FDG PET/CT in a rare case of multiple cutaneous metastases in carcinoma larynx
A 65-year-old male smoker patient diagnosed to have SCC of larynx in year 2002 presented with complaints of change in voice, significant weight loss, difficulty in swallowing, reduced appetite, and gradual progressive random appearance of nodular cutaneous lesions. He also had past history of foreign body sensation associated with throat discomfort. Laryngoscopy in 2002 revealed a 1.5-cm mass arising from the undersurface of epiglottis on the left side. Biopsy of the mass confirmed moderately differentiated SCC. The patient did not take any standard treatment and remained on self medication with homemade remedies. He continued to have throat discomfort intermittently during this period. This patient reported to our hospital when he developed progressive and generalized skin lesion over the body. Clinically, the patient had a poor built and emaciated looks with tachycardia. He had multiple nodular lesions of varying sizes over trunk, chest, back, face, scalp, and extremities; some of these lesions were erythematosus and crusted [Figure and ]. The patient had a nasal twang in speech. Rest of the systemic examination and routine blood examination were apparently normal. Indirect laryngoscopy was done, which revealed a proliferative growth on the laryngeal surface of epiglottis. 18F-fluorodeoxyglucose positron emission tomography computed tomography (FDG PET/CT) was done that showed an irregular soft tissue thickening in the epiglottis, multiple FDG avid cutaneous deposits of varying sizes involving all extremities, trunk, neck, scalp, and face, multiple FDG avid pleural-based nodules FDG avid abdominal lymph nodes, and a solitary skeletal lesion in left scapula [Figures and ]. A representative lesion was excised and histopathology as well as immunohistochemistry confirmed the deposits of poorly differentiated carcinoma consistent with metastasis in a known case of carcinoma of larynx.