Histomorphologic Spectrum of Laryngeal Neuroendocrine Carcinoma: A Rare Case
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CLINICAL REPORT
Histomorphologic Spectrum of Laryngeal Neuroendocrine Carcinoma: A Rare Case Mekala Lakshminarayanan1
•
Ann Kurian1 • Ajit Pai2
Received: 26 August 2020 / Accepted: 14 October 2020 Ó Association of Otolaryngologists of India 2020
Introduction Non squamous tumours of the larynx are rare. The most common non squamous neoplasms of the larynx are neuroendocrine tumours [1]. Neuroendocrine neoplasms (NEN) of larynx are classified into three types -well differentiated (typical carcinoid), moderately differentiated (atypical carcinoid) and poorly differentiated neuroendocrine carcinoma (NEC) based on the histomorphologic features [2]. Well and moderately differentiated NECs are also termed as Neuroendocrine tumour Grade 1 and 2 respectively. All these three neoplasms show different biological behaviour and prognosis thereby requiring different management [3]. We present a rare case of neuroendocrine NEC of larynx which showed a different histomorphology in small biopsy and resection specimen.
Case Report A 43 y old gentleman presented with a history of hoarseness of voice of one month duration. On physical examination, he had a palpable left cervical level II lymph node measuring 2 9 2 cm that was firm in consistency. & Mekala Lakshminarayanan [email protected] Ann Kurian [email protected] 1
Department of Histopathology, Apollo Speciality Cancer Hospital, Teynampet, Chennai 600035, India
2
Department of Surgical Oncology, Apollo Speciality Cancer Hospital, Teynampet, Chennai 600035, India
Systemic examination was unremarkable. A computed tomography scan showed a left false vocal cord lesion with pre and paraglottic fat involvement. Direct laryngoscopy revealed a left false vocal cord lesion without glottic extension or anterior commissure involvement. Histopathological examination of the biopsy sample obtained at laryngoscopy showed fragments of a tumour composed of small cells with high nucleocytoplasmic ratio, inconspicuous nucleoli, scant cytoplasm and coarse condensed nuclear chromatin and apoptosis. In some areas, these cells showed crush artefact (Fig. 1). Differential diagnoses considered were high grade NEC, mixed neuroendocrine-non neuroendocrine carcinoma (MiNEN) and small cell type of squamous cell carcinoma. Immunohistochemistry studies were performed. The tumour cells were positive for cytokeratin, synaptophysin and chromogranin with a high Ki67 proliferation index of 60–65%. Squamous markers such as p63 and High Molecular Weight Cytokeratin were negative. A diagnosis of poorly differentiated small cell neuroendocrine carcinoma was rendered. Following this biopsy report, the patient underwent Positron Emission Tomography-Computed Tomography scan which showed disease involving the left hemilarynx including left false vocal cord, anterior one third of left true vocal cord, anterior commissure and pre-epiglottic fat plane and lamina of thyroid cartilage (Fig. 2). He underwent a Supracricoid partial laryngectomy with cricohyoidepiglottopexy [CHEP], bilateral selective neck dissecti
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