Retromolar Small Cell Neuroendocrine Carcinoma: Case Report

Small cell carcinoma (SmCC) is a poorly diff erentiated neuroendocrine carcinoma that has been reported in several sites throughout the head and neck region, including salivary glands where it is a rare primary tumor accounting for less than 1% of all salivary gland tumors. We report a case of a 55-yearold man with problems consisting of neck pain and diffi cult swallowing induced by a retromolar mass. Physical examination revealed an exophytic infi ltrative process in the right retromolar trigonum, measuring 2 centimeters in diameter. On cut surface the tumor was white and grayish. Microscopically, it was composed of sheets, ribbons and nests of mitotically active tumor cells set within a variably fi brous stroma. Th ere was a positive immunohistochemical reaction for broad spectrum keratin, EMA, synaptophysin and chromogranin. Th e combination of fi ndings was in favor of small cell neuroendocrine carcinoma with the probable origin from a small salivary gland. In the 2005 WHO classifi cation of head and neck tumors, SmCC of salivary glands is defi ned as a rare malignant epithelial tumor. Diff erential diagnosis includes metastatic pulmonary SmCC and cutaneous neuroendocrine carcinoma (Merkel cell carcinoma). Although salivary gland SmCC does not metastasize as frequently as pulmonary SmCC, locoregional metastases are present at diagnosis in as many as 50% of cases. SmCC arising in major or minor salivary glands has a better prognosis than pulmonary SmCC, but in our case the patient survived for just one month after the diagnosis. Th e autopsy confi rmed oropharynx as the primary location of the tumor. Besides multiple liver metastases, there were no signs of tumor anywhere else in the body. MELANOMA METASTASIS TO THYROID FOLLICULAR ADENOMA