Nakano Takafumi, Motoshita Junichi, Tanaka Risa, Okabe Midori, Tamae Akihiro, Shiratsuchi Hideki, Yasumatsu Ryuji, Nakashima Torahiko, Nakagawa Takashi
Department of Otolaryngology, Hamanomachi Hospital, Nagahama 3-3-1, Chuo-ku, Fukuoka 810-8539, Japan; Department of Otolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
Department of Pathology, Hamanomachi Hospital, Nagahama 3-3-1, Chuo-ku, Fukuoka 810-8539, Japan.
Auris Nasus Larynx. 2017 Aug;44(4):472-478. doi: 10.1016/j.anl.2016.07.011. Epub 2016 Aug 3.
Combined small cell carcinoma (SCC) and squamous cell carcinoma (SqCC) of the oropharynx is extremely rare and shows an aggressive clinical course. There are only 5 reported cases of combined SCC and SqCC in the English language literature. Here, we report a 59-year-old male presenting with a right tonsillar mass. The mass was biopsied, and the histological findings showed a proliferation of small-sized tumor cells with scant cytoplasm. Immunohistochemically, the tumor cells were positive for neuroendocrine markers (synaptophysin, chromogranin A, and CD56). Our first diagnosis was tonsillar small cell carcinoma. We treated the patient with concurrent chemoradiotherapy together with cisplatin followed by surgery. The resected tonsillar specimen showed a residual tumor composed of SCC and SqCC, and lymph nodes showed metastatic tumor cells of the SCC component. Immunohistochemically, the SCC component was positive for all neuroendocrine markers and p16; on the other hand, the SqCC component was positive for p40, p63, p16, and EGFR. Fluorescence in situ hybridization revealed that neither component showed any EGFR gene copy number gain. The patient was treated with adjuvant chemotherapy consisting of irinotecan and cisplatin. Liver and bone metastases developed, resulting in the death of the patient. We discuss the present case and review similar cases. Most cases of combined SCC and SqCC occur regardless of p16 status, and a therapeutic strategy has yet to be determined. Further examination of this kind of combined tumor is necessary.
口咽小细胞癌（SCC）合并鳞状细胞癌（SqCC）极为罕见，临床病程呈侵袭性。英文文献中仅报道了5例SCC合并SqCC的病例。在此，我们报告一名59岁男性，其右侧扁桃体出现肿物。对该肿物进行活检，组织学检查结果显示为小尺寸肿瘤细胞增殖，胞质稀少。免疫组化显示，肿瘤细胞神经内分泌标志物（突触素、嗜铬粒蛋白A和CD56）呈阳性。我们最初的诊断为扁桃体小细胞癌。我们对患者采用顺铂同步放化疗，随后进行手术。切除的扁桃体标本显示残留肿瘤由SCC和SqCC组成，淋巴结显示有SCC成分的转移瘤细胞。免疫组化方面，SCC成分所有神经内分泌标志物和p16均呈阳性；另一方面，SqCC成分p40、p63、p16和表皮生长因子受体（EGFR）呈阳性。荧光原位杂交显示，两种成分均未显示任何EGFR基因拷贝数增加。患者接受了由伊立替康和顺铂组成的辅助化疗。发生了肝转移和骨转移，导致患者死亡。我们对本病例进行讨论并回顾类似病例。大多数SCC合并SqCC病例的发生与p16状态无关，且治疗策略尚未确定。有必要对这种合并肿瘤进行进一步研究。
