulty if the metastasis is located with an occult primary, and is associated with a higher incidence of multiple synchronous primaries. This article describes a 52-yearold patient with multiple swellings on the left side of the neck and hoarseness of voice. On evaluation, the multiple swellings were found to be cutaneous metastasis from a hypopharyngeal squamous cell carcinoma, with a leukemoid reaction. He opted for palliative radiotherapy and succumbed to his illness within 3 months of presentation. This article discusses the importance of this unusual presentation and diagnostic difficulties associated with it.

Cutaneous metastasis of a hypopharyngeal squamous cell carcinoma-unusual presentation

“…Cutaneous metastases are uncommon, accounting for only 2% of all skin cancers and less than 10% of all distant metastatic lesions [1][2][3][4][5]. There is a correlation between the frequency of cutaneous metastasis and the type and prevalence of primary cancer, according to age and sex, with breast and lung cancers being the most common, in women and men, respectively [3,6].…”

“…However, they rarely metastasize to skin and the reported incidence is only 0.8-1.3% . Hypopharyngeal carcinomas represent a small sub-group of HNSCC and cutaneous metastasis are extremely rare [2,5,7]. Most common metastatic sites for this tumor include lung, liver, and bone [7,8].…”