Leiomyosarcoma of the larynx. Review of the literature and report of two cases

Epstein-Barr virus-associated leiomyosarcoma of the larynx in an adult patient with human immunodeficiency virus infection: Case report and review of the literature

We investigated the clinical features, treatment, and prognosis of laryngeal leiomyosarcoma (LLMS) and Epstein-Barr virus-associated (EBV-associated) LMS. We report a case of EBV-associated LLMS in an adult patient with HIV infection. We also conducted a review of the English-language literature on LLMS and EBV-associated leiomyosarcoma. To the best of our knowledge, 62 cases of LLMS and EBV-associated leiomyosarcoma have been reported to date. Of patients with LLS, 18.9% had distant metastases and 17.0% had local recurrence. The overall 5-year survival rate was 64.0%. Distant metastases affected the survival of patients with LLMS (p = 0.04). EBV-positive patients had a low survival rate (p = 0.01). Among patients with EBV-associated LMS, 8.2% had distant metastases and recurrence and the overall 5-year survival rate was 50.0%. EBV-associated LLMS is rare. The EBV infection might be a poor prognostic factor of LLMS.

Dedifferentiated Leiomyosarcoma of the Auricle with Heterologous Osteosarcoma Component: Case Report and Literature Review

Leiomyosarcomas are rare malignant tumors of smooth muscles. Head and neck involvement by this disease is very rare, and cutaneous leiomoysarcomas of the ear are even rarer. This is way clinically they are usually mistaken for either squamous or basal cell carcinomas, as was the case in an 85-year-old male patient presented in this report. However, the final diagnosis was even more interesting considering that it was a dedifferentiated leiomyosarcoma of the auricle with a heterologous component of osteosarcoma. The auricular cutaneous malignancies have a much higher rate of recurrence than the corresponding malignancy in other regions of the head and neck, even when resected with negative surgical margins, and dedifferentiated leiomyosarcoma is clinically even more aggressive. Thus, the treatment of choice is a total auriculectomy and great attention should be paid to appropriate margins.

Simultaneous double laryngeal tumours: a diagnostic and therapeutic challenge

Leiomyosarcomas are soft tissue tumours that rarely occur in the larynx. This case report describes the presentation and management of a 77-year-old man referred to the otolaryngology clinic with hoarseness who was found to have a large supraglottic leiomyosarcoma after panendoscopy and biopsies. He subsequently underwent laryngectomy for treatment of this tumour but, unexpectedly, the histological analysis of the laryngectomy specimen revealed a second primary tumour in the larynx-a squamous cell carcinoma (SCC). The patient had further treatment with neck radiotherapy. Three years after treatment, there are no signs of recurrence of either tumour. This case report discusses the very few similar cases of leiomyosarcoma coexisting with SCC in the larynx, collating the evidence surrounding the treatment of this rare presentation.

Laryngeal sarcomas: A case series of 5 cases

Primary sarcomas of the larynx are rare and miscellaneous. The most common is chondrosarcoma. Other sarcomas are very rare. Sarcomas can have heterogeneous morphologic features of spindle, small round, epithelioid, pleomorphic and giant cells. Laryngeal sarcomas may mimic carcinomas, lymphomas, small cell carcinoma, mesothelioma and melanoma. This imposes diagnostic challenges for unfamiliar pathologists particularly in small laryngeal biopsies. Our aim was to study the different types of sarcomas that can involve the larynx in our institution, to investigate their diagnostic challenges and potential pitfalls and to find helpful histologic clues to avoid misinterpretation and missed diagnosis. We performed a retrospective review study over 13 years. We retrieved 5 cases of laryngeal sarcomas. They included Kaposi sarcoma, low-grade chondrosarcoma, epithelioid angiosarcoma, polypoid leiomyosarcoma and small cell osteosarcoma. The age range was between 32 and 74 years with an average age of 52 years. The male to female ratio was 3:2. The Kaposi sarcoma and chondrosarcoma were correctly diagnosed. The angiosarcoma was initially missed as recurrent carcinoma. The leiomyosarcoma was initially inferred as polypoid sarcomatoid squamous cell carcinoma. The small cell osteosarcoma initiated the differential diagnosis of high-grade lymphoma, small cell carcinoma, undifferentiated carcinoma, Ewing sarcoma and rhabdomyosarcoma. An implementation of a panel of immunohistochemical markers guided by certain histomorphologic clues was helpful to make the correct diagnosis. Pathologists should be aware of the morphologic spectrum and different growth patterns of laryngeal sarcomas. Immunohistochemistry studies are essential. Correct diagnosis, classification and grading of laryngeal sarcomas are clinically important for the prognosis and appropriate management of patients.

A rare association of leiomyosarcoma with squamous cell carcinoma of the larynx: two cases

OBJECTIVE

To discuss the histopathogenesis and treatment choices for synchronous tumours of the larynx.

CASE REPORTS

We present two cases of synchronous laryngeal leiomyosarcoma and squamous cell carcinoma. The first case was an early-stage tumour and the second an advanced-stage tumour of the larynx. Selection of adequate treatment for synchronous tumours is difficult because of different spreading rates and metastatic patterns. Treatment choices for both the primary tumour site and the neck should be related to the stage of the squamous component of the tumour.

CONCLUSION

In such cases, the tumour location, tumour stage and lymphatic metastases must be carefully evaluated in order to make the optimum treatment choice. Treatment evaluation of the neck should be related to the stage of the squamous component of these synchronous tumours. Partial laryngectomy techniques may be preferred if the extent of the disease permits.

Tumour-to-tumour metastasis of laryngeal leiomyosarcoma to an axillary hibernoma

Tumour-to-tumour metastasis is a rare, but well-recognised occurrence. This case report documents the metastasis of a primary laryngeal leiomyosarcoma to a hibernoma. We believe that this is the first recorded case of leiomyosarcoma metastasising to another neoplasm, and the first recorded case of a hibernoma acting as a recipient tumour for metastasis. This case study emphasises the importance of re-imaging a known benign mass in the presence of new symptoms in a patient with underlying malignancy, to ensure prompt diagnosis and management of potentially treatable metastasis. The imaging findings including whole body magnetic resonance imaging (MRI) staging, macroscopic and histological features are presented.

Leiomyosarcoma of the larynx as a local relapse of squamous cell carcinoma--report of an unusual case

BACKGROUND

The authors report on leiomyosarcoma after previously treated squamous cell carcinoma (SCC) at the glottis.

METHODS

Primary tumor and relapses were investigated morphologically, immunohistochemically, and with molecular methods.

RESULTS

The SCC was typical, but few cells showed a spindle-shaped pattern. The relapse tumor was a spindle-shaped and epitheloid tumor with the morphological and immunohistochemical appearance of leiomyosarcoma (sm-actin+, desmin+, caldesmon+, vimentin+, keratin-).The comparative genomic hybridization (CGH) revealed some gains and losses in the leiomyosarcoma. Because of altered material, the investigation failed in the primary. A fluorescence in situ hybridization (5p) focally detected 3 chromosmomal copies, corresponding to gains on 5p in CGH of leiomyosarcoma.

CONCLUSION

Leiomyosarcoma after SCC is very uncommon. A connection between both seems likely in this case. Transdifferentiation, also seen in other tumors or carcinosarcomas, could be based on aberrant differentiation of a pluripotent stem cell.

[Laryngeal leiomyosarcoma in clinical cases of the Otolaryngology Departament in the University Hospital of Krakow]

INTRODUCTION

Leiomyosarcoma is a malign neoplasm coming from the non-epithelial tissue. It rarely developes in the larynx. 0,5-1% of all of the neoplasm of the larynx is leiomyosarcoma. It usually developes in the age of 40-70 and mostly effects men.

AIMS

Improvement of the therapy of patients with leiomyosarcoma of the larynx.

MATERIAL AND METHODS

The analysis of the medical documentation of the 5 patients with the diagonosis of leiomyosarcoma laryngis treated in Otorhinolaryngologic Clinic UJ in 1996-2006 was performed. The procedures and effects of the therapy were analized.

RESULTS

In this particular period of time 11 patients was operated because of the sarcoma of the larynx. In this group there were 5 cases of leiomyosarcoma, 4 cases of chodrosarcoma and 1 case of agniomyxofibrosarcoma and 1 case of sarcomy synoviale.

CONCLUSIONS

On the basis of the material of the Clinic the frequency of these tumors was estimated and the therapeutic procedure including widening of the surgical indications for the partial laryngectomy and narrowing the indications for nodular surgery of the neck was proposed.

Leiomyosarcoma of the Larynx: Case Report and Review of the Literature

Leiomyosarcoma of the larynx is an extremely rare entity. This tumor is aggressive and is associated with dismal treatment results. We present a case of leiomyosarcoma of the larynx treated with surgery and postoperative radiotherapy. In this article we also discuss laryngeal leiomyosarcoma's clinical manifestations, associated diagnostic dilemmas, and optimal management, as well as a review of the literature.

Leiomyosarcoma of larynx: A case report

Leiomyosarcoma of larynx is a rare tumor. We report a case of 70 year old male who had presented to our department with respiratory distress and stridor. Patient's emergency was managed with tracheostomy with subsequent total laryngectomy and post-op external radiotherapy. One year into follow-up, patient is tumor free.

Laryngeal leiomyosarcoma: a case report and review of the literature

Laryngeal leiomyosarcoma (LLM) is a rare malignancy originating from the smooth muscles of blood vessels or from aberrant undifferentiated mesenchymal tissue. Histological diagnosis may be particularly difficult and correct diagnosis is based on immunohistochemical investigations and electron microscopy. A case report of a LLM in a 74-year-old man is presented. Direct laryngoscopy revealed a large glottic lesion causing airway compromise and an emergency tracheotomy was performed. Subsequent total laryngectomy confirmed the diagnosis of leiomyosarcoma. Lung metastases developed 8 months following treatment, despite the absence of local or regional recurrence, and the patient died 3 months later. A review of the English and French literature revealed 30 previous cases of LLM. Clinical presentation, histological diagnosis, and management of this rare malignancy are analyzed aiming to improve our knowledge regarding the best treatment modality.

Leiomyosarkom des Kehlkopfs

Leiomyosarcoma is usually found in the female genital tract, retroperitoneum, the wall of the gastrointestinal tract and subcutaneous tissues. An appearance of this malignant tumor in the larynx is extremely rare and may be difficult to diagnose. Because of its rarity, little information exists on management and prognosis. We report on a 64-year old male with a supraglottic leiomyosarcoma who was treated with supraglottic laryngectomy and postoperative radiotherapy. After 19 months the patient was well and free of disease. The most commonly used diagnostic and therapeutic procedures are analysed in a review of the 46 published cases of laryngeal leiomyosarcoma.

Leiomyosarcoma of the Larynx: A Case Report

Leiomyosarcoma of the larynx is an extremely rare neoplasm; only about 50 cases have been reported in the English-language literature. We report a new case of laryngeal leiomyosarcoma in a 65-year-old man. The metastatic work-up was negative, and the patient underwent total laryngectomy. He remained disease-free 12 months postoperatively.

Leiomyosarcoma of the head and neck: Report of two cases and review of the literature

Leiomyosarcoma is a malignant smooth-muscle tumor that is exceedingly rare in the head and neck region. Two cases of this uncommon tumor localized in the larynx and the parapharyngeal region are presented in this report, which might be the second leiomyosarcoma in the parapharyngeal region reported so far to our knowledge. We also discuss the diagnosis and treatment of leiomyosarcoma in this aspect.

Epstein-Barr Virus Infection-Associated Smooth-Muscle Tumors in Patients with AIDS

BACKGROUND

The aim of our study is to describe the unusual clinical manifestations of smooth-muscle tumors (SMTs) in patients with acquired immunodeficiency virus (AIDS) and to demonstrate the association between Epstein-Barr virus (EBV) infection and SMTs.

METHODS

Nine patients with AIDS and SMTs were characterized at Chulalongkorn Hospital (Bangkok, Thailand) from 2001 through 2003. Tumor tissues suitable for immunohistochemical analysis and in situ hybridization were assayed for SMTs and EBV, respectively. Plasma and serum samples were tested for EBV by real-time quantitative polymerase chain reaction and serologic analysis.

RESULTS

The study included 8 adults and 1 child (3 males and 6 females). All patients had CD4 cell counts of <200 cells/microL. By the end of the study, 3 patients had died, and 6 patients had survived. The sites of SMTs were the epidura (5 intracranial and 4 intraspinal SMTs), vocal cords (2), adrenal glands (2), abdominal wall (2), iris (1), liver (1), lung (1), orbit (1), and thigh (1). Seven patients had multicentric SMTs involving intracranial sites only (4 SMTs), extra- and intracranial sites (3), or extracranial sites only (2), which occurred either concurrently or sequentially. We found evidence of EBV infection, as determined by in situ hybridization, in all SMTs. Furthermore, EBV DNA was detectable in plasma samples from 2 patients. The results of serologic analysis were consistent with past EBV infection.

CONCLUSIONS

SMTs in patients with AIDS typically arise in multiple and very unusual sites that are not often observed in SMTs among immunocompetent individuals. Our series also suggests association between EBV infection and SMTs in patients with AIDS. The exact role of EBV in smooth-muscle oncogenesis awaits further study.

Leiomyosarcoma of the larynx: critical analysis of the diagnostic role played by immunohistochemistry

Laryngeal leiomyosarcoma (LMS) is definitely considered a rare occurrence: our exhaustive literature review disclosed to date only 45 cases (including the new case we have reported). The morphological diagnosis of laryngeal LMS may be problematic on conventional light microscopy especially in small laryngeal specimens. In the past, LMSs of the larynx were frequently confused with other spindle-cell malignant tumors. Nowadays, immunohistochemical investigations are considered necessary to distinguishing LMS from other spindle-cell tumors. On immunostaining, LMS is usually positive for muscle-specific actin and negative for cytokeratins and epithelial membrane antigen. In most cases, immunohistochemical study allows reliable diagnosis of LMS, but it can produce ambiguous or inconclusive results when the tumor cells lack specific immunohistochemical reactivity. In these controversial cases, LMS diagnosis has to be substantiated by electron microscopy. Distinguishing laryngeal LMS from other spindle-cell malignancies plays a role not only in academic interest. Confusion in the diagnosis of a spindle-cell laryngeal malignancy could result in inappropriate clinical management and inadequate treatment.

Subglottic leiomyosarcoma of the larynx; a case report

Leiomyosarcoma of the larynx is very rare. We herein report an especially rare case of leiomyosarcoma originating in the subglottic mucosa. The majority of cases reported in the literature indicate that laryngeal leiomyosarcomas originate in the supraglottic or glottic area. Our patient underwent simple total laryngectomy and is free of disease 5 years after the operation. The literature is reviewed regarding the choice of treatment and the distribution of the reported sites of origin of laryngeal leiomyosarcoma.