Double vision and hyponatremia – Symptoms of a rare differential diagnosis for head and neck tumors

Distant metastases of squamous cell carcinoma of the head and neck typically only occur at an advanced stage of the disease. They are most commonly found in mediastinal lymph nodes, the lungs or the liver. Here we report the interesting case of a singular metastasis in the area of Sella turcica and pituitary gland in a patient with cT3 oropharyngeal cancer recurrence. Six months earlier, the initial diagnosis of a p16-negative G2 squamous cell carcinoma of the right oropharynx (initially staged pT4a pN2a M0) had been made and a therapy by means of transoral laser resection, bilateral neck dissection and adjuvant radiochemotherapy had been carried out. Due to recurrent oropharyngeal bleeding, the patient presented himself again in our clinic. A local recurrence in the region of the oropharyngeal sidewall was identified as the cause of bleeding by panendoscopy. Furthermore, using CT and MRI diagnostics, a bone-destructive lesion of the sella with infiltration of the pituitary gland was found and could be confirmed as squamous cell carcinoma metastasis by means of a trans-nasal biopsy. The metastasis became symptomatic first by double images and then, within only a couple of days, with a severe hyponatremia of 119 mmol/L. An ophthalmological examination detected a slight elevation deficit and depression deficit of the right eye as a result of an oculomotor paresis, most likely due to tumor infiltration of the cavernosus sinus. CT-scans of the neck and thorax as well as abdominal ultrasound showed no indication for the presence of further locoregional or distant metastases. In summary, we conclude that even head and neck tumors can metastasize in unusual localizations.

Publication History

Publication Date:
18 April 2018 (online)