Radiologic Diagnosis of Nonsquamous Tumors of the Head and Neck

Neuroendocrine neoplasms of the larynx: Advances in identification, understanding, and management

While 85-90% of laryngeal malignancies prove to be squamous carcinomas, the second most common tumour type found in the laryngeal region will prove to be a member of the family of neuroendocrine tumours. Laryngeal carcinoid tumours have a capacity for metastasis, and so are more aggressive tumours than their light microscopic features might imply--5-year survival rates are in the vicinity of 50%. Laryngeal atypical carcinoid tumours are lesions with a well-recognized capacity for local recurrence as well as metastasis, with a 5-year survival of just under 50%. Laryngeal small cell neuroendocrine carcinomas are particularly aggressive tumours, with a 5-year survival of no more than 5-10%. Laryngeal paragangliomas are lesions without any real capacity for metastasizing. Surgical excision is the mainstay of treatment of carcinoid tumours, atypical carcinoid tumours, and paragangliomas. Small cell neuroendocrine carcinomas are chiefly treated by way of radiation and chemotherapy; the role of adjuvant therapy in the treatment of atypical carcinoid tumours remains to be established.

Neurilemmomas of the cervical vagus nerve

Four patients were seen with neurilemmoma which arose in the cervical vagus nerve. Three tumors arose in the upper third of the lateral neck, and the remaining one in the lower third. Lateral neck mass was a prominent symptom in 3 patients, and parapharyngeal mass in the remaining one. The parapharyngeal mass bulged into the oropharynx in the tonsillar and retrotonsillar region and caused mild swallowing difficulty. Complete surgical extirpation by means of intracapsular enucleation was possible in all 4 patients. All patients remained free of disease for periods ranging from 15 to 75 months following surgery. It would appear that an intracapsular enucleation may be advisable for clearance of this kind of tumor.

Review of neuroendocrine carcinomas of the larynx

Neuroendocrine carcinomas of the larynx are uncommon tumors of considerable scientific interest and clinical importance. They include typical carcinoid tumors, atypical carcinoid tumors, and small cell neuroendocrine carcinomas. This paper considers these neoplasms from a personal experience and reviews the relevant medical literature. About 200 cases of neuroendocrine carcinomas of the larynx have been reported. The diagnosis is based on light microscopy and is confirmed by ultrastructural evidence of neurosecretory granules. Histochemical and immunocytochemical investigations may support it. Paraneoplastic syndromes associated with laryngeal neuroendocrine carcinomas have been reported occasionally. The histogenesis, treatment, and prognosis of these lesions also are discussed.