General Discussion: Synovial biopsy done 2 months prior to the bone scan, showed acute and chronic inflammation- treated with steroids and pain medications and symptoms continued.
A CT guided biopsy of soft tissue mass in the dorsum of left wrist and lunate done after the last set of plain films demonstrated metastatic poorly differentiated squamous cell carcinoma of the lunate.
Squamous cell carcinoma of the head and neck has a predilection for cervical lymph node metastasis, and hematogenous spread is less frequent. However, with improvements in locoregional disease control associated with modern therapies the reported rate of distant spread appears to have risen.
Distant metastasis from laryngeal cancer is distinctly uncommon. Abramson et al (1975) cited a clinical estimate of 1.3% to 4.1%. Autopsy studies have demonstrated a metastasis rate of up to 88% with a compiled incidence of 26.5% in advanced laryngeal malignancy. Papac (1984) noted a high incidence of distant metastases in advanced laryngeal cancer (58.6%). Kotwall et al (1987) found a 44% incidence of distant metastasis at autopsy; most of these (89%) also had residual or recurrent locoregional disease. The most common sites for metastasis is the lung, followed by mediastinal nodes. Less frequent are osseous, hepatic, and other distal sites.