Vertebral metastasis from squamous cell carcinoma of the tongue

Abstract

Tongue squamous cell carcinoma represents the most frequent and aggressive cancer of the oral cavity. It usually metastasizes via the lymphatic system at cervical level and distant metastases are uncommon. In case of metastasis outside the neck, the lung is the organ most frequently affected (1). In contrast, vertebral metastases are extremely rare. Approximatively, 7 cases of squamous cell carcinoma of tongue with spinal metastases have been described (2). The most common symptom related with vertebral metastases is the pain described as progressive and unremitting. Moreover, it is worse at night and usually improves with activity and anti-inflammatory medication (3). Motor and sensory dysfunctions are also common with the progressive spinal infiltration. X-ray, CT scan, PET and MRI are useful to confirm the lesion in case of suspicious. The treatment aims to reduce neurological disability and pain. According with literature, radiotherapy, palliative CT, decompressive surgery and steroids may be useful to manage this complication (4).We report three cases of vertebral metastases in patients affected by squamous cell carcinoma of the oral tongue. Two of these patients were males of 36 and 43 years old respectively (Patient 1 and 2), and the third was a female of 79 years old (Patient 3). All patients presented a positive biopsy for squamous cell carcinoma of the tongue before surgery and all of them underwent tumorectomy of the primary tumor and neck dissection. Interestingly, only one of these patients (patient 2) presented the common risk factors for squamous cell carcinoma of the oral cavity (alcohol and tobacco). According with the postoperative pathological findings the patients were staged as T2N1M0 (DOI 0.9 cm) (patient 1), T3N2aM0 (DOI 1.3 cm) (patient 2) and T1N2aM0 (DOI 0.4 cm) (patient 3) with free surgical margins. The clinical stage of the primary tumor was established following the recommendations of the International Union Against Cancer 8 th edition (UICC) (5).

Epidemiological and pathological characteristics of spinal metastases from gastrointestinal cancers – a series of 40 cases

“…Spinal metastases originating in the oral cavity cancer can be located in the cervical, thoracic and lumbar regions [ 15 , 17 , 18 ], although some authors emphasize that they metastasize mainly in the lumbar region and are most frequently represented by moderately differentiated or poorly differentiated squamous cell carcinoma and much less often by an adenoid cystic carcinoma of the tongue [ 17 , 18 , 19 , 20 , 21 ], aspects that are similar to those identified in our series.…”

“…For this reason, there are few data in the literature as only isolated cases or very small series of four to seven cases being published [ 15 , 17 , 18 , 19 , 20 , 21 ].…”

Soft tissue metastases affecting the paravertebral and vertebral region from squamous cell carcinoma of the upper jaw: a case report

“…Indeed, bone destruction is more extensive in case the metastasis originates in the vertebra and secondarily affects the muscular plane. Specifically, vertebral metastases are often associated with the pathological fracture of the affected vertebra (7,10). A definitive diagnosis is only possible with postoperative histopathological examination of the lesion (11).…”