Hypopharynx cancers are uncommon, accounting for less then 5% of all head and neck cancers1. The squamous cell carcinoma (SCC) of the hypopharynx is very difficult to diagnose and treat1. Normally it is a very aggressive carcinoma that develops in an area with rich lymphatic drainage, being very prone to metastization and an overall poor outcome2.
The production of metabolites of tumorous cells can have a systemic effect in multiple organic systems, in what is described as paraneoplastic syndrome. Although rare, this syndrome is commonly associated with SCC and relates to poor outcome and relevant comorbidity. One of the possible manifestations is hypercalcemia and it is related to the secretion of a parathyroid hormone (PTH) related peptide, which binds to the PTH receptors and stimulates calcium reabsorption while inhibiting its excretion3.
We present the case of a fifty-year-old man, active smoker, with a stage IV hypopharynx squamous cell carcinoma with bilateral cervical ganglion invasion plus lung metastasis. This lesion progressed despite 2 cycles of chemotherapy (docetaxel, cisplatin e 5-fluorouracil). Admitted for treatment of hypercalcemia with moderate neurologic dysfunction. The study showed a low PTH and cholecalciferol levels, and treatment was started for paraneoplastic hypercalcemia with zoledronic acid, loop diuretics and fluid therapy.
Even though it was possible to symptomatically control the hypercalcemia the lesion grown to an extension of 150mm. The patient was discharged to a Palliative Care Unit and died 3 months later.
The authors present the image of an extremely exuberant cervical mass and intend to alert either to its rare origin and its paraneoplastic manifestations.
Figura I
Large heterogeneous cervical mass from a hypopharynx squamous cell carcinoma (front and lateral view).
BIBLIOGRAFIA
(1) Hall SF, Groome PA, Irish J and O’Sullivan B. The Natural History of Patients With Squamous Cell Carcinoma of the Hypopharynx. Laryngoscope, 118:1362–1371, 2008
(2) Yamamoto K, Takano K, Kondo A, Kurose M, Obata K and Himi T. Clinical and Prognostic Analysis of Hypopharyngeal Squamous Cell Carcinoma with Synchronous and Metachronous Multiple Malignancies. In Vivo. January-February 2018 vol. 32 no. 1 165-170
(3) Mathew DB, Rooban T, Janani V, Joshua E, Rao UK and Ranganathan K. Review of paraneoplastic syndromes associated with oropharyngeal squamous cell carcinoma. Oral Maxillofac Pathol. 2010 Jul-Dec; 14(2): 41–47.
