case_images: PMC10697695_01
case_images: A) Axial section with level 2A metastasis on the left; B) Expansive, infiltrative, and ulcerated formation, with heterogeneous contrast enhancement, transglottic, affecting the glottic and supraglottic larynx on the left; C and D) Laryngoscopy images evidentiating the left vocal fold presenting vegetative and infiltrative lesion in the vestibular fold that reaches the petiole of the epiglottis. Fixation and immobility of the left vocal fold was observed. The right vocal fold had normal mobility and no mucosal lesion
case_images: 2317-6385-eins-21-eRC0618-gf01.jpg
case_images: PMC10697695_01_2317-6385-eins-21-eRC0618-gf01.jpg
case_images: f1
case_images: Physical examination revealed a lump of level 2 at the left side of his neck (Figures 1A and 1B); laryngoscopy showed a single mass fixing the left vocal cord extending to the vestibular fold with vegetative and infiltrative components (Figures 1C and 1D).
case_images: A) Hematoxylin and Eosin (HE) (larynx): longitudinal section showing the supraglottic neoplasm (the true vocal fold, on the right, is free from involvement). There is a superficial component on the upper left (in situ and invasive SCC) and a predominant component on the right and in the depth (LCNEC); B) Transition of SCC (upper half) and LCNEC (lower half) components; C) HE (larynx): detail of the predominant component (LCNEC), with a neoplastic block in the center showing rosettes and punctate necrosis; D) Immunohistochemistry (larynx): cytokeratin 5/6 confirming squamous differentiation from SCC; E) Immunohistochemistry (larynx): synaptophysin confirming neuroendocrine differentiation from the predominant component (neuroendocrine carcinoma); F) Immunohistochemistry (metastasis): cytokeratin 5/6 positive in the SCC component. Around, negative neoplastic blocks (component of neuroendocrine carcinoma); G) Immunohistochemistry (metastasis): positive synaptophysin in the neuroendocrine carcinoma component. In the center, negative neoplastic blocks (SCC component); H) Immunohistochemistry (larynx): p40 confirming squamous differentiation from SCC; I) HE (metastasis): two components present. In the circle, the squamous component, confirmed by immunohistochemical positivity of cytokeratin 5/6
case_images: 2317-6385-eins-21-eRC0618-gf02.jpg
case_images: PMC10697695_01_2317-6385-eins-21-eRC0618-gf02.jpg
case_images: f2
case_images: These results allowed us to consider a combined carcinoma, with two components: squamous cell carcinoma and predominant large cell neuroendocrine carcinoma (Figure 2).