Extensive Muscular and Subcutaneous Metastases in Moderately Differentiated Squamous Cell Carcinoma of the Tongue: A Case Report

This report details a unique case of extensive muscular and subcutaneous metastasis in the setting of moderately differentiated squamous cell carcinoma of the tongue, diagnosed in a 70-year-old male. The patient presented with a painless ulceration of the tongue, non-specific swelling of both soft tissue on the scalp, chin and upper left arm, as well as unintentional and continued weight loss. While metastatic squamous cell carcinoma of the tongue will usually follow the classic pattern of metastasizing to the lungs, liver and bones, this case presented with broad soft tissue involvement of the scalp, skeletal muscle and subcutaneous tissue. Imaging showed multiple lytic osseous metastases and extensive soft tissue deposits. The patient underwent hemiglossectomy followed by chemotherapy. This case underlines the importance of proper imaging and multidisciplinary management in advanced tongue cancer - accentuating the atypical pattern of metastatic spread and its implications for diagnosis, staging and treatment.