Background
Common sites of distant metastasis of oral squamous cell carcinoma (SCC) are the liver and lungs. We present a rare case of distant metastasis of pT4N0 oral SCC to bilateral neck of femurs.
Clinical Case
A 73 year-old male was seen in the Oral and Maxillofacial Department with a 3-month history of an ulcer on the right alveolus. On examination, a 2.5cm ulcer was present without cervical lymphadenopathy. A biopsy proved SCC and disease staging was carried out. The patient underwent a right mandibular rim resection and neck dissection.
The histopathology results of the resection confirmed pT4N0 moderately-differentiated SCC. The patient declined adjuvant radiotherapy.
Three months following the resection, he presented with bilateral atraumatic neck of femur fractures with prior hip pain. This was confirmed radiologically and pathologically as metastatic SCC of bilateral femurs and Meckel’s cave contents. The patient is currently undergoing palliative chemotherapy.
Conclusion
This is a rare case of distant metastasis of oral SCC to long bones in the absence of nodal involvement. This demonstrates the challenges in identifying bone metastases in a background of oral SCC. Close attention should be paid to systemic symptoms and further investigations should be more readily considered if there is suspicion of distant metastasis.
Francesca Lee1, Saoirse Kilgarriff1, Akinsola Ogunbowale1, Michael Gilbride1
1 Department of Oral and Maxillofacial Surgery, University Hospital Limerick, Limerick