PMC7580477_01
Clinical picture after extensive locoregional recurrence.
JNMA-58-221-52-g1.jpg
PMC7580477_01_JNMA-58-221-52-g1.jpg
f1
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.
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).
JNMA-58-221-52-g2.jpg
PMC7580477_01_JNMA-58-221-52-g2.jpg
f2
A small focus of squamous cell carcinoma in situ (highlighted by p40 immunostain) was also noted (Figure 2).
Serial whole-body PET-CT scans demonstrating the evolution of disease.
JNMA-58-221-52-g3.jpg
PMC7580477_01_JNMA-58-221-52-g3.jpg
f3
A whole-body PET scan revealed a large volume loco-regional progression of the tumor (Figure 3) without any evidence of distant metastasis.