Synchronous metastatic cutaneous squamous cell carcinoma and chronic lymphocytic leukaemia/small lymphocytic lymphoma in a cervical lymph node: Case report of an unusual event

Abstract

The synchronous occurrence of two different neoplasias is an uncommon event, which may arise between tumors originating in the same organ or in cancer-to-cancer metastasis. We report a rare case of chronic lymphocytic leukaemia / small lymphocytic lymphoma associated with a cutaneous metastatic squamous cell carcinoma in a cervical lymph node. In the affected lymph node, it was observed an effacement of the normal architecture by neoplastic lymphocytes and it was noted the presence of neoplastic invasive epithelial islands. Immunohistochemical analysis demonstrated that lymphocytic proliferation was positive for CD20, CD5, CD23 and Kappa, and negative for CD3, CD10, Cyclin D1 and Lambda. The morphological and immunohistochemical profile lead to a phenotype of B-cell chronic lymphocytic leukaemia / small lymphocytic lymphoma. The epithelial cells were positive for CK5, thus rendering the diagnosis of synchronous metastatic cutaneous squamous cell carcinoma and chronic lymphocytic leukaemia/small lymphocytic lymphoma. Literature supports the poor prognosis in cases that present coexistence of squamous cell carcinoma and chronic lymphocytic leukaemia / small lymphocytic lymphoma. Thus, it is necessary to be aware about this unusual finding in order to provide specific treatment. Key words:Chronic lymphocytic leukaemia, small lymphocytic lymphoma, squamous cell carcinoma, metastasis.

Synchronous Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma and Metastatic Squamous Cell Carcinoma of the Cervix Involving the Coronary Arteries Leading to Acute Myocardial Infarction

“…On thorough review, all these cases involved male patients who ranged from 44 to 83 years of age [1]. Another case report, written seven years prior, stated that there have only been 11 reported cases of cutaneous SCC metastatic to tissues involving CLL/SLL.…”

“…It has been suggested that the mechanism underlying the development of synchronous malignancies may be the result of cancer-to-cancer metastasis which is influenced by nonmodifiable factors such as age and genetic susceptibility or modifiable factors such as exposure to carcinogenic agents via environment or lifestyle habits. Furthermore, cancer-tocancer metastasis can be investigated by using specific immunohistochemical profiles [1]. Although many theories have been postulated, the exact mechanism has yet to be established.…”

“…The mechanism for which chronic lymphocytic leukemia leads to impaired flow through the coronary arteries is proposed as different compared to that of an atherosclerotic plaque or thrombus. Tumor encases the coronary arteries causing external compression of the vessel, whereas atherosclerotic plaque or thrombus precipitates occlusion within the vessel [1]. This was demonstrated on autopsy in which malignant cells extended into the tunica adventitia and tunica media.…”

“…Synchronous tumors are rare. Patients who present with CLL/SLL associated with an aggressive metastatic SCC are more vulnerable to malignant spread, recurrence, and death as compared to individuals without an associated secondary malignancy [1]. It is known that cancer cells impact the coagulation cascade leading to a hypercoagulable state, thrombus formation and propagation, and anemia which can lead to venous thromboembolism.…”

Carcinoma of Maxillary Gingiva with Non-specific Cervical Lymph Node Swelling

“…Swelling of the cervical lymph nodes may indicate lymphadenitis 5) , malignant lymphoma 15) , or lymph node metastasis 4) . In cases where the nodes are larger than 10 mm on postoperative computed tomography (CT) images of a malignant tumor, metastasis can be assumed.…”