An Unusual Adrenal Gland Metastasis in a Case of Squamous Cell Carcinoma of Buccal Mucosa

The majority of oral cavity cancers presents as localized disease and remain localized until late in the course of their development. Distant metastasis is very rare in carcinoma of buccal mucosa and has a very dismal prognosis. Distant spread is either related to uncontrolled local disease or inadequate local treatment. Lungs and bones are common site for metastases. Extensive metastatic workup should be considered in locally advanced buccal mucosa patients, who either defaulted complete treatment or have an uncontrolled loco-regional relapse. We report a case of unusual adrenal metastasis from Squamous Cell Carcinoma (SCC) of buccal mucosa. 42 years old lady initially presented with cT2N1M0 SCC of buccal mucosa (left) underwent radical surgery followed by post-operative Radiotherapy. After eight months of follow up she developed local relapse. After an initial response to salvage systemic chemotherapy, patient discontinued chemotherapy. After 6 months of discontinuation patient had gradually increasing abdominal pain. Contrast Enhanced Computer Tomography Scan (CECT) showed Left adrenal mass with para-aortic lymph node. Other investigations were normal. CT guided Fine needle Aspiration Cytology (FNAC) showed metastatic deposit of squamous cell origin. Patient is being treated with Tab Gefitinib and supportive medications