Yamagata Kenji, Terada Kazuhiro, Uchida Fumihiko, Kanno Naomi, Hasegawa Shogo, Yanagawa Toru, Bukawa Hiroki
Department of Oral and Maxillofacial Surgery, Institute of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Case Rep Dent. 2016;2016:7532805. doi: 10.1155/2016/7532805. Epub 2016 Dec 27.
The combined squamous cell carcinoma (SCC) with neuroendocrine (atypical carcinoid (AC)) tumor is extremely rare in the head and neck. We present here the first case of SCC with AC arising in the floor of the mouth of 65-year-old man. The tumor is comprised of two components of SCC and AC in the biopsy specimen. Neuroendocrine tumor component was classified as AC from the punctate necrosis and 2-10>/10 HPF. Immunohistochemical staining was HMW-CK/34B (+) and P63 (+) in SCC and synaptophysin (+) and CD56 (+) in AC. The pathological diagnosis of SCC with AC was made from both the morphological and immunological exam. Concurrent chemoradiotherapy was performed with radiotherapy 70.2 Gy and chemotherapy of CDDP and VP-16. Although the treatment effect was complete response both of primary tumor and of neck metastases, the recurrence of the primary tumor was after 6 months. Bilateral modified radical neck dissection and tumor resection of the floor of the mouth with reconstructive surgery of anterior lateral thigh free flap were performed. Although the primary and neck tumor did not recur, the multiple lung metastases and mediastinum lymph node metastases occurred at 6 months after surgery.
头颈部联合鳞状细胞癌（SCC）与神经内分泌（非典型类癌（AC））肿瘤极为罕见。我们在此报告首例发生于一名65岁男性口腔底部的SCC合并AC肿瘤。活检标本中的肿瘤由SCC和AC两个成分组成。神经内分泌肿瘤成分因有斑点状坏死且每10个高倍视野中有2 - 10个以上核分裂象而被分类为AC。免疫组化染色显示SCC中高分子量细胞角蛋白/34βE12（HMW - CK/PE12）（+）和P63（+），AC中突触素（+）和CD56（+）。通过形态学和免疫学检查做出了SCC合并AC的病理诊断。采用70.2 Gy放疗以及顺铂（CDDP）和依托泊苷（VP - 16）化疗进行同步放化疗。尽管治疗效果为原发肿瘤和颈部转移灶均达到完全缓解，但原发肿瘤在6个月后复发。遂进行了双侧改良根治性颈清扫术以及口腔底部肿瘤切除术，并采用前外侧股游离皮瓣进行重建手术。尽管原发灶和颈部肿瘤未再复发，但术后6个月出现了多发肺转移和纵隔淋巴结转移。
