[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-329821-105":59,"doc-detail-329821-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","fdg-pet-ct-missed-tibial-metastasis-in-head-and-neck-cancer-case-report-and-systematic-review","FDG PET-CT missed tibial metastasis in head and neck cancer - case report and systematic review","","Head and neck squamous cell carcinoma (HNSCC) commonly presents with metastasis, while distal lower-limb bone metastases are rarely documented. This article reports an HNSCC case managed with induction chemotherapy, surgery, and adjuvant chemo-radiotherapy, where right tibial pain during adjuvant treatment revealed a distal tibial metastasis that had not been detected on guideline-recommended FDG PET-CT. The discussion examines guideline scope to the popliteal fossae and summarizes only six eligible prior cases.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/fdg-pet-ct-missed-tibial-metastasis-in-head-and-neck-cancer-case-report-and-systematic-review/329821/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/fdg-pet-ct-missed-tibial-metastasis-in-head-and-neck-cancer-case-report-and-systematic-review/329821.png","ImageObject",300,407,{"name":92,"@type":93},"Aurelia","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-21",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why was the tibial metastasis not detected on FDG PET-CT?","Question",{"text":113,"@type":114},"Current guidelines request FDG PET-CT down to the popliteal fossae, so disease below this level can be missed, leading to an undetected tibial metastasis in this case.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What treatment sequence was used for the reported HNSCC patient?",{"text":118,"@type":114},"The patient was managed with induction chemotherapy, followed by surgery and adjuvant chemo-radiotherapy, with additional supportive care including nutrition support, psychology, and pain management.",{"name":120,"@type":111,"acceptedAnswer":121},"How extensive is evidence for distal lower-limb metastasis from head and neck cancer?",{"text":122,"@type":114},"A systematic review identified only six eligible cases of distal lower-limb metastasis from head and neck cancer suitable for discussion.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},329821,1790070168,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":29,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145},1099514068365,"https://ap-avatar.wpscdn.com/avatar/10000253d8d9f28188e?_k=1776742907772140068","International Journal of Surgery Case Reports 127 (2025) 110677  \nContents lists available at ScienceDirect  \nInternational Journal of Surgery Case Reports  \njournal [homepage:](homepage: www.elsevier.com/locate/ijscr)[ www.elsevier.com/locate/ijscr](homepage: www.elsevier.com/locate/ijscr)  \n| Case report\u003Cbr>FDG PET-CT missed tibial metastasis in head and neck cancer, case report and systematic review\u003Cbr>Vanden Haute No´emie a,*, Vervaet Catherine a, Maindiaux Laureb, Taylor Stephen c, Durieux Valerie d, Holbrechts Stephaned\u003Cbr>a D´epartement de chirurgie orale et maxillo-faciale, HELORA hˆopital de Mons site Kennedy, Boulevard John Fitzgerald Kennedy, 2, 7000 Mons, Belgium b D´epartement d'oncologie, HELORA hˆopital de Mons site Kennedy, Boulevard John Fitzgerald Kennedy, 2, 7000 Mons, Belgium\u003Cbr>c D´epartement de radiologie, HELORA hˆopital de Mons site Kennedy, Boulevard John Fitzgerald Kennedy, 2, 7000 Mons, Belgium\u003Cbr>d Biblioth`eque des Sciences de la Sant´e, Universit´e libre de Bruxelles (ULB), Campus Erasme-CP 607, Route de Lennik, 808, 1070 Bruxelles, Belgium |  |  |\n| --- | --- | --- |\n| A R T I C L E I N F O |  | A B S T R A C T |\n| Keywords:\u003Cbr>Head and neck cancer Oral cancer\u003Cbr>Bone metastasis Tibial metastasis Lower limb metastasis FDG PET-CT |  | Introduction: Head and neck squamous cell carcinoma (HNSCC) is the seventh most common type of cancer in the world. Metastases occur in up to 40 % of cases and bones are the second most frequent site. Metastases in extremities are uncommon with very few publications covering distal lower-limb bone metastasis.\u003Cbr>Case presentation: Here we report the case of a patient with HNSCC managed by induction chemotherapy, surgery and adjuvant chemo-radiotherapy. During the adjuvant treatment, the patient presented pain in the right tibia, with additional workup revealing a distal lower-limb bone metastasis which had remained undetected during the recommended standard workup for HNSCC.\u003Cbr>Discussion: Current guidelines request that FDG PET-CT is performed down to the popliteal fossae. The undetected metastasis led to overtreatment of the patient. Systematic review of the literature showed only six cases of head and neck cancer's distal lower-limb metastasis which are eligible for discussion.\u003Cbr>Conclusion: Although rare, physicians should keep in mind that as recommended FDG PET-CT does not extend below the popliteal fossae, metastases could be missed and therefore lead to inappropriate treatment. |\n\n1. Introduction  \nHead and Neck Squamous Cell Carcinoma (HNSCC) is the seventh most common type of cancer. It is estimated that up to 40 % of HNSCC patients will develop metastasis during the course of their disease.[1–3]. Lungs are the most common site of metastasis,(60–70 % of cases), followed by the spine (4–23 %), non-cervical lymph nodes (15.5 %), and liver (13 %) [4,5].  \nBone metastasis is not uncommon in HNSCC, axial skeleton is affected in 85 % of cases, including the spinal column, ribs, pelvis, humerus, and proximal femur. Tibial metastasis is infrequent and has been rarely described in HNSCC to our knowledge [6,7].  \nFDG PET-CT has replaced bone scintigraphy since 2014 for the detection of bone metastasis and current guidelines request that FDGPET-CT is performed down to the popliteal fossae [8]. Here we report a case of a patient with an HNSCC who developed a tibial metastasis missed at the FDG PET-CT during the recommended workup. This case  \nreport has been reported in line with the SCARE criteria and the work has been reported in line with the PROCESS criteria [9,10].  \n2. Case report  \nA 47-year-old man presented with a few months' history of painful swelling of the left gonial angle. He also complained of generalized weakness and reported unquantified weight loss. The patient is an active heavy smoker (>30 pack-years). Intra-buccal examination highlighted teeth mobility, a swelling of the left vestibule and induration of the mouth's floor with an erythematous muco","cbCaieruJEb3uGLC","https://ap.wps.com/l/cbCaieruJEb3uGLC","pdf",1289287,"English","# Introduction\n## Case report\n# Discussion\n# Conclusion","[{\"question\":\"Why was the tibial metastasis not detected on FDG PET-CT?\",\"answer\":\"Current guidelines request FDG PET-CT down to the popliteal fossae, so disease below this level can be missed, leading to an undetected tibial metastasis in this case.\"},{\"question\":\"What treatment sequence was used for the reported HNSCC patient?\",\"answer\":\"The patient was managed with induction chemotherapy, followed by surgery and adjuvant chemo-radiotherapy, with additional supportive care including nutrition support, psychology, and pain management.\"},{\"question\":\"How extensive is evidence for distal lower-limb metastasis from head and neck cancer?\",\"answer\":\"A systematic review identified only six eligible cases of distal lower-limb metastasis from head and neck cancer suitable for discussion.\"}]","FDG PET-CT missed tibial metastasis in head and neck cancer - case report and systematic review | PDF",1789985725,15]