Soft tissue sarcomas of the head and neck: an update

Undifferentiated chondrosarcoma of extraskeletal supraclavicular localization

We reported a rare extraskeletal localization of undifferentiated chondroscarcoma in a 71-year old patient. The neoplasm with a 20-year history in the left supraclavicular region exhibited a rapid growth in only a few months. Six months after a total tumor excision the patient has been in an excellent general health condition, with no signs of either a local relapse or distant metastases.

Myofibroblastoma of the larynx: a study of two cases

BACKGROUND

We describe, for the first time, the occurrence of two pure examples of spindle cell neoplasm with fibrous and smooth muscle differentiation in the larynx.

MATERIALS AND METHOD

Tissue sections from both tumors stained with hematoxylin and eosin were reviewed. Immunophenotypic analysis using keratin, S-100 protein, SMA, and h-Caldesmon markers was performed.

RESULTS

Tumors were seen as raised submucosal nodules in the glottic region of two elderly male patients. Histopathologically, the lesions were unencapsulated and composed of spindle cells that manifested variable cellular anaplasia and expressed SMA and were negative for keratin, S-100, and h-Caldesmon.

CONCLUSIONS

We document histologically low-grade malignant myofibroblastic tumors of the larynx. Complete excision is advised.

Locoregional treatment for adult soft tissue sarcomas of the head and neck: an institutional review

PURPOSE

The purpose of this study was to review treatment results for primary soft tissue sarcomas of the head and neck in order to determine prognostic factors.

PATIENTS AND METHODS

From 1970 to 2000, 44 adult patients were diagnosed with a biopsy-proven, nonmetastatic primary soft tissue sarcoma in a head and neck subsite; were treated with curative intent; and had adequate follow-up and records for our review. Patients with extraosseous Ewing's sarcoma, Kaposi's sarcoma, rhabdomyosarcoma, dermatofibrosarcoma protuberans, and desmoid tumor were excluded. The most common tumor histologies included malignant fibrous histiocytoma (15 patients), angiosarcoma (nine patients), fibrosarcoma (six patients), and leiomyosarcoma (six patients).

RESULTS

The median overall survival for all patients was 79 months. The actuarial 5-year local control for all patients was 55% and was highly correlated with the extent of surgical excision: 25% for subtotal resection/debulking, 65% for wide local excision, and 100% for radical excision. Local control at 5 years was 60% for patients treated with both surgery and radiotherapy, 54% for those treated with surgery alone, and 43% for those treated with radiotherapy alone. Adjuvant radiotherapy significantly improved the local control rates (from 25% to 54%) for patients with close (<2 mm) or positive surgical margins. Of 14 patients with locoregional failure in whom salvage was attempted, nine (64%) were rendered disease free.

CONCLUSIONS

Multimodality therapy with both surgery and radiotherapy improves local control, particularly in patients with close or positive surgical margins. Aggressive attempts at salvage therapy for locoregional failures are warranted and frequently produce long-term disease control.