Moderately differentiated neuroendocrine carcinoma of the larynx. A clinicopathologic study of 54 cases

Small cell carcinoma of the larynx: imaging findings

Small cell carcinoma of the larynx is an uncommon epithelial tumor, which is the most aggressive subtype of neuroendocrine carcinomas. Because of its nonspecific clinical and radiological manifestations, the diagnosis of small cell carcinoma of the larynx is essentially based on the light microscopic examination aided by electron microscopy or immunohistochemical staining. We report a case of supraglottic small cell carcinoma accompanied by large bilateral cervical lymph node metastasis ocurring in a 70-year-old man. On CT scans, no area of low attenuation indicating necrosis was demonstrated within such large metastatic lymph nodes. We suggest that small cell carcinoma of the larynx should be included in the diagnostic considerations when a laryngeal mass is accompanied by large cervical lymph nodes without necrosis shown by CT.

Atypical carcinoid tumor of the larynx: an immunohistochemical, ultrastructural, and flow cytometric analysis

The clinicopathologic features, including a detailed immunohistochemical, ultrastructural, and flow cytometric analysis, are described in three cases of atypical carcinoid tumor of the larynx. All patients had metastatic disease within cervical lymph nodes at presentation and eventually developed distant metastases. Special stains revealed focal intracytoplasmic mucin accumulation, and immunohistochemistry showed the tumors to be positive for CAM 5.2, CEA, chromogranin A, and calcitonin. In two cases, double-staining techniques revealed occasional cells that stained for both mucin and chromogranin A. The histochemical and immunohistochemical findings in these two cases were confirmed at the ultrastructural level, with most tumor cells containing many neurosecretory granules. Smaller numbers of cells contained mucin vacuoles and, in occasional cells, both mucin and neuroendocrine granules were identified. The three tumors exhibited positive staining with D07 (anti-p53), and flow cytometric analysis revealed DNA aneuploidy and polyploidy. The double-staining and ultrastructural features indicate that laryngeal atypical carcinoid qualifies for the designation of true amphicrine carcinoma. Further study is necessary to determine whether mutation of the p53 gene is important in the evolution of laryngeal neuroendocrine tumors and whether DNA aneuploidy or polyploidy identifies a subset of these tumors with a poor prognosis.

Neuroendocrine carcinoma of the larynx

A rare case of moderately differentiated neuroendocrine carcinoma (atypical carcinoid) of the larynx is presented. The role of immunohistochemistry in the diagnosis of the lesion is described. The importance of considering the diagnosis in a patient with prolonged cervical pain with features of glossopharyngeal neuralgia, is discussed.

Squamous neoplastic component in unconventional squamous cell carcinomas of the larynx

Both otolaryngologists and surgical pathologists are involved in the diagnosis and treatment of lesions of the larynx that are best diagnosed as invasive squamous cell carcinomas of some specified degree of differentiation, not further subclassified (that is, conventional squamous cell carcinomas). On occasion, however, a patient will present with an invasive tumor that on histologic examination diverges from the expected pattern of a squamous cell carcinoma of the usual type and so raises the question of proper classification (on the part of the pathologist) and, following classification, a consideration of the prognostic and therapeutic implications of such a classification (on the part of the clinician). While some of these unconventional squamous cell carcinomas are rather indolent lesions (as, for example, the hybrid verrucous squamous cell carcinoma), others behave in a fashion similar to conventional squamous cell carcinomas (such as the adenoid squamous cell carcinomas), and yet others seem to behave more aggressively than do conventional squamous cell carcinomas of a similar size and stage (examples include the basaloid squamous cell carcinomas and adenosquamous carcinomas). Finally, the possibility exists within the larynx, as elsewhere in the body, that a nonepithelial lesion such as malignant melanoma may mimic a tumor more commonly encountered in that vicinity- namely, a squamous cell carcinoma- and so receive inappropriate treatment if such mimicry is not recognized.

Cancer of the larynx in Hong Kong: a clinico-pathological study

Laryngeal cancer is a relatively common cancer in Hong Kong when compared with other cities over the world. The purpose of this study is to characterize and identify the clinico-pathological features of patients with laryngeal cancer being resected or autopsied in our hospital for the years 1973 to 1992. The peak age at presentation of 451 patients (408 males, 43 females) with primary laryngeal cancer resected was 62 years old and 1.6% of patients were under 40. The incidence increased with age in both sexes. The patients were noted to be ageing steadily in the 20-year study period. Most patients (30%) had tumours involving both the supra-glottis and glottis. Histological examination revealed that the cancers comprised squamous cell carcinomas (98.3%), spindle cell carcinoma (0.7%), adenoid cystic carcinoma (0.2%), mucoepidermoid carcinoma (0.2%), atypical carcinoid (0.2%) and chondrosarcoma (0.4%). Most cases of squamous cell carcinoma were moderately differentiated (67.3%). Poorly differentiated squamous cell carcinomas were more often noted in females. Forty-six laryngeal cancers were noted in the study period giving an autopsy incidence of laryngeal cancers of 0.46%. Distant metastases were found in 50% of these autopsied cases. The metastatic lesions were found in the lung (43%), liver (18%), diaphragm/pleura (18%), kidney (9%), bone (7%), heart (5%), spleen (2%), nostril (2%) and small intestine (2%). The results indicate that there are different histological subtypes of laryngeal cancer in Hong Kong Chinese and they share similar epidemiological characteristics with those reported in other studies.

Neuroendocrine Tumors of the Head and Neck: A Selected Review with Emphasis on Terminology

Virtually every variant of neuroendocrine neoplasia can occur, at least rarely, in the head and neck region. This review focuses on the terminology surrounding neuroendocrine carcinomas of the larynx and their distinction from morphologically similar but biologically distinctive neoplasms. It is suggested that rare typical laryngeal carcinoids be labeled as such. There is little evidence that these lesions are part of a morphologic continuum. In contrast, more common "carcinoid-like" carcinomas, previously referred to as "atypical carcinoids" are more appropriately labeled as "moderately differentiated neuroendocrine carcinomas." These neoplasms should, in turn, be distinguished from "small cell neuroendocrine carcinomas," although these latter two neoplasms do represent a morphologic and behavioral spectrum. Light microscopic and immunohistochemical features distinguishing neuroendocrine carcinomas of the larynx from paraganglioma, metastatic medullary carcinoma, malignant melanoma, and basaloid squamous cell carcinoma are presented. The second portion of this review outlines the clinicopathologic features of two head and neck neoplasms exhibiting varying degrees of neuroendocrine differentiation. Olfactory neuroblastomas have well-developed neuroendocrine differentiation, almost invariably arise from the olfactory mucosa, typically exhibit low-grade cytologic features, and may have protracted clinical course with an approximately 50% overall 5-yr survival. In contrast, sinonasal undifferentiated carcinoma is a microscopically high-grade neoplasm with minimal, abortive neuroendocrine features, a highly aggressive clinical course, and virtually 100% mortality. They can arise throughout the sinonasal region.

Neuroendocrine neoplasms of the larynx

Neuroendocrine neoplasms of the larynx are a rare group of tumors that include carcinoid tumor, atypical carcinoid tumor, and small cell carcinoma. These neoplasms pose interesting diagnostic, prognostic, and therapeutic dilemmas, and they are, as a whole, aggressive tumors with a tendency for local and distant spread. The authors of this study examined six new cases of laryngeal neuroendocrine neoplasms. One case manifested itself as a primary atypical carcinoid tumor and caused a "carcinoid syndrome." The remaining five cases were small cell carcinomas of the larynx. Histologic, immunocytochemical, DNA flow cytometric, and p53 studies were performed on all cases. The expression of neuron-specific enolase and chromogranin were the most useful markers in this group of tumors. Overexpression of p53 protein was present in the majority of cases, including the atypical carcinoid tumor. The implications of these studies for diagnosis, classification, and treatment are discussed.

Atypical carcinoid tumour of the larynx

The case of an atypical carcinoid tumour of the larynx is described in a 65-year-old man. This rare tumour may present diagnostic difficulties, but the diagnosis should be considered in a patient presenting with symptoms of local or referred pain and an apparently small, non-ulcerating supraglottic tumour. Immunocytochemistry has an important role in establishing the diagnosis. A very unusual feature of this case was positive staining for S-100 protein by sustentacular cells. Atypical carcinoid tumours do not respond well to radiotherapy so the primary treatment should be surgical resection.

Immunohistochemical markers in the diagnosis of neuroendocrine neoplasms of the head and neck

Immunohistochemistry is important in the diagnosis of neuroendocrine neoplasms of the head and neck, particularly in the differential diagnosis of the various neuroendocrine neoplasms, although the results of staining should never be interpreted alone, but together with conventional histopathologic findings. It is emphasized that there are currently no markers capable of distinguishing between benign and malignant tumors. A correct diagnosis is of paramount importance, since treatment depends on the diagnostic accuracy and prognosis is naturally related substantially to the phenotype.

Laryngeal paraganglioma versus atypical carcinoid tumor

Paraganglioma and atypical carcinoid tumor of the larynx are two neuroendocrine neoplasms that have often been confused in the past, and even in the present, in the literature. The clinicopathological profile of the two lesions is presented and the differential diagnosis is discussed. A correct diagnosis is of paramount importance, since treatment and prognosis depend on diagnostic accuracy and differ for the two lesions. Paraganglioma of the larynx is usually benign, whereas atypical carcinoid tumor is malignant and has an aggressive clinical course.

Well-differentiated (oncocytoid) neuroendocrine carcinoma of the larynx with multiple skin metastases: a brief report

A 63-year-old woman presented with a history of increasing dysphagia of about two weeks duration. Laryngoscopy revealed a nonulcerated supraglottic epitheliomatous lesion that morphologically appeared well-differentiated and distinctly oncocytoid. Although the tumour lacked any criteria for malignancy such as cellular atypia, pleomorphism or necroses, it recurred twice after primary surgery and later gave rise to multiple painful skin metastases. The diagnosis of an oncocytoid differentiated neuroendocrine carcinoma of the larynx (laryngeal carcinoid) was made. Misinterpretation of laryngeal carcinoids is common, but can be avoided if one is familiar with this rare variant of laryngeal neoplasms.

Immunocytochemical characterization of neuroendocrine tumours of the larynx

Twenty-two neuroendocrine tumours of the larynx were investigated using a panel of immunocytochemical markers. Three were small cell carcinomas, eight were large cell neuroendocrine carcinomas and 11 were paragangliomas. Twenty were positive for protein gene product 9.5, 19 for neuron-specific enolase, 15 for chromogranin A, nine for bombesin, eight for substance P, eight for neuropeptide Y, eight for metenkephalin, seven for somatostatin, five for calcitonin, eight for calcitonin gene-related peptide and one for vasoactive intestinal polypeptide. Bombesin immunoreactivity was largely restricted to the small cell carcinomas and large cell neuroendocrine carcinomas and neuropeptide Y, metenkephalin and substance P to the paragangliomas. This comprehensive immunocytochemical analysis of neuroendocrine tumours of the larynx demonstrates that these tumours represent special entities but have similar patterns of immunostaining to those of neuroendocrine tumours in other sites.

Neuroendocrine carcinomas of the larynx

The clinical and histopathological characteristics of seven cases of Moderately Differentiated Neuroendocrine Carcinomas (MDNEC) and two cases of Poorly Differentiated Neuroendocrine Carcinomas (PDNEC) have been reviewed. The tumours arose in the supraglottis of predominantly elderly men. Two cases had raised levels of urinary 5-hydroxy-indole-acetic acid at presentation but no case developed the carcinoid syndrome. PDNEC were histologically identical to the oat cell type carcinoma of the bronchus and were associated with an extremely aggressive clinical course with both patients dying of widespread metastases within one month of registration. MDNEC also metastasized frequently with four of seven cases dying with widespread disease. The tumours have previously been reported as not being radiosensitive; however three cases remain free of disease following biopsy and radiotherapy alone. The place of radiotherapy in the management of these tumours is discussed.

Medullary (thyroid) carcinoma-like carcinoids of the larynx

The histopathological spectrum of neuroendocrine neoplasms of the larynx includes a subset that may be indistinguishable from a medullary carcinoma of the thyroid gland. For a patient who presents with a medullary carcinoma-like metastasis in a cervical lymph node and in whom there is no clinically demonstrable thyroid lesion, a laryngeal atypical carcinoid must be excluded. The literature's third example of a primary medullary carcinoma-like atypical carcinoid of the larynx is presented.

Synchronous arytenoid and pancreatic neuroendocrine carcinoma

Neuroendocrine laryngeal carcinoid tumours are uncommon. The supraglottis is the main location of these tumours. Eighty-one cases have been reported in the world literature. We present the first case of a synchronous laryngeal and pancreatic neuroendocrine tumour.

Laryngeal paragangliomas and neuroendocrine carcinomas

Forty-eight neuroendocrine tumours of the larynx were studied, of which 41 were classified as large cell neuroendocrine carcinoma. Most of these tumours occurred in the supraglottic larynx and the patients were predominantly male. Exquisite pain was a presenting feature in one third. These carcinomas metastasized, frequently to skin, giving rise to painful secondary lesions, but long-time survival occurred. Histologically, large cell neuroendocrine carcinoma had a number of features seen in neuroendocrine tumours at other sites, including grouping into 'Zellballen' which mimics paraganglioma. Four tumours were definite paragangliomas. These tumours have behaved benignly. There were three cases of small cell neuroendocrine carcinoma, a tumour which is histologically identical to its counterpart in the bronchus and has a very aggressive course. All three types of tumour expressed general neuroendocrine markers, but only large cell neuroendocrine carcinoma marked for both cytokeratin and calcitonin. In the paraganglioma cases sustentacular cells were identified and marked for S-100 protein and glial fibrillary acidic protein. Histological examination, supplemented with immunohistochemistry, helped distinguish these tumours into those requiring different treatment regimens.

Metastasizing neuroendocrine carcinoma of the larynx with calcitonin and somatostatin secretion and CEA production, resembling medullary thyroid carcinoma

A 55-year-old man presented with a metastasizing moderately differentiated neuroendocrine carcinoma of the larynx (atypical carcinoid). Immunocytochemical demonstration of neuroendocrine markers (neuron-specific enolase and chromogranin-A) and presence of membrane-bound neurosecretory granules in the cells established the neuroendocrine nature of the tumour. In addition, the tumour was found to produce calcitonin, somatostatin and carcino-embryonic antigen (CEA). Calcitonin and somatostatin were also secreted. On the basis of this particular marker constellation the tumour closely resembles medullary thyroid carcinoma. Review of the recent literature on carcinoids of the larynx reveals immunoreactivity for calcitonin and CEA in a high percentage of cases.

Primary composite squamous cell carcinoma and large cell neuroendocrine carcinoma of the hypopharynx

Neuroendocrine carcinomas are rare neoplasms of the larynx and hypopharynx. Tumours composed of both neuroendocrine and squamous cell elements are very rare. We report a case of a primary hypopharyngeal carcinoma composed of both squamous cell and large cell neuroendocrine carcinoma and discuss the treatment of this patient and management of neuroendocrine carcinomas of the larynx and hypopharynx.