# Distant Multilevel Spinal Metastasis Secondary to Hypopharyngeal Squamous Cell Carcinoma

## TL;DR

This paper reports a rare case of hypopharyngeal cancer spreading to the cervical spine, emphasizing the need for awareness of such metastasis in similar patients.

## Contribution

The novelty lies in presenting a rare clinical case of spinal metastasis from hypopharyngeal squamous cell carcinoma.

## Key findings

- The patient developed cervical spine metastasis three months after surgery for hypopharyngeal cancer.
- MRI and biopsy confirmed osseous metastasis from the primary hypopharyngeal tumor.
- The case underscores the importance of considering spinal metastasis in patients with a history of hypopharyngeal cancer.

## Abstract

Head and neck squamous cell carcinomas account for most head and neck malignancies. While multi-modality treatment may be offered for locally advanced cancer, distant metastasis still occurs in a significant number of patients. This paper aims to present a rare case of a patient who developed bony metastases in the cervical spine from a primary hypopharyngeal malignancy status post-laryngopharyngectomy.
We report a case of a male patient presenting with acute-on-chronic hypercapnic and hypoxic respiratory failure with two months of dysphagia and weight loss. On arrival, a barium swallow revealed mucosal irregularity of the upper thoracic esophagus as well as narrowing and stenosis. A direct laryngoscopy with biopsy revealed squamous cell carcinoma of the hypopharynx. CT neck and chest were obtained for staging. He underwent a total laryngopharyngectomy, bilateral neck dissections, and a free flap. His final staging was pT4aN2c cM0. Three months post-admission, during inpatient radiation therapy, the patient reported midline neck pain with focal bone tenderness, and an MRI was obtained of his cervical and thoracic spine with a report concerning spinal metastasis.A subsequent bone biopsy showed findings consistent with osseous metastasis from a primary hypopharyngeal squamous cell carcinoma. After multidisciplinary goals of care discussions, the patient ultimately decided to be discharged to inpatient hospice.

This report highlights a rare case of hypopharyngeal carcinoma metastasis to the cervical spine. Despite its rarity and poor prognosis, such a metastasis should be considered in the differential diagnosis of patients with a history of hypopharyngeal squamous cell carcinoma and localizing symptoms.