Noémie Vanden Haute, Catherine Vervaet, Laure Maindiaux, Stephen Taylor, Valerie Durieux, Stephane Holbrechts
Département de chirurgie orale et maxillo-faciale, HELORA hôpital de Mons site Kennedy, Boulevard John Fitzgerald Kennedy, 2, 7000 Mons, Belgium.
Département d'oncologie, HELORA hôpital de Mons site Kennedy, Boulevard John Fitzgerald Kennedy, 2, 7000 Mons, Belgium.
Int J Surg Case Rep. 2025 Feb;127:110677. doi: 10.1016/j.ijscr.2024.110677. Epub 2024 Dec 6.
Head and neck squamous cell carcinoma (HNSCC) is the seventh most common type of cancer in the world. Metastases occur in up to 40 % of cases and bones are the second most frequent site. Metastases in extremities are uncommon with very few publications covering distal lower-limb bone metastasis.
Here we report the case of a patient with HNSCC managed by induction chemotherapy, surgery and adjuvant chemo-radiotherapy. During the adjuvant treatment, the patient presented pain in the right tibia, with additional workup revealing a distal lower-limb bone metastasis which had remained undetected during the recommended standard workup for HNSCC.
Current guidelines request that FDG PET-CT is performed down to the popliteal fossae. The undetected metastasis led to overtreatment of the patient. Systematic review of the literature showed only six cases of head and neck cancer's distal lower-limb metastasis which are eligible for discussion.
Although rare, physicians should keep in mind that as recommended FDG PET-CT does not extend below the popliteal fossae, metastases could be missed and therefore lead to inappropriate treatment.
头颈部鳞状细胞癌（HNSCC）是全球第七大常见癌症类型。高达40%的病例会发生转移，骨骼是第二常见的转移部位。四肢转移并不常见，关于下肢远端骨转移的出版物很少。
在此，我们报告一例HNSCC患者，接受了诱导化疗、手术及辅助放化疗。在辅助治疗期间，患者出现右胫骨疼痛，进一步检查发现下肢远端骨转移，而在HNSCC推荐的标准检查中未检测到。
当前指南要求进行FDG PET-CT检查至腘窝水平。未检测到的转移导致对该患者的过度治疗。文献系统综述显示，仅有6例头颈部癌下肢远端转移病例适合讨论。
尽管罕见，但医生应牢记，按照推荐，FDG PET-CT检查不涵盖腘窝以下部位，可能会漏诊转移，从而导致不恰当的治疗。
