Solitary brain metastasis from laryngeal squamous cell carcinoma in a 68-year-old male: A Case Report

Abstract

Introduction and importance: Laryngeal squamous cell carcinoma (LSCC) commonly metastasizes to regional lymph nodes, lungs, liver, and bones. Intracranial metastasis from LSCC is exceedingly rare, reported in only 0.4% of cases. The atypical presentation can delay diagnosis and negatively impact prognosis. We report a rare case of solitary brain metastasis from LSCC, highlighting the diagnostic challenges and clinical considerations.

Case presentation: A 68-year-old Pakistani male with a prior diagnosis of LSCC presented with new-onset generalized tonic-clonic seizures. He had previously undergone total laryngectomy, radiotherapy, and chemotherapy. Brain MRI revealed a right frontal lobe lesion with surrounding edema, consistent with a solitary metastasis. Histopathology following craniotomy confirmed metastatic squamous cell carcinoma. The patient was managed with antiepileptics and referred for palliative whole-brain radiotherapy. He and his family opted for palliative care, declining further aggressive treatment.

Clinical discussion: Distant brain metastasis in LSCC is rare and may occur without prior systemic spread. The mechanism may involve perineural invasion, although the exact pathophysiology remains unclear. Current diagnostic approaches include MRI and FDG-PET/CT. Due to limited cases, standardized treatment protocols are lacking. Management options include surgery, radiotherapy, chemotherapy, and palliative care, depending on disease progression and patient preference. Seizures as a presenting symptom are uncommon but may indicate intracranial involvement.

Conclusion: This case emphasizes the need for high clinical suspicion and comprehensive neurological assessment in patients with advanced LSCC. Early diagnosis and multidisciplinary management are essential for improving outcomes in this rare but serious manifestation.

Figure 1.

CT neck demonstrates a well-defined heterogeneous mass centered on the right true vocal cord with supraglottic extension. It is causing partial obstruction of the airway. There is associated cervical lymphadenopathy.

Figure 2.

MRI brain is heterogeneous with an iso to hyper appearance in T2 and necrotic part visible in T1 post contrast. T1 hypointense, T2 hyperintense intraparenchymal lesion in the right premotor area of frontal lobe with peripheral post-contrast enhancement and extensive vasogenic edema. Blooming artifact is noted on GRE sequence, signifying internal hemorrhage. Findings are in keeping with a solitary metastatic lesion.

Figure 3.

Neoplastic cells having abundant cytoplasm, atypical nuclei, and keratinization at the center.