P0166 - A Rare Case of Tonsillar Squamous Cell Carcinoma With Metastases to the Colon

Bianca Varda, MD, Tanuj Sharma, MD, Sarabdeep Mann, MD
St. Joseph's Hospital and Medical Center, Creighton University School of Medicine, Phoenix, AZ

Introduction: Head and neck squamous cell carcinoma (HNSCC) is associated with tobacco and alcohol use. The incidence of HNSCC in association with human papillomavirus (HPV) has also been increasing in recent years. The most common sites of metastases of HNSCC include the lung and bones. While there have been some reports of esophageal SCC metastasizing to the colon, HNSCC metastasizing to the colon is an even rarer occurrence. Here, we report a case of primary right tonsillar SCC with metastases to the colon.

Case Description/Methods: A 59-year-old male with a history of right tonsillar squamous cell carcinoma with metastases to the neck and chest status-post concurrent chemoradiation presented to our hospital due to worsening right upper quadrant abdominal pain. The patient was originally diagnosed with cancer roughly 2 years prior and had been receiving treatment with Oncology. He reported a 7-week history of abdominal pain which had greatly worsened a few days prior to presentation. On evaluation, he was afebrile and hemodynamically stable. Physical examination was notable for RUQ abdominal tenderness. CT of the abdomen demonstrated a circumferential mass of the cecum and ascending colon extending ~ 7 cm, right lower quadrant lymphadenopathy, and liver metastases. The patient underwent colonoscopy for further evaluation which showed a malignant-appearing, nearly-obstructive ascending colon mass. Pathology from biopsies of the mass showed metastatic squamous cell carcinoma. The patient subsequently underwent open right hemicolectomy with ileocolostomy. Unfortunately, his course was complicated by infection of his wound and pneumonia and he ultimately succumbed to his disease.

Discussion: Oropharyngeal SCC is associated with tobacco use and human papillomavirus. The most common sites of metastasis from head and neck cancers are the lung and bones. While it occasionally spreads to the liver or brain, metastatic spread to the colon is rarely reported. To the best of our knowledge, there have been two reports of metastatic SCC to the colon. One case illustrates metastatic spread of SCC to the colon and cervical lymph nodes from an unknown primary malignancy, while the other describes a case of primary submandibular SCC that spread to the colon. There have been a select number of cases describing head and neck SCC metastasizing to the small bowel, but spread to the colon is even rarer. This case illustrates a very rare presentation of SCC of the colon in the setting of a primary tonsillar malignancy.


Figure: Malignant-appearing ascending colon mass


Disclosures:
Bianca Varda indicated no relevant financial relationships.
Tanuj Sharma indicated no relevant financial relationships.
Sarabdeep Mann indicated no relevant financial relationships.


Bianca Varda, MD, Tanuj Sharma, MD, Sarabdeep Mann, MD. P0166 - A Rare Case of Tonsillar Squamous Cell Carcinoma With Metastases to the Colon, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.