Vildé F, Arkwright S, Paoli C, Périchon I, Le Charpentier Y, Le Bodic M F
Service d'Anatomie Pathologique (Pr Vildé), Hôpital Boucicaut, Paris.
Ann Pathol. 1996;16(2):104-7.
Neuroendocrine carcinomas of the larynx are rare and their links with thyroid neoplastic lesions are not specified in most reported cases. We report such a case secondary to medullary thyroid carcinoma. In a 63-year-old man, a supra glottic laryngeal carcinoma confirmed by biopsy was initially treated by chemotherapy. A second biopsy of the laryngeal lesion after incomplete remission displayed a neuroendocrine carcinoma with calcitonin in neoplastic cells. Laryngectomy, cervical bilateral neck dissection and thyroid isthmic adenoma dissection were performed. Numerous neoplastic cells from these tissues contained calcitonin revealed by immunohistochemical method. Calcitoninemia was highly increased and multiple bone metastases were discovered. Secondary total thyroidectomy was not possible and the patient died 6 months after. In this case the neuroendocrine laryngeal carcinoma was probably secondary to a latent medullary thyroid carcinoma. Medullary thyroid carcinoma is most often unknown in similar previously reported cases of neuroendocrine laryngeal carcinoma. Thus a neuroendocrine tumour of the larynx should require search for extra thyroid and over all thyroid neuroendocrine carcinoma, even limited to a small and latent lesion.
喉神经内分泌癌较为罕见，在大多数已报道的病例中，其与甲状腺肿瘤性病变的关联并未明确阐述。我们报告了一例继发于甲状腺髓样癌的此类病例。一名63岁男性，经活检确诊为声门上喉癌，最初接受了化疗。在病情未完全缓解后对喉部病变进行的再次活检显示为神经内分泌癌，肿瘤细胞中含有降钙素。随后进行了喉切除术、双侧颈部淋巴结清扫术以及甲状腺峡部腺瘤切除术。免疫组化方法显示，这些组织中的大量肿瘤细胞含有降钙素。降钙素血症显著升高，且发现了多处骨转移。无法进行二期全甲状腺切除术，患者在6个月后死亡。在该病例中，神经内分泌性喉癌可能继发于隐匿性甲状腺髓样癌。在先前报道的类似神经内分泌性喉癌病例中，甲状腺髓样癌大多未被发现。因此，对于喉部神经内分泌肿瘤，即使局限于微小且隐匿的病变，也应排查甲状腺外及整个甲状腺的神经内分泌癌。
