A 50-year-old man, a known heavy smoker for more than 20 years, presented to our clinic with hoarseness for the last 2 months. Indirect laryngoscopy showed a bulging mass over the left false cord (Fig. 1A) without vocal cord immobility. Biopsy of the mass was performed and the pathology diagnosis was small cell neuroendocrine carcinoma (SCNC) (Fig. 1B). Chest CT scan, abdomen sonography, and whole body bone scan disclosed no distant metastasis. However, head and neck CT scan suggested an equivocal node over left level II neck, which was confirmed to be metastatic node by PET scan (Fig. 1C, D) and sono-guided fine needle aspiration.
Indirect laryngoscopy (A) shows submucosal bulging mass (asterisk) over the left false cord. Photomicrograph (H&E, ×400) (B) shows small cells with hyperchromatic nuclei and scant cytoplasm. Nuclear moulding and crush artefact are present. PET/CT (C, D) showed increased 18F-FDG uptake in the left supraglottis (SUVmax=2.3) and left neck lymph nodes (SUVmax=4.0).
SCNC is aggressive malignancy which occurs mostly in the lung. Extrapulmonary SCNC is relatively rare and encompasses 2.5%–5% of the all SCNCs.1 Neuroendocrine neoplasms are the most common non-squamous malignancies of the larynx with a predilection for the supraglottis. The survival rate of laryngeal SCNC is similar to pulmonary SCNC, which remains dismal. The extent of the disease rather than tumour size is the independent prognostic factor for survival. Definitive chemoradiotherapy is currently the best form of treatment.2 Surgery is only reserved for loco-regional recurrence without evidence of distant metastasis.
