Transcript Diapositiva 1

ATYPICAL CARCINOID TUMOUR OF THE
LARYNX.
A CASE REPORT.
S.Squillaci (1)
R.Marchione (1)
C.Spairani (1)
M.Bisceglia (2)
Department of Pathology, Hospital of Vallecamonica, Esine (Italy) (1);
Department of Pathology, IRCCS “Casa Sollievo della Sofferenza”,
San Giovanni Rotondo (Italy) (2).
INTRODUCTION
Neuroendocrine neoplasms of the larynx have been recognized
as the most usual non-squamous types of neoplasms of this
area, accounting for less than 1% of all laryngeal neoplasms.
The latest classification edited by WHO divides neuroendocrine
neoplastic lesions of the larynx into two types: epithelial
(including carcinoid tumour, atypical carcinoid tumour and small
cell neuroendocrine carcinoma) and those of neural derivation
(paraganglioma). Atypical carcinoid tumour (ACT) is the most
common laryngeal neuroendocrine tumour with approximately
350 cases being reported in the international literature.
CASE REPORT
A 68-year-old female with dysphagia and hoarseness has been
subjected to laryngoscopy which revealed the presence of a
neoplasm of the epiglottis, about 1.5 cm in diameter, greyishwhite in colour, sessile, submucosal and with diffuse superficial
telangiectasias. The patient has been submitted to biopsy and
subsequent supraglottic laryngectomy.
Gross finding
HISTOLOGICAL FEATURES
The histological specimens of the laryngeal excised tissue
and subsequent metastases showed a proliferation of
polygonal and columnar cells, with a nest and adenoid-like
trabecular organisation. Tumor cells contained round to
elongated moderately hyperchromic nuclei, prominent
nucleoli, eosinophilic granular cytoplasm, and sparse
mitoses. The surgical margins of the resection and the
cartilage were free from tumour. Four lymph nodes showed
metastatic deposits.
EE.
100X
EE,
100X
EE, 100X
EE, 250X
EE, 400X
PAS DIASTASE
PAS-DIASTASE
This tumour has focally stained
with mucin stains.
Cam 5.2
Synapthophysin
Chromogranin
Calcitonin
CEA
TTF-1
Immunohistochemical features
At immunohistochemistry, the tumour cells did not react with
TTF-1, whereas a strong diffuse positivity was found for
calcitonin,
NSE,
chromogranin,
synaptophysin
and
cytokeratins. A weak to moderate focal immunostaining for
CEA was noted.
At this point, a diagnosis of atypical carcinoid tumour of the
larynx (ACT) was favoured.
Six
months
after
laryngectomy
a
suspicious
lymphadenopathy was observed upon laterocervical
echography, and bilateral cervical regional lymph node
dissection was performed. Three years later, the patient
developed multiple disseminated skin and subcutaneous
metastases. After two years, she died of respiratory failure
due to multiple pulmonary metastases.
Conclusions
Laryngeal ACTs are lesions with a well-recognized capacity for
local recurrence and metastasis, with a 5-year survival bit under
50%.
The introduction of IHC has proved particularly useful in the
recognition and classification of neuroendocrine tumours of the
larynx, which on routine histological examination might otherwise
have been diagnosed as undifferentiated carcinoma, acinic cell
carcinoma,
adenocarcinoma,
or
amelanotic
malignant
melanoma. The differential diagnosis of ACT must essentially be
made versus other types of neuroendocrine neoplasms, with
particular attention to paragangliomas.
Paragangliomas may stain for chromogranin, synapthophysin,
NSE, and galanin but they are negative for epithelial markers
(cytokeratin, EMA, CEA).
References
1. Ferlito A., Devaney KO, Rinaldo A. Neuroendocrine
neoplasms of the larynx: advances in identification,
understanding, and management. Oral Oncol.2006;42:770788.
2. Ferlito A, Rinaldo A. The spectrum of endocrinocarcinomas of
the larynx. Oral Oncol.2005;41:878-883.
3. Squillaci S, Gal AA. Galanin immunoreactivity in a laryngeal
paraganglioma: case report and literature review. Pathologica
2004;96:111-116 [in italian].
4. Myssiorek D, Rinaldo A, Barnes L, Ferlito A. Laryngeal
paraganglioma: an updated critical review. Acta Otolaryngol.
2004;124:995-999.