Clinical And Pathological Features Of Laryngeal Carcinoid

Objective:To investigate the clinical and pathological characteristics, diagnosis, differential diagnosis, therapy and prognosis of laryngeal carcinoid.Method:The clinical and follow-up datas of 4 cases of laryngeal carcinoid were studied retrospectively, then observed the clicical and pathological features, made immunohistochemistry by S-P two-steps method with these antibodys:CgA,Syn,TTF,CEA,P53,Ki67,CK7,Vim,CK(AE1/AE3),CD56,CK8/18,CT,HMB-45,CD34,SMA and CD10.Result:Two histological types were found:typical carcinoid(TC)(1 case), atypical carcinoid(AC)(3 cases).â‘ Clinical features:Throat pain was the initial symptom of TC; 2 patients of AC had sore throat as the initial symptom,1 patient of AC had the initial symptom of hoarseness. All of the 4 cases were supraglottic tumor, TC was located in the right side of the ventricular band, showed submucosal and no lymph node metastasis; 3 cases of AC were located respectively in the right side of the ventricular band, arytenoid and aryepiglottic fold, the right side of the ventricular band, and the epiglottis. The surface of the AC were smooth or unsmooth. All of AC were associated with cervical lymph node metastasis. The case located in right side of the arytenoid and aryepiglottic fold had 1 in 8 lymph nodes metastasis, the case located in the right side of the ventricular band had 1 in 9 lymph nodes metastasis, the case located in the epiglottis, the left side of the cervical lymph nodes metastasis was 3 in 18, and the right side was 9 in 22.â‘¡Pathological features: Microscopically, TC had typical organ-like structures, which mainly composed of round and spindle cells arranged in small nests, trabecular, and was separated by some fibers, blood vessels and transparent metamorphic connective tissue, and rosettes-like structures could be observed. The size and morphology of the cancer cell were uniform, atypia was unconspicuous. There was no nucleolus, mitosis or necrosis. There were abundant interstitial blood vessels. AC cells arranged in small nests, trabecular, adenoid, sheet, tubular, cribriform and organ samples. Compared with the TC, cancer cells of AC were big, varied sizes, pleomorphic, polygon or circle shape, conspicuous atypia, mitosis, and cell mass was medium and Iraqi red. Nucleus was central or eccentric, with prominent nucleolus. There was necrosis and a little stroma. Immunohistochemistry:CgA, Syn and CK were positive. TC:CgA, Syn, TTF, Ki67, Vim, CK (AE1/AE3) and CD56 were positive; AC:CgA, Syn, TTF, CEA, P53, Ki67, CK7, Vim, CK (AE1/AE3), CD56, CK8/18 and CT were positive.â‘¢Treatment and follow-up:4 cases were treated mainly by surgery:TC was purely treated by vertical partial laryngectomy, followed up for 6 months and no recurrence; 2 cases of AC were treated by vertical partial laryngectomy+ipsilateral neck dissection, respectively followed-up for 3 years add 1 month,8 months, no recurrence; 1 case of AC was treated by horizontal supraglottic partial laryngectomy+bilateral neck dissection+cellular immunotherapy, followed up for 6 months, no recurrence. Tracheal tubes of these 4 cases had been pulled out.Conclusion:Laryngeal carcinoid is a rare malignant tumor. It induces submucosal lesions mainly. Some patients may feel sore throat in the early time. It can be differentiated from other laryngeal tumors based on the pathological characteristics, optical microscopy, electron microscopy, and immunohistochemistry examination are helpful. Histological type of the tumor is important for clinical therapy and prognostic evaluation, because TC and AC has different biological behavior, clinical features and pathology.