Complete regression of laryngeal neuroendocrine carcinoma after surgery and radiotherapy





Abstract


A 67-year-old man presented to the outpatient clinic with a 2-month history of hoarseness and dysphagia, accompanied by occasional cough. He used to smoke since he was young until he quit smoking 8 years ago. Head and neck examinations were normal. Endoscopic examination showed a vascular bluish mass in the supraglottic area, which partially obstructed the view of laryngeal inlet and airway. The mass was pedunculated and moved with each breathing. The patient underwent extirpation biopsy to remove the tumor. Immunohistochemistry confirmed the diagnosis of laryngeal small cell type neuroendocrine carcinoma. The patient received radiotherapy in another hospital and returned to our hospital for posttreatment evaluation. Post-radiotherapy endoscopy showed a patent airway with no sign of the tumor. Evaluations by computerized tomography (CT) scan and endoscopy were done periodically and there was no recurrence nor metastasis during a follow-up period of 23 months.


Introduction


Neuroendocrine carcinoma (NEC) is a rare type of tumor with neuron and endocrine properties. NEC have been described in the central nervous system, respiratory tract, larynx, gastrointestinal tract, thyroid, skin, breasts, and urogenital tract [ ]. The supraglottic region in the larynx is the most common site for NEC in the head and neck [ , ]. This tumor mainly occurs in older patients, mostly who have a long-term smoking history [ ]. The tumor usually clinically presents as hoarseness, dysphagia and pain [ ].


In the update of WHO Classification of Head and Neck Tumors in 2017, NEC was classified as follows: 1) well-differentiated NEC, 2) moderately-differentiated NEC, and 3) poorly-differentiated NEC, with small cell and large cell types [ ]. The precise diagnosis of the tumor and its subtyping have an important role in the management of the disease because the treatment modalities, therapeutic responses and prognosis of each subtype are different [ , ]. We report a case of complete regression of laryngeal small cell type NEC after surgery and radiotherapy.


Case presentation


A 67-year-old man presented to the outpatient clinic in January 2018 with a 2-month history of hoarseness and dysphagia, accompanied by occasional cough. He used to smoke since he was young until he quit smoking 8 years ago. Endoscopic examination revealed a vascular bluish mass in the supraglottic area, which partially obstructed the view of laryngeal inlet and airway. The mass was pedunculated and moved with each inspiration and expiration ( Fig. 1 A). A cervical CT scan without contrast demonstrated a hypodense mass of 1.84 × 1.83 × 1.76 cm at the supraglottic region. No cervical lymphadenopathy was observed. ( Fig. 2 A and B). Chest X-rays of this patient were normal.




Fig. 1


Direct laryngoscopy before the surgery (A) showed a pedunculated laryngeal mass in the supraglottic area, which partially obstructed the view of laryngeal inlet and airway. Laryngoscopy after the surgery (B) showed healing lesion and 1-year after (C) showed supraglottic area clear of tumor. Laryngoscopy on 23-months after surgery (D) showed supraglottic area clear of tumor.

Jul 5, 2021 | Posted by in OTOLARYNGOLOGY | Comments Off on Complete regression of laryngeal neuroendocrine carcinoma after surgery and radiotherapy
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