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Ferlito A. Some Considerations on Laryngeal Neuroendocrine Neoplasms. Oncol Ther 2024:10.1007/s40487-024-00273-8. [PMID: 38520635 DOI: 10.1007/s40487-024-00273-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 03/11/2024] [Indexed: 03/25/2024] Open
Affiliation(s)
- Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy.
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2
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Mesolella M, Allosso S, Buono S, Ricciardiello F, Motta G. Neuroendocrine carcinoma of the larynx with Lambert-Eaton myasthenic syndrome: a rare case report and literature review. J Int Med Res 2021; 49:3000605211014784. [PMID: 33983073 PMCID: PMC8127768 DOI: 10.1177/03000605211014784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
This current report describes a rare clinical case of neuroendocrine carcinoma (NEC) of the larynx with associated Lambert-Eaton myasthenic paraneoplastic syndrome (LEMS). A 68-year-old male patient presented with severe dysphonia and dysphagia. He underwent a total laryngectomy and the excised lesion was extremely large. A pathological examination demonstrated ‘morphological findings of a poorly differentiated carcinoma (G3) with aspects of neuroendocrine differentiation’ (i.e. a poorly differentiated neuroendocrine carcinomas [PD-NEC]). Based on the patient’s medical history and the immunohistochemical findings, he was treated with three cycles of neoadjuvant chemotherapy (cisplatin–etoposide) and then radiotherapy with a total dose of 70 Gy. Of the 10 cases of paraneoplastic syndrome (PNS) related to laryngeal NEC reported in the literature, nine of these syndromes were of an endocrine type. Only one case of PNS associated with laryngeal cancer had a neurological manifestation, which was LEMS. To the best of our knowledge, this current case has only one similar precedent in the literature and it is the second report of an association between a PD-NEC and LEMS. Laryngeal NECs are rare lesions with different prognostic characteristics. The diagnosis should be made using an endocrinological, neurological, radiological and histological multidisciplinary approach. A radical surgical approach is recommended.
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Affiliation(s)
- Massimo Mesolella
- Unit of Otorhinolaryngology, Department of Neuroscience, Reproductive Sciences and Dentistry, Federico II University of Naples, Naples, Italy
| | - Salvatore Allosso
- Unit of Otorhinolaryngology, Department of Neuroscience, Reproductive Sciences and Dentistry, Federico II University of Naples, Naples, Italy
| | - Sarah Buono
- Unit of Otorhinolaryngology, Department of Neuroscience, Reproductive Sciences and Dentistry, Federico II University of Naples, Naples, Italy
| | | | - Gaetano Motta
- Unit of Otorhinolaryngology, University Luigi Vanvitelli, Napoli, Italy
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3
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Rinaldo A, Coca-Pelaz A, Silver CE, Ferlito A. Paraneoplastic Syndromes Associated with Laryngeal Cancer. Adv Ther 2020; 37:140-154. [PMID: 31802393 PMCID: PMC6979447 DOI: 10.1007/s12325-019-01160-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Paraneoplastic syndromes occur rarely in association with laryngeal cancer. When present, the syndrome may be the first sign of the malignancy. The aim of the present study was to review and report on all published cases in the international literature. METHODS A search of PubMed was conducted for "paraneoplastic syndromes in laryngeal cancer" without any restrictions on language or publication year. The full texts of all relevant articles were reviewed and all cases of paraneoplastic syndromes associated with any type of laryngeal cancer were extracted and analyzed. RESULTS We identified 59 cases of paraneoplastic syndromes related to laryngeal cancer in the literature published from 1963 until recently. There were 46 squamous cell carcinomas and 10 neuroendocrine carcinomas. Twenty-two of the paraneoplastic syndromes involved the endocrine system, 21 were dermatologic or cutaneous, 8 neurologic, 5 osteoarticular or rheumatologic, 1 ocular, 1 muscular, and 1 hematologic. Treatment strategies included surgery, radiotherapy, chemotherapy, and often multimodal therapy, depending on the histology and stage of the laryngeal cancer. CONCLUSIONS Because of their rarity, paraneoplastic syndromes associated with laryngeal cancer are difficult to diagnose. By presenting and systematically reviewing all published cases in the international literature, the present review may help clinicians to recognize them and to suspect the diagnosis of laryngeal cancer at an earlier stage than otherwise might be possible.
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Affiliation(s)
| | - Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo, Spain
| | - Carl E Silver
- Department of Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy.
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4
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Strojan P, Hernandez-Prera JC, Beitler JJ, Eisbruch A, Saba NF, Mendenhall WM, Nieto CS, Smee R, Rinaldo A, Ferlito A. Small cell and large cell neuroendocrine carcinoma of the larynx: A comparative analysis. Cancer Treat Rev 2019; 78:42-51. [DOI: 10.1016/j.ctrv.2019.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/06/2019] [Indexed: 02/07/2023]
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5
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Ferlito A, Rinaldo A. Paraneoplastic Syndromes in Patients with Cancer of the Larynx and Hypopharynx. Ann Otol Rhinol Laryngol 2016; 116:502-13. [PMID: 17727081 DOI: 10.1177/000348940711600705] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Paraneoplastic syndromes may be the first sign of a malignancy. They are systemic, nonmetastatic manifestations associated with a variety of malignant neoplasms and occurring in a minority of cancer patients. These associations of symptoms and signs are not directly related to the site or local manifestations of a malignant tumor or its metastases, but their recognition may facilitate the detection of malignancies or recurrences. Paraneoplastic syndromes are categorized into 6 types: Dermatologic or cutaneous, endocrine, hematologic, neurologic, osteoarticular or rheumatologic, and ocular. Different oncotypes have rarely been associated with paraneoplastic syndromes in patients with cancer of the larynx and hypopharynx. The world literature has been reviewed.
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Affiliation(s)
- Alfio Ferlito
- Department of Surgical Sciences, ENT Clinic, University of Udine, Udine, Italy
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6
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Erro Aguirre M, Gila L, Olaziregui O. Paraneoplastic sensory neuropathy associated with squamous cell carcinoma of the larynx. NEUROLOGÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.nrleng.2014.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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7
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Sahu R, Rathaur BP, Chaudhari TS, Shukla R, Malhotra KP. Laryngeal carcinoma presenting as polymyositis: A paraneoplastic syndrome. Ann Indian Acad Neurol 2016; 19:150-1. [PMID: 27011653 PMCID: PMC4782538 DOI: 10.4103/0972-2327.170571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Laryngeal carcinoma is rarely associated with paraneoplastic syndrome. Inflammatory myopathy presenting as paraneoplastic event is commonly associated with carcinomas of ovary, lung, pancreas, stomach, colorectal, and non-Hodgkin's lymphoma. We report a case of elderly male, who presented with proximal muscle weakness and found to be associated with laryngeal carcinoma. Diagnosis of polymyositis (PM) was confirmed based on clinical features, laboratory test, and muscle biopsy. Exclusion of other commonly associated malignancies was done. This patient improved gradually after 6 months of immunosuppressive therapy and management of underlying cancer.
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Affiliation(s)
- Ritesh Sahu
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Bhanu Pratap Rathaur
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | | | - Rakesh Shukla
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Kiran Preet Malhotra
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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8
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Paraneoplastic syndromes in patients with laryngeal neuroendocrine carcinomas: clinical manifestations and prognostic significance. Eur Arch Otorhinolaryngol 2014; 273:533-6. [DOI: 10.1007/s00405-014-3351-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 10/20/2014] [Indexed: 12/15/2022]
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9
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Erro Aguirre ME, Gila L, Olaziregui O. [Paraneoplastic sensory neuropathy associated with squamous cell carcinoma of the larynx]. Neurologia 2014; 31:286-8. [PMID: 25129419 DOI: 10.1016/j.nrl.2014.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/23/2014] [Accepted: 06/29/2014] [Indexed: 11/18/2022] Open
Affiliation(s)
- M E Erro Aguirre
- Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España.
| | - L Gila
- Neurofisiología Clínica, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - O Olaziregui
- Neurofisiología Clínica, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
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van der Laan TP, Plaat BEC, van der Laan BFAM, Halmos GB. Clinical recommendations on the treatment of neuroendocrine carcinoma of the larynx: A meta-analysis of 436 reported cases. Head Neck 2014; 37:707-15. [PMID: 24596175 DOI: 10.1002/hed.23666] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 12/14/2013] [Accepted: 03/02/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Current recommendations on the treatment of neuroendocrine carcinoma of the larynx (NCL) are based on anecdotal evidence. With this meta-analysis, our purpose was to provide clinicians with more substantiated guidelines in order to improve the treatment outcome of the patients affected with NCL. METHODS A structured literature search for all research concerning NCL was performed against the MEDLINE and EMBASE databases. Available data was normalized, pooled, and statistically analyzed. RESULTS Four hundred thirty-six cases of NCL were extracted from 182 studies, of which 23 were typical carcinoid, 163 were atypical carcinoid, 183 were small-cell neuroendocrine carcinoma, 29 were large-cell neuroendocrine carcinoma, and 38 were unspecified carcinoid tumors. The 5-year disease-specific survival (DSS) was 100% for typical carcinoid, 53% for atypical carcinoid, 19% for small-cell neuroendocrine carcinoma, and 15% for large-cell neuroendocrine carcinoma (p < .001). Patients with an atypical carcinoid treated with surgery had better DSS than those treated with radiotherapy (60% vs 54%; p = .035). Postoperative radiotherapy did not result in better DSS in atypical carcinoid. Patients with an atypical carcinoid, not undergoing surgical treatment of the neck, developed isolated regional recurrence in 30% of cases (p = .001). Radiochemotherapy yielded the best DSS for small-cell neuroendocrine carcinoma compared to other modalities (31% vs 13%; p = .001). CONCLUSION Typical carcinoid can be treated by local excision alone. Atypical carcinoids do not seem to respond well to radiotherapy and are best managed through radical surgical excision in combination with elective neck dissection. Patients with small-cell neuroendocrine carcinoma or large-cell neuroendocrine carcinoma seem to benefit most from chemoradiotherapy.
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Affiliation(s)
- Tom P van der Laan
- Department of Otolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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11
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Primary, combined, atypical carcinoid and squamous cell carcinoma of the larynx: a new variety of composite tumour. The Journal of Laryngology & Otology 2009; 124:226-9. [PMID: 19930775 DOI: 10.1017/s0022215109991228] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE We report the first case of a laryngeal composite tumour consisting of a squamous cell carcinoma combined with an atypical carcinoid. METHODS Case report and review of the literature concerning laryngeal composite tumours. RESULTS Primary laryngeal carcinoma is the most common malignancy of the upper aerodigestive tract. The vast majority are of the squamous cell type. Primary neuroendocrine neoplasms represent a rare, heterogeneous subset of laryngeal malignancies, comprising typical carcinoid, atypical carcinoid, small cell carcinoma and paraganglioma. Primary combined neuroendocrine and squamous cell carcinoma of the larynx is even more rarely encountered, with only 14 publications of this so-called composite tumour to date. In each case, the neuroendocrine component has been small cell carcinoma. CONCLUSION The treatment of primary neoplasms comprising more than one histological type is tailored to the most biologically aggressive tumour. Accurate diagnosis of the histological nature of laryngeal composite tumours is imperative to ensure optimal therapy.
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12
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Ferlito A, Rinaldo A. Primary and secondary small cell neuroendocrine carcinoma of the larynx: A review. Head Neck 2008; 30:518-24. [DOI: 10.1002/hed.20797] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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13
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Verschuuren JJGM, Wirtz PW, Titulaer MJ, Willems LNA, van Gerven J. Available treatment options for the management of Lambert-Eaton myasthenic syndrome. Expert Opin Pharmacother 2007; 7:1323-36. [PMID: 16805718 DOI: 10.1517/14656566.7.10.1323] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Lambert-Eaton myasthenic syndrome is a rare, but reasonably well-understood, antibody-mediated autoimmune disease that is caused by serum auto-antibodies and results in muscle weakness and autonomic dysfunction. One half of the patients have an idiopathic form, the other half a tumour-associated form of the disease. Three randomised trials and a large number of smaller clinical studies have resulted in a number of drugs becoming available for the treatment of Lambert-Eaton myasthenic syndrome. Several drugs are available for the symptomatic treatment of the disease, including guanidine, aminopyridines or acetylcholinesterase inhibitors. Other therapies aim to deplete the serum autoantibodies or to suppress the immune system. For this purpose, immunomodulating strategies, such as intravenous immunoglobulins or plasmapheresis, or several immunosuppressive agents are available. Chemotherapy has successfully ameliorated the course of disease in Lambert-Eaton myasthenic syndrome patients with an underlying tumour.
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Affiliation(s)
- Jan J G M Verschuuren
- Leiden University Medical Centre, Department of Neurology, PO Box 9600, 2300 RC Leiden, Leiden, The Netherlands.
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14
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Abstract
Small cell carcinoma (SCC) has become recognized as a distinct, though relatively infrequent, clinical pathology that occurs in multiple sites throughout the head and neck. Excluding cases that are considered to arise from skin, SCC in the head and neck has been found to develop in nearly all structures associated with the upper aerodigestive tract. Among the head and neck sites, the frequency of SCC is greatest in the larynx, with salivary glands and the sinonasal region comprising the other principle areas of origin. Controversy exist as to whether SCC can develop as a distinct entity in the thyroid, with most tumors that previously would have been considered as SCC now found to be lymphomas or variant forms of other types of thyroid malignancy. While there seems to be some differences among tumors arising from the various subsites, in general all SCC that originate in the head and neck have a tendency for aggressive local invasion and a strong propensity for both regional and distant metastasis. Treatment may include surgical resection, radiotherapy, chemotherapy, or some combination of these modalities. Due to the infrequency of these tumors, it is very unlikely that any large, controlled study will ever be done. For this reason, recommendations for treatment of SCC arising in the head and neck are based primarily on retrospective data from various small case series and on comparative data for treatment of SCC of bronchogenic and other extrapulmonary origin. Although patients with truly limited local disease may enjoy some prolonged survival, most patients with this tumor do poorly despite all current attempts at treatment.
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Affiliation(s)
- Gregory Renner
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, Columbia, MO 65212, USA.
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15
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Ferlito A, Elsheikh MN, Manni JJ, Rinaldo A. Paraneoplastic syndromes in patients with primary head and neck cancer. Eur Arch Otorhinolaryngol 2007; 264:211-22. [PMID: 17206403 DOI: 10.1007/s00405-006-0217-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2006] [Accepted: 12/06/2006] [Indexed: 11/12/2022]
Abstract
Paraneoplastic syndromes represent the clinical manifestations of the indirect and remote effects produced by tumor metabolites or other products. The clinical spectrum of the various paraneoplastic syndromes related to primary malignancies of the head and neck region is presented. A review of the literature on paraneoplastic syndromes in patients with primary head and neck cancer was carried out. Paraneoplastic syndromes related to primary malignancies of the head and neck region can be categorized as: endocrine, cutaneous or dermatologic, hematologic, neurologic, osteoarticular or rheumatologic, ocular syndromes. Sometimes, paraneoplastic syndromes can be more serious than the consequences of the primary tumor itself and can precede, follow or be concurrent to the diagnosis of a malignancy; moreover, they can dominate the clinical picture and thus lead to errors with respect to the origin and type of the primary tumor. Physicians who deal with cancer-associated syndromes should be able to differentiate the paraneoplastic syndromes from the benign disorders that mimic them. Patients with a suspected paraneoplastic disorder should undergo a complete panel of laboratory studies, in addition to imaging studies and endoscopy. Identification of paraneoplastic syndromes allow the clinician to make an early diagnosis and to provide adequate treatment of tumors, with a favorable oncologic outcome and improved life expectancy for the patient. These syndromes can follow the clinical course of the tumor and thus be useful for monitoring its evolution.
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Affiliation(s)
- Alfio Ferlito
- Department of Surgical Sciences, ENT Clinic, University of Udine, Policlinico Universitario Piazzale S. Maria della Misericordia, 33100, Udine, Italy.
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16
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Ferlito A, Devaney KO, Rinaldo A. Neuroendocrine neoplasms of the larynx: Advances in identification, understanding, and management. Oral Oncol 2006; 42:770-88. [PMID: 16815077 DOI: 10.1016/j.oraloncology.2006.01.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Accepted: 01/06/2006] [Indexed: 10/24/2022]
Abstract
While 85-90% of laryngeal malignancies prove to be squamous carcinomas, the second most common tumour type found in the laryngeal region will prove to be a member of the family of neuroendocrine tumours. Laryngeal carcinoid tumours have a capacity for metastasis, and so are more aggressive tumours than their light microscopic features might imply--5-year survival rates are in the vicinity of 50%. Laryngeal atypical carcinoid tumours are lesions with a well-recognized capacity for local recurrence as well as metastasis, with a 5-year survival of just under 50%. Laryngeal small cell neuroendocrine carcinomas are particularly aggressive tumours, with a 5-year survival of no more than 5-10%. Laryngeal paragangliomas are lesions without any real capacity for metastasizing. Surgical excision is the mainstay of treatment of carcinoid tumours, atypical carcinoid tumours, and paragangliomas. Small cell neuroendocrine carcinomas are chiefly treated by way of radiation and chemotherapy; the role of adjuvant therapy in the treatment of atypical carcinoid tumours remains to be established.
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Affiliation(s)
- Alfio Ferlito
- Department of Surgical Sciences, ENT Clinic, University of Udine, Policlinico Universitario, Piazzale S. Maria della Misericordia, I-33100 Udine, Italy.
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Baijens LWJ, Manni JJ. Paraneoplastic syndromes in patients with primary malignancies of the head and neck. Four cases and a review of the literature. Eur Arch Otorhinolaryngol 2005; 263:32-6. [PMID: 15986184 DOI: 10.1007/s00405-005-0942-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2004] [Accepted: 01/31/2005] [Indexed: 12/19/2022]
Abstract
Paraneoplastic syndromes rarely affect patients with head and neck cancer. Four patients with different histological types of head and neck cancer are presented in which the primary malignancy was preceded and/or accompanied by a paraneoplastic syndrome. In the first patient erythrodermia preceded the diagnosis of a nasopharyngeal carcinoma. The second patient presented with a B cell lymphoma of the nasopharynx in association with the syndrome of inappropriate secretion of arginine vasopressine (Schwartz-Bartter syndrome). In the third patient paraneoplastic polyarthritis had been diagnosed 5 months before a hypopharyngeal carcinoma was diagnosed. In the last patient the paraneoplastic anti-Hu positive encephalomyelitis was associated with a primary malignancy in the larynx with neck metastases. Diagnostic procedures, treatment and follow-up of these patients are reported and accompanied by a review of the literature.
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Affiliation(s)
- L W J Baijens
- Department of Otorhinolaryngology Head and Neck Surgery, Maastricht University Hospital, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
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18
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Jaiswal VR, Hoang MP. Primary combined squamous and small cell carcinoma of the larynx: a case report and review of the literature. Arch Pathol Lab Med 2005; 128:1279-82. [PMID: 15504064 DOI: 10.5858/2004-128-1279-pcsasc] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Primary laryngeal carcinomas comprise approximately 2% to 5% of all malignancies worldwide. Of these laryngeal carcinomas, approximately 99% are primary squamous cell carcinomas. During the past 30 years, about 160 cases of primary small cell carcinoma of the larynx have been reported. Combined primary squamous and small cell carcinoma of the larynx, the so-called composite tumor of the larynx, is even more rare, with only 13 published cases to date. Although the major risk factors for developing these composite tumors of the larynx are thought to be similar to other more common neoplasms of the larynx, such as squamous cell carcinoma, the treatment and prognosis are different. We report an additional case of combined small cell carcinoma of the larynx and discuss the histogenesis of this unusual neoplasm.
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Affiliation(s)
- Vilkesh R Jaiswal
- Department of Pathology, The University of Texas Southwestern Medical Center, Dallas 75390-9073, USA
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19
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Ferlito A, Shaha AR, Rinaldo A. Paraneoplastic syndromes in neuroendocrine neoplasms of the head and neck: have they an impact on prognosis? Acta Otolaryngol 2001; 121:756-8. [PMID: 11678176 DOI: 10.1080/00016480152583719] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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20
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Yücel OT, Sökmensüer C, Gedikoglu G, Ayas K. Combined small cell and squamous cell carcinoma of the larynx: short communication. TUMORI JOURNAL 2001; 86:434-6. [PMID: 11130578 DOI: 10.1177/030089160008600515] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- O T Yücel
- Department of Otorhinolaryngology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
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Mineta H, Miura K, Takebayashi S, Araki K, Ueda Y, Harada H, Misawa K. Immunohistochemical analysis of small cell carcinoma of the head and neck: a report of four patients and a review of sixteen patients in the literature with ectopic hormone production. Ann Otol Rhinol Laryngol 2001; 110:76-82. [PMID: 11201814 DOI: 10.1177/000348940111000114] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Small cell carcinoma (SCC) occurs mostly in the lung, and in some patients is accompanied by production of ectopic hormones. Small cell carcinoma of the head and neck is very rare. We report 4 patients with SCC of the head and neck (larynx, tonsil, maxillary sinus, and parotid gland). The patient with SCC of the maxillary sinus demonstrated a high level of plasma serotonin and overexpression of parathyroid hormone; however, he did not show any related symptoms. The patient with SCC of the tonsil showed the syndrome of inappropriate secretion of antidiuretic hormone associated with antidiuretic hormone hyperproduction at the terminal stage. In the literature, 16 patients with SCC of the head and neck with ectopic hormone production have been reported. Antidiuretic hormone and adrenocorticotropic hormone were the hormones that caused clinical symptoms (paraneoplastic syndromes). We believe that the evaluation of hormonal syndromes is valuable for diagnosis and treatment.
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Affiliation(s)
- H Mineta
- Department of Otolaryngology, Hamamatsu University School of Medicine, Japan
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Ferlito A, Rinaldo A. Paraneoplastic syndromes in patients with laryngeal and hypopharyngeal cancers. Ann Otol Rhinol Laryngol 2000; 109:109-17. [PMID: 10651424 DOI: 10.1177/000348940010900121] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Paraneoplastic syndromes are systemic, nonmetastatic manifestations associated with a variety of malignant neoplasms and occurring in a minority of cancer patients. Paraneoplastic syndromes in association with cancers of the larynx and hypopharynx are considered rare. The world literature is reviewed, dividing paraneoplastic syndromes into 4 main groups, ie, cutaneous (acanthosis nigricans, Bazex's syndrome, Bowen's disease, bullous pemphigoid, dermatomyositis, pruritus, Sweet's syndrome, yellow nail syndrome, and tylosis), endocrine (carcinoid syndrome, adrenocorticotropic hormone syndrome, Schwartz-Bartter syndrome, hypercalcemia), hematologic (Trousseau's syndrome), and neurologic (cerebellar degeneration, Eaton-Lambert myasthenic syndrome). A paraneoplastic syndrome may precede the clinical manifestations of a persistent or recurrent tumor or of asymptomatic metastases, and its onset may even, in a minority of cases, be the presenting sign of a malignancy. Otolaryngologists and head and neck surgeons should have a knowledge of the paraneoplastic syndromes in order to facilitate their detection of malignancies or recurrences.
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Affiliation(s)
- A Ferlito
- Department of Otolaryngology-Head and Neck Surgery, University of Udine, Italy
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Ferlito A, Barnes L, Rinaldo A, Gnepp DR, Milroy CM. A review of neuroendocrine neoplasms of the larynx: update on diagnosis and treatment. J Laryngol Otol 1998; 112:827-34. [PMID: 9876371 DOI: 10.1017/s0022215100141830] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Neuroendocrine neoplasms of the larynx have been divided into those of epithelial or neural origin. The latter consist of paragangliomas while the epithelial origin group can be divided into the typical and atypical carcinoids and small cell neuroendocrine carcinomata, the latter consisting of the oat cell type, the intermediate cell type and the combined cell type. There are now over 500 cases of neuroendocrine neoplasms of the larynx in the literature. The diagnosis is primarily based on light microscopy, and, in some instances, it may be supported by special histochemical studies. It should be confirmed by immunocytochemical and/or ultrastructural investigation. The different biological behaviour of neuroendocrine neoplasms of the larynx makes a specific diagnosis of paramount importance, since treatment depends on diagnostic accuracy. Typical carcinoid is an extremely rare lesion. It is treated preferably by conservative surgery; elective neck dissection is not necessary because of the lack of lymph node metastases at diagnosis. Chemotherapy and/or radiotherapy have not been effective in the limited number of patients treated thus far. Prognosis is excellent with cure following surgery. Atypical carcinoid is the most frequent non-squamous carcinoma of the larynx. The mainstay of treatment is surgery. Elective neck dissection should be performed because of the high likelihood of cervical lymph node metastases. Primary radiation therapy with adjuvant chemotherapy is not indicated. The survival rate is 48 per cent at five years and 30 per cent at 10 years. Although the larynx is one of its most common extrapulmonary sites, small cell neuroendocrine carcinoma is still a rare tumour. Surgical results for this tumour have been disappointing and is reserved for cases of local relapse with no evidence of metastasis. Chemotherapy and radiotherapy currently appear to offer the least disabling and most effective forms of therapy. The two- and five-year survival rates are 16 per cent and five per cent, respectively. Paraneoplastic syndromes have occasionally been reported in association with carcinoid tumours (typical and atypical) and small cell neuroendocrine carcinoma. There have been also rare reports of an elevated neuropeptide serum level. Paraganglioma is the only laryngeal neuroendocrine neoplasm with a female preponderance (3:1). Confusion with atypical carcinoid has led to incorrect diagnosis and inappropriate classification schemes, erroneously suggesting that laryngeal paraganglioma has the potential for aggressive behaviour. Conservative surgery represents the treatment of choice; elective neck dissection is not necessary, and the prognosis is excellent.
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Affiliation(s)
- A Ferlito
- Department of Otolaryngology-Head and Neck Surgery, University of Udine, Italy
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Eggelmeijer F, Macfarlane JD. Polyarthritis as the presenting symptom of the occurrence and recurrence of a laryngeal carcinoma. Ann Rheum Dis 1992; 51:556-7. [PMID: 1586262 PMCID: PMC1004716 DOI: 10.1136/ard.51.4.556] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A 50 year old male smoker presented with an identical seronegative polyarthritis before both the occurrence and recurrence of a laryngeal tumour. The interval between the joint symptoms and discovery of the tumour was 11 and 13 months respectively. Treatment of the tumour resulted in complete disappearance of the arthritis on both occasions.
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Affiliation(s)
- F Eggelmeijer
- Department of Rheumatology, University Hospital, Leiden, The Netherlands
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25
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Abstract
Composite tumor of the larynx has been described as a mixed squamous cell and oat cell carcinoma originating in the larynx. Only eight cases of composite tumor of the larynx have been described in the world medical literature. We present the ninth case ever reported. Therapy for this very aggressive malignancy is with a combined approach - surgery, radiation, and chemotherapy. A common etiology for both squamous cell and oat cell carcinoma has been proposed. Recommendations for diagnostic evaluation as well as therapeutic intervention will be discussed.
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Affiliation(s)
- Gerard J. Gianoli
- Department of Otolaryngology - Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | | | - Edward J. Martin
- Department of Pathology, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, Louisiana
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26
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Abstract
A review of the international literature has revealed 68 paragangliomas, 42 large cell, and 74 small cell tumors of the larynx. Paragangliomas are usually benign, although malignant cases have been reported. Large cell tumors are malignancies associated with a high incidence of early cervical metastasis. Small cell tumors are aggressive cancers characterized by early, diffuse metastatic disease. All three neoplasms demonstrate a propensity for the supraglottic larynx. While surgery remains the treatment of choice for paragangliomas and large cell cancers, small cell cancers are best treated by radiotherapy and chemotherapy. The determinate 5-year survival for patients with paragangliomas, large cell, and small cell cancers is 60%, 34%, and 14%, respectively. While representing distinct clinical entities, these neoplasms demonstrate similar ultrastructural and histochemical features and should be classified as neuroendocrine tumors of the larynx (NETL). A comprehensive analysis of these laryngeal tumors is presented herein. Their clinical behavior and management options are reviewed and a scheme for their nomenclature and classification is proposed.
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Affiliation(s)
- I I Moisa
- Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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27
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Abstract
Neuroendocrine carcinomas of the larynx are uncommon tumors of considerable scientific interest and clinical importance. They include typical carcinoid tumors, atypical carcinoid tumors, and small cell neuroendocrine carcinomas. This paper considers these neoplasms from a personal experience and reviews the relevant medical literature. About 200 cases of neuroendocrine carcinomas of the larynx have been reported. The diagnosis is based on light microscopy and is confirmed by ultrastructural evidence of neurosecretory granules. Histochemical and immunocytochemical investigations may support it. Paraneoplastic syndromes associated with laryngeal neuroendocrine carcinomas have been reported occasionally. The histogenesis, treatment, and prognosis of these lesions also are discussed.
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Affiliation(s)
- A Ferlito
- Department of Otolaryngology, Padua-University, Italy
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Têtu B, Ro JY, Ayala AG, Ordóñez NG, Logothetis CJ, von Eschenbach AC. Small cell carcinoma of prostate associated with myasthenic (Eaton-Lambert) syndrome. Urology 1989; 33:148-52. [PMID: 2536972 DOI: 10.1016/0090-4295(89)90017-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A fifty-eight-year-old white man was diagnosed as having an adenocarcinoma of the prostate (grade III by the U.T.M.D. Anderson Hospital grading system). Five years after the initial diagnosis and three months after signs and symptoms of the myasthenic syndrome of Eaton-Lambert (MSEL), he was found to have a small cell carcinoma of the prostate. Histologic examination showed adenocarcinoma merging into a small cell carcinoma component of intermediate cell type. Immunostaining was positive for neuroendocrine markers--namely, neuron-specific enolase and serotonin--and was limited to the small cell carcinoma component. This is the first report of a patient with small cell carcinoma of the prostate presenting with MSEL. Our findings support prior observations of a strong propensity for small cell carcinoma to be associated with paraneoplastic syndromes, regardless of the initial location of the tumor.
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Affiliation(s)
- B Têtu
- Department of Pathology, University of Texas M. D. Anderson Cancer Center, Houston
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29
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Takeuchi K, Nishii S, Jin CS, Ukai K, Sakakura Y. Anaplastic small cell carcinoma of the larynx. Auris Nasus Larynx 1989; 16:127-32. [PMID: 2552973 DOI: 10.1016/s0385-8146(89)80044-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Anaplastic small cell carcinoma of the larynx is an uncommon neuroendocrine tumor. We report a case of this neoplasm of a 53-year-old male. The patient showed persistent hyponatremia accompanied with continuous loss of sodium in the urine, which resulted from inappropriate secretion of antidiuretic hormone (ADH). It is postulated that hyponatremia in this case was due to production of ADH by the tumor cells.
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Affiliation(s)
- K Takeuchi
- Department of Otorhinolaryngology, Mie University School of Medicine, Tsu, Japan
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30
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Abstract
Fifty-four cases of primary laryngeal moderately differentiated neuroendocrine carcinoma from the Armed Forces Institute of Pathology Otolaryngic Tumor Registry (AFIP-OTR) are reported. The tumors most often present in men in their sixth and seventh decades of life and are heralded by an array of symptoms, the most frequent being hoarseness. The primary site was most often the supraglottic larynx. The investigation has included light-microscopic, histochemical, immunocytochemical, and electron microscopic analyses which support expression of both neuroendocrine and epithelial differentiation. Conservative surgery alone can be utilized if early identification of the tumor and complete surgical removal are assured. The follow-up of the patients reveals 62% as remaining tumor-free after surgical extirpation over periods ranging from 1 month to 16 years (median: 3 years, 9 months). Factors adversely affecting prognosis include metastatic disease at initial presentation, incomplete surgical removal, and vascular or lymphatic invasion. There was no correlation between tumor size, morphologic pattern, mitoses or necrosis, and survival. Sixty-eight percent of the patients gave a history of long-term cigarette smoking. The classification and pathogenesis of these neoplasms remains the focus of much speculation. They are suggested as arising from the cells of the dispersed neuroendocrine system (DNES). However, a more uniform and descriptive nomenclature is necessary. This study resolves this and other issues along with a presentation of clinicopathologic data of the tumor entity.
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Affiliation(s)
- B M Wenig
- Department of Otolaryngic Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000
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31
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Baugh RF, Wolf GT, Beals TF, Krause CJ, Forastiere A. Small cell carcinoma of the larynx: results of therapy. Laryngoscope 1986; 96:1283-90. [PMID: 3022085 DOI: 10.1002/lary.1986.96.11.1283] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Primary small cell carcinoma of the larynx is a rare malignancy with a dismal prognosis. A survey of the long-term follow-up from reported cases of small cell carcinoma of the larynx and a review of the recent experience with this tumor at the University of Michigan Hospitals was undertaken to determine if newer treatment approaches incorporating adjuvant chemotherapy were associated with prolonged survival. Median survival for those patients receiving adjuvant chemotherapy was 19 months compared to 11 months for patients treated with surgery and/or radiation therapy alone. Among patients treated initially with primary radiation therapy and adjuvant chemotherapy median survival was 55 months, which was significantly longer than any other treatment regimen (P = 0.02). Systemic chemotherapy and therapeutic irradiation appears to offer the least disabling and most efficacious form of current therapy.
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32
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Ferlito A. Diagnosis and treatment of small cell carcinoma of the larynx: a critical review. Ann Otol Rhinol Laryngol 1986; 95:590-600. [PMID: 3024550 DOI: 10.1177/000348948609500610] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Small cell carcinoma of the larynx is an uncommon neuroendocrine tumor with particular pathologic, therapeutic, and prognostic connotations. The first case of this lesion was observed in Canada in 1972. Fourteen cases of small cell carcinoma of the larynx were observed in the Ear, Nose, and Throat Department of Padua University in a series of 3,284 primary and secondary laryngeal and hypopharyngeal malignant neoplasms. This number constitutes the largest collection from a single institution in the literature and brings the total recorded cases to 66. The tumor is thought to arise from the argyrophilic Kulchitsky cells normally found in laryngeal mucosa. The diagnosis is based on the light microscopic appearance of the neoplasm and can be confirmed by electron microscopy. The differential diagnosis must be made from carcinoid, atypical carcinoid, small cell squamous carcinoma, small cell ductal carcinoma, lymphoma, mycosis fungoides, and metastatic lung small cell cancer. Systemic chemotherapy with radiation therapy is the accepted manner of treatment today. The survival of the patients treated with these modalities may be significantly improved, and some patients may be cured.
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Eckman MH, Robert NJ, Parkinson DR, Latzko G, Pauker SG. Eaton-Lambert syndrome and small cell lung cancer: side effects and certainty. Med Decis Making 1986; 6:174-86. [PMID: 3016451 DOI: 10.1177/0272989x8600600308] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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34
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Baugh RF, Wolf GT, McClatchey KD. Small cell carcinoma of the head and neck. HEAD & NECK SURGERY 1986; 8:343-54. [PMID: 3025134 DOI: 10.1002/hed.2890080505] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Treatment methods for patients with small cell carcinoma of the head and neck are changing. Increasing clinical experience with these tumors and a better appreciation of patterns of recurrence, the need for thorough tumor staging, and the importance of chemotherapy as a form of primary therapy have contributed to these changes. Current concepts regarding small cell carcinoma arising in the head and neck are reviewed. Reported results of treatment for a variety of head and neck sites and site-specific relapse rates are summarized. New cases of small cell carcinoma arising in the hypopharynx, paranasal sinus, and from an unknown primary are added to the reported experience in the literature.
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Ferlito A, Pesavento G, Recher G, Caruso G, Dal Fior S, Montaguti A, Carraro R, Narne S, Pennelli N. Long-term survival in response to combined chemotherapy and radiotherapy in laryngeal small cell carcinoma. Auris Nasus Larynx 1986; 13:113-23. [PMID: 3028349 DOI: 10.1016/s0385-8146(86)80007-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Fourteen patients with small cell carcinoma of the larynx are studied. This represents the largest series, from a single institution, reported in the literature. This neoplasm is usually highly aggressive and the prognosis very poor, but, in our experience, combined chemo- and radiotherapy can significantly improve the clinical course of the disease. Three of six patients who received this combined modality treatment are still clinically disease-free more than six years after the initial diagnosis.
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Abstract
The clinical and pathologic findings of six cases of combined small cell carcinoma of the larynx are described. This tumor is a subtype of small cell carcinoma in which there is a definite component of oat cell carcinoma (or intermediate cell type carcinoma) together with squamous cell carcinoma or adenocarcinoma or both. The neoplasm seems to derive from a common cell with subsequent divergent differentiation into the Kulchitsky cells, squamous cells, and/or glandular cells. After histologic diagnosis, adequate evaluation for tumor staging is mandatory. Like pulmonary combined small cell carcinoma, this neoplasm may be best treated with systemic chemotherapy and radiotherapy. The prognosis is similar to that of other subtypes of small cell carcinoma of the larynx.
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