SHM Converge Scientific Abstract ePoster Gallery-Scalp Lesion and Diplopia as the Initial Presentation of Metastatic Lung Squamous Cell Carcinoma

Scalp Lesion and Diplopia as the Initial Presentation of Metastatic Lung Squamous Cell Carcinoma

Pdf Summary

A 75-year-old man with a history of left upper lobe lung neuroendocrine cancer in remission presented with 4 weeks of progressive diplopia and headaches. Around the same time, he was diagnosed with a vertex scalp squamous cell carcinoma (SCC), but histology showed no connection to the epidermis, raising suspicion for metastasis rather than a primary skin cancer. On exam, he had bilateral sixth cranial nerve palsies.<br /><br />Brain MRI demonstrated abnormal marrow replacement in the clivus with extension into both cavernous sinuses, explaining the diplopia. Further workup of a hepatic lesion by fine needle aspiration and immunohistochemistry showed strong p40 positivity and negative TTF1 staining, supporting metastatic lung SCC. The final diagnosis was metastatic lung squamous cell carcinoma with clival and scalp involvement.<br /><br />This case highlights several important points: scalp lesions and diplopia are unusual initial presentations of lung SCC; clival metastases are extremely rare; and immunohistochemistry is crucial in identifying the tissue of origin when lesions are ambiguous. A high index of suspicion is needed for metastatic disease in patients with a history of lung cancer who develop cranial neuropathies or atypical scalp masses.

Asset Subtitle

Hannah Yoo

Meta Tag

Author List Anthony Corsi, Hannah Yoo, Marianna Babadzhanov, Rebecca H. Dougherty

Category Clinical Vignettes

Concept Metastatic Lung Squamous Cell Carcinoma

Concept Abducens Nerve Palsy

Concept Clival Metastasis

Concept p40

Concept TTF-1

Distinguished Non-Finalist

Presenter Organization Northwell Health

Presenting Author Hannah Yoo

Track Adult

Keywords

lung squamous cell carcinoma

metastasis

clivus

diplopia

cranial nerve palsy

scalp lesion

cavernous sinus

immunohistochemistry

p40 positive

TTF1 negative

Metastatic Lung Squamous Cell Carcinoma

Abducens Nerve Palsy

Clival Metastasis

p40

TTF-1