Neuroendocrine neoplasms of the larynx importance of the correct diagnosis and differences between atypical carcinoid tumors and small-cell neuroendocrine carcinoma

Abstract

Findings in the present study have confirmed that the diagnosis of neuroendocrine tumors of the larynx (NETL) requires that a panel of neuroendocrine markers and electron microscopy be performed. This means that the clinician must be aware of the clinical presentations of such patients and should send fresh biopsy specimens to the clinical laboratory for optimal tissue studies. As shown in this study, the possibility of misdiagnosis of an atypical carcinoid tumor (ACT) is rather high. In establishing a diagnosis, a part of the material should be fixed for conventional histology, a part for immunohistochemistry and a part for electron microscopy. The correct diagnosis of NETL is obviously of great importance for subsequent treatment and prognosis. Patients with the diagnosis of ACT of the larynx require surgical treatment. Our findings also show that small-cell neuroendocrine carcinomas of the larynx should be considered to be a disseminated disease at initial presentation. A metastatic workup is necessary, but radical surgical procedures should be avoided. The combination of radiotherapy and chemotherapy is always indicated.

Contribution of Exfoliative Cytology to the Diagnosis of Laryngeal Lesions

“…2,7 Accurate cytologic identification of these rare neoplasms in exfoliative cytologic material can be difficult or impossible. Immunocytochemistry could be helpful in such cases.…”

“…2,3,7,8,14,[17][18][19][20]22 One should keep in mind that repair or pseudocarcinomatous epithelial atypia, especially in intensively inflamed benign lesions or due to underlying neoplasia, can result in false positive cytologic diagnoses.…”

Small Cell Neuroendocrine Carcinoma of the Larynx: A Preventable and Frustrating Disease with a Highly Aggressive Lethal Behavior

“…In contrast to small cell lung cancer, only 8% of this tumor of the larynx metastasize to the central nervous system and then only as a preterminal event [33]. Many patients (about half) have cervical metastases on initial presentation [4] and the tumor should be considered as a disseminated disease at presentation [11]. In a review by Gnepp et al [32], 73% of patients with laryngeal small cell neuroendocrine carcinoma died of disease with widespread metastases, with a mean survival time of 9.8 months (range 1-26 months).…”

Cutaneous and Subcutaneous Metastases From Atypical Laryngeal Carcinoids

“…Descriptions of treatments are rare. 6,36,40,4,56,58,59 In 1989, Ferlito and Friedmann proposed that painful skin/subcutaneous metastases should be treated surgically. 44 van der Laan et al (2012) suggested that salvage surgery, including palliative metastasectomy, had an important role in the treatment of laryngeal NEC.…”

“…It was thus suggested that chemotherapy was ineffective. Gripp et al (1995) 58 used somatostatin to treat skin metastases from atypical laryngeal carcinoids. However, the drug was no better than other chemotherapies.…”