Multifocal intracranial and spinal metastasis from oral squamous cell carcinoma: A rare case report

Oral cancer is the second most common cancer in India, with squamous cell carcinoma (SCC) noted in 90% of cases. Distant metastasis (brain metastasis) from oral SCCs is rare. The incidence of intracranial metastasis is about 0.4% and 2%–8% and approximately 5% to 10% of all cancer patients develop spinal metastasis. However, vertebral metastasis is rare form of distant metastasis from SCC of the oral cavity. Multifocal metastases to the brain and spine of primary oral squamous cell carcinomas have not been reported till date which prompted us to report this case. A 35-year-old male with a history of radical resection done for SCC of the buccal mucosa followed by postoperative chemoradiotherapy presented with complaints of headache and convulsions accompanied by severe low backache and left lower limb radiculopathy with no motor or sensory deficit. Positron-emission tomography scan showed increased uptake in the left frontal lobe and in the dorsal and lumbar spine suggestive of metastasis. Magnetic resonance imaging of the brain and spine with contrast was done which showed a well-defined lesion in the left frontal lobe and contrast-enhancing lesions L5, L2, and T5 vertebra levels. Craniectomy with gross total excision of the left frontal lobe lesion was done. Histopathological examination was suggestive of metastatic SCC. The patient was advised for follow-up for spinal decompression followed by radiotherapy. We need to have a high index of suspicion for metastasis in brain and spine lesions in patients who have been diagnosed previously with oral malignancies for prompt management and better life expectancy.