School of Medicine Publications and Presentations

S4930 A Rare Case of Submandibular Gland Squamous Cell Carcinoma Metastasized to Small Intestine

Document Type

Article

Publication Date

10-2024

Abstract

Introduction:

Submandibular gland cancer is uncommon ENT malignancy, accounting for less than 1% of head neck cancer. Primary Squamous cell carcinoma of submandibular salivary gland accounts to almost 2% of the tumors, making it rare and typically exhibits a very poor prognosis. Similarly small bowel tumors are also rare. Here we are presenting a case of aggressive submandibular squamous cell cancer with unique metastasis to small bowel.

Case Description/Methods:

65-year-old man with history of hypertension presented with left sided neck mass present for 2 months with concomitant chronic cough, night sweats and 15 lb weight loss. Patient reported smoking history of 1 pack per day for 50 years. Physical exam showed cachectic man with poor dentition and large 6-7 cm firm indurated left submandibular mass with no fluctuance and tenderness. Computed tomography maxillofacial structures with intravenous contrast showed large heterogeneous centrally necrotic mass measuring up to 6.7 cm arising from the left peri-mandibular gland. US guided biopsy of the mass showed squamous cell carcinoma. The computed tomography chest was done which also showed right apical lung mass measuring up to 8.5 cm concerning malignancy with erosion of the adjacent ribs. Computed tomography guided biopsy showed poorly differentiated adenocarcinoma. Overall findings were suggestive of patient having 2 primary malignancies- submandibular squamous cell carcinoma as well as lung adenocarcinoma. To complete metastatic workup, computed tomography abdomen was obtained which showed circumferential mass-like wall thickening involving proximal jejunum. Push enteroscopy was performed which showed a large fungating, friable circumferential mass in proximal jejunum which could not be traversed. Multiple biopsies were obtained which showed poorly differentiated carcinoma with squamous differentiation. Patient was started on palliative radiation however unfortunately patient developed septic shock and was deceased.

Discussion:

Although the small intestine makes up the largest part of the gastrointestinal tract, small bowel cancers are rare in the United States. Metastatic cancers of small intestine account for 10% of all small bowel cancers. The most common sites of primary tumor metastasizing to small bowel are uterus, cervix, colon, lung, breast and melanoma. Most of these metastatic tumors come from adenocarcinoma primaries; squamous cell carcinoma constitutes a very small proportion of all metastatic small intestinal lesions. Metastasis to small bowel by head and neck squamous cell carcinoma is extremely rare and carries an unfavorable prognosis (see Figure 1).

Comments

© 2024 by The American College of Gastroenterology

Publication Title

The American Journal of Gastroenterology

DOI

http://doi.org/10.14309/01.ajg.0001049088.86316.70

Academic Level

faculty

Mentor/PI Department

Internal Medicine

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