Primary oat cell carcinoma of the larynx: An ultrastructural study

Abstract

An extrapulmonary oat cell carcinoma arising in the larynx is described. Ultrastructurally the tumor is identical to the oat cell carcinoma of pulmonary origin. T h e pressure of neurosecretory granules in our case strongly suggests that the tumor is derived from Kulchitsky-like cells, a histogenesis previously proposed for oat cell carcinoma of the lung. CASE REPORTA 64-year-old black man presented with a 3-month history of increasing shortness of breath, hoarseness, and an enlarging right neck mass.Physical examination revealed a 5-cm fixed mass in the right neck. Laryngeal exmination revealed a mass involving the right true and false cords and the right aryepiglottic fold and pyriform sinus. Biopsy revealed a small cell carcinoma of oat cell type. Bronchoscopy, full lung tomograms, and pulmonary scan were negative, as were scans of the brain, liver, and bone. Laboratory studies were all within normal limits.Preoperative radiotherapy of 5500 rads was given to the larynx and both sides of the neck. Pathologic examination of the tissues obtained by laryngectomy and right radical neck dissection that followed revealed no residual tumor in the larynx, and foci of metastatic small cell carcinoma of oat cell type in nodes at all levels.Three months following discharge the patient was readmitted with right shoulder pain and a 10-lb Light Microscopic FindingsHistologically, the tumor involved the laryngeal mucosa and submucosa. It was composed of sheets of closely packed cells with little cytoplasm a n d hyperchromatic nuclei. The cells showed considerable plemorphism with round, oval, and spindleshaped nuclei. Mitotic figures were not frequent (Fig. I ) . Identification of a surface epithelial or minor salivary gland origin for this tumor was not possible, due to the diffuse nature of the laryngeal involvement. Electron Microscopic FindingsSmall blocks of tumor tissue were fixed in 2% gluteraldehyde in phosphate buffer, postfixed in osmium tetroxide, and embedded in Spurr low viscosity embedding medium.' Thin sections were stained with uranyl acetate and lead citrate and examined in a n KCA-Eh4U-4 microscope.Ultrastructurally, the tumor cells varied in size and shape and were characterized by prominent nuclei and scanty cytoplasm. The nuclei frequently contained prominent nucleoli and showed marginal condensation of chromatin (Fig. 2). The cytoplasm showed numerous mitochondria and prominent endoplasmic reticulum (Figs. 3 and 4). Golgi complexes were not uncommon (Fig. 3). Spherical granules composed of a n electron-dense core separated from a single limiting membrane by a thin clear space were identified within approximately onefourth of the cells studied (Figs. 2, 3, and 4). Slight variability in the density of the core was observed. The granules measured from 50-200pm in diameter. The granules in our case are similar to the neuro- 145

Neuroectodermal Neoplasms of the Head and Neck with Emphasis on Neuroendocrine Carcinomas

“…As of now, there are no well or moderately differentiated small cell neuroendocrine carcinomas, so SCNC is an acceptable synonym for the longer term listed above. SCNC of the larynx are uncommon but wellrecognized neoplasms (32,(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49). In a review by Gnepp (49), almost three fourths of patients died of widespread metastases.…”

Clinical recommendations on the treatment of neuroendocrine carcinoma of the larynx: A meta-analysis of 436 reported cases

“…The literature on NCL is fragmented over numerous case reports and series of small sample size, often with contradicting results, making it difficult to decide on an appropriate treatment strategy. Consequently, physicians facing these tumors often resort to treatment paradigms developed for better known neoplasms (eg, squamous cell carcinoma).…”

Primary Oat‐Cell Carcinoma of the Larynx Following Supraglottic Laryngectomy for Squamous‐Cell Carcinoma

“…The tumor was composed of irregular clumps of elongated small cells (Figs. [2][3][4][5] with scanty cytoplasm and hyperchromatic oval, round or spindle-shaped nuclei containing delicate chromatin and often a visible nucleolus. Mitoses were numerous.…”

“…A review of the literature disclosed that only 5 cases of oat-cell laryngeal cancer have been described to date (2)(3)(4)(5)(6).…”