A case of pulmonary metastasis from carcinoma of the external auditory canal

Abstract

We report a case of pulmonary metastasis from an extremely rare carcinoma of the external auditory canal. A 46-year-old woman was referred to our head and neck surgery department for resection of the residual tumor after cyberknife therapy for a primary carcinoma of the right external auditory canal in another hospital in August 2013. In January 2014, we performed subtotal resection of the right lateral temporal bone, radical neck lymph node dissection on the right, and reconstruction with a free rectus abdominis musculocutaneous flap. In November 2014, a new tumor appeared in the right cervical region, which was resected and diagnosed as local recurrence. In May 2015, computed tomography (CT) and magnetic resonance imaging revealed a second recurrent tumor in the right lateral oropharyngeal wall, para-hyoid area, and middle deep cervical lymph nodes, which was resected along with reconstruction with a free radial forearm flap. In December 2015, chest radiograph and CT showed a nodule in the lower lobe of the right lung, suggesting pulmonary metastasis. Therefore, she was referred to the Department of General Thoracic surgery. Thoracoscopic wedge resection of the right lower lobe was performed. Histological examination revealed squamous cell carcinoma similar to the primary carcinoma of the external auditory canal. She was discharged on day 3, and no recurrence and metastasis had occurred at 12 months after pulmonary metastasectomy (38 months after initial treatment). Resection of pulmonary metastasis from carcinoma of the external auditory canal can improve the prognosis, as in other pulmonary metastases from head and neck carcinomas. Therefore, surgery is recommended for pulmonary metastasis from carcinoma of the external auditory canal, and wedge resection is appropriate to ensure a safe resection margin.