Large cell neuroendocrine carcinoma of the larynx: a case report and a review of the classification of this neoplasm

Abstract

This report describes a case of large cell neuroendocrine carcinoma (LCNEC) of the larynx. A 74 year old man who presented with otalgia underwent direct laryngoscopy with biopsy, which revealed an invasive poorly differentiated carcinoma. Laryngectomy with bilateral neck dissections revealed invasion of the pre-epiglottic space by the tumour, with metastases to bilateral lymph nodes (AJCC T3N2c). The tumour was characterised by large cells with vesicular chromatin and prominent nucleoli. The cells were arranged in organoid and trabecular patterns with a background of extensive necrosis and numerous mitotic figures. Immunohistochemical and ultrastructural analyses confirmed the neuroendocrine nature of the tumour. Metastatic disease was present in the liver, and the patient died within weeks of surgery. LCNEC carcinoma is a rare tumour of the larynx. Recognition at this site is essential so that proper patient management can be initiated.

Figure 1

Supraglottic mass involving the left false vocal cord with compression of the left ventricle.

Figure 2

Neoplastic cells infiltrating the epiglottic soft tissues with ulceration of the overlying squamous mucosa. Tumour cells are arranged in organoid and trabecular patterns with pseudorosette-like structures, abundant mitoses, and necrosis. The cells are large with eosinophilic cytoplasm, vesicular chromatin, and prominent nucleoli (haematoxylin and eosin stained; original magnification: ×2 (A), ×10 (B), ×40 (C), and ×60 (D)).

Figure 3

Cytoplasmic immunoreactivity with anti-synaptophysin (immunoperoxidase; original magnification, ×20).

Figure 4

Electron microscopy: neurosecretory granules in the cytoplasm of the tumour cell.