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Journal Information
Vol. 67. Issue 4.
Pages e25-e27 (July - August 2016)
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674
Vol. 67. Issue 4.
Pages e25-e27 (July - August 2016)
Case study
DOI: 10.1016/j.otoeng.2016.07.005
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Laryngeal Adenocarcinoma With Metastasis in Penis
Adenocarcinoma de laringe con metástasis en el pene
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674
Francina Aguilara,
Corresponding author
francinaaguilar@hotmail.com

Corresponding author.
, Deysi Barbara Garcíab, Francisco Cregoa, Ángel Serranoc
a Servicio de Otorrinolaringología, Hospital General de Granollers, Granollers, Barcelona, Spain
b Servicio de Radiología, Hospital General de Granollers, Granollers, Barcelona, Spain
c Servicio de Anatomía Patológica, Hospital General de Granollers, Granollers, Barcelona, Spain
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Clinical Case

Patient aged 68, a smoker who presented with a 15-day history of haemoptysis with moderate dysphagia, vesicular voice disorder, weight loss, voiding syndrome and priapism. Examination showed an epiglottis laryngeal side tumour (Fig. 1) with bilateral cervical swollen lymph nodes under 6cm and the cervical and chest CAT scan showed a new nodular formation of 4cm in the epiglottis, with bilateral metastatic swollen lymph nodes (stages IIa, IIb, IIIb and IVa right and stage IIa left). There were no changes in the region of the chest. The biopsy study reported a moderately differentiated infiltrating adenocarcinoma.

Figure 1.

(A) Computed tomography. (B) Macroscopic imaging of the laryngeal tumour.

(0.18MB).

Cystoscopy ruled out any bladder tumours and urological clinical studies suggested a urethral infection with possible involvement of infection and inflammation in the corpus cavernosum penis. An ultrasound study of the penis showed a hypoechogenic focal area of 7mm of the middle margin of the left corpus cavernosum with poor wall markings, swelling and hypoechogenicity of the surrounding tunicas albugineas. Differential diagnosis was suggested as either intracavernosum boil-abscess or metastasis, and fine-needle aspiration was thus performed. When no material was obtained a biopsy was made which reported metastasis from adenocarcinoma with the same morphological and immunohistochemical characteristics as the previously diagnosed laryngeal adenocarcinoma (Fig. 2).

Figure 2.

Microscopic imaging of the laryngeal tumour. (A) Adenocarcinoma of the larynx. (B) Metastasis in corpus cavernosum.

(0.49MB).

A PET-CAT scan showed a hyper-enhanced suprahioid mass in the suprahioid epiglottis with involvement into the pre-epiglottal space and laterocervical bilateral and mediastinal swollen lympth nodes. The lung was observed to have nodes which were slightly hypermetabolic in LUL and RML. Final diagnosis was adenocarcinoma of the epiglottis, T2N2cM1, stage IVC. In mid diagnosis tracheotomy was performed due to dyspnoea. Oncologically this was a widespread disease which required systemic treatment with palliative chemotherapy. The patient died 3 months after diagnosis.

Discussion

Laryngeal adenocarcinoma has an incidence of under 1% of malignant laryngeal neoplasias,1 and usually presents in males who are smokers in their 60s or 70s. Clinical symptoms are identical to other laryngeal tumours (dyspnoea, dysphonia, dysphagia or odynophagia). Regarding Spain, one case in Galicia has been reported in this same journal in 2008.2

This type of tumour is highly aggressive, with a tendency to metastasize both locally and to other parts of the body, as observed in the case we present. 75% of cases begin with lymph node involvement, and 46% with distant metastasis, and for this reason they are usually diagnosed in advanced stages.3 Furthermore, prognosis is worse than squamous cell carcinoma with the same stage and topography.4 Metastasis in corpus cavernosum, which is rare in other tumours,5,6 is the first case reported in a laryngeal tumour and we have found no case similar to ours in the literature.

Adenocarcinoma starts in the minor or serous and mucus salivary glands of the laryngeal submucous.7 Considering this origin, the most extensive review in the literature is that of Bloom et al.8 which distinguishes between 3 histological varieties: non specific adenocarcinoma (45%), cystic adenoid carcinoma (30%) and mucoepidermoid carcinoma (15%). Of all of these, adenocarcinoma is most inclined to metastasize and has the poorest survival rate,9 and its most frequent location is in the supraglottis.

Due to its infrequency, no scientifically endorsed therapy protocol exists and we only have retrospective studies at our disposal. In published cases, it has always been possible to carry out local and regional surgery. Several authors such as Mendelhall et al.10 also propose post-surgical radiotherapy, above all prior to the existence of adverse factors or in the case of regional metastasis in advanced tumours.

Conflicts of Interest

The authors have no conflict of interests to declare.

References
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Papillary adenocarcinoma of the epiglottis.
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[2]
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Adenocarcinoma de laringe: presentación de un caso.
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[3]
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Hybrid carcinoma of the larynx: a case report (adenoid cystic and adenocarcinoma) and review of the literature.
Case Rep Otolaryngol, 2013 (2013),
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[4]
J. Bloom, A.J. Bekar, D. Zikk, E. Shanon.
Adenocarcinoma of the epiglottis. Report of a case and review of the literature.
Arch Otolaryngol Head Neck Surg, 113 (1987), pp. 1330-1333
[5]
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Secondary penile tumours revisited.
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[6]
A. Chaux, M. Amin, A.L. Cubilla, R.H. Young.
Metastasic tumours to the penis: a report of 17 cases and review of the literature.
Int J Surg Pathol, 19 (2011), pp. 597-606
[7]
T. Ebru, Y. Omer, O.P. Fulya, U. Ufuk, K. Kemal.
Primary mucinous adenocarcinoma of the larynx in female patient: a rare entity.
Ann Diagn Pathol, 16 (2012), pp. 402-406
[8]
J. Bloom, A.J. Behar, E. Shanon.
Adenocarcinoma of the epiglottis. Report of a case and review of the literature.
Arch Otolaryngol Head and Neck Surg, 113 (1987), pp. 1330-1333
[9]
K. Mahisteed, J. Ussmuller, L. Donath.
Malignant sialogenic tumours of the larynx.
J Laryngol Otol, 116 (2002), pp. 119-122
[10]
W.M. Mendenhall, C.G. Morris, R.J. Amdur, J.W. Werning, D.B. Villaret.
Radiotherapy alone or combined with surgery for salivary gland carcinoma.
Cancer, 103 (2005), pp. 2544-2550

Please cite this article as: Aguilar F, García DB, Crego F, Serrano Á. Adenocarcinoma de laringe con metástasis en el pene. Acta Otorrinolaringol Esp. 2016;67:e25–e27.

Copyright © 2015. Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello
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