Sarcomas of the head and neck

Leiomyosarcoma of the jaw: case series

Objectives

Leiomyosarcoma is a malignant neoplasm that affects smooth muscle tissue and it is very rare in the field of oral and maxillofcial surgery. The purpose of this study was to obtain information on diagnosis of and treatment methods for leiomyosarcoma by retrospectively reviewing of the cases.

Patients and Methods

The study included nine patients who were diagnosed with leiomyosarcoma in the Department of Oral and Maxillofacial Surgery at Seoul National University Dental Hospital. The subjects were analyzed with respect to sex, age, clinical features, primary site of disease, treatment method, recurrence, and metastasis.

Results

Particular clinical features included pain, edema, mouth-opening limitations, dysesthesia, and enlarged lymph nodes. All cases except one were surgically treated, and recurrence was found in two cases. Four of nine patients were followed up without recurrence and one patient underwent additional surgery due to recurrence.

Conclusion

In our case series, notable symptoms included pain, edema, mouth-opening limitations, and dysesthesia; however, it was difficult to label these as specific symptoms of leiomyosarcoma. Considering the aggressive characteristics of the disease and poor prognosis, surgical treatment is necessary with careful consideration of postoperative radiotherapy and chemotherapy.

Distant metastasis from oral cavity-correlation between histopathology results and primary site

OBJECTIVES

Oral cancer is the eighth most common type of cancer worldwide and a significant contributor to the global burden caused by this disease. The principal parameters considered to influence prognosis, and thus treatment selection, are size and location of the primary tumor, as well as assessment of the presence and extent of lymph node and distant metastasis (DM). However, no known report regarding the relationship between the primary site and DM has been presented. For effective treatment selection and good prognosis, the correlation of DM with anatomic site and histopathology results of the primary malignancy is important. In the present study, we performed a systematic review of published reports in an effort to determine the relationship between the anatomic site of various types of oral cavity cancer and DM.

METHODS

A systematic review of articles published until the end of 2018 was performed using PubMed/MEDLINE.

RESULTS

A total of 150 studies were selected for this review. The percentage of all cases reported with DM was 6.3%, ranging from 0.6% to 33.1% in the individual studies. The rate of incidence of tongue occurrence was 9.3%. A frequent DM site was the lungs, with adenoid cystic carcinoma the most commonly involved histopathological factor. Malignant melanoma was most frequent (43.4%) in all histopathology findings, whereas there were no cases with an acinic cell carcinoma or cystadenocarcinoma.

CONCLUSIONS

We found that the occurrence of DM from the primary site as well as rate of incidence was dependent on histopathological factors.

Malignant maxillofacial bone tumors

PURPOSE OF REVIEW

Malignant bone tumors of the head and neck region are rare. Due to the paucity of studies on these tumors, patients with these maxillofacial malignancies can suffer from high morbidity and mortality.

RECENT FINDINGS

Currently, mainstay management of these tumors includes wide surgical resection with margins followed by radiotherapy and/or adjuvant chemotherapy. Although much progress has been made over the last few decades regarding the prognosis of many of these tumors, large multicenter trials are needed to better determine their optimal management.

SUMMARY

The current review will provide a broad review of the most current epidemiology, pathogenesis, prognosis, and management of the most common bone malignancies of the maxillofacial skeleton.

Chondrosarcoma of the jaw bones: a review of 224 cases reported to date and an analysis of prognostic factors

The objective was to integrate the available published data on chondrosarcoma (CHS) of the jaw bones into a comprehensive analysis of its clinical and histological features, treatment, and prognostic factors. An electronic search was undertaken in October 2017. To be eligible, the publication had to provide sufficient clinical/histological data to confirm the diagnosis. One hundred and ten publications (224 cases of CHS) were identified and included. There was a slightly higher prevalence of CHS in males than in females. Most subjects with CHS were in the second to fifth decades of life. The most common symptom was swelling and the most commonly observed location was the maxilla. Histologically, most tumours were of the conventional type and were low grade tumours. The treatment of choice was tumour resection. Histological grade, treatment with chemotherapy alone, and the presentation of recurrence or metastasis were found to be significant independent prognostic factors: patients who presented high-grade tumours, who received chemotherapy alone as the treatment of choice, and those who presented recurrence or metastasis were more likely to have a worse prognosis. In addition, radical surgery associated with radiotherapy as the treatment protocol showed a better prognosis.

Leiomyosarcoma in the mandible: A rare case report

Leiomyosarcoma (LMS) is a malignancy which very rarely occurs in maxillofacial location, and the course of the disease is not very characteristic.In this case report, we present a 58-year-old female patient with a painless tumor of the left angle of the mandible causing slight asymmetry of the face. She also reported that she observed deterioration in fitting of the lower denture in the oral cavity for several months, which she had used successfully for 5 years.On the basis of clinical tests, histopatological examination, and imaging (CT, MRI, ultrasound, pantomography), the patient was diagnosed with primary malignant leiomyosarcoma (LMS) of the mandibular corpus and ramus on the left side. The patient received combined surgical and oncological treatment. The first stage was a surgery, and then adjuvant radiotherapy was applied on the site of the resected tumor-a total dose of 60 Gy in 35 fractions. The patient's postoperative course was uneventful. She also underwent adjuvant therapy well. In the period of 3-year follow-up, no signs of recurrence were observed.The findings may extend our knowledge and experiences in the treatment of leiomvosarcoma in the craniofacial area.

Primary oral leiomyosarcoma: a retrospective clinical analysis of 20 cases

PURPOSE

As a review and clinical analysis of primary oral leiomyosarcoma (LMS) cases in West China stomatology Hospital in the past 37 years, this study provides demographic, therapeutic and prognostic information of this rare tumor.

PATIENTS AND METHODS

In our study, 20 cases of primary oral LMS treated between 1972 and 2008 in West China Stomatology Hospital were analyzed retrospectively. A thorough review of clinical records was carried out and potential indicators of survival were analyzed.

RESULTS

The most common symptom of oral LMS presented as a painless mass. The median age of patients was 37 years, and the peak incidence age of this tumor was in the 2nd and 5th decades. There was no predilection of gender, and the male-to-female ratio was 11:9. The most frequently occurring site of oral leiomysarcoma was the jawbones. The prognosis of this tumor was poor as a result of the high local recurrence and the estimated 2 year survival was 17.6%. The bony involvement and method of therapy was observed to have an influence on the prognosis and survival of this tumor (P < 0.05).

CONCLUSION

There was a predilection site of jawbones for oral LMS, and bony involvement was a potential indicator suggesting a poorer prognosis. The recommended method of therapy on this tumor was aggressive, radical surgical resection; however, adjuvant radiotherapy and chemotherapy may also have a beneficial effect.

Primary oral leiomyosarcoma: a clinico-pathologic study and analysis of prognostic factors

This clinico-pathologic study of primary oral leiomyosarcomas and analysis of potential prognostic factors involved a literature review of 64 cases and a report of four cases treated in the authors' unit. The demographic details, clinical presentation, diagnosis, treatment and outcome were documented for the whole group and clinico-pathologic variables analysed to detect potential prognostic factors. The most common presentation was that of a painless mass, with peak incidence in the 6th decade and a slight male predeliction (M:F=1.3:1). The maxilla was the most frequently involved site, followed by the mandible and tongue. Surgical excision was most commonly employed with radiotherapy and chemotherapy being reserved for recurrent and metastatic tumours. Local recurrence (34%) and metastasis (35%) were not uncommon and occurred most frequently to the lungs and regional lymph nodes (15%). Age, sex, size and mitotic index were not statistically related to recurrence or metastasis. Site (P=0.0125) was a predictor of metastasis. Metastasis (P=0.010) and lesions involving the maxilla and mandible (P=0.019) were associated with decreased survival. The estimated 5 year survival was 55% for the whole group and 43% and 19% for patients with bony involvement and metastasis respectively.

Leiomyosarcomas of the oral tissues: clinicopathologic analysis of 50 cases

PURPOSE

Primary oral leiomyosarcomas are rare tumors. Information regarding the biological behavior, prognosis, and appropriate management of this neoplasm is lacking in the literature. The purpose of this report was to summarize the data of isolated case reports of primary oral leiomyosarcoma that have been published in the English literature during the past 25 years. The cases of 4 additional new patients who have been treated in our department during the past 10 years are also presented.

PATIENTS AND METHODS

The data for 46 patients obtained from 32 individual articles retrieved from the English literature were added to our 4 cases and produced a total number of 50 cases of primary leiomyosarcomas of the oral tissues. Patients were analyzed according to demographic data, anatomic location, type of treatment, and survival.

RESULTS

Primary oral leiomyosarcoma may affect any age with peaks of occurrence in the third, sixth, and seventh decades of life. There is no gender predilection. Female patients presented the higher incidence in the third decade, whereas males had an even age distribution. The tumor arises in approximately 70% of the cases in the maxillary and mandibular bones. Radical surgery was the treatment of choice. Radiotherapy and chemotherapy when applied in recurrent tumors had little effect. The most adverse prognostic factor was the positive surgical margins. The 5-year survival was 62% (62.9% for females and 52.6% for males, P > .1968).

CONCLUSIONS

Cases of oral leiomyosarcoma appear to be associated with major neurovascular structures of the facial skeleton, as evidenced from the imaging studies of our 4 patients. Primary oral leiomyosarcoma is a rare tumor that should be managed with aggressive surgical resection in order to safeguard curability. Histopathologic diagnosis is greatly facilitated with positive immunohistochemical staining for smooth muscle antigenic markers.

Soft tissue sarcomas of the head and neck: a single-centre experience

OBJECTIVE

The aim of this study was to report our experience with malignant and borderline soft tissue tumours (STS) of the head and neck region in the period 1977-2000.

DESIGN

Retrospective case study including new evaluation of histological specimens.

SETTING

Tertiary centre, single centre.

PARTICIPANTS

Review of patient's records and new evaluation of pathological specimens were made for 66 patients. After evaluation only 36 patients (26 men and 10 women) still met present criteria for a STS in head and neck in adults.

RESULTS

The original histological diagnosis was changed in 27 (41%) of the 66 patients with a primary diagnosis of sarcoma. After review the most common histological diagnoses were leiomyosarcoma (5) and rhabdomyosarcoma (5). Overall 5-year survival rate was 60%. Overall 5-year disease-free survival rate was 44%. The study showed that both tumour grade and surgical margin had a statistically significant impact on survival. No relation was found between survival and tumour size or age.

CONCLUSION

The grave prognosis especially for high-grade tumours emphasizes the need for improved treatment strategies. Furthermore, conclusions from older studies concerning prognosis may be obsolete as approximately 40% of tumours previously diagnosed as sarcomas may be invalid by present day standards.

Leiomyosarcomas of the oral cavity: an unusual topographic subset easily mistaken for nonmesenchymal tumours

AIMS

Oral leiomyosarcoma is rare and poorly documented. We aimed to characterize these lesions clinicopathologically in order to facilitate their distinction from other spindle cell neoplasms in the oral cavity.

METHODS AND RESULTS

Ten cases of oral leiomyosarcoma were retrieved and studied histologically and immunohistochemically. Clinical data were obtained from referring pathologists and prior literature concerning 46 comparable cases was reviewed. Nine out of 10 cases occurred in adults; 50% arose in the jaws and four showed bone involvement. Histological appearances were similar to leiomyosarcomas elsewhere. In addition to myogenic markers, two cases were also keratin-positive. Four patients developed local recurrence or metastatic disease and three died of tumour (median follow-up 37 months).

CONCLUSIONS

Leiomyosarcoma is under-recognized in the mouth, often being mistaken for a spindle-celled epithelial neoplasm. Aside from an unusual but infrequent tendency to spread to lymph nodes and a location-specific differential diagnosis, its clinicopathological features are comparable to leiomyosarcomas at other locations.

Salivary gland tumours treated in the stomatological clinics in Bratislava

During the period of 1951-1996 a group of 1021 patients (484 men and 537 women, mean age 53 years, range 2-87 years) with salivary gland tumours were analysed retrospectively. The mean follow-up period was 8 years (range 10 months-25 years). The frequency of benign tumours was 74% (n = 755) and malignant tumours 26% (n = 266). Lesions were sited in the parotid gland 83% (n = 847), in the submandibular gland 10.8% (n = 110), in the sublingual gland 3.2% (n = 33) and in the minor salivary glands 3% (n = 31). The most common benign tumours were pleomorphic adenoma in 53.9% (n = 550) and Warthin's tumour 9.7% (n = 99). Of the malignancies, the adenoid cystic carcinoma was most common (6.4% of cases, n = 65) and mucoepidermoid carcinoma occurred in 5.2% (n = 53). The predominant therapy was surgery alone or in combination with postoperative radiotherapy in 93.7% (957 cases), radiotherapy alone after fine needle aspiration biopsy for 4.7%, and 19 patients remained untreated.

A re-evaluation of imaging criteria to assess aggressive masticator space tumors

PURPOSE

To evaluate the correlation between the gross imaging evidence of an aggressive masticator space (MS) tumor and the presence of such a MS malignancy.

MATERIALS AND METHODS

Thirty patients were identified retrospectively who had a malignancy that either arose in or metastasized to the MS, had pathologic verification of the diagnosis, and had magnetic resonance (MR) and/or computed tomographic (CT) images. Specifically evaluated was the presence or absence of gross imaging evidence of mandibular erosion and the integrity of the medial MS fascia as evaluated by a smooth margin between this fascia and the parapharyngeal space fat.

RESULTS

Of the 30 tumors, 28 were high-grade malignancies and 2 were histiocytoses. Of these, 5 had mandibular erosion and violation of the MS fascia, 19 had bone erosion with an intact fascia, 4 had neither bone erosion nor fascial violation (3 of these patients were under the age of 20 years), and 2 had fascial violation with no bone erosion.

CONCLUSIONS

In 76.7% of patients with a malignancy arising in the MS, on imaging the medial MS fascia was grossly intact. There were 4 patients with MS malignancy and neither violation of the medial MS fascia nor mandibular bone erosion. Thus, these imaging findings may not be good criteria to evaluate the presence of a high-grade MS malignancy, especially if the patient is under the age of 20 years, in which age group MS sarcomas are more likely to arise.

Primary leiomyosarcoma of the maxilla with regional lymph node metastasis. Report of a case and review of the literature

A rare case of oral leiomyosarcoma diagnosed with the aid of immunohistochemical and electron microscopic examinations together with a review of the literature are reported. The patient was a 70-year-old Japanese man. The primary tumor involved the maxillary gingiva and bone and metastasized to the cervical lymph nodes. On histologic examination the tumor showed invasive growth into the maxillary bone. It was composed of interlacing fascicles of spindle-shaped cells with eosinophilic cytoplasm and elongated, blunt-ended nuclei. The tumor formed extensive metastatic foci in the cervical lymph nodes. On immunohistochemical examination most of the tumor cells were positive for desmin, smooth muscle-specific actin, and myosin. The ultrastructural characteristics of the tumor cells were abundant microfilaments, pinocytotic vesicles, and basement membrane formation. The findings were indicative of a tumor demonstrating myogenic differentiation. A review of the literature during the past 50 years disclosed a total of 60 oral leiomyosarcomas, including our case.

Prognostic factors in head and neck soft tissue sarcomas: analysis of 128 cases

Soft tissue sarcomas make up a heterogenous group of rare malignant tumors originating from mesodermal tissues. Although there have been several improvements in diagnostic methods, staging, and treatment over the past few years, the prognosis of head and neck sarcomas remains worse than those sited at the trunk or extremities. The purpose of this retrospective study was to report the survival results of 128 consecutive patients with soft tissue sarcomas of the head and neck treated from 1953 to 1985. Of the 93 patients submitted to surgical resection, the procedure was considered radical in 67 patients. Of the operated group, 46 patients (49.5%) developed recurrence of disease. Thirty-two patients underwent further treatment (surgery, radiotherapy, or chemotherapy), and 14 patients were salvaged, giving the ultimate result of 65.6% disease control rate in the operated group. The univariate survival analysis showed no statistical difference (P > 0.05) according to age, race, sex, and site or histologic type of the tumor. Radicality of surgery was an important prognostic factor affecting survival (P = 0.0014 for disease-free interval and P = 0.0183 for overall survival). The multivariate analysis showed that the radicality of surgery and tumor histology were independent prognostic factors affecting recurrence. The same variables and age group were related to the risk of death. Every effort must be made to make an early diagnosis and a radical surgical resection of these tumors must be tried (except for embryonal rhabdomyosarcoma), because it offers the best chance for cure.

Leiomyosarcomas of the oral cavity. Report of four cases and review of the literature

Leiomyosarcomas (LMS) make up 7% of all soft tissue sarcomas. In the oral cavity, the LMS is rare due to the paucity of smooth muscle in that region. Four cases of intraoral LMS are reported, plus 34 cases found in the literature reviewed. There were 24 males and 14 females. The age range at presentation was 10 months to 88 years with no predilection for any particular age group. The commonest presenting symptom was a mass. The intraoral LMS occurred most commonly in the jaws (59% of cases). The mass was painful in 61% of cases. Follow-up of the case reports was assessed. Recurrence occurred in 36% of cases. Distant metastases occurred in 39% of cases, most commonly to the lungs. Cervical nodal metastasis was reported in 15% of cases. The 5-year survival rate determined on cases with adequate follow-up (n = 13) was 23% free of disease, 8% alive with disease and 69% who died of disease. In comparison with stage I and stage II tongue squamous cell carcinomas, the intraoral LMS is very aggressive. It is best treated surgically, early and aggressively.