case_images: PMC7580477_01
case_images: Clinical picture after extensive locoregional recurrence.
case_images: JNMA-58-221-52-g1.jpg
case_images: PMC7580477_01_JNMA-58-221-52-g1.jpg
case_images: f1
case_images: After a 2-month disease-free interval, he developed rapidly enlarging bilateral neck swellings along with progressive hoarseness and respiratory distress (Figure 1), for which he underwent an emergency tracheostomy.
case_images: Photomicrograph showing subepithelial nests of tumor cells with features of small cell carcinoma (a, H&E, x100). Tumor cells have scant cytoplasm and hyperchromatic nuclei with prominent nuclear moulding and crush artefact (b, H&E, x400). Overlying squamous epithelium displaying full thickness dysplasia (carcinoma in situ) (c, H&E, x200). Small cell component is immunopositive for synaptophysin (d) and TTF-1 (e), while squamous component is immunopositive for p40 (f) (IHC, x400).
case_images: JNMA-58-221-52-g2.jpg
case_images: PMC7580477_01_JNMA-58-221-52-g2.jpg
case_images: f2
case_images: A small focus of squamous cell carcinoma in situ (highlighted by p40 immunostain) was also noted (Figure 2).
case_images: Serial whole-body PET-CT scans demonstrating the evolution of disease.
case_images: JNMA-58-221-52-g3.jpg
case_images: PMC7580477_01_JNMA-58-221-52-g3.jpg
case_images: f3
case_images: A whole-body PET scan revealed a large volume loco-regional progression of the tumor (Figure 3) without any evidence of distant metastasis.