Prognosis and Predictive factors

Since radiation and chemotherapy are ineffective, surgery is the treatment of choice. The extent of resection should be as conservative as possible, as long as complete removal is achieved. A neck dissection is not warranted. Although the series is small, data indicate that 33% of patients with TCs of the larynx have experienced distant metastases (liver, bones) {648,2419}. At least one patient developed the carcinoid syndrome and another died of disease five years after treatment. While this suggests that TCs of the larynx may be more aggressive than those of the lung, some of these tumours on critical review are probably best classified as atypical carcinoids.

Fig. 3.33 Atypical carcinoid composed of trabeculae and broad sheets of cells. The cells are larger and more pleomorphic than those seen in a typical carcinoid.
Fig. 3.34 Atypical carcinoid. A Same case as shown in Figure 3.33. Higher magnification shows large cells with prominent nucleoli and mitoses. B Tumour cells are strongly positive for calcitonin.

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