Tonsillar metastasis of gastric cancer

Abstract

Metastasis from a malignant tumor to the palatine tonsils is rare, with only 100 cases reported in the English-language literature. Tonsillar metastasis from a gastric cancer is very rare. We report here a case of palatine tonsillar metastasis after gastric cancer surgery. The patient was an 88-year-old woman who had gastric cancer with abdominal wall invasion. She had undergone a distal gastrectomy with abdominal wall resection and D2 lymph node dissection. Histologically, the tumor was primarily a moderately differentiated adenocarcinoma. It was stage IV (T4, N1, M0) using TNM clinical classification. The patient developed pharyngeal discomfort and abdominal pain and was hospitalized during the follow-up period, 1 year 9 months post-operatively. Multiple lung metastases, Virchow’s lymph node metastasis, and adrenal metastasis were observed. A mass of 2.5 cm was also observed in the right palatine tonsil. It was diagnosed as a moderately differentiated adenocarcinoma, a metastasis from gastric cancer. There was a concern of asphyxiation due to hemorrhage of the tumor; however, the tumor dislodged approximately 10 days after biopsy and tonsillar recurrence was not observed. The patient died 1 year 10 months post-operatively. In the literature there are cases with tonsillar metastases where surgical treatment, radiotherapy, and chemotherapy were performed and extension of survival was seen. Tonsillar metastasis is a form of systemic metastasis of a malignant tumor, and there is a high risk for asphyxiation from tumor dislodgement or hemorrhage. Thus, it is important to recognize tonsillar metastasis as an oncologic emergency.

Tonsillar metastasis of small cell lung carcinoma

“…Pathways of metastasis to tonsils are not fully understood. However, several mechanisms are suggested: Because palatine tonsils do not have efferent lymphatic drainage, tumor cells are transported via retrograde route, and this is only possible in the absence of cervical lymphatic metastasis . Hematogenous, especially intra‐abdominal tumors thought to spread this way . By passing through the lungs by paravertebral plexus . It may be spread through direct inoculation during bronchoscopy. Especially, it is considered that lung cancer implements to the tonsils this way . …”

“…Because palatine tonsils do not have efferent lymphatic drainage, tumor cells are transported via retrograde route, and this is only possible in the absence of cervical lymphatic metastasis .…”

Mucoepidermoid Carcinoma of the Palatine Tonsil

“…Malignant lymphoproliferative diseases are the second most frequent malignancy of the palatine tonsil, with the diffuse large B-cell lymphoma (DLBCL) comprising approximately 30% of all lymphomas [ 4 ]. Metastatic deposits of lung [ 5 ] and gastric carcinomas [ 6 ], as well as melanoma [ 7 ], renal carcinoma [ 8 ], and adenocarcinoma of the colon [ 9 ], have also been described in the palatine tonsils.…”

Palatine Tonsillar Metastasis of Small-Cell Neuroendocrine Carcinoma from the Lung Detected by FDG-PET/CT After Tonsillectomy: A Case Report

“…The most common primary sites are the breast (1), stomach (2), intestinal tract (3), cutaneous melanoma (4) and the kidney (5). Various malignant lung carcinomas may metastasize to the tonsils (6, 7) and a few cases of tonsillar metastasis from neuroendocrine lung carcinoma have been reported (6, 7).…”