Lympho-epithelial carcinoma of the larynx - the big masquerader of squamous cell carcinoma - a case report.

Abstract

Background: Lympho-epithelial carcinoma (LEC) is most commonly found in the nasopharynx, while LEC of the hypopharynx and larynx is rare, with fewer than 50 cases in the published literature. As the non-nasopharyngeal presentations are rare, the clinical course, diagnosis and treatment for this tumour are sparsely reported. Here, we report a rare case report of Epstein-Barr virus negative laryngeal LEC treated with combined modality therapy in a tertiary care centre. We also review the literature regarding currently acceptable treatment strategies.

Case presentation: We present a case of a 59-year-old male who presented with hoarseness of voice and acute onset of respiratory distress. Post emergency tracheostomy for respiratory distress, evaluation with contrast-enhanced computed tomography head and neck revealed cT3N0M0 supraglottic disease. Biopsy revealed poorly differentiated carcinoma. In view of thyroid cartilage erosion, the patient underwent two cycles of neo-adjuvant chemotherapy followed by total laryngectomy, bilateral neck dissection and primary closure. Postoperative histopathology revealed ypT1N0 LEC, with adequate margins and adequate neck dissection. The patient was then treated with adjuvant chemoradiotherapy. 6 months follow-up positron emission tomography/computed comography shows no locoregional disease.

Conclusion: The treatment for rare cases like non-nasopharyngeal LEC is yet to be standardised. However, as seen in our case report, multimodality management including surgery, chemotherapy and radiation therapy seems to be a feasible approach to managing such rare cases of non-nasopharyngeal LEC.