The Head And Neck’s Neuroendocrime Carcinoma; Four Cases Report With Review Of Literature

[Objective]To investigate the pathogenesis, clinical features, diagnosis, management andprognosis of the neuroendocrine carcinoma (NEC) of the head and neck, which is a veryrare kind of malignant tumor from the neuroendocrine cell. To improve the cliniciansawareness of these diseases.[Methods]The clinical data of the4NEC patients hospitalized in Fujian Provincial Hospitalduring the period of2008-2011were analyzed retrospectively. The CT showed the lesionof one patient with the middle ear NEC involving the left tympanic cavity and the leftexternal auditory canal. He was treated by the radical mastoidectomy plus radiotherapyand had no significant complications. Electronic pharyngolaryngoscope and imagingstudies of three cases of larynx NEC revealed the tumor located in the left vocal cord andlaryngeal ventricle in1case who was treated by total laryngectomy plus functional neckdissection plus radiotherapy, the left false vocal cord in1case who was treated byNd:YAP laser resection, and epiglottis throat face in1case who was treated by partiallaryngectomy plus radiotherapy. And no one had significant complications. Acomprehensive review of both the English and Chinese language medical literatureretrieval system and databases was performed using established methodology to identifysimilar cases for clinical analysis. Also the clinical characteristics were summarized andtherapeutic strategies were discussed.[Results]The diagnoses of NEC of the4cases were comfirmed by pathological diagnosisand immunohistochemistry, typical carcinoid for one case, atypical carcinoid for threecases. After a close follow-up of12-29months,2case have survived at the time of thiswork and also shown no local recurrence or high potential malignancy transformation,1 case died of distant metastasis, and1case lost follow-up.[Conclusion]1.The NEC originates in the neural crest. The laryngeal NEC is related to cigarettesmoking, with the reason of giving rise to the mutation of p53. The HPV is considered toan important risk factor in laryngeal NEC. The nasal cavity NEC is related to radiation.2.Recently, the NEC is classified as tpyical carcinoid, atpyical carcinoid, small-cellneuroendocrine carcinoma and large-cell neuroendocrine carcinoma.3. In clinically, the NEC of head and neck expresses local symptom and physical sign.The invasiveness of tpyical carcinoid is less obviously, but the other three types have anhigh lymph node metastasis rate and invasiveness.4.The diagnose of the NEC of the head and neck depend on the representation of mitoticfigure and cell necrosis degree in light microscopy pathological, with the assistance of theexpression of the epithelial and neurogenic marker.5.For the middle ear NEC, the treatment is emphasized on the integrality of the excision.The most recommended treatment for the laryngeal NEC is the complete resection withthe neck dissection plus radiotherapy. And suggesting for the nasal cavity NEC is thecomprehensive therapy combinded with surgery, radiotherapy and chemotherapy. Thetpyical carcinoid has an good prognosis. And the prognosis of the other three types arepoor.