A Case of Primary Combined Squamous Cell Carcinoma with Neuroendocrine (Atypical Carcinoid) Tumor in the Floor of the Mouth.

Kenji Yamagata,Naomi Kanno,Toru Yanagawa,Fumihiko Uchida,Hiroki Bukawa,Shogo Hasegawa,Kazuhiro Terada

doi:10.1155/2016/7532805

Abstract

The combined squamous cell carcinoma (SCC) with neuroendocrine (atypical carcinoid (AC)) tumor is extremely rare in the head and neck. We present here the first case of SCC with AC arising in the floor of the mouth of 65-year-old man. The tumor is comprised of two components of SCC and AC in the biopsy specimen. Neuroendocrine tumor component was classified as AC from the punctate necrosis and 2–10>/10 HPF. Immunohistochemical staining was HMW-CK/34B (+) and P63 (+) in SCC and synaptophysin (+) and CD56 (+) in AC. The pathological diagnosis of SCC with AC was made from both the morphological and immunological exam. Concurrent chemoradiotherapy was performed with radiotherapy 70.2 Gy and chemotherapy of CDDP and VP-16. Although the treatment effect was complete response both of primary tumor and of neck metastases, the recurrence of the primary tumor was after 6 months. Bilateral modified radical neck dissection and tumor resection of the floor of the mouth with reconstructive surgery of anterior lateral thigh free flap were performed. Although the primary and neck tumor did not recur, the multiple lung metastases and mediastinum lymph node metastases occurred at 6 months after surgery.

Highlights

Neuroendocrine neoplasms are a heterogeneous group of tumors that vary from benign to highly malignant
The neuroendocrine tumor (NET) is a tumor that occurs in the lung and larynx, oral cavity is a rare site for a primary NET [2]
Neuroendocrine differentiation has recently been reported in squamous cell carcinoma (SCC) of the lung and esophagus

Summary

Introduction

Neuroendocrine neoplasms are a heterogeneous group of tumors that vary from benign to highly malignant. WHO (2005) classified neuroendocrine tumor (NET) of the larynx into 4 types: (1) typical carcinoid, (2) atypical carcinoid (AC), (3) small cell carcinoma, neuroendocrine type, and (4) combined small cell carcinoma, neuroendocrine type, with nonsmall cell carcinoma [1]. The AC (synonyms of malignant carcinoid, moderately differentiated neuroendocrine carcinoma, and large cell neuroendocrine carcinoma) is the most frequent, constituting 54% of all NET in this site, followed by the small cell carcinoma, neuroendocrine type (34%), paraganglioma (9%), and the typical carcinoid (3%) [1]. The NET is a tumor that occurs in the lung and larynx, oral cavity is a rare site for a primary NET [2]. Combined-type SCC and AC instances in the head and neck area were reported only in 3 cases and very rare [5,6,7]. We report here the fast case of the combined SCC with AC of the floor of the mouth

Case Report

Findings

Discussion