T1N0 laryngeal sarcomatoid carcinoma that showed rapid systemic metastases after radical radiotherapy: a case report and review of literature

Confirmed laryngeal sarcomatoid carcinoma after three vocal cord surgeries in a short period of time: A case report and literature review

Sarcomatoid carcinoma is a rare disease, while larynx sarcomatoid carcinoma is a rarer type of cancer characterized by high malignancy and rapid growth. This type of cancer is prone to misdiagnosis and recurrence. The present case study aimed to provide a detailed report on the diagnosis and treatment of a male patient who underwent three tumor resections in the same location of the vocal cords within a short time. Immunohistochemical analysis was not performed after the first two surgeries at other hospitals, thus resulting in an inconclusive diagnosis. Within a short time, it was suspected that the patient experienced local recurrence, thus rapidly leading to the onset of grade III laryngeal obstruction symptoms. During his last visit to the Second Affiliated Hospital of the Army Military Medical University Outpatient Department (Chongqing, China), a biopsy was carried out and tissue samples were collected for immunohistochemical examination. The diagnosis of larynx sarcomatoid carcinoma was therefore verified. Subsequently, partial laryngectomy combined with laryngeal functional reconstruction and left neck lymph node dissection were performed. Post-surgery immunohistochemical analysis also verified larynx sarcomatoid carcinoma. During the 6-month follow-up, there was no evidence of metastasis or recurrence.

[Clinical analysis of 17 cases of sarcomatoid carcinoma of head and neck]

Objective:The aim of this study is to investigate the pathological features, treatment and prognosis of sarcomatoid carcinoma of head and neck. Methods:The clinical data of 17 patients with sarcomatoid carcinoma of the head and neck treated in the First Affiliated Hospital of Zhengzhou University from September 2013 to September 2020 were retrospectively analyzed, and the pathological characteristics, treatment and follow-up were summarized. Kaplan-Meier method was used to calculate the overall survival rate. Results:The histopathological examination of all patients showed the coexistence of cancer components and sarcoma components, and there was a transitional transition area between them. In terms of treatment, 12 of the 17 patients received surgical treatment, and 5 patients received palliative treatment because they could not tolerate surgery or distant metastasis; The cumulative 1-year, 3-year and 5-year survival rates of 17 patients with head and neck sarcomatoid carcinoma calculated by Kaplan-Meier method were 64.7%, 26.5%, and 13.2%, respectively. Conclusion:Pathological examination of head and neck sarcomatoid carcinoma is the gold standard for diagnosis. Radical surgery is the first choice for treatment. It has a high degree of malignancy and poor prognosis. Early diagnosis and radical surgery can improve the survival rate of patients to a certain extent.

Remarkable Response of Toripalimab Combined with Chemotherapy in Sarcomatoid Carcinoma of Palatine Tonsil: A Case Report

Background

Sarcomatoid carcinoma (SaCa) of the palatine tonsil is a rare and aggressive subset of head and neck (H&N) cancer which is characterized by insensitivity to surgery and radiotherapy and a poor prognosis. Immunotherapy has led advances in the treatment of melanoma and H&N cancer, but the combined effects of immunotherapy and chemotherapy have not been sufficiently investigated.

Case Presentation

Herein, we report the case of 29-year-old Chinese women with local advanced non-resectable SaCa of the palatine tonsil who exhibited a substantial partial response to toripalimab and chemotherapy followed by radiation therapy. To the best of our knowledge, this is the first report of its successful application in this context.

Conclusion

Toripalimab combined with chemotherapy may be an effective approach for locally advanced H&N cancer in rare categories of patients, which was the first application as far as we know.

Complete response to radiation therapy for nasopharyngeal sarcomatoid carcinoma

Nasopharyngeal sarcomatoid carcinoma (SaCa) is extremely rare, and concurrent chemoradiation is the standard treatment for squamous cell-based nasopharyngeal cancer (NPC). This case report gives the first explanation of a nasopharyngeal SaCa patient treated with volumetric modulated arc therapy (VMAT) with simultaneous integrated boost (SIB), which is an excellent treatment modality that leads to complete response for locally advanced NPC. A 70-year-old male presented with nasal obstruction, epistaxis, and right neck node enlargements. Examination revealed an extensive tumor of nasopharyngeal tumor extending into the nasal cavity and right parapharyngeal space with bilateral lymphadenopathy on positron emission tomography (PET)-computed tomography images of focal hypermetabolic bone lesion in C4 body (stage T3N2M1). An excisional biopsy of nasopharyngeal wall mass showed a SaCa. He received concurrent chemoradiation which was VMAT and systemic chemotherapy (cisplatin 60 mg). A dose of 70 Gy was delivered to the planning target volume (PTV₇₀) (gross tumor volume plus margin 3-5 mm) and PTV_59.4(a wider margin around high-risk clinical target volume, including the clivus and neck nodes) all given in 33 fractions. Radiological examination such as magnetic resonance imaging (MRI) and PET images at the completion of external beam therapy revealed questionable residual disease. Follow-up MRI scans 4 weeks after radiotherapy revealed a complete tumor response. VMAT with SIB can be an effective treatment option for SaCa of the advanced nasopharynx.

Age Limit and Radiotherapy Option for Sarcomatoid Carcinoma of the Larynx: A Case Report with Literature Review

Sarcomatoid carcinomas, also known as spindle cell carcinomas (SPCCs), are rare carcinomas, predominantly developing in the lung. They have lots of features of sarcoma in their histological features. The standard laryngeal carcinoma classification is based on tumor size, lymph node affection, and metastasis (TNM), it is the classification scheme of the American Joint Committee on Cancer Staging (AJCC), and it is used in the same way for stage spindle cell carcinoma (SPCC). We present a case report of a young female along with a literature review of sarcomatoid carcinoma of the larynx.

True hypopharyngeal carcinosarcoma: a case report and literature review

Objective

Carcinosarcoma consists of carcinomatous and sarcomatous tissues and is an aggressive malignant tumor. It is rarely reported in the hypopharynx.

Methods

A 72-year-old man presented with dysphagia and dyspnea. Laryngoscopy, computed tomography (CT), and ¹⁸F-fluorodeoxyglucose positron emission tomography/CT (¹⁸F-FDG PET/CT) showed a neoplasm on the left posterior hypopharyngeal wall. The patient underwent bilateral neck dissection and excision of the hypopharyngeal cancer followed by postoperative radiation therapy.

Results

Immunohistochemistry revealed carcinomatous cells with membrane positivity for cytokeratin, glucose transporter-1 (GLUT-1), phosphoinositide-3 kinase (PI3K), hypoxia-inducible factor-1α (HIF-1α), and hexokinase-II as well as sarcomatous cells with membrane positivity for smooth muscle actin, GLUT-1, HIF-1α, and PI3K. Histopathology and immunohistochemistry revealed a true carcinosarcoma of the hypopharynx (pT3N0M0, Stage III).

Conclusions

Thorough immunohistochemistry is required for a correct diagnosis of hypopharyngeal carcinosarcoma. ¹⁸F-FDG PET/CT may help to distinguish hypopharyngeal carcinosarcoma from benign tumors.

Spindle cell carcinoma of the head and neck region: treatment and outcomes of 15 patients

Introduction

Spindle cell carcinoma of the head and neck is a rare entity and the evidence of optimal management is lacking. The objective of our study was to report the treatment and outcomes of 15 patients treated in a single institution over a seven year period.

Materials and Methods

A total of 15 patients (12 males and 3 females) with spindle cell carcinoma of the head and neck were treated between July 2007 to June 2014. In six patients the disease developed after previous radiotherapy. Of the 15 patients, five patients had their primary in the tongue, four in the paranasal sinuses, two in the hypopharynx, two in the vocal cords, and one each in the soft palate and the floor of mouth. Eleven patients were treated with radical intent (seven patients required surgery only and four were treated with combined modality). The remaining four patients were treated with palliative intent.

Results

Among 11 patients treated with radical intent eight are alive or died of non-oncological causes. The disease recurred locally in three patients and they died of the disease (two patients with locally advanced disease in the tongue and one patient with T1N0 tumour in the hypopharynx). Median overall survival (OS) was 18 months.

Conclusion

Surgery or surgery combined with radiotherapy has a real impact on the natural cause of spindle cell carcinoma of the head and neck region. Even locally advanced tumours can be controlled with aggressive treatment. The worst outcome is seen with the tongue as the primary site because of a high local recurrence rate.

[Spindle Cell Carcinoma of the Head and Neck: A Report of 6 Cases]

Spindle cell carcinoma of the head and neck is a rare neoplasm. We at Kyushu Cancer Center experienced 6 cases of spindle cell carcinoma which accounted for 0.9% of all cases of head and neck squamous cell carcinoma. These cases presented with the characteristic clinical presentation, such as a particular form (polypoid and exophytic) and difficulty of pathological diagnosis. For treatment, surgery was performed in the main, but in one case of hypopharyngeal cancer chemoradiotherapy was undertaken. Spindle cell carcinoma exhibits a poor prognosis, compared with the other squamous cell carcinomas. However for the moment, 4 of 6 cases are surviving, and disease free. We will require long-term monitoring of these cases.

Spindle cell carcinoma of the tongue: a rare tumor in an unusual location

Spindle cell carcinoma is a rare biphasic tumor consisting of epithelial and mesenchymal components. Presence of this tumor type in the tongue has rarely been reported. Herein, a case of 55-year-old woman who presented with a polypoid lesion at her tongue has been reported. Surgery was performed and pathologic examination revealed a spindle cell carcinoma. We present this rare tumor with an unusual location to contribute in part to the better understanding and awareness of this rare malignancy.