Minimally invasive surgery for recurrent neuroendocrine carcinoma of the supraglottic larynx

Abstract

Calcitonin-secreting neuroendocrine carcinomas of the supraglottic larynx are infrequent tumors, making it difficult to agree on treatment plans for recurrent tumors. Furthermore, this rare malignancy is often confused with the more common medullary thyroid carcinoma, resulting in inappropriate thyroidectomies. We present a case report of a calcitonin-secreting recurrent neuroendocrine carcinoma of the supraglottic larynx, in which surgery and pentagastrin stimulation were performed repeatedly at various stages of the disease. The recurrent laryngeal tumor was ultimately identified and, after construction of a protective tracheostomy, resected transorally en bloc with the underlying arytenoid cartilage. Postoperatively, the patient did well and stimulated calcitonin levels never exceeded double baseline values. Laryngoscopic removal of smaller laryngeal carcinomas is both technically feasible and safe, even when tumors are recurrent. In calcitonin-secreting malignancies, pentagastrin stimulation may facilitate the distinction between laryngeal and medullary thyroid carcinoma and thus help avoid unnecessary thyroidectomies.