A case of large cell neuroendocrine carcinoma of the tongue

Ryuta Osaka, I. Uchida, Sadao Oyama, H. Miyashita, S. Kawai, T. Shibahara
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Abstract

Large cell neuroendocrine carcinomas (LCNEC) are relatively rare tumors that arise in various organs. We report a case of primary LCNEC of the tongue. A 60-year-old man was referred to our department because of impaired swallowing function due to pain while eating, as well as an ulcer on the left side of the tongue. Squamous cell carcinoma was suspected on biopsy. A whole-body examination showed no evidence of metastasis. Therefore, the patient was given a clinical diagnosis of squamous cell carcinoma of the left side of the tongue suspected (cT4aN2bM0: Stage IVa). After preoperative chemotherapy, we performed a tracheostomy, bilateral neck dissection, complete removal of the tongue, and reconstructive surgery using a rectus abdominis free flap, with the patient under general anesthesia. Histologically, the tumor was composed of solid nests of atypical large cells. Necrosis was remarkable. Tumor nests showed peripheral palisading and rosette formation. Immunohistochemically, the cancer cells were positive for chromogranin A and synaptophysin. We diagnosed this tumor as LCNEC, based on the criteria established for pulmonary tumors. The patient is alive without recurrence or metastasis 55 months after surgery. Since LCNEC is exceptionally rare in the head and neck region, especially in the oral cavity, the prognosis was unclear, and treatment has not been established. Hence, studies of further cases are required to establish adequate treatment for LCNEC of the head and neck region.
舌大细胞神经内分泌癌1例
大细胞神经内分泌癌(LCNEC)是一种发生在各种器官的相对罕见的肿瘤。我们报告一例原发性舌头LCNEC。一位60岁男性患者因进食时疼痛导致吞咽功能受损,并伴有左侧舌部溃疡而转介至我科。活检怀疑为鳞状细胞癌。全身检查未见转移迹象。因此,临床诊断疑似舌左侧鳞状细胞癌(cT4aN2bM0: IVa期)。术前化疗后,我们在全身麻醉下进行了气管切开、双侧颈部清扫、完全切除舌头和腹直肌游离皮瓣重建手术。组织学上,肿瘤由非典型大细胞组成的实巢。坏死明显。肿瘤巢外周呈栅栏状,呈玫瑰花结状。免疫组化结果显示,肿瘤细胞嗜铬粒蛋白A和突触素阳性。根据肺肿瘤的诊断标准,我们将该肿瘤诊断为LCNEC。患者术后55个月无复发或转移。由于LCNEC在头颈部特别罕见,尤其是在口腔,预后不明确,治疗方法尚未建立。因此,需要对更多的病例进行研究,以确定头颈部LCNEC的适当治疗方法。
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