Combined larynx large cell neuroendocrine and squamous cell carcinoma: a case report

Laryngeal cancer ranks third among the most common head and neck neoplasms. The most common histological subtype is squamous cell carcinoma, and neuroendocrine tumors are rare. An even rarer entity is a composite tumor with both these histologies. This case reports a metastatic combined carcinoma of squamous cells and large neuroendocrine cells, presenting favorable response to treatment with a total laryngectomy followed by adjuvant therapy including chemo-, radio-, and immunotherapy.

Keywords:
Laryngeal neoplasms; Carcinoma, neuroendocrine; Carcinoma, squamous cell; Head and neck neoplasms; Carcinoma, large cell

Authorship

Juliana Hesse

data curation

writing and editing

Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.Hospital Israelita Albert EinsteinBrazilSão Paulo, SP, BrazilFaculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.

https://orcid.org/0000-0001-9658-6824

Leandro Aurélio Liporoni Martins

pathology analysis

text review

Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.Hospital Israelita Albert EinsteinBrazilSão Paulo, SP, BrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.

https://orcid.org/0000-0002-9203-8860

Leonardo Haddad

data collection

text review

Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.Hospital Israelita Albert EinsteinBrazilSão Paulo, SP, BrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.

https://orcid.org/0000-0003-3392-6259

Fabio Pupo Ceccon Corresponding author: Fabio Pupo Ceccon Rua Afonso Braz 579, room 66/68 Zip code: 04511-011, São Paulo, SP, Brazil Phone: (55 11) 99405-0493 Email: fpceccon@uol.com.br

data collection

writing

supervision and text review

Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.Hospital Israelita Albert EinsteinBrazilSão Paulo, SP, BrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.

https://orcid.org/0000-0002-9040-8450

Corresponding author: Fabio Pupo Ceccon Rua Afonso Braz 579, room 66/68 Zip code: 04511-011, São Paulo, SP, Brazil Phone: (55 11) 99405-0493 Email: fpceccon@uol.com.br

SCIMAGO INSTITUTIONS RANKINGS

Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.Hospital Israelita Albert EinsteinBrazilSão Paulo, SP, BrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.

Figures

Figures (2)

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Figure 1
A) Axial section with level 2A metastasis on the left; B) Expansive, infiltrative, and ulcerated formation, with heterogeneous contrast enhancement, transglottic, affecting the glottic and supraglottic larynx on the left; C and D) Laryngoscopy images evidentiating the left vocal fold presenting vegetative and infiltrative lesion in the vestibular fold that reaches the petiole of the epiglottis. Fixation and immobility of the left vocal fold was observed. The right vocal fold had normal mobility and no mucosal lesion

Thumbnail

Figure 2
A) Hematoxylin and Eosin (HE) (larynx): longitudinal section showing the supraglottic neoplasm (the true vocal fold, on the right, is free from involvement). There is a superficial component on the upper left (in situ and invasive SCC) and a predominant component on the right and in the depth (LCNEC); B) Transition of SCC (upper half) and LCNEC (lower half) components; C) HE (larynx): detail of the predominant component (LCNEC), with a neoplastic block in the center showing rosettes and punctate necrosis; D) Immunohistochemistry (larynx): cytokeratin 5/6 confirming squamous differentiation from SCC; E) Immunohistochemistry (larynx): synaptophysin confirming neuroendocrine differentiation from the predominant component (neuroendocrine carcinoma); F) Immunohistochemistry (metastasis): cytokeratin 5/6 positive in the SCC component. Around, negative neoplastic blocks (component of neuroendocrine carcinoma); G) Immunohistochemistry (metastasis): positive synaptophysin in the neuroendocrine carcinoma component. In the center, negative neoplastic blocks (SCC component); H) Immunohistochemistry (larynx): p40 confirming squamous differentiation from SCC; I) HE (metastasis): two components present. In the circle, the squamous component, confirmed by immunohistochemical positivity of cytokeratin 5/6

Figure 1 A) Axial section with level 2A metastasis on the left; B) Expansive, infiltrative, and ulcerated formation, with heterogeneous contrast enhancement, transglottic, affecting the glottic and supraglottic larynx on the left; C and D) Laryngoscopy images evidentiating the left vocal fold presenting vegetative and infiltrative lesion in the vestibular fold that reaches the petiole of the epiglottis. Fixation and immobility of the left vocal fold was observed. The right vocal fold had normal mobility and no mucosal lesion

Figure 2 A) Hematoxylin and Eosin (HE) (larynx): longitudinal section showing the supraglottic neoplasm (the true vocal fold, on the right, is free from involvement). There is a superficial component on the upper left (in situ and invasive SCC) and a predominant component on the right and in the depth (LCNEC); B) Transition of SCC (upper half) and LCNEC (lower half) components; C) HE (larynx): detail of the predominant component (LCNEC), with a neoplastic block in the center showing rosettes and punctate necrosis; D) Immunohistochemistry (larynx): cytokeratin 5/6 confirming squamous differentiation from SCC; E) Immunohistochemistry (larynx): synaptophysin confirming neuroendocrine differentiation from the predominant component (neuroendocrine carcinoma); F) Immunohistochemistry (metastasis): cytokeratin 5/6 positive in the SCC component. Around, negative neoplastic blocks (component of neuroendocrine carcinoma); G) Immunohistochemistry (metastasis): positive synaptophysin in the neuroendocrine carcinoma component. In the center, negative neoplastic blocks (SCC component); H) Immunohistochemistry (larynx): p40 confirming squamous differentiation from SCC; I) HE (metastasis): two components present. In the circle, the squamous component, confirmed by immunohistochemical positivity of cytokeratin 5/6

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E-mail: revista@einstein.br

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Combined larynx large cell neuroendocrine and squamous cell carcinoma: a case report

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[1] Corresponding author: Fabio Pupo Ceccon Rua Afonso Braz 579, room 66/68 Zip code: 04511-011, São Paulo, SP, Brazil Phone: (55 11) 99405-0493 Email: fpceccon@uol.com.br