P-236 Combined squamous cell and neuroendocrine carcinoma of the larynx. A case report

Abstract

Presented by: Javier Padilla-Cabello (jpadillacabello@gmail.com) Introduction A 67-year-old male patient, smoker of more than a pack a day since childhood, presented to the emergency department with a right cervical tumor and dysphagia of twoweeks' evolution. On examination, cervical palpation revealed an adenopathy in the right area IIa of about 5 cm in diameter, stony and adherent to deep planes. Fibrolaryngoscopy showed a lesion on the right laryngeal surface of the epiglottis and a leukoplakia in the right lateral glossoepiglottic fold. Therefore, it was decided to perform transoral laryngeal microsurgery to take biopsies and request CT for extension study. Materials and Methods The samples taken in the operating room and the CT scan showed that it was an epidermoid carcinoma of the supraglottis stage cT1N2BM0. It was decided to perform a right hemiepiglottectomy with extension to the right lateral glossoepiglottic fold by transoral laser surgery together with bilateral functional cervical emptying. The patient required a tracheotomy due to an episode of severe post-surgical laryngeal edema and the cannula had to be maintained, together with a gastrostomy, because the patient subsequently developed dysphagia with aspiration of secretions and food. Results Histopathological analysis showed that it was a combined tumor: on the one hand a poorly differentiated epiglottic neuroendocrine carcinoma (NEC) (CK-20 +, S100 +, Ki67 90%) with cervical metastasis and on the other hand a supraglottic squamous cell carcinoma in the right glossoepiglottic fold with one cervical metastasis (pT1N1). The case was presented to the oncology committee and it was decided to complete treatment with chemoradiotherapy. Chemotherapy was administered with a reduced dose of carboplatin (AUC = 3) and etoposide. Despite treatment, local cervical tumor progression was observed in the control CT scan and the patient finally died a few weeks later due to COVID19. Conclusions NEC of the larynx are very rare and aggressive, so an accurate histopathologic diagnosis is essential for early treatment. Their most frequent location is the supraglottis and the clinical presentation of the patient is a mild odynophagia or a cervical mass. Very few associated cases of synchronous laryngeal squamous cell carcinoma have been described. Treatment of NEC is based on chemoradiotherapy with a survival rate of less than 5% at 5 years.