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ISSN: 2165-7920
Journal of Clinical Case Reports
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Rapidly Growing Neck Metastasis in Immunodeficiency

Nabeel Zahid Ilyas*, Chris Bowles and Peter A Brennan

Queen Alexandra Hospital, UK

*Corresponding Author:
Nabeel Zahid Ilyas
Queen Alexandra Hospital, UK
Tel: +442392286000
E-mail: nabeelilyas@hotmail.co.uk

Received Date: April 06, 2017; Accepted Date: May 22, 2017; Published Date: May 27, 2017

Citation: Ilyas NZ, Bowles C, Brennan PA (2017) Rapidly Growing Neck Metastasis in Immunodeficiency. J Clin Case Rep 7:962. doi: 10.4172/2165-7920.1000962

Copyright: © 2017 Ilyas NZ, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

An 80-year-old fit male with known long-standing stable chronic lymphatic leukaemia (CLL) presented with a rapidly enlarging left neck mass. The mass invaded the neck skin and began to fungate reaching to 10 cm in less than 3 weeks. Whilst head and neck skin SCC can metastasise to the regional lymph nodes (including to the contra-lateral side) rapid growth as occurred in this case is exceptionally rare and to our knowledge has not been previously reported.

Keywords

Metastasis; CLL; Chronic lymphoid leukaemia; Head and neck cancer; SCC; Contra-lateral growth

Case Report

An 80-year-old fit male with known long-standing stable chronic lymphatic leukaemia (CLL) and several stable small volume 1.5 cm neck nodes presented with a rapidly enlarging left neck mass. The mass invaded the neck skin and began to fungate (Figure 1). Initial Ultrasound and fine need aspiration showed a 3 cm mass, which on subsequent CT staging was shown to have grown to 10 cm in less than 3 weeks. There was no evidence of any lung metastasis. Some 2 years earlier he underwent removal of a 1 cm squamous cell carcinoma (SCC) from the right alar region of his nose. Ultrasound-guided fine needle aspiration cytology of the neck mass confirmed metastatic SCC rather than CLL. CT demonstrated a large necrotic mass with necrosis confirming rapid growth, with the tumour outstripping its blood supply (Figures 2 and 3). Following discussion at the head and neck MDT, he was managed surgically with a radical neck dissection including removal of the overlying skin, with a latissimus dorsi flap reconstruction (Figure 4) followed by post-operative radiotherapy. To date there has been no tumour recurrence.

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Figure 1: Large 10 cm fungating left neck mass.

clinical-case-reports-Coronal-view

Figure 2: Coronal view of CT scan showing fungating neck mass.

clinical-case-reports-Axial-view

Figure 3: Axial view of CT scan showing fungating neck mass.

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Figure 4: Post operative reconstruction with latissimus dorsi flap.

Whilst head and neck skin SCC can metastasise to the regional lymph nodes (including to the contra-lateral side 1) rapid growth as occurred in this case is exceptionally rare and to our knowledge has not been previously reported. In a presentation such as this, immunosupression (such as CLL, drugs, HIV and other causes) should always be considered resulting in rapid primary tumour growth or unusual metastatic presentation [1,2].

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