Small cell carcinoma of the head and neck: a review

Oropharyngeal Mixed Neuroendocrine-Nonneuroendocrine Neoplasm (MiNEN): A Case Report and Literature Review

Mixed neuroendocrine-nonneuroendocrine (MiNEN) neoplasms in the head and neck are exceptionally rare biphasic tumors with unclear pathogenesis and an aggressive clinical behavior. This is the first reported case of an oropharyngeal MiNEN with the nonneuroendocrine component being an HPV-associated adenocarcinoma. The tumor arose in a 56 year-old male with history of long-term cigarette smoking and was composed of an adenocarcinoma intermixed with a small cell neuroendocrine carcinoma. P16 immunohistochemical stain and HPV16/18 in-situ hybridization were strongly and diffusely expressed in both components.

Primary Small Cell Neuroendocrine Carcinoma of nasopharynx with metastatic cervical lymph nodes: an exceedingly rare entity with review of literature

Small cell neuroendocrine carcinoma of nasopharynx is extremely rare and displays aggressive nature with a poor prognosis. Neuroendocrine tumours rarely arise from the head and neck region and pose a diagnostic and management challenge. In English literature, only 16 cases of primary small cell neuroendocrine carcinoma of nasopharynx have been reported so far; and to the best of our knowledge, this is the seventeenth case and second in the younger age group. Here, we report the case of an adolescent male patient who presented with nasal blockage, repeated episodes of epistaxis and neck swellings. After proper diagnostic workup, the diagnosis of small cell neuroendocrine carcinoma of nasopharynx was made. The patient was treated with chemotherapy, followed by radiotherapy. Imaging investigation executed after the end of the treatment exhibited complete remission of the disease. The patient is kept under active surveillance with no signs of relapse at present.

PET/CT Imaging in Treatment Planning and Surveillance of Sinonasal Neoplasms

Sinonasal cancers are uncommon malignancies with a generally unfavorable prognosis, often presenting at an advanced stage. Their high rate of recurrence supports close imaging surveillance and the utilization of functional imaging techniques. Whole-body 18F-FDG PET/CT has very high sensitivity for the diagnosis of sinonasal malignancies and can also be used as a "metabolic biopsy" in the characterization of some of the more common subgroups of these tumors, though due to overlap in uptake, histological confirmation is still needed. For certain tumor types, radiotracers, such as 11C-choline, and radiolabeled somatostatin analogs, including 68Ga-DOTATATE/DOTATOC, have proven useful in treatment planning and surveillance. Although serial scans for posttreatment surveillance allow the detection of subclinical lesions, the optimal schedule and efficacy in terms of survival are yet to be determined. Pitfalls of 18F-FDG, such as post-surgical and post-radiotherapy crusting and inflammation, may cause false-positive hypermetabolism in the absence of relapse.

Non-conventional laryngeal malignancies: a multicentre review of management and outcomes

PURPOSE

Non-conventional laryngeal malignancies (NSCC) often have limited published data to guide management despite individual histopathological subtypes often exhibiting heterogeneous behaviour, characteristics, and treatment responses compared to laryngeal squamous cell carcinoma (SCC). This study aimed to compare oncological outcomes with SCC, specifically disease-free survival (DFS), disease-specific survival (DSS) and overall survival (OS). Secondary objectives were to compare treatment differences and perform a state of the art review.

METHODS

This was a multicentre retrospective cohort study at four tertiary head and neck centres. Survival outcomes between NSCC and SCC patients were analysed with Kaplan-Meier curves and compared by log rank testing. Univariate Cox regression analysis was performed to predict survival by histopathological subgroup, T-stage, N-stage and M-stage.

RESULTS

There were no significant differences in 3-year DFS (p = 0.499), DSS (p = 0.329), OS (p = 0.360) or Kaplan Meier survival curves (DSS/OS) between SCC and overall NSCC groups. However, univariate Cox regression analysis identified "rare" histopathologies (mostly small cell carcinoma) to be predictive of less favourable OS (p = 0.035) but this result was not observed for other NSCC histopathological subgroups. N-stage (p = 0.027) and M-stage (p = 0.048) also predicted OS for NSCC malignancies. Significant differences in treatment modalities were identified with treatment of NSCC typically involving surgical resection and SCC often managed non-surgically (e.g., primary radiotherapy).

CONCLUSIONS

Although overall NSCC is managed differently compared to SCC, there do not appear to be differences in survival outcomes between these groups. N-stage and M-stage appear to be more predictive of OS than histopathology than many NSCC subtypes.

Smartphone-based follow-up of upper airway symptoms in head and neck cancer survivors one year after radiation therapy

BACKGROUND

Improvements in treatment of head-and-neck cancer (HNC) have resulted in improved long-term survival rates so there is a growing interest in long-term consequences.

OBJECTIVE

The aim was to perform a smartphone-based assessment to analyse the upper airway dysfunction-related symptoms in HNC 1 year after radiotherapy (RT) during social distancing due to COVID-19.

METHODS & PROCEDURES

Smartphone-based assessment on upper airway function 1 year after RT was performed. Upper airway functions include perceived impact of voice on quality of life (Voice Handicap Index, VHI-30), swallowing (Functional Oral Intake, FOIS; and Swallowing Quality of Life questionnaire, SWAL-QOL) and sleep-disordered breathing (Pittsburgh Sleep Quality Index, PSQI) assessments. Additionally, quality of life was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire.

OUTCOMES & RESULTS

The HNC group presented worse results in the VHI-30 scale, in the three subscales (p < 0.001). Swallowing function also presented worse results in the HNC group, with a lower score in the FOIS questionnaire (p < 0.001) and a poorer score in the SWAL-QOL (p < 0.001). Regarding to the sleep-disordered breathing, the HNC group presented poorer scores in all subscales (p < 0.05). The HNC group also presented worse scores in quality of life.

CONCLUSION

Our findings showed that HNC survivors presented a poorer upper airway function and a worse quality of life. This population needs to be systematically screened for those function impairments.

WHAT THIS PAPER ADDS

What is already known on the subject Head-and-neck cancer radiotherapy treatment is anatomically related to the upper airway, involved in several functions such as breathing, swallowing and speech that could be affected by the treatment. Public health restrictions caused by the COVID-19 pandemic have made it difficult, and in many cases impossible, to see patients in person and complete assessments that are often crucial to improve their approach. Telephone interviews appear to be largely equivalent to face-to-face interviews, which could solve these problems. What this paper adds to existing knowledge The aim of this study was to perform a smartphone-based assessment to analyse the upper airway dysfunction-related symptoms in head-and-neck cancer survivors 1 year after radiotherapy treatment. Our findings showed that head-and-neck cancer survivors who have been treated with radiotherapy presented a poorer upper airway function, with subjective speech and voice problems, swallowing and sleep-disordered breathing compared to a control group matched for age and sex 1 year after the treatment. What are the potential or actual clinical implications of this work? The results of this study will allow a better approach to treatment of head-and-neck cancer survivors.

A primary small cell neuroendocrine carcinoma (SCNC) of the oral cavity (cheek mucosa): Description of a case report

BACKGROUND

Small cell neuroendocrine carcinoma (SCNC) of the oral cavity is a poorly differentiated, high-grade and very aggressive tumor with a poor prognosis.

CASE DESCRIPTION

A 64-year-old, Caucasian, smoker man consulted for an ulcero-necrotic, exophytic, lesion of the right retromolar trigone. Haed&neck CT scan showed a right tonsillar tumor lesion. The ¹⁸F-PET scan confirmed the presence of a right, highly hypermetabolic tonsillar lesion and two homolateral, cervical lymph nodes. Histology and immunohistochemistry were consisted with the diagnosis of a primary SCNC of the oral cavity. As the tumor was locally advanced and unresectable, the patient underwent a definitive radio-chemotherapy with a cisplatin/etoposide combined regimen (4 cycles). The treatment was well tolerated and led to a complete tumor response.

CONCLUSION

The particularity of this case relies on the rarity of the oral SCNC, its difficult and challenging diagnosis, and the complexity of its management that is not validated by large clinical trials, data being extrapolated from small cell lung cancer. In our case, the patient presenting a locally advanced tumor was treated by a combined radio-chemiotherapy leading to a complete tumor regression. The patient's follow up is too short to assess the real benefit of this treatment on overall survival.

Head and neck small-cell carcinoma: A multicenter study of 39 cases from 10 institutions

Objective

Basal information of head and neck small-cell carcinoma (HNSmCC) including epidemiology, primary site, treatment, and prognosis remains sparse due to its rarity. We report here a multicenter retrospective study on the diagnosis, treatment, and outcomes of patients with HNSmCC.

Materials and methods

This study involved 47 patients with HNSmCC from 10 participating institutions. Eight patients were excluded for whom no pathological specimens were available (n = 2) and for discrepant central pathological judgements (n = 6). The remaining 39 patients were processed for data analysis.

Results

As pretreatment examinations, computed tomography (CT) was performed for the brain (n = 8), neck (n = 39), and chest (n = 32), magnetic resonance imaging (MRI) for the brain (n = 4) and neck (n = 23), positron emission tomography-CT (PET-CT) in 23 patients, bone scintigraphy in 4, neck ultrasonography in 9, and tumor markers in 25. Primary sites were oral cavity (n = 1), nasal cavity/paranasal sinuses (n = 16), nasopharynx (n = 2), oropharynx (n = 4), hypopharynx (n = 2), larynx (n = 6), salivary gland (n = 3), thyroid (n = 2), and others (n = 3). Stages were II/III/IV-A/IV-B/IV-C/Not determined = 3/5/16/6/5/4; stage IV comprised 69%. No patient had brain metastases. First-line treatments were divided into 3 groups: the chemoradiotherapy (CRT) group (n = 27), non-CRT group (n = 8), and best supportive care group (n = 4). The CRT group included concurrent CRT (CCRT) (n = 17), chemotherapy (Chemo) followed by radiotherapy (RT) (n = 5), and surgery (Surg) followed by CCRT (n = 5). The non-CRT group included Surg followed by RT (n = 2), Surg followed by Chemo (n = 1), RT alone (n = 2), and Chemo alone (n = 3). The 1-year/2-year overall survival (OS) of all 39 patients was 65.3/53.3%. The 1-year OS of the CRT group (77.6%) was significantly better compared with the non-CRT group (31.3%). There were no significant differences in adverse events between the CCRT group (n = 22) and the Chemo without concurrent RT group (n = 9).

Conclusion

Neck and chest CT, neck MRI, and PET-CT would be necessary and sufficient examinations in the diagnostic set up for HNSmCC. CCRT may be recommended as the first-line treatment. The 1-year/2-year OS was 65.3%/53.3%. This study would provide basal data for a proposing the diagnostic and treatment algorithms for HNSmCC.

Small cell neuroendocrine carcinoma of buccal mucosa: Innocuous but invasive

Small cell neuroendocrine carcinoma (SNEC) was first described in the 19^th century which is usually seen in association with lung cancer and is very rare in the oral cavity. Here, we report one such case in a 39-year-old male patient who presented with swelling on the left middle third of the face for 6 months. This is the 12^th SNEC of oral cavity case so far reported in the English literature and the third case to be present on buccal mucosa. It presented as a nodular swelling over the buccal mucosa and was clinically diagnosed as a traumatic fibroma. The histopathological sections showed diffuse sheets of round cells with granular chromatin. Immunohistochemical findings helped us arrive at a final diagnosis. SNECs are highly proliferative tumors characterized by early and widespread metastases through the vascular channels. Hence, the diagnosis and appropriate management of these lesions is important to decrease the morbidity and mortality rate.

Small Cell Neuroendocrine Carcinoma Presenting as Recurrent Dacryocystitis: Case Report of a Rare Entity

An 84-year-old man presented with a localized, firm, tender mass over the right lacrimal sac. He had a history of acute dacryocystitis in the same eye 6 months before presentation, which resolved with antibiotics followed by uneventful dacryocystorhinostomy. At repeat presentation, the patient underwent orbital imaging and excisional biopsy of the lesion. Histologic studies revealed a small cell neuroendocrine carcinoma. The patient was subsequently treated with chemotherapy and radiation. Although there are rare reports of small cell neuroendocrine carcinoma originating in the sino-orbital-lacrimal region, this is the first report of tumor presentation with acute dacryocystitis in a patient with prior dacryocystorhinostomy.

Nasopharyngeal neuroendocrine neoplasms: Systematic review of the literature and case presentation

Most of neuroendocrine neoplasms (NENs) are located in the gastrointestinal tract and lung, and they are rarely found on the upper aero-digestive tract, which limit the current literature about nasopharyngeal NENs. This systemic review will summarize the clinical, pathological features and optimal diagnosis and management of different types of nasopharyngeal NENs (NP NENs). In-addition, we herein report an EBV negative TP53-mutated/ Rb-wild type nasopharyngeal neuroendocrine carcinoma (NEC) in a young man in which touch preparation cytology studies were integral to establishing a definitive diagnosis. To our knowledge, only very few cases of primary neuroendocrine carcinoma of the nasopharynx have been reported in the literature and the reports of these cases have not included detailed description of different types and how to optimally diagnose and manage them. In this abstract, we also highlighted the evidence about the safety of using growth factors in patients with sickle cell anemia who are receiving cytotoxic chemotherapy.

Small Cell Carcinoma of the Head and Neck: Update on the University of Florida Experience

We updated the University of Florida experience treating head and neck small cell carcinoma. Eight patients received a median of 67.7 Gy between 1989 and 2017. The 2-year rates of local, regional, distant, and disease control were 73, 60, 33, and 13%, respectively. The 2-year overall survival rate was 38%; median survival was 1.4 years. The longest disease-free period was 9.5 years after treatment with no evidence of disease. Radiotherapy is an acceptable treatment for these patients, who tend to have poor outcomes and distant metastatic disease. Superior systemic chemotherapy may improve outcomes and decrease the likelihood of distant recurrence.

Clinicopathological characteristics, treatment and prognosis of head & neck small cell carcinoma: a SEER population-based study

Background

To investigate the clinicopathological characteristics of head and neck small cell carcinoma (H&NSmCC) and identify prognostic factors on the basis of the Surveillance, Epidemiology and End Results (SEER) database.

Methods

Total of 789 primary cases from 1973 to 2016 were included. Univariate and multivariate analyses were performed to identify independent prognostic indicators. An H&NSmCC-specific nomogram was constructed and compared with the AJCC staging system by calculating the time-dependent area under the curve (AUC) of the receiver operating characteristic (ROC) curves.

Results

The incidence of H&NSmCC peaked during the period of 50 to 70 years old, and the most frequent location was the salivary gland. The 5-year disease specific survival (DSS) was 27%. In the multivariate survival analysis, AJCC III + IV stage [HR = 2.5, P = 0.03, I + II stage as Ref], positive N stage [HR = 1.67, P = 0.05, negative N stage as Ref], positive M stage [HR = 4.12, P = 0.000, negative M stage as Ref] and without chemotherapy [HR = 0.56, P = 0.023, received chemotherapy as Ref] were independently associated with DSS. The H&NSmCC-specific nomogram was built based on the independent prognostic indicators. The nomogram demonstrated better predictive capacity than the AJCC staging system for 5-year DSS [(AUC: 0.75 vs 0.634; Harrell’s C-index (95% CI): 0.7(0.66–0.74) vs 0.59(0.55–0.62), P < 0.05].

Conclusion

N stage, M stage, AJCC stage and chemotherapy were independent prognostic indicators included in the prognostic nomogram model, which can better predict the survival of H&NSmCC than the AJCC staging system.

Neuroendocrine carcinoma of the nasal cavity with epiphora as the first symptom: A case report

RATIONALE

Neuroendocrine carcinomas (NECs) are rare malignancies that originate from the hormone-producing cells of the neuroendocrine system. They can grow in most organs of the body but are commonly found in the gastrointestinal and respiratory tracts. The nasal cavity is a rare site for NECs.

PATIENT CONCERNS

We report a case of NECs in a 45-year-old woman who presented with epiphora in the right eye for a year owing to an unknown reason.

DIAGNOSES

The diagnosis was initially confirmed via histological and immunohistochemical assays. Postoperatively, computed tomography of the neck revealed C4 vertebral bone metastasis.

INTERVENTIONS

The tumor was endoscopically removed from the right eye. The patient received a full course of adjuvant polychemotherapy.

OUTCOMES

Six months after diagnosis, the patient died due to bone metastasis.

LESSONS

Diagnosing nasal neuroendocrine carcinoma is clinically challenging. It must be distinguished from other orbital masses, such as chronic dacryocystitis or nasal polyps. The treatment should be further investigated for this rare malignancy in near future.

Primary small cell neuroendocrine carcinoma of the right posterior tongue

Small cell neuroendocrine carcinoma (SNEC) is an extremely aggressive tumor and mainly occurs in the lung. Primary extra-pulmonary SNEC is rare. To date, only 11 primary SNECs occurring in the oral cavity have been reported in the English literature. We describe a case of primary SNEC of the right posterior tongue in a 46-year-old man. The patient had stage IVA disease and received adjuvant chemotherapy, followed by radical surgery and radiotherapy. He remained tumor-free for 20 mo before death due to gastrointestinal metastasis. The relevant literature on the 11 previously reported patients was reviewed, and the clinical features, histopathological characteristics, differential diagnosis and therapeutic strategies of this rare tumor were analyzed.

Extrapulmonary small cell carcinoma of the external auditory canal: a case report and review of the literature

Extrapulmonary small cell carcinoma (EPSCC) affecting the external auditory canal (EAC) is uncommon. We herein report a case involving a 56-year-old man with EPSCC of the EAC who had a 48-year history of recurrent purulent discharge in both ears and a 20-day history of right ear pain and hemorrhage followed by incomplete right eyelid closure and an askew mouth. He underwent surgical removal of middle ear granulation tissue, residual ossicles, and a right EAC mass. Postoperatively, pathomorphological examination combined with immunohistochemical staining supported a diagnosis of small cell carcinoma. Radiation therapy at a dose of 60.06 Gy in 33 daily fractions was completed 1 month after surgery, and synchronous etoposide-cisplatin regimen chemotherapy was performed for two cycles and four sequential cycles. One year postoperatively, magnetic resonance imaging showed no tumor in the ear; however, computed tomography showed multiple liver space-occupying lesions that were considered to indicate liver metastasis. Further chemotherapy was performed, but the patient died 15 months postoperatively. This case indicates that timely and accurate chemoradiotherapy is likely the most reasonable approach to EPSCC of the EAC given the aggressiveness of this tumor.

Clinicopathological Profile and Treatment Outcomes of Sinonasal Small Cell Neuroendocrine Carcinoma: A Rare Case Series

Sinonasal small cell neuroendocrine carcinoma is a rare tumour in the head and neck region. Patients become symptomatic as the disease progresses to advanced stages. They are at risk for recurrence and distant metastasis following treatment. Early diagnosis and treatment have shown to improve the disease prognosis. This is a retrospective analysis of sinonasal small cell neuroendocrine carcinomas that underwent treatment based on institutional protocol. Data was collected from medical records of the patients and analyzed using descriptive statistics. Cell morphology on electron microscopy and immunohistochemistry played a significant role in differentiating small cell neuroendocrine carcinoma from other neuroendocrine tumours. 75% of cases presented in an advanced stage of malignancy. None of the patients had distant metastasis at initial presentation. Equal proportion of cases underwent surgery followed by adjuvant radiation (33.3%) and concurrent chemoradiation (33.3%). 25% of patients had recurrence of disease. The 2-year overall survival rate was 78.8%. Disease-free survival for cases that underwent surgery followed by radiation was higher than that of chemoradiation or radiation alone arms. There has been an improvement in treatment outcomes of sinonasal small cell neuroendocrine carcinoma which is best explained by paradigm shift in multimodality management towards surgery followed by adjuvant treatment.

Small Cell and Squamous Cell Carcinomas of the Head and Neck: Comparing Incidence and Survival Trends Based on Surveillance, Epidemiology, and End Results (SEER) Data

BACKGROUND

Small cell carcinomas of the head and neck (SmCCHNs) are rare neoplasms with an unfavorable prognosis. Population-based data describing survival and prognostic factors for SmCCHN are limited.

METHODS

Data were obtained from the U.S. National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database for 1973-2013. Patient and tumor-related characteristics for SmCCHN were compared with those for squamous cell carcinoma of the head and neck (SCCHN). Survival was compared by constructing Kaplan-Meier curves and Cox proportional hazard models with and without propensity score matching.

RESULTS

The data set included 609 SmCCHN and 227,943 SCCHN cases. Both histological subtypes were more common in men than women and more common in white patients. SmCCHN was most likely to originate in the larynx, glottis and hypopharynx, or salivary glands and to present with more advanced stage and grade. SCCHN was most likely to originate in the oral cavity and was found infrequently in the salivary glands. Overall 5- and 10-year survival estimates were 27% and 18% for SmCCHN and 46% and 31% for SCCHN, respectively. In multivariable survival analyses adjusting for age, sex, race, marital status, year of diagnosis, stage, grade, and receipt of radiation, the hazard ratio (HR) comparing SmCCHN with SCCHN was 1.53 with a 95% confidence interval (CI) from 1.39 to 1.68. Average 5-year survival varied widely between the histologic types when comparing tumor sites: 14.5% for SmCCHN versus 48.9% for SCCHN in the oropharynx. In propensity score matched analyses, the corresponding HR was 1.27 (95% CI, 1.15-1.40).

CONCLUSION

Compared with SCCHN, SmCCHN carries a worse survival and is more likely to present with more advanced stage.

IMPLICATIONS FOR PRACTICE

Small cell carcinoma of the head and neck (SmCCHN) is a rare subtype of head and neck cancer. In this Surveillance, Epidemiology, and End Results (SEER) data analysis, the characteristics and survival of SmCCHN are compared with those of the common squamous cell carcinoma of the head and neck. Results show that SmCCHN carries a worse prognosis and tends to present at a more advanced stage; SmCCHN also is ten times more likely to originate from the salivary glands. These findings may have implications for clinical practice, as location of the tumor may strongly associate with the pathologic diagnosis. If a SmCCHN is diagnosed, a disseminated disease is likely; hence vigilance in staging procedures is indicated.

'Primary small cell carcinoma of tonsil: An extreme rarity.'

Introduction

Small cell neuroendocrine carcinoma (NEC) that originates in the tonsil is extremely rare and carries a poor prognosis. Only a few cases of this tumor have been reported so far and the standard treatment protocol remains uncertain.

Case report

Here, we describe a 65-year-old woman presenting with throat pain. Computed tomography (CT) scan revealed a mass with moderate enhancement in the right tonsil. A biopsy of the tonsillar mass was performed and histologic examination revealed small round to oval tumor cells arranged in cords or nests, containing hyperchromatic nuclei and scant cytoplasm. Mitotic figures were readily identified. Immunohistochemical staining further corroborated the diagnosis. A diagnosis of primary small cell NEC of the left tonsil was rendered. The patient was treated by six cycles of cisplatin combined with etoposide and the masses showed initial complete response. We also provide a succinct review of all tonsillar SCC cases reported in the English literature and their outcomes.

Conclusion

Small Cell Carcinoma of the tonsil is an extremely rare entity with an aggressive disease course and poor prognosis. Therefore, it is important for the clinicians to be aware of the uncommon occurrence of this disease and its management.

•

Small cell NECs of the tonsil are extreme­ly rare and only a few cases were added since it was firstly repoted.

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The cell of origin was initially thought to be from amine-precursor uptake and decarboxylase (APUD or Kulchitsky) cells; however, the current opinion favors their origin from multipotential stem cells.

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Thus far, the therapeutic strategy has not been properly formulated due to the paucity of data.

Primary poorly differentiated small cell type neuroendocrine carcinoma of the hypopharynx

The incidence of primary poorly differentiated neuroendocrine carcinoma (PDNC) of the hypopharynx iŝ4%. However, the disease pathogenesis, natural history, and prognostic factors remain poorly understood. We report the case of a 66-year-old man who presented with multiple metastases from primary PDNC of the hypopharynx. Physical examination revealed ã3×4 cm left cervical mass located at the level III, with tenderness and an unclear boundary. Laryngoscopy revealed a large mass arising from the posterior hypopharynx; glottis and vocal cord movements were invisible. After consultation with our head and neck oncological multidisciplinary team, diagnosis and specific treatment plan were made. Under general anesthesia, a biopsy sample was obtained via suspension laryngoscopy. Routine pathology revealed small cell carcinoma. Immunohistochemical staining identified neoplastic cells that were positive for cytokeratins, CD56, chromogranin A, and synaptophysin. The Ki-67 mitotic index approached 80%. These findings confirmed hypopharyngeal PDNC, and chemotherapy was prescribed. After 7 months, the tumor metastasized to the left side of the anterior chest wall, bilateral lungs, left liver, and skeleton. The soft tissue of the chest wall was biopsied, and pathology revealed PDNC. Subsequent examinations over the next 4 months confirmed multiple liver metastatic lesions. The patient succumbed to the cancer progression a month later. Here, we systematically review the clinical manifestations, pathogenesis, prognostic factors, and treatment of the disease. In conclusion, patients always have a poor prognosis due to a lack of optimal treatment.

From Mouth to Brain: Neuroendocrine Markers Play as a Crosstalk Among Oral and Neurodegenerative Diseases

The neuroendocrine system consists of various cells distributed in non-endocrine functional structures, able to synthesize amines and peptides with both local (paracrine) and systemic (endocrine) effects. The presence of such cells, belonging to the neuroendocrine system, is highlighted by the presence of neuroendocrine markers: the most suggestive are chromogranin A, synaptophysin, S-100B protein and glial fibrillary acidic protein. The presence of neuroendocrine markers is commonly associated to the occurrence of neuroendocrine cancers, currently representing the 0.5 percent of all malignant tumors. Nevertheless, neuroendocrine markers have been found to be overexpressed in rare oral neuroendocrine tumors, but also in quite common inflammatory conditions, such as severe periodontitis. The monitoring of neuroendocrine markers is, thus, a common factor of interest among dentistry and neurology: the analysis of neuroendocrine markers in oral diseases may be predictive and prognostic about the severity of neurological diseases, such as lateral amyotrophic sclerosis and traumatic brain injuries. The aim of this mini-review is to highlight the role of neuroendocrine molecules as advantageous diagnostic and prognostic markers for both oral diseases and neurodegenerative disorders.

Sinonasal inverted papilloma associated with small cell neuroendocrine carcinoma: A case report and literature review of rare malignancies associated with inverted papilloma

We report a rare case of sinonasal inverted papilloma (IP) associated with small cell neuroendocrine carcinoma (SNEC). To our knowledge, this is the first report to describe SNEC found during the treatment of sinonasal IP. Surgery and five cycles of cisplatin plus etoposide with concurrent intensity modulated radiation therapy were performed. Neither local recurrence nor distant metastasis was noted during 6 years of post-diagnostic follow-up. The prognosis of SNEC is very poor. Treatment planning for sinonasal IP should consider a possible association with this rare but aggressive malignancy, whose treatment is completely different from that of squamous cell carcinoma, a malignancy which is commonly associated with IP. We also performed a PubMed review of the literature to identify the incidence and pathological diagnosis of associated malignancy. Among a total of 5286 cases of sinonasal IP (61 studies), the incidence of associated malignancy was 8.02% in squamous cell carcinoma, 0.19% in transitional cell carcinoma, 0.04% in mucoepidermoid carcinoma, 0.02% in verrucous cell carcinoma and 0.02% in adenocarcinoma. The incidence of associated malignancy was significantly higher in East and Southeast Asia (11.0%) and North America (10.4%) than in Europe (3.9%) (p=0.04 and p=0.03, respectively; T-test).

Case of metastatic small cell carcinoma of the oropharynx successfully treated with image-guided volumetric modulated arc therapy (IG-VMAT): pushing the limits of technology to match treatment intent

Extrapulmonary small cell carcinomas (EPSCC) are a rare subtype of neuroendocrine tumours which have been documented to arise from a multitude of sites and treatment outcomes are disappointing. The most common site involved in the head and neck region is the larynx and the oropharynx as a primary site has been infrequently reported. The patient presented with bilateral neck swelling and an ulcerated lesion was noted in the base of tongue (BOT). A biopsy revealed small cell carcinoma (SCC) and was confirmed with immunohistochemistry. The final diagnosis after workup was SCC of BOT stage IVc. He received induction chemotherapy to which the tumour responded partially, followed by curative intent chemoradiotherapy and adjuvant chemotherapy. The patient achieved a radiological complete response to treatment and almost all treatment-induced toxicities resolved. An aggressive approach to managing EPSCC is possible with modern radiotherapy techniques, with tolerable treatment-induced toxicities.

The First Report of Small Cell Cancer of the Uvula Presenting With Ectopic Adrenocorticotropic Hormone Syndrome

Small cell carcinoma (SmCC) of the head and neck is a rare occurrence. We herein present a case of a 62-year-old female who was diagnosed with small cell cancer of the uvula. The patient developed increased body swelling, elevated blood pressure, persistent hypokalemia and new onset diabetes mellitus. Further workup confirmed a diagnosis of Cushing's syndrome secondary to ectopic adrenocorticotropic hormone (ACTH) production. To our knowledge, this is only the second case of SmCC of the uvula described in literature, and the first associated with any paraneoplastic syndrome. By reporting this case, we aim to characterize the tumor clinical course and highlight the aggressive nature of its growth.

Successful cisplatin-etoposide chemotherapy-based treatment of a primary small cell neuroendocrine carcinoma of the tonsil with multiple metastases: a case report

Extrapulmonary small cell neuroendocrine carcinoma (SNEC) is an extremely rare and highly malignant tumor with a poor prognosis. Multiple metastases of SNEC are even more rare, and patients with locally advanced and metastatic disease generally face a poor outcome. To date, only a few cases of SNEC have been reported. Here, we describe a rare case of a 70-year-old female patient with SNEC of the tonsil who presented with multiple metastases and had achieved a complete response (CR) of the primary lesion and cervical lymph nodes for more than 1 year after receiving palliative chemotherapy. Initially, the patient presented with a 2-month history of throat pain. Magnetic resonance imaging and computed tomography revealed a soft mass with moderate enhancement on the left tonsil, which was confirmed by incisional aspiration biopsy. She was additionally sent for a positron emission tomography scan to evaluate small metastases in the left cervical lymph node, right lung, multiple mediastinal lymph nodes, and the fourth lumbar (L4) vertebra body metastases. Histopathological examination of the SNEC confirmed a nested, typical endocrine appearance with small round cells containing ovoid-shaped nuclei and high mitotic activity. Immunohistochemically, the tumor cells were positive for cytokeratin 8/18+, synaptophysin+, CD56+, and Ki-67 (<50%). The patient received 6 cycles of cisplatin combined with etoposide and was subsequently placed under close observation (<12 months). To date, she has achieved a CR of the primary lesion and cervical lymph nodes. In summary, we have described a case of successful treatment after chemotherapy for SNEC and have elucidated professional knowledge regarding the relevant aspects of SNEC.

Differentially expressed proteins in positive versus negative HNSCC lymph nodes

Background

Lymph node metastasis is one of the most important prognostic factors in head and neck squamous cell carcinomas (HNSCCs) and critical for delineating their treatment. However, clinical and histological criteria for the diagnosis of nodal status remain limited. In the present study, we aimed to characterize the proteomic profile of lymph node metastasis from HNSCC patients.

Methods

In the present study, we used one- and two-dimensional electrophoresis and mass spectrometry analysis to characterize the proteomic profile of lymph node metastasis from HNSCC.

Results

Comparison of metastatic and non-metastatic lymph nodes showed 52 differentially expressed proteins associated with neoplastic development and progression. The results reinforced the idea that tumors from different anatomical subsites have dissimilar behaviors, which may be influenced by micro-environmental factor including the lymphatic network. The expression pattern of heat shock proteins and glycolytic enzymes also suggested an effect of the lymph node environment in controlling tumor growth or in metabolic reprogramming of the metastatic cell. Our study, for the first time, provided direct evidence of annexin A1 overexpression in lymph node metastasis of head and neck cancer, adding information that may be useful for diagnosing aggressive disease.

Conclusions

In brief, this study contributed to our understanding of the metastatic phenotype of HNSCC and provided potential targets for diagnostic in this group of carcinomas.

Electronic supplementary material

The online version of this article (10.1186/s12920-018-0382-6) contains supplementary material, which is available to authorized users.

Small Cell Carcinoma of the Hypopharynx

Small cell carcinoma is rarely found to originate from the hypopharynx and there exists no treatment guidelines due to the small number of cases. Here, we present a case of a female patient with metastatic small cell carcinoma originating from the posterior hypopharynx with lymph node involvement. Her treatment consisted of chemotherapy with etoposide and cisplatin as well as radiation therapy. Her post-treatment computed tomography (CT) scan indicated resolution of the disease at the primary site and follow-up positron emission tomography (PET)-CT scan at three-month post radiation therapy revealed that the patient is clear of the disease.

Large cell neuroendocrine carcinoma of the nasal cavity: an extremely rare and new distinct entity

Large cell neuroendocrine carcinoma (LCNEC) is a rare but distinct entity of nasal cavity carcinomas. Only a very few cases have been reported in the nasal cavity. Its treatment is not well established. We report the case of a LCNEC in a 70 years old patient who presented with right nasal obstruction and epistaxis since 2 months. Diagnosis was confirmed by histological and immunohistochemical study. The patient underwent complete endoscopic removal of the tumor combined to adjuvant chemoradiotherapy. After 6 month follow-up, the patient was in complete clinical and radiological remission. We will discuss in this paper the various epidemiology, clinical features, pathological findings, differential diagnosis, and evolution of treatment of this uncommon malignancy in the light of current knowledge. Optimal treatment strategies are yet to be determined for this rare malignancy with poor prognosis including surgery and chemoradiotherapy.

Tonsillar Small Cell Carcinoma: Potential Contribution of Human Papillomavirus

Patient: Female, 64

Final Diagnosis: Small cell carcinoma of the tonsil

Symptoms: Sore throat

Medication: —

Clinical Procedure: —

Specialty: Oncology

Human Papillomavirus-Related Neuroendocrine Carcinomas of the Head and Neck

Human papillomavirus (HPV)-related head and neck carcinoma (HNC) represents an important subgroup of head and neck cancer that is characterized by a consistent microscopic appearance and a favorable prognosis. A growing experience with HPV testing, however, has uncovered variants that deviate from the prototypic HPV-HNC with respect to morphology. While these HPV-HNCs may deviate morphologically from the prototype, they do not appear to stray far from the favorable clinical outcome assigned to HPV-positive status. In effect, HPV positivity trumps traditional prognostic features predicated on morphology such as tumor grade and histologic subtype when it comes to predicting clinical behavior. For the diagnostic pathologist, the pedestrian task of tumor grading and subtyping would seem to be of little prognostic or therapeutic relevance when it comes to HPV-HNC. Recognition and documentation of neuroendocrine differentiation is a most notable exception. Forms of HPV-HNC have now been reported that morphologically resemble small cell carcinoma (SCC) and large cell neuroendocrine carcinoma (LCNEC) of other sites, and that immunohistochemically exhibit neuroendocrine differentiation. Despite the presence of HPV, these SCCs and LCNECs share the same aggressive clinical behavior of their counterparts in the lung and other sites where the high grade neuroendocrine phenotype is associated with early distant spread and poor overall survival. Consequently, the high grade neuroendocrine phenotype should be regarded as an aggressive form of HPV-HNC where tumor morphology displaces HPV positivity as the most important prognostic feature.

Sinonasal Neuroendocrine Neoplasms: Current Challenges and Advances in Diagnosis and Treatment, with a Focus on Olfactory Neuroblastoma

Sinonasal tumors with neuroendocrine differentiation form a group of rare heterogeneous neoplasms of neuroectodermal and epithelial origin, consisting of olfactory neuroblastomas and neuroendocrine carcinomas. Because the natural history and biological behavior of this group of tumors vary, the morphological diagnosis coupled with grading/staging is important for prognostication, and the approach to treatment and rehabilitation is multidisciplinary. The identification of molecular abnormalities underlying these tumors is critical to the development of specific targeted therapies and the design of clinical trials.

Primary Small Cell Carcinoma of the Hypopharynx: A Report of Two Cases and Review of Nine Additional Cases

Objective

Two patients with primary small cell carcinoma (SmCC) of the hypopharynx, an extremely rare site for the occurrence of SmCC, are reported and nine additional well-documented cases are reviewed.

Methods

Case report and review of the literature concerning primary SmCC of the hypopharynx.

Results

On the final analysis, we reviewed eleven cases of primary SmCC of the hypopharynx. The tumors contained mixed elements of SmCC and squamous cell carcinoma (SCC) in six (55%) of eleven patients. Out of eleven patients, two patients had distant metastasis at the initial presentation. Even though nine patients presented with locoregional disease, development of distant metastasis after treatment was seen in five patients (56%), whereas there was no report of treatment failure on the primary site. To achieve more than two-year survival, patients should have received more than 4 cycles of chemotherapy.

Conclusion

We report two cases of primary SmCC of the hypopharynx with a review of the literature. In more than half of the cases, combined carcinomas with SCC are seen. Because this tumor has a strong propensity for distant metastasis even in patients with clinically localized tumor, new powerful systemic agents should be explored.

Small cell carcinoma of the head and neck: An analysis of the National Cancer Database

PURPOSE/OBJECTIVE(S)

To evaluate treatment trends and overall survival of patients with small cell carcinoma of the head and neck region.

MATERIALS/METHODS

Patients from 2004 to 2012 were identified from the National Cancer Database. Patient demographics and overall survival were analyzed. Multivariable analysis was used to identify predictors of survival.

RESULTS

Among 347,252 head and neck patients a total of 1042 (0.3%) patients with small cell carcinoma were identified. 17% of patients were diagnosed as stage I/II, 61% as stage III/IVA/IVB and 22% as stage IVC disease. The distribution by anatomic site was 9% oral cavity, 12% oropharynx, 35% larynx, 4% hypopharynx, 10% nasopharynx and 30% nasal cavity and paranasal sinuses. The median overall survival by anatomical site was 20.8months for oral cavity, 23.7months for oropharynx, 17.9months for larynx/hypopharynx, 15.1months for nasopharynx and 36.4months for nasal cavity primary tumors. On multivariable analysis across stage, patients with nasal cavity and paranasal sinuses tumors had the best survival and patients with nasopharynx primaries had the worst survival. In stage I/II patients, type of treatment delivered resulted in no overall survival difference (p=0.78). In patients with locally advanced disease, there was no difference in survival between those treated with combined surgery, radiotherapy and chemotherapy compared to those treated only with radiotherapy and chemotherapy (p=0.46). The addition of radiotherapy to chemotherapy in the metastatic setting did not result in improved survival (p=0.14).

CONCLUSIONS

Small cell carcinoma of the head and neck is a rare malignancy with a poor prognosis. The addition of surgery to radiotherapy and chemotherapy did not improve survival in patients with locally advanced disease.

Human papillomavirus-related small cell carcinoma of the oropharynx: a case report and literature review

Background

Small cell carcinoma (SCC) is a rare variant of head and neck cancer characterized by a high-grade neuroendocrine cancer with similar features to small cell lung carcinoma (SCLC). Human papillomavirus (HPV) is an increasingly recognized cause of head and neck cancer but usually associated squamous cell carcinoma of the oropharynx. In this report, we present the clinical presentation, diagnosis, and management of a patient with HPV-related SCC of the oropharynx that responded favorably to chemotherapy with cisplatin plus etoposide and concomitant radiation therapy, a regimen typically used in SCLC.

Case presentation

We present a rare case of a 56-year-old man who presented with a three-month history of an enlarging left-sided neck mass. Imaging was consistent with a soft tissue density at the left tongue base, left level IIB nodal conglomerate, and multiple bilateral cervical lymph nodes, without evidence of distant metastasis. The patient underwent a core biopsy of the left neck level II node which read as a poorly differentiated neuroendocrine carcinoma consistent with small cell carcinoma. Polymerase chain reaction revealed that the tumor was positive for HPV16. The tumor was staged T1N2cM0 (stage IVA). He went on to receive four cycles of cisplatin and etoposide. On cycle two, he started radiotherapy to the oropharynx and involved neck nodes. He received a dose of 70 Gray (2 Gy/fraction) over a seven week-period. During the concomitant phase of chemo-radiation, the patient experienced grade IV mucositis, grade II nausea, and dehydration for which he received additional outpatient fluid and electrolyte replacement. Three months after completion of therapy, a PET/CT showed complete resolution of the tumor and metastatic lymph nodes along with no evidence of distant metastasis.

Conclusion

Patients with HPV-related cancer of the oropharynx require identification of the small cell variant to optimize therapy and improve outcomes.

Small cell carcinoma of the head and neck: A comparative study by primary site based on population data

OBJECTIVES/HYPOTHESIS

Small cell carcinoma (SmCC) of the head and neck is an extremely rare neuroendocrine malignancy. In this study, we describe the incidence and determinants of survival of patients with SmCC of the head and neck between the years of 1973 and 2012 using the Surveillance, Epidemiology, and End Results database as differed by primary site.

STUDY DESIGN

Retrospective, population-based cohort study.

METHODS

A total of 237 cases of SmCC of the head and neck were identified, which was divided into sinonasal primaries (n = 82) and all other head and neck primaries (n = 155). Clinicopathologic and epidemiologic variables were analyzed as predictors of overall survival (OS) and disease-specific survival (DSS) based on the Kaplan-Meier method.

RESULTS

More than half of sinonasal primaries presented with Kadish stage C or D. On multivariate analysis, surgery was the only independent predictor of improved DSS (P = .008) for sinonasal primaries; in contrast, radiation therapy was a favorable prognosticator for OS (P = .007) and DSS (P = .043) in extrasinonasal sites. Comparison of survival between sinonasal primaries and all other sites demonstrated that sinonasal SmCC had uniformly better OS (P = .002) and DSS (P = .006).

CONCLUSIONS

SmCC in the head and neck remains rare, and sinonasal primaries appear to have improved survival compared to other sites. Based on these results, optimal treatment for sinonasal SmCC appears to be surgical therapy, whereas radiation therapy is the preferred treatment for SmCC of other primary sites, particularly the larynx.

LEVEL OF EVIDENCE

4. Laryngoscope, 127:1785-1790, 2017.

Secondary Neuroendocrine Carcinoma Following High-Dose Radiotherapy for Head and Neck Cancer: Report of Two Cases

Patients treated with radiation have an increased risk of developing second cancers, of which carcinomas, sarcomas, and hematological malignancies have most commonly been reported. Neuroendocrine carcinomas (NEC) are rarely reported in patients previously treated with radiation. Two patients, who had successfully undergone chemoradiotherapy for head and neck cancers at our institution, developed secondary NEC within the radiation field more than five years after the treatment. Both patients underwent curative-intent treatment of secondary malignancies, one with chemotherapy, radiation and surgery (Case 1) and the other with chemotherapy and surgery (Case 2). Both had no evidence of disease at a short follow-up of twelve months (Case 1), and three months (Case 2) after treatment. NEC can develop post-radiotherapy; a multidisciplinary approach is necessary to successfully treat these patients.

Human papillomavirus-associated small cell carcinoma/neuroendocrine carcinoma of the oropharynx: a report of two cases

Introduction

Small cell carcinoma/neuroendocrine carcinoma (SCNEC) of the oropharynx is uncommon. Two cases of SCNEC in an 81-year-old woman and in a 54-year-old man are presented here.

Case description

We have documented two cases of SCNEC arising in the oropharynx with evidence of high-risk human papillomavirus (HPV) infection. Histologically, both cases were classified as poorly differentiated SCNEC with high nuclear-to-cytoplasmic ratios and nuclear molding. Observations using a transmission electron microscope revealed membrane-bound neuroendocrine granules in some tumor cells. Both tumors expressed high levels of p16, a surrogate marker for high-risk HPV infection. HPV infection was confirmed in both cases using HPV polymerase chain reaction analysis; HPV subtype 16 was identified in one case and HPV subtype 18 in the other.

Discussion and Evaluation

SCNEC of the oropharynx is a rare and novel HPV-associated disease with neuroendocrine granules and aggressive clinical behavior.

Conclusions

Herein, we present two cases of SCNEC, focusing on its histologic features and treatment modalities. More studies are required to elucidate the pathophysiology of HPV-associated SCNEC in different organ systems.

Electronic supplementary material

The online version of this article (doi:10.1186/s40064-016-3501-x) contains supplementary material, which is available to authorized users.

Small cell carcinoma of the pyriform sinus successfully treated with concurrent chemo-radiotherapy: A case report

BACKGROUND

Primary small cell carcinomas (SCCs) are uncommon in extrapulmonary sites and account for only 2.5% to 5.0% of all SCCs. SCCs in the pyriform sinus are rare and there is little information regarding this disease, especially on therapeutics. Herein, we present a case of successfully treated SCC in the right pyriform sinus that occurred in a patient with small cell lung carcinoma (SCLC) that completely resolved 4 years prior.

METHODS

A 1.5 × 1.5-cm mass in the right pyriform sinus was detected on imaging studies in a 71-year-old male at a regular check-up visit after being in remission from SCLC.

RESULTS

Based on histologic examination and immunohistochemistry, the tumor in the right pyriform sinus was diagnosed as an extrapulmonary SCC. Chemo-radiotherapy was applied to the SCC of the pyriform sinus with a regimen of etoposide and cisplatin. The patient exhibited complete response to treatment and has been disease free for 11 months.

CONCLUSION

This interesting case shows that chemotherapy with concurrent radiation may be an effective therapeutic modality for localized extrapulmonary SCC similar to localized SCLC, which is treated with concurrent chemo-radiotherapy as the standard therapeutic option.

Primary combined small cell carcinoma and squamous cell carcinoma of the oropharynx with special reference to EGFR status of small cell carcinoma component: Case report and review of the literature

Combined small cell carcinoma (SCC) and squamous cell carcinoma (SqCC) of the oropharynx is extremely rare and shows an aggressive clinical course. There are only 5 reported cases of combined SCC and SqCC in the English language literature. Here, we report a 59-year-old male presenting with a right tonsillar mass. The mass was biopsied, and the histological findings showed a proliferation of small-sized tumor cells with scant cytoplasm. Immunohistochemically, the tumor cells were positive for neuroendocrine markers (synaptophysin, chromogranin A, and CD56). Our first diagnosis was tonsillar small cell carcinoma. We treated the patient with concurrent chemoradiotherapy together with cisplatin followed by surgery. The resected tonsillar specimen showed a residual tumor composed of SCC and SqCC, and lymph nodes showed metastatic tumor cells of the SCC component. Immunohistochemically, the SCC component was positive for all neuroendocrine markers and p16; on the other hand, the SqCC component was positive for p40, p63, p16, and EGFR. Fluorescence in situ hybridization revealed that neither component showed any EGFR gene copy number gain. The patient was treated with adjuvant chemotherapy consisting of irinotecan and cisplatin. Liver and bone metastases developed, resulting in the death of the patient. We discuss the present case and review similar cases. Most cases of combined SCC and SqCC occur regardless of p16 status, and a therapeutic strategy has yet to be determined. Further examination of this kind of combined tumor is necessary.

Predictors of survival in parotid small cell carcinoma: A study of 344 cases

OBJECTIVES/HYPOTHESIS

We sought to better characterize patient, tumor, and long-term survival characteristics of parotid small cell carcinoma (SmCC) with the National Cancer Database (NCDB).

STUDY DESIGN

Retrospective database review.

METHODS

We reviewed the NCDB (1998-2012) for all cases of parotid SmCC. Relevant demographic, tumor, and survival variables were extracted and analyzed. Cox multivariate regression was performed to identify prognosticators.

RESULTS

Out of 30,813 parotid gland cancers in the NCDB, we found 344 cases of parotid SmCC (1.11%). Age at diagnosis ranged from 23 to 91 years (mean = 73 years). Most patients (73.0%) were male. Most tumors were 2 to 4 cm in size (51.4%). Regional metastases were common (50.8% cN+ and 65.1% pN+) and distant metastasis (7.3%) was uncommon. Occult nodes were found in 14.4% of cases. Overall survival at 5 and 10 years was 37% and 20%, respectively. Although numerous variables were found to significantly impact survival on univariate regression analysis, age (hazard ratio [HR]: 1.05, 95% confidence interval [CI]: 1.03-1.08, P < .001), tumor size of 2 to 4 cm (HR: 2.51, 95% CI: 1.83-5.11, P = .011), tumors >4 cm (HR: 3.44, 95% CI: 1.63-7.27) and distant metastasis (HR: 2.06, 95% CI: 1.02-4.14, P = .043) remained significant prognosticators in our multivariate model. Nodal disease was not a significant risk factor after adjustment (P = .055).

CONCLUSIONS

SmCC is a rare parotid malignancy with a poor prognosis. Regional metastases were common, whereas distant metastases were uncommon. Elective neck treatment should be considered due to the incidence of occult nodal disease.

LEVEL OF EVIDENCE

4 Laryngoscope, 126:2036-2040, 2016.

Primary combined small and squamous cell carcinoma of the hypopharynx: A case report

We herein report a very rare case of combined small-cell carcinoma (SmCC) of the hypopharynx, with a squamous cell carcinoma (SqCC) element. A 74-year-old man presented with a 3-month history of throat pain and hoarseness. On hypopharyngoscopy, a tumor was identified in the right anterior wall of the piriform sinus and, following examination of a biopsy sample, the lesion was diagnosed as SqCC. Total laryngectomy with bilateral neck dissection was performed and the malignancy was diagnosed as combined SmCC. One month after surgery, concomitant chemoradiotherapy with cisplatin and etoposide was administered. Immunohistochemically, the SmCC element was positive for CD56 and Ki-67 (50.2%), whereas the SqCC element was positive for cytokeratin 34βE12 and Ki-67 (47.5%). Furthermore, the SmCC element was positive for KIT and platelet-derived growth factor α (PDGFRα), while the SqCC element was positive for epidermal growth factor receptor (EGFR) and PDGFRα. By genetic analysis, a silent mutation in the PDGFRα gene was recognized. The expression of KIT, PDGFRα and EGFR in this case provided evidence that combined SmCC may be a candidate for molecular-targeted therapy, although further investigations are required.

Sinonasal small cell neuroendocrine carcinoma: a systematic review of 80 patients

BACKGROUND

The objective of this study was to review the published literature related to sinonasal small cell neuroendocrine carcinomas (SCNECs). Clinical presentation, demographics, treatment, and outcomes of this uncommon disease are reported.

METHODS

A systematic review of studies for sinonasal SCNECs in PubMed and Ovid databases from 1970 to 2014 was conducted. Bibliographies of selected articles were also examined. Articles were examined for patient data that reported disease outcome.

RESULTS

Thirty-four articles were included in this analysis, comprising a total of 80 cases. The mean age of presentation was 53.0 years. Nasal obstruction (53.8%) and epistaxis (48.8%) were the most common presenting symptoms. The nasal cavity and septum (32.5%) was the most common site of involvement. Seventy percent of patients presented with American Joint Committee on Cancer (AJCC) stage IV disease. Combination chemotherapy and radiation therapy was the most common treatment modality, used in 21 cases (26.3%). The second and third most common treatment modalities was combination surgery and chemoradiation therapy (21.3%), and surgery alone (18.8%), respectively. A total of 37 patients (46.3%) were alive after a mean follow-up of 30.8 months (median 15.5 months), independent of treatment modality. Of the treatment modalities, multimodality therapy remained the most common therapy.

CONCLUSION

This review contains the largest pool of sinonasal SCNEC patients to date. Sinonasal SCNEC is a rare and aggressive neoplasm, and there is currently no standard of care for treatment. Various treatment modalities have been employed. Our systematic review suggests that multimodality therapy remains the most common treatment of sinonasal SCNEC.

Neuroendocrine Neoplasms of the Sinonasal Tract: Neuroendocrine Carcinomas and Olfactory Neuroblastoma

Neuroendocrine neoplasms (NENs) can occur in organs or tissues that do not contain neuroendocrine cells normally and do not necessarily imply embryologic derivation from the neuroectoderm; but rather reflect a shared phenotype characterized by the expression of multiple genes encoding both endocrine and neuronal features. NENs are rare in the sinonasal tract and are subdivided into epithelial and neural subtypes based on the presence of keratins or neurofilaments, respectively. Although relatively rare, neuroendocrine carcinomas (NECs) and olfactory neuroblastoma (ONB) are the most common neuroendocrine neoplasms of the sinonasal tract. The focus of this review is to highlight recent developments in the pathology of sinonasal NECs and ONB in light of the upcoming update of the World Health Organization (WHO) 2005 classification of tumors of the head and neck.

Nodal metastasis and elective nodal level treatment in sinonasal small-cell and sinonasal undifferentiated carcinoma: a surveillance, epidemiology and end results analysis

OBJECTIVE

Risk of nodal involvement in patients with sinonasal small-cell carcinoma and sinonasal undifferentiated carcinoma (SNUC) has not been well defined because of their rarity. We describe a population-based assessment of specific nodal level involvement in this group of rare neuroectodermal tumours.

METHODS

The Surveillance, Epidemiology and End Results (SEER) database from 2004 to 2011 identified patients with SNUC and sinonasal small-cell carcinoma. Overall neck involvement and individual nodal level involvement at presentation were assessed, and comparison was made with a contemporaneous cohort of patients with a borderline clinically significant risk of nodal involvement and recurrence.

RESULTS

Of 141 patients, 31 (22%) had gross nodal involvement at presentation (range 14-33% by site and histology). Non-nasal, non-ethmoid site with SNUC histology has the highest rates of initial nodal involvement, whereas higher stage and size do not predict for higher nodal involvement rates. Bilateral Levels 2-3 for all sinonasal small cell; Levels 2-3 for nasal or ethmoid SNUC; and bilateral Levels 1-3 in non-nasal/non-ethmoid SNUC have the highest rates of involvement compared with a clinical reference standard.

CONCLUSION

We found high rates of initial nodal involvement in all SNUC and sinonasal small-cell carcinoma. We found higher initial involvement of Levels 2 and 3 and in certain cases to the Level 1 nodal levels, hypothesizing benefit for elective treatment to those levels.

ADVANCES IN KNOWLEDGE

With small single-institution series reporting conflicting nodal involvement rates, our data support high rates of nodal presentation at diagnosis, hypothesizing benefit for elective nodal treatment in this cohort.

Extrapulmonary small cell carcinoma: imaging features with radiologic-pathologic correlation

Extrapulmonary small cell carcinoma (EPSCC) refers to small cell carcinoma arising outside of the lungs. EPSCC extrapulmonary small cell carcinoma is a rare aggressive neoplasm, representing a minority of all small cell carcinomas. Despite its uncommon occurrence, EPSCC extrapulmonary small cell carcinoma has been described in nearly every organ, most commonly in the gastrointestinal and genitourinary systems. As such, it is important for radiologists to be aware of the entity. Although imaging is neither sensitive nor specific for EPSCC extrapulmonary small cell carcinoma , it plays an important role by helping exclude metastases from a primary pulmonary tumor, establish tumor staging, and assess response to therapy. EPSCC extrapulmonary small cell carcinoma is diagnosed by demonstrating pathologic features of small cell carcinoma in an extrapulmonary site. There are two ways to stage EPSCC extrapulmonary small cell carcinoma . One method uses the Veterans Administration Lung Study Group system developed for small cell lung cancer that allocates patients into limited or extensive disease categories. The second approach is the American Joint Committee on Cancer tumor-node-metastasis system applied to other tumor subtypes arising from the same organ. Because of its rare and varied manifestations, the most effective treatment for EPSCC extrapulmonary small cell carcinoma has not been established. Current management recommendations are derived from retrospective studies and single-institution experiences or are extrapolated from small cell lung cancer data. Regardless of therapy, overall survival rates are poor, with 5-year survival rates around 13%. To help radiologists increase their familiarity with EPSCC extrapulmonary small cell carcinoma , this article provides (a) a background for EPSCC extrapulmonary small cell carcinoma based on the literature and (b) a pictorial review of EPSCC extrapulmonary small cell carcinoma in multiple organs, with radiologic-pathologic correlation.