See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/14805216 An unusual presentation of oat cell carcinoma Article in The Journal of Laryngology & Otology · July 1993 DOI: 10.1017/S0022215100123709 · Source: PubMed CITATIONS READS 3 18 3 authors , including: Ruth Capper Patrick Magennis Doncaster and Bassetlaw Hospitals NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 24 PUBLICATIONS 230 CITATIONS 202 PUBLICATIONS 1,760 CITATIONS SEE PROFILE SEE PROFILE Some of the authors of this publication are also working on these related projects: Curricula in OMFS View project Academic background of OMFS trainees View project All content following this page was uploaded by Patrick Magennis on 25 June 2014. The user has requested enhancement of the downloaded file.
The Journal of Laryngology and Otology June 1993, Vol. 107, pp. 559-560 An unusual presentation of oat cell carcinoma R. CAPPER, F.R.C.S.I.,* T. J. STEWART, F.R.C.S.,* J. P. MAGENNIS, F.F.D., R.C.S.I.** Abstract A case is reported of oat cell carcinoma of the lung presenting with unusual sites of metastasis to the orofacial region. Dis- tant metastases are common in oat cell carcinoma but a literature review did not reveal any reports of metastases either to the hard palate or to medial canthus of the eye. Key words: Lung neoplasms; Carcinoma, oat cell; Neoplasm metastasis, head and neck He complained of some difficulty in swallowing and in artic- Introduction ulation. He had no respiratory symptoms and his general health Oat cell carcinoma is well recognized for producing extra- was good. He had smoked 12 cigarettes per day for many years. thoracic metastases. These were present in more than 95 per cent On examination there was a soft, non-tender, mobile, well- of postmortem studies performed on patients who died of the delineated swelling measuring 2 x 2 x 1 cm at the medial can- disease (Brodsky and Rabsien, 1985). Less frequently, the thus of the right eye. The intra-oral swelling was similar in disease is diagnosed initially after recognition of such metasta- appearance and consistency, measuring 3 x 3 x 3 cm in the ses. A case of oat cell carcinoma of the lung is reported where the midline of the hard palate. On nasal examination, the septum was initial presenting features were metastases to the palate and to deviated to the left with no view of the posterior airway on this the right infra-orbital region. side. The right nasal airway was clear. It was impossible to view the post-nasal space as the patient could not tolerate a mirror in his pharynx. There were no palpable cervical lymph nodes. Case report X-rays of skull and sinuses (Fig. 1) showed soft tissue A 55-year-old man (S.W.), was referred by his general shadowing to the right of the nose with no involvement of under- medical practitioner to the Ear, Nose and Throat Outpatient lying bone. In view of the unusual nature of the swellings a pro- Department with a two-week history of a painless, rapidly grow- visional diagnosis of neoplastia was made. Blood tests were ing swelling on the hard palate and a four-week history of a taken and a chest X-ray requested. An appointment was arranged similarly painless swelling inferior to the right medial canthus. FIG. 1 FIG. 2 X-ray of sinuses showing soft tissue shadowing at the right inner Chest X-ray showing a large lesion at the right hilum. canthus. From the *Department of Otolaryngology, Ulster Hospital, Belfast and **The Queen's University, Belfast. Accepted for publication: 30 January 1993. 559
View publication stats View publication stats 560 R. CAPPER, T. J. STEWART, J. P. MAGENNIS for further investigation of the lesions in one week's time fol- tissue, with the most common sites being the base of the tongue lowing a course of broad spectrum antibiotics. and the gingivae. Metastatic oat cell carcinoma has also been described in the major salivary glands (Brodsky and Rabsien, After this time, the swellings had increased in size. The chest 1985; Cantera and Hernandex, 1989); tonsils (Seddon, 1989); X-ray was reported as showing a large infiltrating mass at the right hilum with a paratracheal stripe on the right, suggesting tongue (Sridhar et al., 1985) and pre-auricular area (Falk et al, associated paratracheal lymphadenopathy (Fig. 2). The full 1980). Multiple subcutaneous nodules, as seen in this case, have blood picture, urea and electrolytes and bone profile were also been described (Brodsky and Rabsien, 1985). normal. ESR was 13 mm in the first hour. Liver function tests This case is unusual in that the initial presentation of a rela- showed elevation of alkaline phosphatase and y-glutamine- tively common tumour was with a rare metastatic lesion to the transferase in keeping with secondary tumour deposits within hard palate. It was this intra-oral lesion which caused the pres- the liver. enting problems of dysphagia and dysarthria but a cutaneous The patient was admitted to hospital. The hard palate lesion lesion at the medial canthus predated it by two weeks. was biopsied and a fine needle aspiration was performed on the Where an unusual or atypical swelling is encountered, the facial swelling. The histopathology and aspiration cytology importance of biopsy or aspiration cytology in its diagnosis can- were reported as being in keeping with metastases from a poorly not be stressed too highly. differentiated oat cell carcinoma of the bronchus. His lung tumour was judged to be too advanced for surgery by a thoracic surgeon and he was referred for palliative chemotherapy. References Three weeks later he was readmitted to hospital as the lesion Brodsky, G., Rabsien, A. B. (1985) Metastases to the submandibular on the palate had grown rapidly and now completely filled the gland as the initial presentation of small cell carcinoma. Oral Sur- arch of the hard palate. He had severe candidiasis of the mouth gery, Oral Medicine and Oral Pathology 58: 76-80. and was experiencing difficulty maintaining an adequate oral Camera, J. M. G., Hernandex, A. V. (1989) Bilateral parotid gland fluid intake. The lesion on the right malar region now completely metastasis as the initial presentation of a small cell lung car- occluded the right eye. Multiple small subcutaneous nodules had cinoma. Journal of Oral and Maxillofacial Surgery 47 (part II): appeared on his face and upper thorax. 1199-1201. Coslett, L. M., Katlic, M. R. (1990) Lung cancer with skin metasta- Further chemotherapy was abandoned and he was transferred sis. Chest 97: 757-759. to the regional Hospice for terminal care. He died seven weeks Falk, H. J., Samit, A. M., Leban, S. G., Mashberg, A. (1980) Pre- after his initial presentation. auricular oat cell carcinoma metastases. Surgical Oncology 13: 295-300. Discussion Kaugars, G. E., Svirsky, J. A. (1981) Lung malignancies metastatic to the oral cavity. Oral Surgery, Oral Medicine and Oral Pathol- Oat cell carcinoma of the lung accounts for approximately 25 ogy 51 (2): 179-186. per cent of all bronchial carcinomas. It is an aggressive tumour Seddon, D. J. (1989) Tonsillar metastases at presentation of small and early metastasis is common. In the majority of cases, the cell carcinoma of the lung. Journal of Royal Society of Medicine tumour has spread beyond the lung by the time of diagnosis. The 82: 688. most frequent sites for metastases are hilar lymph nodes (96 per Sridhar, K. S., Chaninian, P., Schwartz, I. S. (1985) Tongue metasta- cent), liver (77 per cent), bone (59 per cent), adrenal glands (49 sis from undifferentiated small cell (oat cell) lung cancer. Journal per cent), brain (25 per cent) and kidney (24 per cent) (Falk et al., of Florida Medical Association 72 (part 6): 28-30. 1980). Wu, Y. T. (1990) Metastatic carcinoma of the oral tissues and jaws: a study of 25 cases. Chung-Hua Kou Ching I Hseueh Tsa Chih 25 The orofacial region is an uncommon site for any secondary (5): 258-261, 317. tumour. In a series of 2409 oral and jaw malignant tumours only Zachariades, N. (1989) Neoplasms metastatic to the mouth, jaws and 24 (1 per cent) were metastatic, 12 presenting as lesions in the surrounding tissues. Journal of Cranio-Maxillo-Facial Surgery bone of the mandible or maxilla and 13 in the soft tissue (12 gin- 17: 283-290. gival and 1 lip). Sixteen per cent of metastatic lesions arise in the lung (Wu, 1990). In two review articles, between 13 per cent Address for correspondence: (Kaugars and Svirsky, 1981) and 22.5 per cent (Zachariades, Miss Ruth Capper, F.R.C.S.I., 1989) of all metastatic lung lesions to the orofacial region were Longwood Cottage, oat cell in type. The Bath Clinic, Review of the reported cases of bronchial oat cell carcinoma Claverton Down, metastasizing to the perioral region reveals a predilection for soft Bath BA2 7BR.
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