Marioni Gino, Blandamura Stella, Calgaro Nicola, Ferraro Silvia Maria, Stramare Roberto, Staffieri Alberto, De Filippis Cosimo
Department of Otolaryngology, Head and Neck Surgery, University of Padua, Padua, Italy.
Acta Otolaryngol. 2005 Jun;125(6):678-82. doi: 10.1080/00016480410024613.
Clinical evidence of non-lymphatic distant metastasis has been reported in approximately 10% of cases of head and neck squamous cell carcinoma (HNSCC). The lungs are the commonest site of distant metastasis of HNSCC, followed by the bones, liver and skin. A 65-year-old male underwent supraglottic laryngectomy and left modified neck dissection for a carcinoma of the laryngeal surface of the epiglottis extending to both false cords. Eight months later the patient underwent right radical modified neck dissection for hypodermal metastatic disease involving the underlying (sternocleidomastoid) muscle. Thirty-two months later, surgical excision of a lesion in the right gluteus maximus muscle was performed. Histological study diagnosed a muscular metastasis with the same morphological aspect as the laryngeal carcinoma. The patient showed no evidence of cervical or distant recurrence at follow-up after 13 months. Although skeletal muscles represent approximately 50% of total body mass and receive a large proportion of total cardiac output, haematogenous metastases to skeletal muscle are extremely uncommon. Most skeletal muscle metastases are of pulmonary origin. Distant skeletal muscle metastasis from HNSCC is an extremely rare occurrence. Treatment options, depending upon the clinical setting, include observation, radiotherapy, chemotherapy and excision; these approaches rarely alter the patient outcome. The prognosis associated with skeletal muscle metastasis is thought to be poor, consistent with the fact that it generally occurs as a feature of systemic spread.
据报道，约10%的头颈部鳞状细胞癌（HNSCC）病例存在非淋巴远处转移的临床证据。肺是HNSCC远处转移最常见的部位，其次是骨、肝和皮肤。一名65岁男性因会厌喉面癌累及双侧假声带，接受了声门上喉切除术和左侧改良颈清扫术。八个月后，患者因皮下转移性疾病累及深层（胸锁乳突肌）肌肉，接受了右侧根治性改良颈清扫术。三十二个月后，对右侧臀大肌的一个病灶进行了手术切除。组织学研究诊断为肌肉转移，其形态与喉癌相同。随访13个月后，患者未出现颈部或远处复发迹象。虽然骨骼肌约占全身质量的50%，并接受大部分的心输出量，但血行转移至骨骼肌极为罕见。大多数骨骼肌转移灶起源于肺。HNSCC远处骨骼肌转移极为罕见。根据临床情况，治疗选择包括观察、放疗、化疗和切除；这些方法很少能改变患者的预后。与骨骼肌转移相关的预后被认为很差，这与它通常作为全身扩散的一个特征出现这一事实相符。
