A case of small cell lung cancer found by tonsillar metastasis

Abstract

　Tonsillar metastasis from lung cancer is uncommon. We report herein on a case of small cell lung cancer found by tonsillar metastasis. A-67-year-old man complaining of an abnormal sensation of his throat and dyspnea was referred to our hospital. Physical examination revealed that a right palatine tonsil was swollen, the surface of which was rough, but which had good mobility. A biopsy of the tonsillar tumor and immunohistological analysis led to a histological diagnosis of small cell carcinoma. CT scan showed the enlargement of a right cervical lymph node and a mass in the left lower lobe of the lung. Small cell carcinoma of the lung was diagnosed following a transbronchial biopsy. Because of metastasis to the tonsil, we diagnosed the primary as T2N0M1b, Stage IV lung cancer. The patient underwent intravenous chemotherapy, and the tumor lesions in the tonsil, neck, and lung reduced subsequently in size for a while, but still remained. We performed a right tonsillectomy and right neck dissection. After the surgery, there was no recurrence in the head and neck lesion. Fifteen months after diagnosis of tonsillar metastasis, the patient is still alive, and the lung tumor has been treated with chemotherapy. In cases of tonsillar metastasis, it is often difficult to treat the primary lesion. However, surgery for the metastasis lesions may be effective to prevent symptoms such as pain, bleeding and dyspnea.