Krishnan Sathish, Abbasi Faheem, Jayapal Praveen, Selvarajan Dhileepan
Pulmonary and Critical Care Medicine, Community Health Network, Indianapolis, USA.
Radiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, USA.
Cureus. 2025 Jan 4;17(1):e76903. doi: 10.7759/cureus.76903. eCollection 2025 Jan.
Head and neck squamous cell carcinoma (HNSCC) typically originates from the squamous cells lining the mucosal surfaces of the head and neck. Patients may present with diverse symptoms, including hoarseness of voice, difficulty swallowing (dysphagia), a neck mass, or a cough. While metastasis is usually regional, distant metastases, including tracheobronchial involvement, though rare, can occur and are often associated with a poor prognosis. Here, we report the case of a 64-year-old patient with a history of smoking who presented with complaints of exertional dyspnea and a chronic cough for six months. Pulmonary function tests confirmed a diagnosis of chronic obstructive pulmonary disease (COPD), and bronchodilator therapy with ipratropium was initiated. Four months later, at a follow-up, the patient reported worsening cough and new-onset hoarseness. A CT scan of the neck revealed a lesion on the left vocal cord, and a flexible nasopharyngolaryngoscopy confirmed a left vocal cord tumor. A biopsy and elective tracheostomy were performed, with pathology demonstrating an invasive, moderately differentiated squamous cell carcinoma. A positron emission tomography-computed tomography (PET-CT) scan showed intense fluorodeoxyglucose (FDG) uptake in the vocal cord lesion and bilateral cervical lymph nodes, leading to a diagnosis of stage IV laryngeal cancer (T3N2cM0). The patient underwent concurrent chemotherapy with cisplatin for seven weeks and radiation therapy targeted at the larynx and bilateral neck lymph nodes. A follow-up laryngoscopy and CT scan of the neck, five months post-diagnosis, showed near-complete resolution of the left vocal cord tumor and a reduction in the size of the cervical lymph nodes. Another PET-CT scan, performed six months post-diagnosis, showed no FDG uptake in the left vocal cord and cervical lymph nodes. However, a small focus of FDG uptake was noted in the upper posterolateral aspect of the tracheoesophageal stripe, which was reported as a tracheoesophageal lymph node. An esophagogastroduodenoscopy (EGD) with endoscopic ultrasound (EUS) was planned. However, after a thorough review of PET-CT scan images and discussion at the multidisciplinary team (MDT) meeting, the patient underwent a bronchoscopy instead. This revealed two small endotracheal lesions, confirmed by biopsy as invasive, moderately differentiated keratinizing squamous cell carcinoma. Despite an excellent local response, the patient developed endotracheal metastasis, an uncommon occurrence. This case underscores the complexities in diagnosing head and neck squamous cell carcinoma (HNSCC) with atypical metastatic presentations. It highlights the necessity of an integrated approach for timely diagnosis and expeditious treatment.
头颈部鳞状细胞癌（HNSCC）通常起源于头颈部黏膜表面的鳞状细胞。患者可能出现多种症状，包括声音嘶哑、吞咽困难（吞咽障碍）、颈部肿块或咳嗽。虽然转移通常是区域性的，但远处转移，包括气管支气管受累，虽然罕见，但也可能发生，且往往与预后不良相关。在此，我们报告一例64岁有吸烟史的患者，其主诉劳力性呼吸困难和慢性咳嗽6个月。肺功能测试确诊为慢性阻塞性肺疾病（COPD），并开始使用异丙托溴铵进行支气管扩张剂治疗。四个月后随访时，患者报告咳嗽加重且出现新发声音嘶哑。颈部CT扫描显示左侧声带处有一病变，纤维鼻咽喉镜检查证实为左侧声带肿瘤。进行了活检和择期气管切开术，病理显示为浸润性、中度分化的鳞状细胞癌。正电子发射断层扫描-计算机断层扫描（PET-CT）显示声带病变和双侧颈部淋巴结有强烈的氟脱氧葡萄糖（FDG）摄取，从而诊断为IV期喉癌（T3N2cM0）。患者接受了为期7周的顺铂同步化疗以及针对喉部和双侧颈部淋巴结的放射治疗。诊断后5个月的随访喉镜检查和颈部CT扫描显示左侧声带肿瘤几乎完全消退，颈部淋巴结大小减小。诊断后6个月进行的另一次PET-CT扫描显示左侧声带和颈部淋巴结无FDG摄取。然而，在气管食管间隙的上后外侧发现一个小的FDG摄取灶，报告为气管食管淋巴结。计划进行食管胃十二指肠镜检查（EGD）并结合内镜超声（EUS）。然而，在对PET-CT扫描图像进行全面审查并在多学科团队（MDT）会议上进行讨论后，患者改为接受支气管镜检查。这发现了两个小的气管内病变，活检证实为浸润性、中度分化的角化鳞状细胞癌。尽管局部反应良好，但患者发生了气管内转移，这是一种罕见的情况。该病例强调了诊断具有非典型转移表现的头颈部鳞状细胞癌（HNSCC）的复杂性。它突出了采用综合方法进行及时诊断和快速治疗的必要性。
