Radiation-induced malignant fibrous histiocytoma of the neck in a patient with laryngeal carcinoma

Primary Sarcomas of the Larynx: A Case Series of Four Different Histopathologic Types

Primary laryngeal sarcomas are rare. Their nomenclature and classification are similar to soft tissue counterparts; however, there are notable differences between clinical presentation, behavior, treatment, and follow-up. There is sparse information regarding the clinical features, biologic behavior, and treatment modalities of laryngeal sarcomas. To increase our understanding about these tumors, we describe herein an additional series of four cases of different pathologic types of laryngeal sarcomas, including low-grade chondrosarcoma, leiomyosarcoma, well-differentiated liposarcoma, and undifferentiated pleomorphic sarcoma. Our main aim is to upsurge awareness about the morphologic variations of laryngeal sarcomas, to avoid potential pitfalls during histopathologic examination. It is essential to ensure that correct diagnosis, subclassification, and grading are achieved for proper guidance of treatment and clinical follow-up at multidisciplinary team meetings.

Primary Sarcomas of the Larynx: A Clinicopathologic Study of 27 Cases

Primary sarcomas of the larynx are rare and are associated with diagnostic and treatment challenges. Studies of these tumors are limited, and most examples have been reported as small series. To further increase our understanding of laryngeal sarcomas, we reviewed our experience of an adult cohort. A retrospective search for laryngeal sarcomas from our pathology archives and consultation files of one of the authors was performed. We studied 27 primary laryngeal sarcomas that included 25 males, and 2 females, with a mean age of 60 years (range 33-85). The cases included conventional chondrosarcoma (16), well-differentiated liposarcoma (2), clear cell chondrosarcoma (1), leiomyosarcoma (2), high grade myxofibrosarcoma (2), high grade myofibroblastic sarcoma (1), low-grade myofibroblastic sarcoma (1), malignant granular cell tumor (1), and Kaposi sarcoma (1). Data on treatment and follow-up was available in 17 and 16 cases, respectively. 12 patients underwent partial laryngeal resection; five had total laryngectomy, and the patient with Kaposi sarcoma received combined highly active antiretroviral therapy and chemotherapy. Three patients developed local recurrence, and two patients developed metastases. The remaining patients with follow up had a favorable outcome and were disease-free after treatment. The important differential diagnosis of spindle cell sarcoma is sarcomatoid squamous cell carcinoma, and their distinction often requires extensive sampling of the mucosal surface and immunohistochemical analysis. The mainstay of treatment for laryngeal sarcomas is surgical removal, with the extent dictated by tumor type and grade. Adjuvant therapy is reserved for high-grade sarcomas and may be given in a neoadjuvant or adjuvant setting.

Simultaneous squamous cell carcinoma with primary malignant fibrous histiocytoma of the larynx: a case report

Simultaneous multiple malignancies of the larynx are rarely reported. In this study, we describe a case with simultaneous laryngeal, moderately differentiated squamous cell carcinoma (SCC) and primary malignant fibrous histiocytoma (MFH) in a patient presenting with progressive hoarseness and without cervical lymphadenopathy. The clinical presentation, intraoperative findings, radiographic images and pathology slides are presented. The diagnosis was confirmed using H&E staining and immunohistochemical testing. A partial laryngectomy with bilateral neck selective dissection was performed. The patient survived for more than 46 months following surgery without recurrence or metastasis. To our knowledge, this is the first report of a case with simultaneous laryngeal SCC and primary MFH in the English literature. The results indicate that the markers used to assess the prognosis of MFH may also be used to assess simultaneous laryngeal SCC and primary MFH, and that laryngectomy to preserve function may be performed in early-stage patients.

Early radiation-induced laryngeal malignant fibrous histiocytoma (MFH)

Postradiation sarcoma is a potential late sequela of ionising radiation and its frequency is rare. We present the case of a man with a radiation-induced malignant fibrous histiocytoma with a latent period of 20 months.

Malignant Fibrous Histiocytoma of the Head and Neck after Radiation for Squamous Cell Carcinoma

A 60-year-old man presented with malignant fibrous histiocytoma of the oropharynx. The mass extended into the nasopharynx and larynx and caused severe upper airway obstruction that required emergency tracheotomy. Ten years earlier, he had undergone a right partial glossectomy and segmental mandibulectomy for squamous cell carcinoma of the right tongue base, followed by 50 Gy of radiation delivered over 33 sessions. The tumor was so aggressive that changes in its volume were visually distinguishable during physical examination over a 2-week hospital stay. Histologic evaluation revealed 7 mitotic figures per high-power field. Although radiation-induced malignant fibrous histiocytoma is rare in the head and neck, the recent medical literature indicates that its incidence is rising. This rise has been attributed to the increased effectiveness of head and neck cancer therapy, which results in prolonging patients’ survival and, hence, their risk of subsequent disease. Because malignant fibrous histiocytoma is a late complication of radiation therapy, appearing on average 10 years following treatment, it is important that physicians who treat head and neck cancer monitor these patients over the long term and remain alert for its appearance, even despite the apparent “cure” of their original neoplasm.