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PRIMARY COMBINED SMALL CELL CARCINOMA OF THE HYPOPHARYNX

Ana Isabel Gonçalves*, André Carção, Delfim Duarte, Ditza Vilhena

A male in his sixties with a 40-pack-year smoking history presented with a 1 month history of left-sided neck swelling. Upon neck palpation, the existence of a left, hardened, painful and fixed adenopathy was evident occupying lymph node levels II and III. Laryngoscopy identified a large ulcerovegetative lesion centered on the left piriform sinus, extending to the left pharyngoepiglottic and aryepiglottic folds, with normal vocal cord movement. An ultrasoundguided microbiopsy of the adenopathy revealed a metastatic squamous cell carcinoma (SqCC). A biopsy of the hypopharynx lesion was also done, revealing a combined carcinoma, comprising both SqCC and small cell carcinoma (SmCC) components. Computed tomography (CT) showed a heterogeneously enhanced tumor extending through the left piriform sinus. The neck adenopathy sized 65 × 52 mm. There was no evidence of distant metastasis. The final diagnosis was a primary combined SmCC of the hypopharynx cT3N3aM0. The patient was proposed for chemoradiotherapy.