PMC5436919_01
Photomicrography of the biopsy specimen. A - Extensive areas of necrosis (H&E, 100X); B - Sheets of small cells with high nuclear-cytoplasmic ratio surrounding the vessels (H&E, 400X); C - Positivity immunostaining for CAM 5.2 (400X); D - Focal positivity for synaptophysin (400X).
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The result was inconclusive (esthesioneuroblastoma vs. small cell carcinoma), but another biopsy favored the diagnosis of small cell neuroendocrine carcinoma, confirmed by the immunohistochemical study, which presented diffuse expression of CAM 5.2 and synaptophysin in rare neoplastic cells, in the absence of neuron-specific enolase, chromogranin, and neurofilaments (Figure 1).
Planning CT scan showing the extensive nasopharyngeal lesion extending to the nasal fossae, parapharyngeal space, and pterygoid muscles, with soft palate invasion. A and B - Axial sections; C - Coronal section; D - Sagittal section.
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AUC5 (day 1) and etoposide 100 mg/m2 (days 1, 2, and 3) every 21 days. After the end of the fourth cycle of chemotherapy, the patient underwent a planning CT scan (Figure 2) and started radiotherapy receiving a total dose of 70 Gy to the nasopharynx and 60 Gy to the cervical region.