Posterior Pharyngeal Wall Metastasis of Pleomorphic Lung Carcinoma: Long-Term Remission following Curative Local Treatment

Oropharyngeal metastasis from non-small cell lung carcinoma (NSCLC) is rare, particularly to the posterior pharyngeal wall (PPW), and can mimic head and neck neoplasms. A 78-year-old man with globus had a 2×3 cm PPW mass and a synchronous left upper-lobe lesion; biopsies from both revealed poorly differentiated pleomorphic carcinoma. Stereotactic body radiotherapy (SBRT; 60 Gy/4 fractions) to the lung achieved regression, and the PPW tumor was resected via transoral robotic surgery (TORS) with negative margins. Pathology confirmed metastatic pleomorphic carcinoma with thyroid transcription factor-1 (TTF-1) positivity and a high proliferative index. Ten months later, right level IIa nodal metastasis was excised by modified radical neck dissection; the node showed squamoid change with loss of TTF-1, and no human papillomavirus or tonsillar primary was identified. Without systemic therapy, the patient remains disease-free 5 years after TORS and 8 years after SBRT, supporting curative-intent local therapy in oligometastatic NSCLC.