Collision tumor of a hypopharyngeal adenoidcystic carcinoma and a laryngeal squamous cell carcinoma

INTRODUCTION: Malignancies in head and neck cancer are mainly squamous cell carcinomas. Adenoid cystic carcinomas are rare lesions of this site. Laryngeal adenoid cystic carcinoma is estimated to occur in 0.1 - 0.7 % of all laryngeal carcinomas. Adenoid cystic carcinomas are rarely located in the hypopharynx. To our knowledge there is no case report of adenoid cystic carcinoma of the hypopharynx as part of a collision tumor of the larynx. CASE REPORT: A 47-year-old male patient was diagnosed with an adenoid cystic carcinoma of the hypopharynx and a squamous cell carcinoma of the larynx. Because of local extension of both tumors laryngectomy and partial pharyngotomy with bilateral neck dissection was performed followed by radiation therapy. Clinical aspects as well as histomorphological and immunohistochemical criteria of both tumor entities are discussed. DISCUSSION AND CONCLUSIONS: Immunohistochemical characteristics showed two different carcinoma entities in the larynx and hypopharynx. Only by complete histological investigation of a carcinoma those rare cases of a collision tumor can be detected. Both tumor entities need to be considered for therapy strategy and oncological follow-up planning.     

Basaloid squamous cell carcinoma of the larynx

Basaloid squamous cell carcinoma (BSCC) is a rare tumor with distinct morphological and biological features that differentiate it from the common form of squamous cell carcinoma (SCC) in the head and neck region. It is mostly seen in the supraglottic larynx, hypopharynx and a base of the tongue. We present two cases of BSCC of the larynx; both being transglottic tumors. Both of the patients underwent primary surgery including bilateral neck dissections. None of the patients had cervical metastases at histopathological examination. Both patients received radiotherapy after surgery. They were alive and free of disease at 24 and 27 months, respectively.     

Analysis of 2,500 squamous cell carcinoma of the head and neck

The purpose of this paper is to define the prevalence of squamous cell carcinoma of the head and neck as seen at the ENT Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain in the last years, studying 2500 cases. Relative frequencies at the various sites, age distribution, male to female ratios, TNM stage are reported. From the results we point out that laryngeal squamous cell carcinomas (1297 cases) were more than 50% of all tumors, followed by oropharygeal carcinomas, oral cavity carcinomas and hypopharyngeal carcinomas. The mean age was 61 years, and patients with nasopharyngeal carcinomas were the youngest. 92% of the patients were males, and the highest rate of males was seen in the larynx and hypopharynx (97% males). Only 9% of the patients were non-smokers and 18% were not alcohol drinkers. Hypopharyngeal squamous cell carcinomas concentrated the highest rate of patients with severe toxic consumption. A significant proportion of earlier tumors was only seen in the larynx and oral cavity (54% and 41% Stages I-II, respectively). On the other hand, hypopharyngeal carcinoma, oropharyngeal carcinoma and nasopharyngeal carcinomas were mainly diagnosed in advanced stages.     

Basaloid squamous cell carcinoma of the larynx: report of a early laryngeal cancer

Basaloid squamous cell carcinoma is a recently recognized, rare and aggressive variant of squamous cell carcinoma with a predilection to occur in base of the tongue, hypopharynx and larynx (especially the supraglottic tract). It is usually diagnosed in advanced stage, frequently with distant metastases, requiring aggressive surgical intervention. The prognosis is remarkably poor even after the association of radiotherapy or chemotherapy. Nevertheless recently it has been reported that in the early stage this neoplasm seems to have a behaviour less aggressive, similar to conventional squamous carcinoma. The therapeutic approach is not clearly defined when the neoplasm is diagnosed at an early stage. We present a case of early stage of basaloid squamous cell carcinoma of the supraglottic larynx.     

Small cell neuroendocrine carcinoma in the petrous apex

With the exception of moderately differentiated neuroendocrine carcinoma of the larynx, neuroendocrine carcinomas are very rare head and neck malignancies. We report a case of a small cell neuroendocrine carcinoma in the petrous apex of the temporal bone. This unusual site for this tumour has not yet been reported in the literature. We confirmed the location and extent of the primary tumour by positron-emission tomography scan. The final histopathological diagnosis was of small cell carcinoma, and this was confirmed by immunohistochemistry. We treated this patient with surgery followed by radiotherapy and chemotherapy. After the treatment was completed there was subtotal remission of the tumour, with no distant metastases.     

Hypopharyngeal squamous cell carcinoma in a child

Squamous cell carcinoma of the hypopharynx is extremely rare in children. We present a 13-year-old girl with squamous cell carcinoma of the hypopharynx whose father was a coal-miner and a heavy smoker.     

Spindle cell carcinoma of the larynx

Histology, histogenesis, biology and treatment of the rare spindle cell carcinoma of the larynx are presented. The histogenesis of spindle cell tumours has been much debated, but electron microscopic investigations have shown that most of the laryngeal lesions are squamous epithelial carcinomas that have undergone transformation to a spindle cell pattern. As confusion with supporting tissue neoplasms may occur in the light microscope, the use of the electron microscope in differential diagnostics is recommended.     

Cytokeratin 18 expression in squamous cell carcinoma of the head and neck

Cytokeratin (CK) expression was studied in squamous cell carcinomas of different subsites in the head and neck by using cryostat sections from 27 head and neck squamous cell carcinomas (HNSCCs) and 6 cell lines established from HNSCC. All tissues were analyzed immunohistochemically with a panel of monospecific anti-keratin monoclonal antibodies. Most carcinomas recapitulated the expression pattern of keratins present in the basal layer of normal epithelium from the site of tumor origin. Regional differences in the expression of simple-epithelial type of keratins in stratified (pseudostratified) epithelia were to a large extent repeated in corresponding carcinomas. In the present study, localization of various keratins were surveyed and CK 18 specific monoclonal antibodies were specifically used to distinguish SCCs of the larynx or hypopharynx from SCCs of the oral cavity. CK 18 staining of almost all tumor cells was detected in 11 of 12 SCCs of the larynx and hypopharynx, but was only detected sporadically in 3 of 9 SCCs of the oral cavity. The present results show that CK 18 typing might be useful for distinguishing sites of origin of various HNSCCs. Findings also indicate that CK 18 expression in SCC might be modulated by microenvironmental factors.     

Papillary squamous cell carcinoma of the larynx

A case of papillary squamous cell carcinoma of the larynx in a 50-year-old man is reported. The lesion was located in the supraglottic region and grossly presented a characteristic finger-like pattern of growth. The tumour pursued an indolent clinical course, and the patient is well and free of disease after 47 months of follow-up. The present paper recapitulates the macro- and microscopic features of this rare neoplasm and stresses its differential diagnosis with other exophytic squamous cell carcinomas of the region.     

Primary Small Cell ("Oat Cell") carcinoma of the larynx and hypopharynx

The present paper is a clinico-pathological study of 8 cases of small cell("oat cell") carcinoma of the larynx and hypopharynx investigates at the Section of Pathology of the ENT Department of Padua University during the last 14 years (from January 1966 to December 1969). Besides a review of the world literature, several problems connected with terminology, histogenesis and pathologic patterns (microscopic, histochemical and ultrastructural) and examined, together with the differential diagnosis, clinical aspects and therapeutic approach. The association of small cell carcinoma with squamous cell carcinoma both in the larynx and hypopharynx is reported.     

DNA倍体和Ki67对喉鳞状细胞癌预后的预测价值

目的 探讨DNA倍体及细胞增殖抗原标记物Ki67对喉鳞状细胞癌预后预测的价值.方法 采用Feulgen染色和免疫组化方法,对298例喉鳞状细胞癌石蜡标本DNA倍体情况及Ki67表达进行分析.结果 喉鳞状细胞癌组织中存在着DNA非整倍体肿瘤和DNA二倍体肿瘤;DNA非整倍体肿瘤中Ki67表达高于DNA二倍体肿瘤中的表达,结果差异有统计学意义(P＜0.05);进一步经COX回归多因素分析发现喉鳞状细胞癌中DNA倍体的不同和Ki67表达的高低是影响肿瘤死亡的独立因素(P =0.003,P=0.007).结论 在喉鳞状细胞癌中,DNA倍体和Ki67表达水平与颈部淋巴结转移、肿瘤复发及患者生存率相关,是判断喉鳞状细胞癌患者预后估计的提示性依据.     

Neuroendocrine tumor of the larynx. Small cell carcinoma

A 69-year-old patient diagnosed, in 1985, of squamous cell carcinoma of the right vocal cord (T1, N0, M0) was treated with cordectomy and radiotherapy. Eleven years later he presented with a larynx tumor of the glotto-subglottic region. Histopathological examination stated a small cells neuroendocrine tumor. We contribute with one new case to those rare laryngeal tumors, which we see often published in the specialty journals, probably due to the wide employed immunohistochemistry dyes.     

Small cell carcinoma of the larynx: imaging findings

Small cell carcinoma of the larynx is an uncommon epithelial tumor, which is the most aggressive subtype of neuroendocrine carcinomas. Because of its nonspecific clinical and radiological manifestations, the diagnosis of small cell carcinoma of the larynx is essentially based on the light microscopic examination aided by electron microscopy or immunohistochemical staining. We report a case of supraglottic small cell carcinoma accompanied by large bilateral cervical lymph node metastasis ocurring in a 70-year-old man. On CT scans, no area of low attenuation indicating necrosis was demonstrated within such large metastatic lymph nodes. We suggest that small cell carcinoma of the larynx should be included in the diagnostic considerations when a laryngeal mass is accompanied by large cervical lymph nodes without necrosis shown by CT.     

Basaloid squamous cell carcinoma of the larynx

Most of the malignancies arising from the upper respiratory system are squamous cell carcinomas (SCC). Basaloid squamous cell carcinoma (BSCC) is a rarely seen high grade variant of SCC that carries a poor prognosis. In this article, we present a case of BSCC of the larynx. In addition, we provide a review of the relevant literature along with a discussion of the differential diagnosis.     

Superficial extending carcinoma of the larynx

Superficial extending carcinoma of the hypopharynx is a recently recognized form of carcinoma regarded as a possible pharyngeal counterpart to early gastric cancer and superficial esophageal carcinoma. In this study we report the radiological, clinical, and pathological features of three carcinomas of the larynx, which show architectural and histopathological features similar to those previously described in superficial extending carcinoma of the hypopharynx. These cases were singled out from a series of 37 consecutive laryngectomy specimens of primary infiltrating laryngeal carcinomas that were uniformly studied by means of a whole-organ sections technique. Pathologically, these cases showed a clearly invasive growth through the basal membrane into the lamina propria and an entire or predominant, extensive, superficial type of spread; infiltration of underlying muscle or gland structures was restricted to a few microscopic foci, regardless of the presence of lymph node metastases. The present study demonstrates that infiltrating carcinomas with a preferential superficial type of growth may also be encountered in the larynx. Differences between the histological features of these carcinomas of the larynx and the histopathological spectrum of so-called early laryngeal cancer are emphasized.     

Simultaneous squamous cell carcinomas of the oral cavity and oropharynx

INTRODUCTION: Squamous cell carcinoma of the oral cavity is often a single localization, but the discovery of another or several associated lesions is not exceptional. The goal of our study was a retrospective analysis of patients having 2 simultaneous squamous cell carcinomas of the upper aerodigestive tract (UADT), i.e. diagnosed during the same panendoscopy by excluding the esophagus and the lung. PATIENTS AND METHODS: Between 1995 and 2001, 1,129 patients were treated for squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, and larynx in the Bordeaux Maxillo-facial Surgery Unit. 1% of these patients presented 2 simultaneous squamous cell carcinomas of UADT. RESULTS: Our series was divided in 9 men (75%) and 3 women (25%) with an average age of 61.3 years (48-86). At the end of the study 2 patients were lost to follow-up, 3 patients were alive without recurrence, and 1 patient was alive with recurrence. The average follow-up time was 17.6 months. DISCUSSION: A review of the literature gave an incidence of simultaneous squamous cell carcinomas of UADT varying from 1.3 to 12.8% according to authors. Thus, any patient having squamous cell carcinoma of the UADT must be considered as having an important potential risk to present another simultaneous cancer and to benefit from a systematic panendoscopy. In spite of an early diagnosis, the prognostic of these lesions remains bad.     

Minimally invasive surgery for recurrent neuroendocrine carcinoma of the supraglottic larynx

Calcitonin-secreting neuroendocrine carcinomas of the supraglottic larynx are infrequent tumors, making it difficult to agree on treatment plans for recurrent tumors. Furthermore, this rare malignancy is often confused with the more common medullary thyroid carcinoma, resulting in inappropriate thyroidectomies. We present a case report of a calcitonin-secreting recurrent neuroendocrine carcinoma of the supraglottic larynx, in which surgery and pentagastrin stimulation were performed repeatedly at various stages of the disease. The recurrent laryngeal tumor was ultimately identified and, after construction of a protective tracheostomy, resected transorally en bloc with the underlying arytenoid cartilage. Postoperatively, the patient did well and stimulated calcitonin levels never exceeded double baseline values. Laryngoscopic removal of smaller laryngeal carcinomas is both technically feasible and safe, even when tumors are recurrent. In calcitonin-secreting malignancies, pentagastrin stimulation may facilitate the distinction between laryngeal and medullary thyroid carcinoma and thus help avoid unnecessary thyroidectomies. Received: 17 August 1998 / Accepted: 24 November 1998     

咽喉鳞癌组织中增殖细胞核抗原和核仁组成区相关嗜银蛋白的表达

目的 :研究 4 3例喉癌和 18例下咽癌术后标本中增殖细胞核抗原 (PCNA)的表达并对核仁组成区相关嗜银蛋白 (AgNOR)计数 ,分析其与临床分期、病理分化、复发、转移、生存期之间的相关性 ,评估其对预后及监测患者病情的价值。方法 :采用免疫组化法及Crocker’sAgNOR染色技术定量观察 6 1例鳞状细胞癌术后标本及9例良性喉肿瘤患者的非瘤区粘膜中PCNA的表达及AgNOR计数。分析其与喉癌及下咽癌临床分期、病理分级、复发、转移、生存期之间的相关性。结果 :PCNA阳性细胞百分率 (PCNA指数 )与AgNOR计数呈正相关 ;PC NA指数与AgNOR计数由早期到晚期 ,由高分化到低分化逐渐提高 ;两者在复发、转移及期内死亡患者的癌组织中增加 (P <0 .0 5 )。结论 :PCNA指数和AgNOR计数可作为喉及下咽鳞癌的诊断性预测指标。     

Basaloid squamous cell carcinoma of the supraglottic larynx

Basaloid squamous cell carcinoma (BSC) is regarded as a variant of squamous cell carcinoma, but displays distinct morphological and biological features as well as a different clinical course. The tumor is frequently seen in the head and neck and is preferentially located in the larynx, especially in supraglottic sites. Ten patients with BSC of the supraglottic larynx were treated from 1991 to 1995 at the Medical Faculty of the University of Istanbul. Results of treatment were compared retrospectively with a control group consisting of 44 patients with well-differentiated squamous cell carcinomas. Ages, ¶localizations, stages and treatment procedures were similar. In both groups mean survival, nodal involvement and distant metastases were comparable although the local ¶(laryngeal) recurrence rate in patients with early supraglottic (T2) disease in the BSC group after conservative partial surgery was distinct compared to the control group (P < 0.05). These results indicate that conservative surgery should be assessed with caution in patients with BSC, and postoperative irradiation be taken into consideration.     

Combined small cell carcinoma of the hypopharynx

We report an extremely rare case of combined small cell carcinoma (combined SmCC) of the hypopharynx. A 73-year-old male presented with multiple left neck swellings for 1 month. A tumorous lesion was found in the left pyriform sinus, and biopsy revealed that the lesion was squamous cell carcinoma (SqCC). Surgery was performed and pathological examination led to a diagnosis as combined SmCC, composed of SqCC and small cell carcinoma (SmCC). One month after surgery, a contrast-CT indicated metastases to the cervical lymph node (LN), mediastinum and liver. We performed 5 courses of chemotherapy with the use of cisplatin (CDDP) and irinotecan (CPT-11). The patient temporarily showed a favorable response to the chemotherapy; however, eventually he died of regrowth of the tumor. Combined SmCC is a disease with a poor prognosis. Although biopsy sometimes fails to detect the SmCC component, intensive diagnosis and treatment are necessary.