Article
Axillary metastasis in head and neck cancer: two case reports
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Published: | July 30, 2013 |
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Introduction: Axillary metastasis secondary to squamous cell carcinoma (SCC) of the head and neck are extremely rare. To the best of our knowledge, only six patients with cancer of the larynx and two with oropharyngeal cancer were reported in the literature over the last four decades.
Case Reports: A 64-year-old man with a relapse of a laryngeal carcinoma after laser surgery was treated with laryngectomy and neck dissection. Three years later a peritracheal recurrent tumor growth was diagnosed. The patient underwent hemithyreoidectomy, tracheal resection and radiochemotherapy. An axilary swelling was noted after one year and the patient scheduled for axillary lymphadenectomy. Local axillary recurrence after another year was treated by radical lymphadenectomy and radiochemotherapy. He is recurrence-free for 20 month now. A second, 55 year-old patient with an oropharyngeal SCC was treated by laser surgery, neck dissection and radiochemotherapy. Three years later a local recurrence with cervical nodal metastasis was treated by brachytherapy and neck dissection. An mandibular osteoradionecrosis requiring plastic reconstructive surgery with a free radial forearm flap. Seven years later the patient noticed an axillary swelling which was found to be solitary in PET-CT. Therefore, radical axillary lymphadenectomy and radiochemotherapy was undertaken. Two years later a local axillary recurrent tumor was diagnosed. Palliative chemotherapy was cancelled due to progressive tumour growth.
Conclusion: Radical surgery of the neck region obviously has an impact on the lymphatic drainage. Alternative lymphatic drainage pathways may result in unusual axillary metastasis in cases of head and neck cancer. This should be considered in the oncological follow-up.