Mucoepidermoid carcinoma of the larynx in a child

Clinical Behavior of the Mucoepidermoid Carcinoma of the Larynx-A Scoping Review

OBJECTIVE

Mucoepidermoid carcinomas (MEC) of the larynx account for less than 1% of all laryngeal tumors. The unique features and clinical behavior of these rare entities remain unknown. To fill this knowledge gap, we performed a scoping review of every reported case of laryngeal MEC to study the clinical behavior and the treatment modalities in this rare entity.

REVIEW METHODS

We followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) statement.

DATA SOURCES

MedLine, Google Scholar, and Science Direct databases were searched to identify eligible studies.

RESULTS

We concluded with 25 studies and overall 66 cases. Our study revealed that the average age of cases was 55.7 years, and the range was from 12 to 81 years, with younger onset in females. Supraglottic (60%) is the most common subsite of laryngeal MEC s followed by glottis (27.3%). Supraglottic carcinomas frequently present with metastatic neck disease at the time of the initial diagnosis and require more extensive surgical approaches. Surgery with negative surgical margins seems to be the cornerstone in the treatment of MEC. Radiation therapy has not been tested widely as monotherapy but is considered a useful adjuvant modality.

CONCLUSION

This study suggests that negative surgical margins seem to be associated to higher disease control rate and that high-grade supraglottic cases likely benefit from addressing neck disease simultaneously.

LEVEL OF EVIDENCE

NA Laryngoscope, 134:2578-2584, 2024.

How Phenotype Guides Management of the Most Common Malignant Salivary Neoplasms of the Larynx?

Salivary gland carcinomas of the larynx are uncommon. Adenoid cystic carcinoma is the most prevalent type of salivary gland carcinoma in this region, although other histologies such as mucoepidermoid carcinoma and adenocarcinomas have been reported. These tumors may present with advanced-stage due to nonspecific symptoms and their relatively slow-growing nature. The index of suspicion for a non-squamous cell carcinoma entity should be high when a submucosal mass is present. An accurate diagnosis is mandatory due to the impact each biologic entity has on treatment and outcome. Data concerning treatment and outcome are scarce, but primary surgery with utmost focus on free surgical margins is the treatment of choice. The role of adjuvant radiotherapy has not been well defined, although there is an agreement that it should be considered in advanced-stage or high-grade disease. This review considers only the most common malignant salivary neoplasms of the larynx with a focus on clinical management of these tumors.

Epiglottic masses identified on CT imaging: A case report and review of the broad differential diagnosis

Epiglottic masses may be cystic, granulomatous, infectious, benign or malignant neoplastic, or manifestations of a systemic disease. When large in size, the airway may become obstructed, and when accompanied by suspicious features such as cartilaginous invasion, extension to the pre-epiglottic or para-glottic spaces, or lymphadenopathy, the radiologist must consider malignancy as a primary differential diagnosis. However, when only benign features are identified, the differential diagnosis is broad. We present a 65-year-old female with an incidental 1 cm exophytic, pedunculated, papillomatous lesion on the laryngeal surface of the epiglottis discovered upon endoscopic evaluation for dyspepsia and heartburn. Because of her risk factors for malignancy, CT scan was requested and revealed only benign features. Subsequent excisional biopsy revealed a benign squamous papilloma; however, multiple additional differential considerations were entertained preoperatively.

Mucoepidermoid carcinoma of the larynx with transglottic involvement in a child: a case report

Mucoepidermoid carcinoma (MEC) of the larynx is one of the rarest tumors in the pediatric age group. Our review of the English-language literature found only 1 previously reported case of a laryngeal MEC in a child. We present what to the best of our knowledge is the first case of a pediatric MEC of the larynx with transglottic involvement. Our patient was a 12-year-old girl who presented with long-standing hoarseness and recent dysphagia, breathing difficulty, and pain radiating to the left ear. Investigation revealed the presence of an endophytic mass in the larynx. Histopathologic examination of biopsy tissue identified the mass as a low-grade MEC. The patient was scheduled to undergo a total laryngectomy 1 week later, but she did not report for surgery. Three weeks later, she presented to the emergency department in a semiconscious state and in respiratory distress. Despite all resuscitative measures, she died.

Clinical features and differential diagnoses in laryngeal mucoepidermoid carcinoma

Mucoepidermoid carcinoma is the most common malignant tumor of salivary glands. However, it is a rare entity in larynx. Laryngeal cases are frequently misdiagnosed with other malignancies and they are under-reported. So, recognizing the clinical and histological features of this tumor is essential. Laryngeal mucoepidermoid carcinoma can arise in supraglottis, glottis and subglottis. Generally, it presents as a submucosal mass; therefore, progressive symptoms without any identifiable lesion in laryngoscopy must be well considered. The prognosis is somehow dependent on the histological features. In high-grade tumors, recurrence is more common and radical surgery with radiotherapy is recommended. In this paper, we provide a thorough literature review on mucoepidermoid carcinoma in the larynx. The most important distinguishing features of mucoepidermoid carcinoma and its two major differential diagnoses (squamous cell carcinoma and adenosquamous carcinoma) are clearly stated and pitfalls in true diagnosis of this tumor are discussed.

Mucoepidermoid carcinoma of an adolescent epiglottis

Laryngeal mucoepidermoid carcinoma is rare and extremely rare in adolescents. We present the case of a 17-year-old girl. Magnetic resonance imaging clearly depicted the tumor, and histopathological study of the surgical specimen confirmed the diagnosis of mucoepidermoid carcinoma.

Malignancy of the Larynx in a Child

Squamous cell carcinoma of the larynx in children is rare. The management of laryngeal malignancy is more difficult in children than adults for several reasons: the aggressive nature of a tumor that is often diagnosed late in children; the delicacy of pediatric anatomic structures; intraoperative blood loss; long-term post-treatment complications; and psychological factors particular to children. A tracheostomized 13-year-old boy came to us with a 4-month history of hoarseness, breathing difficulty, and swelling in the neck. A detailed examination revealed that a transglottic tumor had infiltrated the thyroid and cricoid cartilage, the upper two tracheal rings, and the thyroid gland. Such an infiltration has not been previously reported. The lesion proved to be a well-differentiated squamous cell carcinoma. We performed a wide-field total laryngectomy, which was followed by radiotherapy. Unfortunately, the child survived only 3 years postoperatively.

Laryngeal malignant neoplasms in children and adolescents

An exhaustive literature review of the last two decades discloses 47 laryngeal malignant neoplasms in children and adolescents. The most frequent malignant neoplasm is the embryonal variant of rhabdomyosarcoma. The timely diagnosis of a laryngeal neoplasm depends on maintaining a high index of suspicion in a patient with progressive airway obstruction, dysphagia or dysphonia, and conducting an efficient work-up-including magnetic resonance imaging and direct laryngoscopy under general anesthesia in association with bronchoscopy-in order to define the extent of the lesion, rule out multiple lesions, establish and maintain an airway, and perform a biopsy of the tumor. The authors observed that several risk factors, such as previous radiation therapy for juvenile laryngeal papillomatosis, intrauterine exposure to ionizing radiation, chemical carcinogens, smoking or tobacco exposure were lacking in those patients with a detailed clinical history. Probably, cancer of the larynx in these unusual patients is the final result of an interaction of immunological and genetic factors. The choice of therapy depends on several factors, including the clinical stage at presentation, histological type and potential radio-chemosensitivity of the tumor.

Malignant laryngeal tumors in children: a 15-year experience with four patients

Malignant laryngeal neoplasms in children are uncommon and present diagnostic and therapeutic challenges. A 15-year retrospective review of laryngeal tumors at our institution identified four patients with malignant neoplasms. These children, 7 months to 16 years of age, were treated for squamous cell carcinoma, choriocarcinoma, rhabdomyosarcoma, and primitive neuroectodermal tumor. This report details these cases, emphasizing diagnostic approaches, treatment decisions (medical oncologic management, surgical resection), and rehabilitation measures for postlaryngectomy communication. A multi-institutional pediatric head and neck tumor registry would be a useful reference to assist with individual treatment decisions.