A. Ferlito

Ackerman's tumor (verrucous carcinoma) of the larynx. A clinicopathologic study of 77 cases

A series of 77 cases of verrucous carcinoma of the larynx is presented. The tumor is relatively rare and the present series has been selected from 2,398 primary and recurrent malignant neoplasms of the larynx and hypopharynx evaluated at the Department of Otolaryngology of Padua University during the period from January 1966 to December 1978. The median age of patients was 58 years. The tumor appears to be exophytic, broadly implanted and fungating in aspect, with papillary fronds and a locally invasive character. It is composed of highly differentiated epithelial squamous cells covered by a thick keratinized layer arranged in deeply invaginated folds. Cellular response in tumor stroma is marked, and the neoplasm has a low‐grade malignancy. Close cooperation between the pathologist and the clinician is needed in order to establish the nature of the lesion, which looks clinically malignant but may appear histologically benign. Benign responses such as hyperkeratosis, acanthosis, or the presence of a benign papillomatous area necessitate further investigation with another biopsy examination from deeper layers. The elective treatment is surgery, as irradiation may cause anaplastic transformation with metastatic spread. Neck dissection is not indicated as this laryngeal tumor has so far never metastasized to cervical lymph nodes or to other organs.

Primary anaplastic small cell (oat cell) carcinoma of the larynx. Review of the literature and report of 18 cases

Anaplastic small cell (oat cell) carcinoma is a neoplasm commonly arising in the lungs. However, it may also occur, though rarely, in the larynx. A series of 43 cases is presented (ten cases from the Armed Forces Institute of Pathology, eight from the Department of Otolaryngology of the Padua University, and 25 from the literature). The tumor often presents in the sixth and seventh decades of life and appears to be highly aggressive, and metastases develop early. The most common presenting symptom is hoarseness. As in pulmonary small cell carcinoma, prognosis is poor and does not seem to depend upon therapeutic modalities, tumor location or the extent of initial local disease. The tumor seems to derive from the Kulchitsky cell present not only in the bronchial mucosa but also in the laryngeal lining. Like pulmonary anaplastic small cell carcinoma, small cell carcinoma of the larynx should be treated with systemic chemotherapy and radiotherapy. The association of small cell carcinoma with squamous carcinoma of the larynx is also reported and problems connected with the histogenesis of this mixed tumor are discussed.

NEUROENDOCRINE NEOPLASMS OF THE LARYNX: AN OVERVIEW

Neuroendocrine neoplasms of the larynx are rare but are the most common nonsquamous tumors of this organ. In the past, there has been considerable confusion about the nature and classification of these neoplasms, but the current consensus is that there are 4 different types of laryngeal neuroendocrine tumors composed of paraganglioma, typical carcinoid, atypical carcinoid tumor, and small cell neuroendocrine carcinoma. Carcinoids and small cell neuroendocrine carcinomas are epithelial neoplasms, whereas paragangliomas are of neural origin. Diagnosis is based primarily on light microscopy and confirmed by immunohistochemistry and electron microscopy. Precise diagnosis is essential because the natural history, treatment, and prognosis vary widely for the different neoplastic categories.

Benign mixed tumour of heterotopic salivary gland tissue in upper neck. Report of a case with a review of the literature on heterotopic salivary gland tissue.

A case of benign mixed tumour arising in ectopic salivary gland tissue of the mucous type is described. The tumour was located at the angle of the right mandible, in the upper middle third of the neck, along the anterior border of the sternomastoid muscle. This observation is substantiated by a pathomorphological study. A comprehensive review of the world literature on heteroptic salivary gland tissue has also been carried out, together with a search of the possible pathogenesis which seems to be connected with an anomalous embryonic development within the branchial apparatus.

Is primary radiotherapy an appropriate option for the treatment of verrucous carcinoma of the head and neck

The literature on verrucous carcinoma of the head and neck was reviewed to analyse the use of primary radiation therapy in the treatment of this lesion. The results emphasize an overall local control rate of 43.2 per cent, and 6.7 per cent of true anaplastic transformation following irradiation. Diagnosis remains the fundamental problem: without a correct diagnosis of verrucous carcinoma, no correct treatment can be applied.

Diagnosis and treatment of small cell carcinoma of the larynx: a critical review.

Small cell carcinoma of the larynx is an uncommon neuroendocrine tumor with particular pathologic, therapeutic, and prognostic connotations. The first case of this lesion was observed in Canada in 1972. Fourteen cases of small cell carcinoma of the larynx were observed in the Ear, Nose, and Throat Department of Padua University in a series of 3,284 primary and secondary laryngeal and hypopharyngeal malignant neoplasms. This number constitutes the largest collection from a single institution in the literature and brings the total recorded cases to 66. The tumor is thought to arise from the argyrophilic Kulchitsky cells normally found in laryngeal mucosa. The diagnosis is based on the light microscopic appearance of the neoplasm and can be confirmed by electron microscopy. The differential diagnosis must be made from carcinoid, atypical carcinoid, small cell squamous carcinoma, small cell ductal carcinoma, lymphoma, mycosis fungoides, and metastatic lung small cell cancer. Systemic chemotherapy with radiation therapy is the accepted manner of treatment today. The survival of the patients treated with these modalities may be significantly improved, and some patients may be cured.

Oat cell carcinoma of the larynx.

A case of oat cell carcinoma of larynx occurring in a 67-year-old male is reported. This neoplasm is extremely rare in the larynx and the case described is the second so far reported in world literature. The tumor is morphologically identical to those arising in the lung.

Histiocytic tumors of the larynx. A clinicopathological study with review of the literature

A case of primary malignant fibrous histiocytoma of the larynx occurring in a 58‐year‐old man is described. This neoplasm is extremely rare in the larynx and the case reported (the second described by me) is the fifth so far reported in the world literature. The patient died after 19 months from first surgical treatment and the autopsy confirmed the histological diagnosis. The cases of histiocytic tumors of the larynx previously reported in the literature are re‐examined and reclassified. Biological behavior and therapy of the tumor, as well as differential diagnosis from other neoplasms, are discussed.

Simultaneous Primary Oat Cell Carcinoma (Apudoma) and Squamous Cell Carcinoma of the Hypopharynx

The first case of the association of oat cell carcinoma and squamous carcinoma of the hypopharynx occurring in a 57-year-old man is reported. The patient underwent total laryngopharyngectomy with radical neck dissection, but died 3 1/2 months after diagnosis with multiple bone metastases of the ribs and vertebrae. The histogenesis of oat cell carcinoma in the hypopharynx is discussed, together with the therapeutic approach for the simultaneous occurrence of two primary malignant neoplasms in the same organ.

Primary combined small cell carcinoma of the larynx

The clinical and pathologic findings of six cases of combined small cell carcinoma of the larynx are described. This tumor is a subtype of small cell carcinoma in which there is a definite component of oat cell carcinoma (or intermediate cell type carcinoma) together with squamous cell carcinoma or adenocarcinoma or both. The neoplasm seems to derive from a common cell with subsequent divergent differentiation into the Kulchitsky cells, squamous cells, and/or glandular cells. After histologic diagnosis, adequate evaluation for tumor staging is mandatory. Like pulmonary combined small cell carcinoma, this neoplasm may be best treated with systemic chemotherapy and radiotherapy. The prognosis is similar to that of other subtypes of small cell carcinoma of the larynx.