Oncocytic and oncocytoid carcinoid tumors (well-differentiated neuroendocrine carcinomas) of the larynx

Carcinoid tumors of the larynx are exceedingly rare neoplasms. With the inclusion of the five neoplasms we report herein, the total number reported in the English-language literature is 16. These five neoplasms all showed light microscopic features of oncocytic (or oncocytoid) cells. Ultrastructurally, all lesions contained dense-core granules of the neurosecretory type. One case further met the ultrastructural criteria for true oncocytoma (that is, an oncocytic carcinoid). The lesion did not metastasize, and the patient was successfully treated surgically. In the other four cases, the lesions were considered to be oncocytoid carcinoids, since they failed to meet the ultrastructural requirements of a true oncocytoma. Each of these four lesions metastasized, although one patient did have a long, indolent course.     

Papillary cystadenoma of the larynx

A patient with a tumor of the larynx resembling a Warthin's tumor of the parotid salivary gland is described. A comparison is drawn between this lesion and oncocytoma. A discussion of the morphology and pathogenesis of oncocytic adenomas is presented.     

Oncocytoma of the larynx

A case of oncocytoma of the larynx is presented. These lesions are rarely found in the larynx, and have been more commonly described in the salivary and thyroid glands. The histopathological diagnosis is often difficult and the light microscopy can be unreliable for oncocytic lesions. For a more accurate definition of these tumours, the use of histochemical stains together with electron microscopy are advocated. With adequate surgery, the prognosis is excellent, and tumours are unlikely to recur. This paper discusses the management of a patient with a benign oncocytoma of the true vocal cord, and presents a review of the world literature.     

Oncocytic lesions of the larynx

True laryngeal adenomas are considered extremely rare and some doubt their existence. Laryngeal lesions having oncocytes as the predominant cell type have been described in the literature under a variety of different names: oncocytoma, oncocytic papillary cystadenoma, papillary cystade-noma, oxyphilic granular cells adenoma, etc. The oncocytes originate from changes in normal acinic and ductal cells. The significance of these changes is controversial. Whether the oncocytic laryngeal lesions represent true neoplasms or are degenerative in nature remains to be determined. We present clinical and histopathological details of four cases of oncocytic lesions of the larynx and compare their histology with microscopic findings in 30 cases filed as laryngeal cysts at the Minneapolis V.A. and University of Minnesota Hospitals. While the controversy regarding the neoplastic versus degenerative etiology of these lesions could not be resolved from a histopathological standpoint, their clinical behavior is that of a benign neoplasm. We review the literature on the subject and suggest a course of treatment for these lesions.     

Oncocytic Sialolipoma of the Submandibular Gland

Sialolipoma, a rare tumor of the salivary gland, is a recently described variant of salivary gland lipoma. Oncocytic sialolipoma was first described by Pusiol et al. in 2009. We report the case of an oncocytic sialolipoma of the submandibular gland in a 43-year-old female. Excision of the tumor was performed with preservation of the submandibular gland. The tumor had a thin, fibrous capsule and consisted of abundant adipose tissue, an oncocytic nodule, and scattered normal glandular structures surrounded by adipose tissue. Four cases of sialolipoma of the submandibular gland, including the present case, were reviewed. All 4 tumors were developed on the right submandibular glands, with a composition of adipose tissue as high as that of sialolipoma of the parotid gland; in contrast to previous reports, three cases were in females. As newly described tumor type, care should be taken to distinguish oncocytic sialolipoma from other salivary gland neoplasms such as simple lipoma, pleomorphic adenoma, or oncocytoma.     

Oncocytic carcinoma of the maxillary sinus: a rare neoplasm

Oncocytic neoplasms are tumors composed of oncocytes (i.e., epithelial cells with a large cytoplasm that is rich in mitochondria). Most cases are benign and originate from the major salivary glands, while the minor salivary glands are rarely involved. Occurrence of oncocytic carcinoma (or malignant oncocytoma) within the sinonasal tract is an unusual event. We report a rare case of maxillary sinus oncocytic carcinoma occurring in a 45-year-old male. Biopsy was consistent with an unspecified salivary gland neoplasm. The patient underwent total maxillectomy through a lateral rhinotomic approach; hard palate reconstruction with temporal myofascial flap was performed. Definitive histology was consistent with oncocytic carcinoma. Due to the local extension of the lesion, postoperative radiotherapy (60 Gy) was delivered. Three years after surgery, the patient is free from disease. A brief analysis of the literature was also accomplished in order to discuss treatment options and prognosis of this unusual neoplasm.     

Presentation of multiple oncocytic type laryngeal cysts. Clinical and histopathological findings

Oncocytic cysts are a histologically well-defined subgroup of cystic lesions of the larynx. Oncocytic cysts of the larynx are rare, clinically similar to simple laryngeal cysts, and occur as a casual finding of pathology studies. Multiple oncocytic cysts have rarely been described. Microscopic examination of laryngeal biopsies showed cysts within the lamina propria lined by oncocytic epithelium. The differential diagnosis and pathogenesis of oncocytic cysts is discussed and other laryngeal cystic lesions are reviewed.     

Oncocytic lesions of the larynx

Summary Three cases of oncocytic lesions of the larynx diagnosed at the Section of Pathology, Dep. of Otolaryngology, Padua University from November 1974 until December 1980 are reported. The lesion is uncommon but not exceptional and occurs in elderly people. Problems connected with pathology and the clinico-therapeutic approach are dealt with. The pathogenesis of the lesion is also discussed, with particular stress on whether it is a true neoplasm or a process of metaplasia-hyperplasia from the ductal epithelium in connection with senile involution of the upper respiratory tract.Supported by private funds     

Multiple oncocytic papillary cystadenomas of the larynx: A case report

A patient had multiple oncocytic cysts of the larynx and, concurrently, epidermoid carcinoma of the larynx. Total laryngectomy for the epidermoid carcinoma made it possible to carefully examine and histologically document the multifocal and oncocytic nature of the lesions. The authors interpret the findings to represent both hyperplastic and metaplastic processes.     

Oncocytic cystic lesions of the upper respiratory tract

Oncocytic cystic lesions in the larynx comprise an uncommon but pathologically well-defined group, whereas only one case has been reported in the nasopharynx. The laryngeal cysts generally originate from the ventricle and occur in an older age group. Hoarseness is the most common clinical manifestation, with lesions appearing as polypoid masses. Their pathogenesis is considered to be the result of oncocytic metaplasia, apparently related to aging of cells in the seromucinous gland and ducts. The cystic dilatation is probably due to an obstructive phenomenon. Complete endoscopic removal is the treatment of choice. Examples of these lesions in the larynx and in the nasopharyngeal mucosa are described.     

Bilateral oncocytoma of the parotid gland

Oncocytic neoplasms are a group of rare tumours that mostly affect the parotid gland (80%), sometimes affect the submandibular gland (9%) and rarely affect the intraoral minor salivary glands. The incidence of oncocytic neoplasms represents approximately 1% of parotid neoplasms and bilateral presentation is very rare. Herein we describe a single case involving bilateral presentation of oncocytoma of the parotid glands.     

Oncocytic adenocarcinoma of the submandibular gland

BACKGROUND: Malignant oncocytic tumors rarely occur in major salivary glands and generally account for < 1% of all salivary tumors. There is no difference of both sexes and appearing mainly between 50 and 60 years of age. They comprise oncocytes, which are epithelial cells with abnormally formed cytoplasm and acidophilic granular cytoplasma. In the process of the malignant transformation the coexistence from oncocytic rests and untypical oncocytic carcinoma portions can be seen. The tumors show no capsule and an infiltrative local growth with perineural and vascular expansions. PATIENT AND METHOD: A rare case of a 59-year-old man with malignant oncocytoma is presented. The tumor was found in the left submandibular gland with one enlarged lymph node near by. RESULT AND CONCLUSIONS: A general overview of the available literature and the histological classification of oncocytomas is given. Therapy consists of surgical resection and radiotherapy. Close clinical controls are necessary.     

A case of bilateral oncocytomas of the submandibular gland and synchronous renal oncocytomas

A case of 42 years-old man with bilateral big sized (12 x 5 cm and 10 x 4,5 cm) oncocytoma in submandibular glands was presented. Oncocytoma is a rare benign neoplasm observed in numerous of organs. In the case described besides submandibular glands tumours, accessory oncocytic tumours in both kidneys were diagnosed. It was the reason of earlier unilateral nephrectomy. Surgical treatment was applied. The comparison of the both tumours histology allowed to establish proper diagnosis. The case is presented because of the explicitly of the oncocytoma location especially in the both submandibular glands simultaneously with tumour of the same histology in distant organs.     

Laryngeal involvement in Von Recklinghausen's disease: a case report and review of the literature.

A case of neurofibromatosis involving the larynx is added to the 19 previously reported cases; furthermore, it represents the only reported case of plexiform ganglioneurofibroma of the larynx in Von Recklinghausen's disease. The reported cases of neurofibromatosis with laryngeal involvement in the world literature are discussed and summarized. The main clinical symptoms are dyspnea, dysphonia and dysphagia which occasionally require tracheotomy when the condition is recognized. Elective surgical excision is the treatment of choice.     

Malignant oncocytic tumour of the parotid salivary gland.

A 49-year-old man developed a tumour mass in his right parotid salivary gland nine years after a histologically proven benign mixed tumour of the same salivary gland had been surgically removed. Radical resection of the right parotid salivary gland and associated lymph nodes and soft tissues of the neck was performed. The parotid tumour was composed of oncocytic cells which infiltrated the surviving salivary gland tissue. Most of the excised lymph nodes contained metastatic deposits of oncocytic cells identical to the tumour seen in the parotid. There are no previous reports of the occurrence of both pleomorphic adenoma and malignant oncocytoma in the same salivary gland.     

A rare malignancy of the parotid gland: oncocytic carcinoma

Oncocytic carcinomas are uncommon; they represent 11% of all oncocytic salivary gland neoplasms, 0.5% of all epithelial salivary gland malignancies and 0.18% of all epithelial salivary gland tumors. A 65-year-old woman was admitted to our ENT clinic with a history of a painless left preauricular mass. No lymph node was palpable on either side of her neck. Computed tomography demonstrated a 3×3-cm solid lesion in the left parotid gland. As oncocytes and atypical cells were seen at the cytologic examination of a fine-needle aspiration biopsy, this finding suggested a malignant epithelial tumor. Total parotidectomy by preserving the facial nerve was performed. The result of the pathologic examination was oncocytic carcinoma regarding histopathologic and immunohistochemical findings and especially the invasive growth pattern. We preferred a close follow-up to an elective neck dissection, and reserved the neck dissection for a recurrence. The prognosis of oncocytic carcinomas is not well known because of their low incidence. Further investigation of the prognosis of patients with oncocytic carcinoma of the parotid gland is warranted as more cases are reported.     

Lipoma of the larynx

Two cases of intrinsic laryngeal lipoma are added to the twenty-four cases recorded previously. Lipoma may occur anywhere beneath the skin over the entire body. In the larynx these tumours lie rather deep and it is therefore important to obtain a deep tissue biopsy. It is possible to remove a substantial part of the swelling endoscopically and to relieve the patient's symptoms. We feel that lipoma of the larynx may be more common than has hitherto been reported in the literature.     

Small cell carcinomas of the larynx: results of combined modality treatments

Four cases of primary small cell carcinoma of the larynx are described. Two patients presented with extensive metastatic disease and two with tumor limited to the larynx. All four cases responded (3PR, 1CR) to systemic combination chemotherapy. Long-term remission was achieved in one patient with limited disease who underwent chemotherapy with a complete response followed by definitive radiotherapy. Treatment results are compared with previously reported cases. The importance of early diagnosis through staging, and combined treatment in small cell carcinoma of the larynx is discussed.     

"Occult" posterior laryngeal cleft

A previously undescribed deficiency of the posterior cricoid at the midline, wherein the mucosa overlying this deficiency is intact, is described. Clinically this presents as a variety of subglottic stenoses wherein the narrowing is primarily in the transverse subglottic diameter; the symptoms are, therefore, those of airway obstruction not laryngeal incompetence. It is suggested that this deformity has been previously overlooked by laryngologists and pathologists by virtue of a postmortem routine in which the larynx is routinely split in the posterior midline. Demonstration in these cases was by serial horizontal section of the intact, unsplit, whole larynx.