1099 Tonsillar Carcinoma Metastasis to the Central Nervous System: Case Report and Literature Review

Abstract

We present a case report of a 51-year-old left-handed male with a background of human papillomovairus 16-positive tonsil squamous cell carcinoma presenting with tonic-clonic seizures and a radiological diagnosis of secondary CNS metastatic deposits. These were initially treated with stereotactic radiosurgery and subsequently with surgery. Surgical resection was performed under general anesthesia with right-sided temporal and parietal approaches. Both the parietal and temporal deposits were removed, while the intraventricular mass was intentionally left to avoid postoperative deficits. Adjuvant radiotherapy and chemotherapy were administered postoperatively. The patient experienced a satisfactory post operative recovery. However, he was reoperated for recurrence 4 months later. He maintained a good quality of life and an excellent performance status throughout, but unfortunately, he passed away in November 2018 due to septic complications. This case history stresses the difficulty in managing oropharyngeal squamous cell carcinomas (SCC) with brain metastatic deposits. There are no current guidelines regarding the management of patients presenting with such a rare condition. Additionally, we performed a literature review and describe the limited previous cases within the literature. More data is thus desirable to better define treatment guidelines and protocols when tonsillar SCC brain metastases are present.