A 71-year-old male presents to the ER for an enlarged left neck mass, dysphagia, and weight loss for an “unknown amount of time.” The patient has an extensive smoking history. He states he is homeless and has not been seen for his neck mass by a physician. Below is photograph and a CT scan of his neck. What is the patient’s diagnosis?

The patient’s neck CT shows an extensive large mass in the left neck with prominent lymphoid tissue seen at the base of the tongue and supraglottic airway suggestive of malignancy.

ENT was consulted, who performed a flexible nasopharnygolaryngoscope exam at bedside that revealed bilateral base of tongue fullness with extension into the vallecula and lingual epiglottis. A punch biopsy and FNA were preformed. The biopsy was positive for high-grade neuroendocrine carcinoma with small cell features.

Oncology was consulted, who recommended a CT of the chest, abdomen, and pelvis for staging. Oncology recommended that the patient undergo chemotherapy and radiation treatment, which the patient refused.

Palliative care was consulted, who offered hospice services and assistance from social work. The patient did not show up for his most recent oncology appointment. Due to the aggressive nature of his cancer, his prognosis is poor. ■