PMC5540251_01
Fiberscopic view of the hypopharynx filled with a large soft tissue mass in the right pyriform sinus (arrow).
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fig1
Laryngoscopy revealed a large tumor in the right pyriform sinus (Figure 1).
Histopathological and immunohistochemical features of the combined SmCC and SCC of the hypopharynx. (a) This tumor consists of a mixture of SmCC (center, arrow) and SCC (peripheral) (hematoxylin-eosin, original magnification 400x). (b) The p63 reactivity is seen in the nuclei of the cells of SCC but is not seen in SmCC component. (c) The CD56 reactivity in SmCC component is seen but is not seen in SCC component. (d) Chromogranin A shows positive cytoplasmic staining in SmCC component.
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fig2
A biopsy of the tumor showed features of neuroendocrine tumor suggesting SmCC and additional component of squamous cell carcinoma (SCC) (Figure 2).
PMC5540251_02
Fiberscopic view of the hypopharynx filled with a large soft tissue mass with necrotic appearance (arrow).
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fig3
Fiberscopic examination revealed a large mass arising from the hypopharynx with normal vocal cord movement (Figure 3).
Preoperative cross-sectional MRI of the neck. (a) An enhanced sagittal image shows the tumor extending to the cervical esophagus (arrow). (b) An enhanced coronal image shows the large tumor completely occupying the hypopharyngeal space (black arrow). Note multiple lymph node metastases in the right neck (white arrows).
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fig4
Magnetic resonance imaging (MRI) studies with intravenous contrast revealed that the tumor occupying the right pyriform sinus extended to the cervical esophagus with the right cervical lymph node metastases (Figure 4). 18F-FDG-PET analysis indicated a positive accumulation in the hypopharynx and the right neck and no evidence of pulmonary primary or distant metastases.
Histopathological and immunohistochemical features of the combined SmCC and SCC of the hypopharynx. (a) SmCC component coexisting with SCC component accompanying keratinization (arrow) (hematoxylin-eosin, original magnification 200x). (b) The CD56 reactivity in SmCC component is seen but is not seen in SCC component. (c) The p63 reactivity is seen in the nuclei of the cells of SCC but is not seen in SmCC component. (d) Synaptophysin shows positive cytoplasmic staining in SmCC component.
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fig5
TTF-1 were negative. The staining patterns of immunohistochemical study allow confirmation of combined small cell neuroendocrine differentiation and SCC in this tumor (Figure 5).