A case of cervical metastases from temporal bone carcinoid.
BACKGROUND
Carcinoids are neuroendocrine tumors that typically occur in the gastrointestinal tract and lung and less frequently in the head and neck region. Whereas the metastatic potential of laryngeal carcinoid is well documented, only one case of metastasis of temporal bone carcinoid to the cervical lymph nodes has been reported. We present the case of a 55-year-old woman with cervical metastases almost 3 years after a primary diagnosis of temporal bone carcinoid.


METHODS
The patient had undergone a subtotal petrosectomy for a temporal bone carcinoid and, 29 months later, revision surgery for a local recurrence. Four months later, multiple laterocervical swelling appeared, and the patient underwent modified radical neck dissection.


RESULTS
Histologic examination after the neck dissection was suggestive of lymph node metastases from a carcinoid tumor. Immunohistochemical analysis of the lymph node metastases showed neoplastic cells positive for keratin, vimentin, chromogranin, and neuron-specific enolase and negative for thyroglobulin, calcitonin, S-100, and parathyroid hormone. The patient was treated with intensity-modulated radiation therapy and neck irradiation.


CONCLUSIONS
We believe that temporal bone carcinoids have metastatic potential not predictable by histologic features. Surgical excision is the treatment of choice for patients with temporal bone carcinoids, with the approach and technique determined by the extent of the mass. Moreover, before planning surgery and during follow-up, neck node status must be carefully detected.
Pellini
Raul
R
Department of Otolaryngology Head and Neck Surgery, National Cancer Institute "Regina Elena," Via E. Chianesi 53, 00144 Rome, Italy.
Ruggieri
Marzia
M
Pichi
Barbara
B
Covello
Renato
R
Danesi
Giovanni
G
Spriano
Giuseppe
G
D002276:Carcinoid Tumor / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D005260:Female; D006258:Head and Neck Neoplasms / Q000556:secondary* / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D008207:Lymphatic Metastasis; D008875:Middle Aged; D037981:Neck Dissection; D012888:Skull Neoplasms / Q000473:pathology* / Q000601:surgery; D013701:Temporal Bone / Q000473:pathology*; D016896:Treatment Outcome