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ISSN: 1734-1922
Archives of Medical Science
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vol. 13
Letter to the Editor

Primary small-cell carcinoma of the palate – the second case report worldwide

Agnieszka Kozak-Rusinek
Radzisław Kordek
Jozef Kozak
Marcin Kozakiewicz

Arch Med Sci 2017; 13, 6: 1504–1506
Online publish date: 2016/08/29
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Extrapulmonary small-cell carcinoma (EPSCC) accounts for 0.1–0.4% of all malignancies and represents 2.5–4% of all cases of small cell carcinoma [1–5].
The most common anatomical sites for EPSCC are gastrointestinal (23–36%), genitourinary (20–28%), head and neck (11–17%), gynecological organs (11%), from unknown primary sites (13–31%), and other sites (4%) [4]. In the head and neck regions, the most common site were the larynx, salivary glands, submandibular region, nasal cavity, paranasal sinuses, pharynx, thyroid gland and tongue [5–11].
The palate location has been described only by Song et al. [1]. To our knowledge this is the second case report of a patient with EPSCC of the palate in the literature.
Excision of the pulmonary primary site is essential for definition of EPSCC. The differentiation between primary and metastatic EPSCC is a clinical challenge. Currently there is no standard guideline for EPSCC treatment because of its rare occurrence and limited experience in its management. We present a case of EPSCC of the palate after pulmonary origin was excluded.
A 51-year-old female patient was admitted to the Department of Maxillofacial Surgery due to a plum-sized, tender tumor of the hard palate fixed to the underlying tissues. A computed tomography (CT) scan examination diagnosed a 3.6 × 2.1 × 1.5 cm mass destroying partially the hard palate of the right maxilla as well as neck lymphadenopathy of both sites. Radiological examination and CT of the chest revealed a small tumor in the left lung, and ultrasonography examination of the abdomen showed no further metastases.
Biopsy of the palate tumor was performed. The pathology report revealed small-cell carcinoma (SCC). Immunohistochemical staining was positive for cluster of differentiation 56 glycoprotein (CD56) as well as EMA, S100, CK AE1/AE3. Ki-67 > 70%. CK20, MART1, p63 and chromogranin A were negative.
The patient underwent maxillectomy with a temporalis myofascial flap (TMF) reconstruction of the palate. Furthermore, selective neck dissection (SND) on the right side was performed.
The postoperative pathology reports were compatible with the biopsy outcome. The SCC was diagnosed and pulmonary origin was suspected (Figure 1). PET-CT revealed a tumor in the left upper lobe of the lung (Figure 2). The patient was transferred to the Department of Thoracic Surgery and Respiratory Rehabilitation, where wedge resection and intraoperative...

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