Carcinoma neuroendocrino supraglótico

Abstract

Introduction and objective: Laryngeal neuroendocrine carcinomas are less than 1% of laryngeal tumors. The small cell variety is rare and mainly affects smokers male, between 50-60 years of age. The most common location is at the supraglottic ( laryngeal face of epiglottis) and EAR. It is the most lethal tumor of the larynx and should be considered disseminated al initial diagnosis. The most common sites of metastasis are : cervical lymph, liver, lung, bone and bone marrow. Method: 58-year-old male, smoker since age 15, current 15-20 cig/day, Crohn’s disease, hypertriglyceridemia, epilepsy, pulmonar emphysema, anxiety. He comes referring progressive odynophagia of 3 months of evolution and in the last month the appearance of a left cervical tumor and weight loss. Examination: hypopigmented vegetative lesion that extends from the foot of the epiglottis towards the laryngeal face, predominantly on the right. VC mobiles without injuries. Left indurated lymphadenopathy III level of approximately 2 cm of diameter and a smaller right lymph node II level. LCM-Biopsy is indicated. Results: Small cell neuroendocrine carcinoma. Cytokeratin in “dot” pattern, homogeneous CD56, Ki67 practically 100% Neck CT : 22-mm supraglottic tumor extending to the right glottic space, obliterating fat plane. Bilateral cervical adenopathies in areas II-III on the right side up to 12 mm and the left side up to 17 mm. PET-CT: Metabolic increase of right supraglottic lesion affecting pre-epiglottic space SUV max 19,61. Right laterocervical adenopathies levels II-IV up to SUV max 27,89 and left levels II-III SUV max 21,67. Uptake in the right parahiliar region with SUV max 13,93. Hypermetabolic foci in liver parenchyma SUV max 11,85. Multiple uptakes in bone structures SUV max 26,85 in the sternal body. Referral to medical oncology, chemotherapy treatment is indicated and after the first sessions, the patients presents complications that lead to hospital admission, dying 5 months after diagnosis. Discussion: In the case presented, the characteristics of a patient with laryngeal neuroendocrine carcinoma were fulfilled: Male fifth decade of life, smoker, supraglottic location and with cervical and distant metastases at the time of diagnosis. Conclusions: Neuroendocrine carcinomas are very rare and aggressive, so accurate diagnosis is essential. The definitive diagnosis is by pathology anatomy by microscopy details and immunohistochemical confirmation. The treatment of these tumors is by chemo-radiotherapy with a survival rate of 5% at 5 years.