title: An unusual metastasis to the thumb in a laryngectomized tracheoesophageal speaker.
abstract: Neoplastic spread by tumor cell implantation into adjacent or distant traumatized tissues is a well-documented phenomenon but is a rare mechanism of tumor dissemination. In patients with head and neck squamous cell carcinoma, mechanical implantation of tumor cells into tracheotomy and percutaneous endoscopic gastrostomy sites has been described, but hematogenous dissemination occurs far more commonly, typically resulting in pulmonary disease. Digital metastases, either by implantation or by hematogenous spread, have never been documented, to our knowledge. We report a case of metastasis to the thumb used for digital occlusion during tracheoesophageal speech in a laryngectomized patient with lung metastases. Although this may have been a manifestation of either hematogenous dissemination or direct neoplastic seeding from contaminated pulmonary secretions, we propose that repeated trauma from digital stomal occlusion predisposed this site to metastatic spread.
authors.affiliation: Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, Houston, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Lewin
authors.forename: K R
authors.initials: KR
authors.lastname: Cleary
authors.forename: S A
authors.initials: SA
authors.lastname: Eicher
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D017809:Fatal Outcome; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery; D007825:Laryngectomy; D007831:Larynx, Artificial; D008175:Lung Neoplasms / Q000556:secondary; D008297:Male; D009366:Neoplasm Seeding; D009360:Neoplastic Cells, Circulating; D010609:Pharyngeal Muscles / Q000601:surgery; D011677:Punctures; D012307:Risk Factors; D012878:Skin Neoplasms / Q000473:pathology / Q000556:secondary*; D013072:Speech, Esophageal; D013933:Thumb / Q000473:pathology*; D014827:Vocal Cords / Q000601:surgery