Grandhe Sundeep, Bajaj Tushar, Duong Hanh, Ratnayake Saman N
Department of Medicine, Kern Medical Center, University of California, Los Angeles (UCLA), Bakersfield, CA, USA.
Department of Medicine, Ross University School of Medicine, Miramar, FL, USA.
Am J Case Rep. 2019 May 9;20:664-667. doi: 10.12659/AJCR.915073.
BACKGROUND Metastatic basaloid squamous cell carcinoma is a fatal, high-grade variant of squamous cell carcinoma that is extremely rare in the oral cavity. We present a rare case of metastatic basaloid squamous cell carcinoma arising from the hypopharynx with pulmonary and brain metastases. Recognizing this diagnostic subtype is of critical importance due to the aggressive nature and high incidence of recurrence, lymph node metastases, and mortality. CASE REPORT A 42-year-old male arrived at the Emergency Department reporting a 1-week headache. Six months prior, he reported throat pain and neck swelling. Triple endoscopy revealed a large ulcerative tumor. A carbon dioxide laser procedure debulked and removed the mass. Incisional biopsy with histopathology was consistent with invasive basaloid squamous cell carcinoma. Computed tomography (CT) of the neck with contrast demonstrated bilateral cervical level II/III necrotic adenopathy, and CT chest with contrast demonstrated bilateral pulmonary nodules. The patient completed chemoradiation therapy with cisplatin; however, repeat CT chest revealed enlarging intrapulmonary metastases. CT brain without contrast demonstrated a central brainstem lesion. The patient started treatment with pembrolizumab. On day 14 of treatment, he presented to the Emergency Department again for headache. MRI of brain with contrast demonstrated a new lesion with vasogenic edema. Intravenous dexamethasone was started and the decision to pursue stereotactic radiosurgery was made. CONCLUSIONS The diagnosis of basaloid squamous cell carcinoma in the setting of intrapulmonary and brain metastases is an extremely rare, high-grade bimorphic aggressive variant of squamous cell carcinoma that needs to be histopathologically differentiated from other tumors. Given its high mortality rate and poor prognosis the decision to pursue further treatment versus aggressive palliative care should be discussed.
背景 转移性基底样鳞状细胞癌是鳞状细胞癌的一种致命的高级别变体，在口腔中极为罕见。我们报告一例罕见的下咽来源的转移性基底样鳞状细胞癌，伴有肺和脑转移。鉴于其侵袭性本质以及高复发率、淋巴结转移率和死亡率，认识这种诊断亚型至关重要。病例报告 一名42岁男性因头痛1周就诊于急诊科。6个月前，他报告有咽痛和颈部肿胀。三联内镜检查发现一个大的溃疡性肿瘤。二氧化碳激光手术切除了肿块。切开活检的组织病理学结果与浸润性基底样鳞状细胞癌一致。颈部增强计算机断层扫描（CT）显示双侧颈II/III级坏死性淋巴结病，胸部增强CT显示双侧肺结节。患者完成了顺铂同步放化疗；然而，复查胸部CT显示肺内转移灶增大。脑部平扫CT显示脑干中央有病变。患者开始使用帕博利珠单抗治疗。治疗第14天，他因头痛再次就诊于急诊科。脑部增强磁共振成像（MRI）显示一个新的伴有血管源性水肿的病变。开始静脉注射地塞米松，并决定进行立体定向放射外科治疗。结论 在伴有肺和脑转移的情况下，基底样鳞状细胞癌的诊断是一种极其罕见的、高级别的双相侵袭性鳞状细胞癌变体，需要通过组织病理学与其他肿瘤进行鉴别。鉴于其高死亡率和不良预后，应讨论进一步治疗与积极姑息治疗的决策。
