title: Small cell neuroendocrine tumour of the anterior tongue: A case report.
abstract: BACKGROUND
  Neuroendocrine carcinomas (NECs) are rare in the oral cavity. There is ambiguity regarding the classification of these tumours, but their aggressive nature is recognised throughout the literature. Merkel cell carcinoma (MCC) is rare and more frequent in skin, though it has also been described intra-orally. High grade neuroendocrine tumours (HGNEC) and MCCs behave aggressively and aggressive treatment strategies have been advocated. We describe the first small cell HGNEC on the anterior tongue.
  
  
  METHODS
  We present the first report of a pT1pN1M0 small cell HGNEC in a 75 year old man on the left lateral anterior tongue. This was widely resected with 20mm peripheral and deep margins to achieve disease clearance. Selective neck dissection of levels 1-4 was also carried out.
  
  
  CONCLUSIONS
  Histological analysis of the tumour confirmed a primary poorly differentiated neuroendocrine tumour of small cell type (small cell HGNEC). Resected node bearing tissue from levels 1-4 confirmed metastasis to a level III node with no extra capsular spread giving a pT1pN1M0 classification. Margins of 11.7mm from the invasive tumour to mucosal margin medially and 7.0mm for the deep margin despite surgical 20mm margin resection. To the best of our knowledge small cell neuroendocrine carcinoma has not been described in the anterior tongue.
  
  
  CONCLUSIONS
  The aggressive nature of this tumour type mandates aggressive surgical resection with margins similar to those now recommended for skin Merkel cell carcinomas. We advocate a wide excision margin of 20mm to give adequate clearance, with neck dissection in order to pathologically stage this cancer type.
authors.affiliation: Head & Neck Research, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ, UK. Electronic address: james.cymerman@bthft.nhs.co.uk.
authors.forename: James A
authors.initials: JA
authors.lastname: Cymerman
authors.forename: Raghav
authors.initials: R
authors.lastname: Kulkarni
authors.forename: David
authors.initials: D
authors.lastname: Gouldesbrough
authors.forename: James
authors.initials: J
authors.lastname: McCaul
keywords: Neuroendocrine; Oral cavity; Resection; Small cell; Tongue