Hypopharyngeal carcinoma with skeletal muscle metastases: a rare clinical entity


  • Nurafiqah Sharudin Otorhinolaryngology Department,Hospital Ampang, Selangor, Malaysia
  • Malinda Jeet Kaur Otorhinolaryngology Department,Hospital Ampang, Selangor, Malaysia
  • Lum Sai Guan Department of Otorhinolaryngology – Head and Neck Surgery, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
  • Shahrul Hitam Otorhinolaryngology Department,Hospital Ampang, Selangor, Malaysia
  • Khairullah Anuar Faculty of Medicine and Health Science, Universiti Sains Islam Malaysia
  • Eyzawiah Hassan Faculty of Medicine and Health Science, Universiti Sains Islam Malaysia
  • Rosna Yusuf Pathology Department, Hospital Kuala Lumpur




Hypophayrngeal carcinoma, Chemotherapy, Triceps muscle, Intramuscular


The common sites of distant metastatic spread of head and neck malignant tumor are lungs, liver, and bones. Skeletal muscles metastases are extremely rare. We present a case of 61-year-old man who was previously treated with radical chemo radiotherapy for hypopharyngeal squamous cell carcinoma, stage T4bN2cM0. During surveillance follow up 21 months post treatment, he developed a right proximal arm mass. There were no neurological or vascular deficit. MRI revealed an irregular enhancing intramuscular soft tissue mass within the right triceps muscle, with widespread nodal and skeletal muscle metastases. Tissue biopsy revealed a metastatic carcinoma favoring poorly differentiated squamous cell carcinoma. He received palliative chemotherapy but died 4 months later. Skeletal muscle metastases must be high in the list of differential diagnosis in a head and neck cancer patient presented with a muscle mass, even though it is rather rare. Radiological imaging and tissue biopsy helped in the diagnosis and prompt management.

Author Biography

Nurafiqah Sharudin, Otorhinolaryngology Department,Hospital Ampang, Selangor, Malaysia

Otorhinolaryngology Department


Wycliffe ND, Grover RS, Kim PD, Simental A Jr. Hypopharyngeal cancer. Top Magn Reson Imaging. 2007;18(4):243-58.

Muir C, Weiland L. Upper aerodigestive tract cancers. Cancer. 1995;75:147Y153.

Barnes L, Johnson JT. Pathologic and clinical considerations in the evaluation of major head and neck specimens resected for cancer. Part I. Pathol Annu. 1986;21:173Y250.

Olsen KD, Lewis JE, Suman VJ. Spindle cell carcinoma of the larynx and hypopharynx. Otolaryngol Head Neck Surg. 1997;116:47Y52.

Blot WJ, McLaughlin JK, Winn DM. Smoking and drinking in relation to oral and pharyngeal cancer. Cancer Res. 1988;48:3282Y3287.

Wynder EL, Hultberg S, Jacobsson F. Environmental factors in cancer of the upper alimentary tract; a Swedish study with special reference to Plummer-Vinson (Paterson-Kelly) syndrome. Cancer. 1957;10:470Y487.

Ahlbom HE. Simple achlorhydric anaemia, Plummer-Vinson syndrome, and carcinoma of the mouth, pharynx, and oesophagus in women. Br Med J. 1936;2:331Y333.

Larsson LG, Sandstro ̈m A, Westling P. Relationship of Plummer-Vinson disease to cancer of the upper alimentary tract in Sweden. Cancer Res. 1975;35:3308Y3316.

Amos A. Women and smoking. Br Med Bull. 1996;52:74Y89.

Spector GJ. Distant metastases from laryngeal and hypopharyngeal cancer. ORL J Otorhinolaryngol Relat Spec. 2001;63(4):224-8.

Haygood TM, Wong J, Lin JC. Skeletal muscle metastases: a three-part study of a not-so-rare entity. Skeletal Radiol. 2012;41(8):899-909.

Pretell-Mazzini, Juan MD, Younis. Skeletal Muscle Metastases from Carcinomas.A Review of the Literature. JBJS. 2020;8(7):e19-8.

Semelka RC, Worawattanakul S, Kelekis NL. Liver lesion detection, characterization, and effect on patient management: comparison of single-phase spiral CT and current MR techniques. J Magn Reson Imaging. 1997;7:1040Y1047.

Schmidt GP, Baur-Melnyk A, Herzog P. High-resolution whole-body MRI tumor staging with the use of parallel imaging versus dual modality PET-CT: experience on a 32-channel system. Invest Radiol. 2005;40:743Y753.

Damron TA, Heiner J. Distant soft tissue metastases: A series of 30 new patients and 91 cases from the literature. Annals of Surgical Oncology. 2000;7:526-534.

Helliwell TR. Acp Best Practice No 169. Evidence based pathology: squamous carcinoma of the hypopharynx. J Clin Pathol. 2003;56:81Y85.






Case Reports