Soft tissue sarcomas of the head and neck: an update

An extremely scarce incidence of primary Undifferentiated Pleomorphic Sarcoma of the Scalp of a 52-year-old female - A Case Report

Introduction and importance

Sarcomas are malignant mesenchymal-cell tumors that comprise 1 % of all adult tumors. Undifferentiated Pleomorphic Sarcoma comprises a vastly rare subtype. It mostly occurs in males in their 6th decade of life. However, their exact incidence remains poorly demarcated, especially those occurring in the scalp. Since they lack any disease-specific presentations, we should maintain high clinical suspicion when presented with similar cases.

Case presentation

Herein, we demonstrate the clinical case of a 52-year-old Middle Eastern female, who presented to the outpatient clinic complaining of a one-year history of progressively growing protuberance in her right side of the scalp. It was painful and rapidly increased in size. Presurgical radiological assessment suspected a cystic formation. Utter resection of the mass was achieved, and histopathological analysis diagnosed it as a primary Undifferentiated Pleomorphic Sarcoma.

Clinical discussion

Meticulous surgical resection was the cornerstone treatment of our patient. Radiological imaging in addition to clinical suspicion was utilized for preoperative assessment. This patient has had a successful post-surgical recovery. She has been surveilled for 6 months so far with no evidence of tumor recurrence, metastasis, or clinical complications.

Conclusion

It is especially rare to see a primary Undifferentiated Pleomorphic Sarcoma in any patient population. It's even rarer that it occurs in such a patient demographic. Hence, it's vital that we document cases of this rare malignancy because that would lead the way in conducting informative clinical studies which enable physicians to select the proper treatment modality.

•

Sarcomas are malignant mesenchymal-cell tumors that comprise 1 % of all adult tumors.

•

Undifferentiated Pleomorphic Sarcoma comprises a rare subtype. It mostly occurs in males in their 6th decade.

•

UPS showed higher tendencies to occur in males rather than females and favored the White rather than African race.

•

To establish a final diagnosis relies on competent histopathological and immunohistochemical analysis.

•

The ideal management of UPS occurring in the head and neck is utter surgical resection with free margins of 2 cm.

Angiosarcomas of the head and neck: Impact of large data analysis on clinical management

Angiosarcoma is a rare but often fatal malignancy from blood and lymphatic vessels that can arise anywhere in the body and often affects the head and neck region. Although its dismal prognosis is predominantly explained by its aggressive biology, several secondary factors contribute to poor outcomes. These include a phenotypic resemblance to innocuous blood vessel lesions, which contributes to a significant degree of late diagnosis. Another important factor is the rarity of angiosarcoma, which has impaired scientific determination of its optimal treatment significantly. As a result, treatment of angiosarcomas has largely been guided by information derived from the study of sarcomas at large, themselves a highly heterogeneous group of mesenchymal cancers both from a diagnostic as well as therapeutical perspective. The Digital Revolution and resultant Information Age promise to focus the clinical management of rare cancers from a generic to a more customized approach. In this paper, we review the current understanding of head and neck angiosarcomas within the context of this process.

An Aggressive growth of cranial sarcoma

Sarcomas are a group of rare malignant tumours of the connective tissues. They can occur in almost any location, but more frequently in the extremities. The occurrence of sarcomas in the head and neck region is less than 1%. We are presenting a case report of a very large cranial sarcoma. Gross total tumour excision was done with pedicle skin graft and titanium mesh cranioplasty. The excised tumour weighed approximately 1.1 kg. Histopathological examination showed primitive intermediate-sized tumour cells arranged in sheets, nests and cords with focal palisading. Postoperative MRI done 2 weeks post surgery showed no evidence of residual tumour.

Primary Sarcoma of the Head and Neck: Three Years’ Experience in a Tertiary Care Cancer Center

Introduction Sarcomas are a heterogeneous group of malignancies originating from the transformed cells of mesenchymal lineage, representing only 1% of all the primary tumors arising within the head and neck region with a prevalence range of 4 to 10%. They are biologically different from the sarcomas of other sites because of the smaller size of the tumor at the time of presentation and higher chances of local recurrences. Due to the rarity in adults, there are very few studies on sarcomas of the head and neck. The aim of this study was to analyze the frequency and spectrum of primary sarcomas in the head and neck region.

Materials and Methods This is a retrospective descriptive study. The authors analyzed 40 cases of histologically and immunohistochemically proven primary sarcomas arising in the head and neck region according to three age groups, pediatric (<12 years), adolescent (12–19 years), and adults (> 19 years).

Results Primary sarcomas represented 0.06% and 2.4% of total cancer cases and total sarcoma cases, respectively. Embryonal rhabdomyosarcoma was the most common histologic type, and nasopharynx the most common location in the pediatric population. Osteoblastic osteosarcomas and Ewing’s sarcoma were typical variants in adolescent age, affecting the hemimandible predominantly. In adults, osteosarcomas were commonest followed by conventional grade 1 chondrosarcoma. Treatment was planned according to the stage and grade of the tumor. Out of the 40 patients, 19 (47.5%) had a disease relapse within a period of 6 months from the completion of therapy.

Conclusion Head and neck sarcomas are notorious to recur. A timely and accurate diagnosis, proper staging, and multidisciplinary treatment plan can yield good patient outcomes.

Sarcomas of the Larynx: One Institution's Experience and Treatment Protocol Analyses

Soft tissue sarcomas in the head and neck are rare malignancies. They occur in this area in less than 1% of all malignant tumors. Some authors have described the development of sarcoma from the mesenchymal tissue in the larynx. The histological diagnosis of a sarcoma depends on the immunohistochemical investigation. In particularly difficult diagnoses, electron microscopy has to be used. The treatment recommendation depends on the histological type of sarcoma. We analysed and summarized data on the diagnostic criteria and therapy for sarcoma of the larynx presented in the literature. We present three new cases of laryngeal sarcoma and describe the analyses of the published diagnostic and treatment schedules of laryngeal sarcomas. We developed a treatment protocol recommendation for laryngeal sarcoma based on an analysis of literature data and case reports. This recommendation is based on histological type, staging, grading, size, and survival data.

Regional Lymph Node Metastasis of Scalp Angiosarcoma: A Detailed Clinical Observation Study of 40 Cases

BACKGROUND

The incidence of lymph node metastasis (LNM) of angiosarcomas is reported to be less than 15%, and elective neck management has not been indicated. This study evaluated the incidence and pattern of regional LNM in patients with scalp angiosarcomas using the clinical data of its full course to understand time-event sequences of scalp angiosarcomas.

METHODS

This retrospective study included all consecutive cases of pathology-confirmed angiosarcomas and analyzed 40 cases of scalp angiosarcomas. The survival plots were estimated using the Kaplan-Meier method, and the results are presented mainly in a descriptive manner.

RESULTS

The overall survival rate for the patients was 35.8% at 2 years. In contrast to previous reports, regional LNM was observed in more than half of the patients (52.5%) with scalp angiosarcoma. Meanwhile, a direct spread to distant organs occurred in only 27.5% of the patients. Regional LNM could predict clinical manifestation of systemic disease within 3 to 6 months. No differences in survival rates between patients with and without LNM were observed in this series. Occurrence of LNM seemed to be correlated with a high mitotic rate of primary tumors, but not with tumor grade or tumor dimension. The first-echelon lymph nodes from scalp angiosarcoma were peri-parotid, post-auricular, and level 2 lymph nodes.

CONCLUSIONS

For a localized scalp angiosarcoma, it seems reasonable for initial curative surgery to include prophylactic evaluation of regional lymph nodes for pathologic nodal staging, prognosis estimation, and the decision for systemic treatments.

Head and Neck Tumors: Management of Primary Undifferentiated Pleomorphic Sarcoma

INTRODUCTION

Sarcomas account for 1% of all tumors originated in the head and neck regions in adults. They constitute a heterogeneous group of tumors of mesenchymal origin with multiple histological variants. The undifferentiated pleomorphic sarcoma (UPS) subtype is the most frequent variant with an incidence range of 2.7-38%.

MATERIALS AND METHODS

This retrospective case series was conducted on 11 patients who were diagnosed with UPS and treated in our institution in the last 11 years.

RESULTS

According to the results, 26.8% of the sarcomas corresponded to UPS variant. Out of 11 patients, 5 cases were female. The median age of the participants was 58 years (range: 18-74 years). Seven and four patients were T1b and T2b, respectively. Ten patients had no metastasis at the moment of diagnosis. Six patients were categorized as intermediate-grade, and the remaining (n=5) were classified as high-grade. The most frequent location was the scalp (n=3). In the patients undergoing surgery, the mean follow-up duration was 52 months. Disease-free survival (DFS) rates were obtained at 70%, 50%, and 50% in the 1st, 3rd, and 5th years, respectively, with the mean DFS of 36 months. In addition, the overall survival rates in the 1st, 3rd, and 5th years were 100%, 100%, and 83%, respectively.

CONCLUSION

The UPS represented the most common histological subtype in our series. They tend to be intermediate or high-grade tumors. An acceptable global survival rate justifies surgical treatment as the main therapeutic tool.

Surgical Management of Head and Neck Soft Tissue Sarcoma: 11-Year Experience at a Tertiary Care Centre in South India

Head and neck soft tissue sarcoma (HNSTS) is a rare neoplasm accounting for 1% of all head and neck tumours. Because of rarity and varied biological behaviour among various subtypes, knowledge about these tumours is limited. This study aimed at analysing clinicopathological, recurrence and survival pattern of surgically treated HNSTS. Case records of 28 patients of HNSTS who underwent surgery at the Regional Cancer Centre (RCC), Trivandrum (India) between 2002 and 2012 were analysed retrospectively for demographic profile, clinical features, treatment given, recurrence pattern and outcome. The median age of patients was 37 years (range, 3-79) with male:female ratio of 3:2. Majority of patients presented with painless lump in the neck as the most common subsite affected followed by scalp and face. One patient had nodal disease, while none had distant metastasis at presentation. The most frequent histological subtypes were synovial sarcoma and fibrosarcoma followed by malignant fibrous histiocytoma, angiosarcoma and rhabdomyosarcoma. Majority (78.5%) of patients received adjuvant therapy in the form of radiation, chemotherapy or chemo-radiation. After mean follow-up of 49 months, four patients had died, and six developed local recurrence and four distant metastasis. The overall 5-year survival was 82.7% while 5-year disease-free survival was 55.3%. HNSTS is a rare entity that requires multimodality treatment to achieve optimum locoregional control and survival.

Survival and Margin Status in Head and Neck Radiation-Induced Sarcomas and De Novo Sarcomas

Objective To describe histologic subtypes and oncologic outcomes among patients with radiation-induced and de novo sarcomas of the head and neck. Study Design Retrospective case series with chart review. Setting Tertiary academic center. Subject and Methods In total, 166 adult patients with sarcoma of the head and neck treated from January 1, 1985, to January 1, 2010, were included. Tumors were characterized as radiation induced (15.1%) vs de novo sarcomas (84.9%). Clinical and tumor characteristics were compared. The primary outcomes were overall survival (OS) and disease-specific survival (DSS). Results Radiation-induced sarcomas were more likely to be high grade ( P = .006) and advanced stage ( P = .03). Chondrosarcoma was more common in de novo tumors ( P = .02) while leiomyosarcoma ( P = .01), sarcoma not otherwise specified ( P = .02), and undifferentiated pleomorphic sarcoma ( P < .001) were more common in radiation-induced sarcomas. Radiation-induced sarcomas were associated with statistically significantly worse DSS ( P = .019) and OS ( P = .005) compared with de novo sarcomas, but when only high-grade soft tissue sarcomas were analyzed, neither DSS ( P = .48) nor OS ( P = .29) differed. Margin status was a significant predictor of survival as both R0 and R1 resections correlated with statistically better DSS and OS compared with R2 ( P < .001) resections and patients treated with radiation therapy/chemoradiation therapy alone ( P = .005). Conclusion Radiation-induced sarcomas of the head and neck correlate with worse survival compared with de novo tumors; however, when controlling for tumor grade and resection status, there is no statistically significant difference in observed outcomes.

Synovial Sarcoma of the Larynx: Report of a Case and Review of Literature

Sarcomas account for less than 1% of malignant neoplasms arising in the head and neck in adults. Laryngeal synovial sarcoma is an extremely rare form of laryngeal malignancy with less than 20 cases reported in the literature. We report the case of a 48-year-old man with synovial sarcoma of the larynx. He underwent excision of the tumor followed by radiation. He is alive in remission at 36 months. The literature on synovial sarcoma of the larynx is reviewed.

Head and neck sarcomas: A single institute series

BACKGROUND

Sarcomas are tumours of mesenchymal origin, accounting for 1% of all malignancies.

METHODS

This is a retrospective analysis of 107 head and neck sarcoma cases, treated over a period of thirteen years.

RESULTS

Fifty-four patients had with craniofacial bone sarcomas (BSs) (male: 33; female: 21) with high grade osteosarcoma being the most predominant type. The soft tissue sarcomas (STS) (53 patients; male: 28, female: 25) were histologically diverse with rhabdomyosarcomas and myxofibrosarcomas being the predominant types. The majority of BSs were managed with neoadjuvant chemotherapy followed by surgery, whereas in STSs treatment included predominantly surgery followed by radiotherapy. Overall survival estimates were 79% at 2years and 64% at 5years (mean follow-up period was 48months).

CONCLUSIONS

The mesenchymal origin of sarcomas, the pattern of disease spread and the different extent of cancellous bone infiltration in contrast to epithelial tumours, dictate distinct principles for surgical clearance.

Salivary gland adenoid cystic carcinoma

Malignant fibrous histiocytoma, also known as pleomorphic undifferentiated sarcoma not otherwise specified, arises in numerous organs. The first-line treatment is complete excision of the mass, but in some cases postoperative chemo- and/or radiotherapy is recommended. Only a few cases of malignant fibrous histiocytoma of the vocal fold have been previously reported in the literature. We report a new case, which originated in the true vocal fold of a 65-year-old man. The mass was removed via CO2 laser excision with preservation of the vocal fold and without the need for further treatment. At 3 years of follow-up, the patient remained recurrence-free.

Head and neck sarcomas: clinical and histopathological presentation, treatment modalities, and outcomes

BACKGROUND

Sarcoma of the head and neck is a rare condition that poses significant challenges in management and often requires radical multimodality treatment.

OBJECTIVES

This study aimed to analyse current clinical presentation, evaluation, management dilemmas and oncological outcomes.

METHODS

Computer records and case notes were analysed, and 39 patients were identified. Variables were compared using Pearson's chi-square test and the log-rank test, while survival outcomes were calculated using the Kaplan-Meier method.

RESULTS

The histopathological diagnosis was Kaposi sarcoma in 20.5 per cent of cases, chondrosarcoma in 15.3 per cent and osteosarcoma in 10.2 per cent. A range of other sarcomas were diagnosed in the remaining patients. The site of disease was most commonly sinonasal, followed by the oral cavity and larynx.

CONCLUSION

Wide local excision with clear resection margins is essential to achieve local control and long-term survival. There is a need for cross-specialty collaboration in order to accrue the evidence which will be necessary to improve long-term outcomes.

Epidemiological Evaluation of Head and Neck Sarcomas in Iran (the Study of 105 Cases Over 13 Years)

Background:

Head and neck sarcomas are exceedingly rare and they include 4% - 10% of all sarcomas and less than 1% of all neoplasm of head and neck.

Objectives:

The aim of this study is to evaluate the epidemiological characteristics of head and neck sarcomas of patients in Isfahan, Iran.

Patients and Methods:

In this retrospective study, from the 16000 patients whose files were evaluated, the total number of 105 head and neck sarcomas were collected. They were evaluated with due attention to age, gender of the patients and the most common location of the lesion.

Results:

From the total number of 105 (0.6%) patients with sarcomas, 56 were men (53.33%) and 49 women (46.66%). The most common head and neck sarcomas among this population were Osteosarcoma (32 cases, 30.47%), Chondrosarcoma (14 cases, 13.33%), and Ewing sarcoma (11 cases, 10.47%).The most common soft tissue sarcoma was Rabdomiosarcoma. Mandible was the most common location for these lesions.

Conclusions:

In this study, the hard tissue sarcomas were more prevalent than soft tissue ones. Hence, special attention should be paid to the patients when being diagnosed.

Soft tissue sarcoma of the head & neck: nomogram validation and analysis of staging systems

BACKGROUND AND OBJECTIVES

Soft tissue sarcomas of the head and neck (STSHN) comprise a rare group of malignancies. Our objective is to determine the utility of soft tissue sarcoma staging systems within the head and neck, and to validate an individualized soft tissue sarcoma nomogram within head and neck primary sites.

METHODS

Previously-untreated patients with STSHN diagnosed and treated between 1982 and 2012 were eligible (n = 319, median follow-up 46 months). Clinical variables were extracted from a prospectively-maintained database. The performance of AJCC/UICC and MSK staging systems and a soft tissue sarcoma-specific nomogram were assessed.

RESULTS

Four-year overall survival (OS), disease specific survival (DSS), and recurrence-free survival (RFS) were 72%, 76%, and 71%, respectively. AJCC/UICC and MSK staging systems accurately stratified outcomes (OS, DSS, and RFS; P < 0.001 for all comparisons). The nomogram stratified outcomes by quartile (P < 0.001), and predicted risk of death at 4, 8 and 12 years (P < 0.001). Concordance indices for overall survival for the AJCC/UICC system, MSK system, and the nomogram were 0.71, 0.70, and 0.78, respectively.

CONCLUSIONS

Oncologic outcomes among groups of patients with STSHN can be accurately predicted using both the AJCC/UICC and MSK staging systems. A soft tissue sarcoma-specific nomogram provides reliable, individualized prognostic information for patients with STSHN.

Analysis of Clinical Prognostic Factors for Adult Patients with Head and Neck Sarcomas

Objective

To evaluate the treatment, outcome, and prognostic factors in patients with head and neck sarcomas treated in an academic medical center.

Study Design

Case series.

Setting

Academic medical center.

Subjects and Methods

We performed a retrospective analysis of adult patients (n = 97) with primary head and neck sarcomas treated between 2000 and 2012. We analyzed the treatment, outcome, and potential factors predictive of disease-free survival and disease-specific survival. We also evaluated the outcome and prognostic factors in patients with bone and soft tissue sarcomas.

Results

The median overall survival was 6.8 years, with 2-year and 5-year overall survival rates of 78% (95% confidence interval [CI], 66%-86%) and 59% (95% CI, 44%-72%), respectively. Univariable analysis revealed that age at diagnosis (>60 years: hazard ratio [HR], 2.7; 95% CI, 1.2-6.2; P = .01), surgical intervention (HR, 8.3; 95% CI, 3.5-19.5; P < .001), and metastatic disease (HR, 4.3; 95% CI, 1.3-13.6; P = .01) were significantly associated with disease-specific survival.

Conclusion

In this study, patients over the age of 60 years at diagnosis and those with inoperable disease at initial presentation had significantly worse disease-specific survival. Surgical intervention remains the optimal treatment modality for those with resectable disease and was associated with significantly better survival in this heterogeneous series. Further multi-institutional studies are required to better define prognostic factors in individual histological subtypes.

John M. Head and neck sarcomas: the UCLA experience

PURPOSE

To profile the clinical presentation, subtype distribution, and treatment results of sarcomas of the head and neck at a single tertiary academic center over an 11-year period.

MATERIALS AND METHODS

A retrospective review was performed by examining the records and reviewing the pathology of 186 patients with head and neck sarcomas treated at UCLA Medical Center from 2000 to 2011.

RESULTS

The mean age of the study population was 49 ± 22 years. 58% of the patients were male and 42% were female. Median duration of follow-up for the entire group was 18.5 months. The most common presenting symptom was a mass lesion in 59.9% of patients. The nasal cavity/sinus was the most common presenting site seen in 22% of patients. Solitary fibrous tumor/hemangiopericytoma was the most common subtype. 15% of patients had evidence of prior radiation exposure. 26.3% of tumors were greater than 5 cm and 35.5% were high-grade. Margins were positive in 31.2% of patients. Lymph node metastasis was rare at 6.5%. Perineural invasion was identified in 6.5%. Among all subtypes, 5-year recurrence-free survival and overall survival were 50% and 49%, respectively. Multivariate analysis demonstrated that grade and margin status were predictors of recurrence-free survival while grade and age affected overall survival.

CONCLUSIONS

Head and neck sarcomas are a rare entity frequently presenting as a mass lesion. In our series, lesions tended to be high-grade with a significant portion of surgical specimens having positive margins. Grade and margin status were the most important predictors of survival.

Radiation-induced malignant fibrous histiocytoma of the occipital: a case report

Malignant fibrous histiocytoma (MFH) is a rare neoplasm exhibiting a propensity for aggressive clinical behavior. Effective treatment modality is surgical resection with wide margins, but its rate of recurrence and metastasis is still high. Early detection and complete excision of the tumor is necessary. A MFH of the occipital developed in a 51-year-old woman eight years after surgery and radiation for medulloblastoma of the cerebellar vermis. The secondary neoplasm arose at the site of tumor resection within the irradiated field, and was resected. The development of sarcomas is a recognized complication of radiation therapy. The final diagnosis after the operation was MFH. Radiation-induced sarcoma (RIS) is well known, but radiation-induced MFH is relatively rare in the head and neck region, especially in the occipital. The imaging findings are not diagnosis specific, but strict follow-up within the radiation field by computerized tomography (CT) and magnetic resonance imaging (MRI) and appreciation of the expected latency period may help in providing the diagnosis of RIS.

Prognostic factors and treatment strategies for adult head and neck soft tissue sarcoma

Adult head and neck soft tissue sarcomas are rare and display a variety of histological types and clinical characteristics; they are also associated with a variety of mortality risks. The purpose of this study was to examine all patients treated at the Instituto Nacional de Cancerologia for head and neck sarcoma during a 5-year period. Fifty-one adult patients were examined and treated for head and neck sarcomas from 2004 to 2009. The 51 tumours were histologically re-evaluated by expert pathologists and classified as low, intermediate or high grade sarcomas. A multivariate analysis was performed to evaluate the surgical margins, histological grades, and clinical stages as prognostic factors for the disease. Adult head and neck soft tissue tumours are rare, and they are associated with poor prognosis for patients, especially at clinical stages III and IV. The average survival rate after 2 years is 45%, and most of these patients die because of disease progression and metastases.

Head and neck soft tissue sarcoma

Sarcomas are malignant neoplasms originating from mesodermal tissues and constitute less than 1% of body's tumors, including those of the head and neck region. 5-15% of adult sarcomas are in the head and neck region (20% from bones and cartilages and 80% in soft tissues). Commonly encountered sarcomas in the head and neck region are - osteosarcoma, rhabdomyosarcoma, malignant fibrous histiocytoma, fibrosarcoma and angiosarcoma. This article reviews the available literature on head and neck sarcomas.

External ear sarcoma: a review of the Surveillance Epidemiology and End Result (SEER 17) database

Soft-tissue sarcomas arising in the skin of the external ear have a better prognosis than might be expected based on the behavior of other sarcomas. Currently there are a few major case series analyzing soft-tissue sarcomas and the factors related to their prognosis. The purpose of this study was to determine the behavior of these tumors and attempt to define factors affecting prognosis. We extracted data from the Surveillance Epidemiology and End Result (SEER) 17 Registry and identified a total of 297 patients with sarcoma of the external ear who were included in the registry from 1973 to 2004. Of these, 176 (59.3%) patients were diagnosed with malignant fibrous histiocytoma. Dermatofibrosarcoma was the second most prevalent soft-tissue sarcoma (56 patients; 18.9%), followed by leiomyosarcoma (27 patients; 9.1%). The overall 5-year survival rate of patients with all histologic types of STS of the external ear was 78.5%.

[Head and neck sarcomas. Our experience]

INTRODUCTION

Head and neck sarcomas are a heterogeneous group of malignant tumours that vary greatly in clinical presentation, with different histopathological and biological characteristics.

MATERIAL AND METHODS

This was a retrospective study of patients with sarcoma located in the head and neck treated in our centre over a period of 25 years.

RESULTS

During the study period, a total of 25 patients were diagnosed with sarcomas in the head and neck, accounting for 0.5% of all malignancies at this level. The most common treatments included surgical resection of the tumour, often supplemented with radiotherapy and/or adjuvant chemotherapy. The final local control, including the salvage, was 52%, with an adjusted survival of 51% at 5 years and 32% at 12 years.

CONCLUSIONS

Surgical treatment of patients with head and neck sarcomas achieves acceptable results of local control and survival.

Low-grade myofibroblastic sarcoma of the larynx

Low-grade myofibroblastic sarcoma is an uncommon sarcoma with myofibroblastic differentiation. It occurs in a wide variety of sites and has a predilection for the head and neck region. Biologically, low-grade myofibroblastic sarcoma has a propensity for local recurrence and is associated with a low risk of metastatic spread. Histologically, it can mimic a variety of different types of benign and malignant processes and often requires immunohistochemical analysis for its accurate identification. This report describes a case and discusses the differential diagnosis of a low-grade myofibroblastic sarcoma that arose in the larynx of a 69-year-old woman with a history of metastatic skin melanoma. To the best of the authors' knowledge this is the first description in the English literature of low-grade myofibroblastic sarcoma originating in the larynx.

Management of adult soft tissue sarcomas of the head and neck

Adult soft tissue sarcoma of the head and neck are rare and represent a heterogeneous group of tumours of different histological variants. Management of these neoplasms presents a great challenge. Malignant fibrous histiocytoma, fibrosarcoma, angiosarcoma and malignant peripheral nerve sheath tumour are the most frequently found sarcoma types in the head and neck. Although traditional morphological assessment is the foundation of clinical decision making, the role of immunohistochemistry and molecular biology are useful for diagnosis, prognosis and identification of possible targets for molecular therapy. The most frequently involved tumour sites are scalp/face, sinonasal tract/anterior skull base and parotid/neck. The management of soft tissue sarcomas in the head and neck is primarily surgical. Since it is difficult to obtain wide margins during surgical treatment in head and neck sarcomas, because of anatomic constraints, most patients undergo post-operative irradiation. Survival varies from 50 to 80%. Prognostic factors are tumour grade, margin status and tumour size. With further insight into the biology of soft tissue sarcoma, modern imaging techniques and new treatment options, we will most certainly be able to improve clinical outcome in patients with soft tissue sarcoma in the upcoming years.

Subcutaneus leiomyosarcoma of the neck: a case report

Introduction

Leiomyosarcomas are rare tumors. The most common site for head and neck leiomyosarcomas is the oral cavity, followed by sinonasal tract and skin. Subcutaneous leiomyosarcomas are thought to arise from small to medium-sized blood vessels in the subcutaneous tissue.

Case Presentation

A 67-year-old female patient underwent excision of a slow growing neck mass of the left posterior neck triangle after a thorough clinical and laboratory examination. The lesion was located in the subcutis and fine needle aspiration biopsy revealed malignant features. Histology revealed subcutaneous leiomyosarcoma and the patient is free from local recurrence and distant metastases 3 years after wide excision of the lesion.

Conclusions

The primary modality of therapy of subcutaneous leiomyosarcoma is surgery, adjuvant radiotherapy or chemotherapy may be used for control of local recurrence, in case of positive surgical margins, high-grade or large tumors.

First case of a myxofibrosarcoma of the vocal folds: case report and review of the literature

We present the first case of an endolaryngeal manifestation of a myxofibrosarcoma. These tumors represent a distinct clinicopathologic entity and are fibroblast-derived soft-tissue neoplasms usually arising in late adulthood. The tumor presented as an edematous swelling of the right vocal fold, appearing as a common Reinke edema. Surgery is the most common form of therapy, only a limited number of papers dealing with radio/chemotherapy exist due to the small number of cases. Unilateral cordectomy was performed, tumor was resected with negative surgical margins. This is the first report of an endolaryngeal myxofibrosarcoma. The tumor presented clinically as a unilateral swelling of the right vocal fold.

[Difficulty in diagnostic procedure in the malignant fibrous histiocytomas of larynx]

Malignant fibrous histiocytomas (MFH) of the upper respiratory tract are rare, aggressive mesenchymal neoplasms. Ultrastructurally MFH consisted of five different types of cells. It occurs principally as a mass of the extremities, abdominal cavity, or retroperitoneum in adults. There have been sporadic laryngeal cases reported in the literature. We report a case of a glottic malignant fibrous histiocytoma on a 45 year old man. There was difficulty to find finally diagnosis. Pathologic and immunohistochemical evaluation revealed tumor a few months after first symptoms. There was unilateral metastases into the neck lymph nodes. Immunohistochemical staining was positive for F13a, CD68 and negative for desmin and cytokeratin. Wide, aggressive excision of the tumour with total larygectomy to be the treatment of choice because it was difficult to prove clinically and pathologically that it was MFH. Unilateral neck dissection was done due to metastases into the neck lymph nodes. Radiation have been used after surgery. About two years after total laryngectomy the patient is well and free of disease.

Sarcomas and sarcomatoid tumor after radiotherapy of oral squamous cell carcinoma: analysis of 4 cases

Radiation-induced sarcoma (RIS) or postirradiation sarcoma has been reported rarely as a long-term complication of radiation therapy (RT). We report 4 cases of oral sarcomas or sarcomatoid tumors with a rather short latency period after radiotherapy of the prior OSCC. Histopathological evaluation and immunohistochemical study were performed using a panel of markers including vimentin, cytokeratin, S-100, desmin, myoglobin, HHF-35, p53, and p16. All reported cases were positive for vimentin and negative for cytokeratin. Two cases were positive for myoglobin, desmin, or HHF-35, and were probably myogenic origin. One case was possibly a fibrosarcoma and the subclassification of the other one was not specified. Diverse expression of p53 and p16 was further observed in these 4 cases. Report of the complicated clinical processes and the analysis of genetic markers of these cases provide useful clinical and pathogenetic insights of mesenchymal malignancies associated with a status post OSCC radiation.

Prognostic factors in adult soft tissue sarcomas of the head and neck: A single-centre experience

Adult soft tissue sarcomas of the head and neck are rare and consist of a variety of histopathological subtypes and sites. The purpose of this study was to review patients treated for adult soft tissue sarcomas of the head and neck at our institute. The medical records of 41 adult patients treated for head and neck soft tissue sarcomas between 1983 and 2004 were reviewed. Thirty-six tumours were histologically reviewed. Histopathological revision showed that 7% of the original sarcomas were found not to be sarcomas and 39% of the sarcoma subtypes changed. Multivariate analysis showed that surgical margin status and lymph node metastases are the most important prognostic factors. Review of histopathological examination of tumours showed a change in subtype in a substantial number of head and neck sarcomas. Negative surgical margins are an important prognostic factor, but are difficult to obtain in head and neck sarcomas.

Soft-tissue sarcomas of the head and neck: a retrospective analysis of the Alberta experience 1974 to 1999

BACKGROUND

Soft-tissue sarcomas (STS) of the head and neck constitute a heterogeneous group of rare malignant tumors occurring in an uncommon site. The most common subtypes of STS in the head and neck are malignant fibrous histiocytoma, dermatofibrosarcoma protuberans, and fibrosarcoma. Evidence based subtype-specific treatment decisions are often not possible.

METHODS

The medical records of 110 patients diagnosed with head and neck sarcomas were reviewed. All were treated at one of the two major Cancer Centers in Alberta, Canada, between 1974 and 1999. Potential prognostic factors including age, sex, tumor size, histology, grade, tumor location (superficial or deep), and use of adjuvant treatment were evaluated. Cox proportional hazards models were developed to study the impact of these covariates on survival.

RESULTS

The median duration of follow-up was 61.5 months. Five year overall, disease specific, and relapse free survival were 65.8%, 83.4%, and 74.2%, respectively. With use of a Cox proportional-hazards model, tumor stage and grade were important prognostic factors affecting survival.

CONCLUSIONS

Tumor size and grade were important prognostic factors affecting survival. Tumor location in relation to the superficial fascia (depth) was the best predictor of outcome. The overall and disease-free survival in this patient group was excellent. However, this likely caused by the high proportion of patients with low-grade tumors in our study.

Sarcoma of the larynx: treatment results and literature review

BACKGROUND

Sarcomas of the larynx are rare neoplasms that constitute less than 1% of laryngeal malignancies. A Medline search found no large series focusing on laryngeal sarcomas. We reviewed the cases of laryngeal sarcomas treated in our cancer center and compared our experiences and treatment results with those from other centers.

METHODS

A retrospective review of 10 patients with laryngeal sarcoma treated in our institute between 1980 and 2000 was done to identify tumor characteristics, therapeutic modalities, and treatment outcomes.

RESULTS

The patients showed a male predominance (9/10) and presented 8 types of pathology. Nine patients underwent surgery, including 2 total laryngectomy, 4 partial laryngectomy, and 3 endoscopic laser cordectomy. During a median follow-up of 92 months, the 5-year overall survival and disease-specific survival were 76% and 90%, respectively. Two patients developed recurrence, including 1 local recurrence and 1 distant metastasis.

CONCLUSION

Surgical intervention was the first choice in the treatment of laryngeal sarcomas. The prognosis is relatively good when compared with sarcoma originating from other anatomic sites.

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.

Update in management of head and neck sarcoma

PURPOSE OF REVIEW

This update addressing head and neck sarcoma presents new data published after January 2003. This new information is presented following review of contemporary management principles established before 2003.

RECENT FINDINGS

The application of advances in molecular and genetic techniques to characterize individual sarcomas has improved classification schemes and hopefully will lead to individually tailored therapy. Maturation and refinements of large tumor registries are permitting more detailed analysis of larger contemporary series of the rare head and neck sarcomas. Improved long-term survival of patients treated for sarcoma in their childhood has allowed study of the morbidity induced by treatment. Novel treatment strategies are under study to decrease morbidity without diminishing the chance for cure.

SUMMARY

Progress in improving the treatment of sarcoma of the head and neck has been slow due to the lack of a large clinical experience with this rare neoplasm. Advances continue and are anticipated to be most striking in the study of genetic mechanisms.

Head and Neck Soft Tissue Sarcomas: A Multivariate Analysis of Outcomes

BACKGROUND

Soft tissue sarcomas of the head and neck region represent a rare group of tumors of which a limited number of published individual- and institution-based experiences exist.

METHODS

We performed an analysis of head and neck sarcoma patients identified from our institution between 1973 and 1999. Exclusion criteria included pediatric rhabdomyosarcomas, sarcomas of the neuromeningeal axis or non-head and neck primary disease sites, and bone sarcomas. All cases underwent pathologic re-review before statistical analysis.

RESULTS

After pathologic review, 111 head and neck sarcoma patients remained (mean age, 47 +/- 20 years). The median duration of follow-up was 51 months; the actuarial 5-year relapse-free, disease-specific, and overall survivals were 55%, 52%, and 44%, respectively. Forty-six percent remained free of recurrence at the most recent follow-up, and the most common site of recurrence was local followed by distant sites. By multivariate analysis, size and grade significantly influenced relapse-free, disease-specific, and overall survivals, whereas margin status additionally influenced relapse-free survival. Subset analysis of the fibrosarcoma/malignant fibrous histiocytoma and desmoid/dermatofibrosarcoma protuberans histologies was undertaken.

CONCLUSIONS

Size >5 cm and high-grade histology are considered poor prognostic indicators. Patients with either of these characteristics should be considered for adjuvant trials.