Collision tumor of primary laryngeal mucosal melanoma and invasive squamous cell carcinoma with IL-17A and CD70 gene over-expression

Abstract

The most common primary malignancy of the larynx is the squamous cell carcinoma (SCC). The primary malignant melanoma is quite rare in this location. Less than 60 cases of laryngeal melanomas have been reported to date. To our knowledge, collision primary malignant melanoma and invasive squamous cell carcinoma in the vocal cords has not been reported. We report a 53-year-old male patient who was diagnosed with a collision tumor of laryngeal melanoma and invasive SCC. Multiple Th17 pathway related genes including CTLA-4, IL-17A-F, PLZF, FoxP3, RorγT, CD27, and CD70 were analyzed by reverse transcriptase-polymerase chain reaction (Rt-PCR) in this case. Both IL-17A and CD70 genes were detected in this case of collision tumor. The results may define useful biomarkers for early diagnosis of mucosal melanoma and open an immunotherapeutic field for clinical management with the potential benefit from the immunomodulators that enhance both genes.

Fig. 1

a Coronal section from non-contrast CT scan shows a 1.7-cm mass present at the left vocal cords, filling the ventricular space (arrow). b Endoscopic view shows a bluish and light brown mass on the left larynx (arrow). c Total laryngectomy specimen shows a dark pigmented mass involving the left vocal cords (arrow)

Fig. 2

Low magnification from the left vocal cord mass shows a laryngeal mucosal tumor composed of dark pigmented cells (a). A closer view shows the over-lined squamous mucosa with high grade dysplasia and pigmented atypical melanocytes (b–c). Invasive squamous cell carcinoma infiltrating into submucosa with mixed atypical melanocytes (d). Immunostain for HMB-45 highlights melanocytes in squamous epithelium and submucosal area (e)

Fig. 3

PCR amplicons. Appropriate sized bands were detected for IL-17A and CD70. No bands were found for IL-17B, IL-17D, IL-17F, PLZF, CD27, CD70, FoxP3, RorγT and negative control (no template DNA). A 100 bp ladder is shown in the left lane. HGAPDH is used as an internal control for reverse transcription