Cutaneous and Subcutaneous Metastases From Atypical Laryngeal Carcinoids: Case Report and Review of the Literature

Neuroendocrine neoplasms of head and neck, genitourinary and gynaecological systems, unknown primaries, parathyroid carcinomas and intrathyroid thymic neoplasms: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up

•This Clinical Practice Guideline provides key recommendations for managing rare endocrine tumours. •Neuroendocrine neoplasms of different origins, parathyroid carcinoma and intrathyroid thymic neoplasms are included. •The guideline covers clinical imaging and pathological diagnosis, staging and risk assessment, treatment and follow-up. •The authors comprise a multidisciplinary group of experts from different institutions and countries in Europe. •Recommendations are based on available scientific data and the authors’ collective expert opinion.

Atypical carcinoid tumour of the larynx

A man in his 80s with long-standing left-sided throat discomfort presented with hypophonia and odynophagia. A flexible nasoendoscopy revealed a supraglottic mass in the left arytenoid. An urgent microlaryngoscopy and biopsy demonstrated a supraglottic laryngeal tumour consistent with atypical carcinoid on histopathological examination. Head and neck multidisciplinary team discussions led to the selection of ablative carbon dioxide laser therapy as primary treatment. Two years later, there was local recurrence, prompting a second laser resection and selective neck dissection. Further laser resection was performed 3 years later for another recurrence. Despite an initial encouraging response with local control, 4 years after the initial treatment, there was substantial progression with multiple cutaneous and subcutaneous metastases and further local recurrence soon after. Palliative radiotherapy to the cutaneous metastases provided partial benefit, transitioning to best supportive care. He died 10 years after the initial onset of symptoms, primarily due to cancer progression.

Reduced expression of secretogranin VGF in laryngeal squamous cell carcinoma

Laryngeal cancer accounts for one-third of all head and neck tumors, with squamous cell carcinoma (SCC) being the most predominant type, followed by neuroendocrine tumors. Chromogranins, are commonly used as biomarkers for neuroendocrine tumors, including laryngeal cancer. It has been reported that secretogranin VGF, a member of the chromogranin family, can be also used as a significant biomarker for neuroendocrine tumors. However, the expression and role of VGF in laryngeal carcinomas have not been previously investigated. Therefore, the present study aimed to determine the expression levels of VGF in laryngeal SCC (LSCC). The present study collected tumor tissues, as well as serum samples, from a cohort of 15 patients with LSCC. The results of reverse transcription-quantitative PCR, western blot analysis and immunofluorescence assays showed that the selective VGF precursor was downregulated in patients with LSCC. Notably, in tumor tissue, the immunoreactivity for VGF was found in vimentin-positive cells, probably corresponding to T lymphocytes. The current preliminary study suggested that the reduced expression levels of VGF observed in tumor tissue and at the systemic level could sustain LSCC phenotype. Overall, VGF could be a potential biomarker for detecting neoplastic lesions with a higher risk of tumor invasiveness, even in non-neuroendocrine tumors.

Atypical Carcinoid of the Larynx: A Case Report

Neuroendocrine carcinomas are a spectrum of rare and highly heterogeneous malignant tumors. Neuroendocrine carcinomas mainly arise from neuroendocrine cells scattered throughout the body. They mainly occur in the lung and gastrointestinal tract. Atypical carcinoid of the larynx is a rare type of neuroendocrine carcinoma, which is easily misdiagnosed as hemangioma in appearance. We mainly feature the disease to you through the diagnosis and treatment of a case of atypical carcinoid of the larynx.

ATYPICAL CARCINOID OF THE LARYNX AND MULTIFOCAL METASTASES

Neuroendocrine carcinoma (NEC) of the larynx is the most frequent neuroendocrine neoplasm of the head and neck and the most common nonsquamous carcinoma of the larynx. It usually occurs in the supraglottic area, in smoking men. We report a case of a 58-year-old woman with no history of smoking who presented with an atypical carcinoid, arising in the right piriform sinus of the larynx. During the 5-year follow-up, the patient developed metastases in the lymph nodes, palatine tonsils, parotid glands, breasts and skin. For this reason the patient underwent several surgical procedures, radiotherapy and eventually was qualified for chemotherapy. Our case shows that NEC of the larynx can have an atypical presentation. The diagnosis requires careful pathological evaluation with immunohistochemistry and a wide spectrum of imaging. The serum concentration of chromogranin A seems to be not useful in the diagnosis and follow-up of laryngeal NEC.

Well-differentiated Neuroendocrine Carcinoma of the Larynx: Confusion of Terminology and Uncertainty of Early Studies

Well-differentiated neuroendocrine carcinoma (also known as "carcinoid") of the larynx is an exceedingly rare tumor that has an epithelial origin. These tumors are malignant and have a low, but definite, risk of metastasis. Although it can be challenging, this tumor should be differentiated from moderately differentiated neuroendocrine carcinoma (also known as "atypical carcinoid"). The clinical and pathologic features of this tumor, as well as treatment and prognosis, are reviewed in detail.

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.