Rare Giant Pedunculated Liposarcoma of the Hypopharynx: Case Report and Review of Literature

Emergent endoscopic submucosal dissection for a polypoid fibroadipose tumor accidentally disgorged from the mouth: an organ-preserving minimally invasive treatment

Video 1The yellow protruded lesion at the larynx is different from the main lesion.

Hazardous giant pharyngoesophageal liposarcoma

A man in his early 80s presented to the otorhinolaryngology department with progressively worsening dysphagia to solids and a recent episode of difficulty breathing accompanied by a very brief expulsion of a solid mass from the mouth. Based on the endoscopic appearance of a fatty lesion of an elongated mass with a thick stalk on the posterior pharyngeal wall, a diagnosis of the benign fibrovascular polyp was given after clinical and radiological correlation. The pharyngeal polyp was resected at the base of its pedicle by transoral endoscopy with a thunder beat vessel sealing device. Histopathological examination of the mass revealed a well-differentiated liposarcoma composed of mature adipocytes. Following surgical excision, the patient made a full recovery. This case signifies the integrated role of preoperative biopsy, new surgical technologies and targeted therapies in managing pharyngoesophageal polyps.

Atypical lipomatous tumor of the oropharynx: A case report

Atypical lipomatous tumor or well-differentiated liposarcoma is a rare condition in the laryngopharynx. We present a case of a 63 year-old male with progressive dysphagia who later manifested with a mass that regurgitates outside the oral cavity. Surgical removal was done via a transoral approach, followed by adjuvant radiotherapy.

An Atypical Lipomatous Tumor of the Hypopharynx: Case Report

Nearly 20% of all mesenchymal tumors are liposarcoma in origin, mostly occurring in extremities and trunk. However, few cases of liposarcoma in the hypopharynx have been documented. This atypical localization of liposarcoma warrants a great interest in reporting such a case. Here, we report an 81-year-old Saudi male who presented to our clinic complaining of progressive dysphagia and globus sensation for two months. On examination, using a flexible nasopharyngoscopy, a hypopharyngeal mass occupying the left piriform sinus originating from the mucosa of the posterior pharyngeal wall and anteriorly from the anterior and medial piriform sinus mucosa was observed. Contrasted head and neck CT-scan revealed a benign-looking well-defined left-sided submucosal cyst aligned along the left aryepiglottic fold encroaching and narrowing the laryngeal inlet with dimensions of 1.8×2.1×2.7 cm. The mass was resected successfully using a trans-oral approach. A histopathological review showed spindle stromal cells that reacted positively for CD34 (Qbend10) on immunohistochemical staining and positive result for MDM2 (12q15) Amp. The pathology result indicates an abnormal amplification of the MDM2 gene region. The patient was followed for almost two years without evidence of recurrence. In conclusion, atypical lipomatous tumors (ALTs) of the hypopharynx are rarely diagnosed, and the gold standard for diagnosis is biopsy. Transoral endoscopic approach has a better outcome than cervical approach. Follow-up of patients with ALT is crucial, due to the highly recurring nature of the disease. Here we present a rare case of ALT, the patient had complete remission without complication.

Resection of a Giant Hypopharyngeal Liposarcoma Invading the Esophagus by Lateral Pharyngotomy: A Case Report

Hypopharyngeal liposarcomas are extremely rare. Due to the lack of experience, pathologists and surgeons find it difficult to make a clear diagnosis and provide accurate, timely treatment. A 43-year-old man with a complaint of foreign body sensation in the throat for 6 months and swallowing difficulty for 2 months was admitted to our department. Contrast-enhanced computed tomography of the chest and larynx revealed a lesion with smooth surface in the esophagus, connected by a pedicle to the hypopharyngeal lesion. The same result was found by gastroscopy. Lateral pharyngotomy was performed for tumor removal, and after 3 weeks, the patient showed good movement of bilateral vocal cords, without dysphagia, choking cough, or hoarseness. This is the first case report of hypopharyngeal liposarcoma invading the esophagus. A thorough preoperative evaluation may be required for the proper diagnosis, prevention, and treatment.

Well-Differentiated/Dedifferentiated Liposarcoma Arising in the Upper Aerodigestive Tract: 8 Cases Mimicking Non-adipocytic Lesions

Well-differentiated (WDL) and dedifferentiated liposarcomas (DL) of the pharynx, larynx and oral cavity are rare, often mimicking benign lipomatous neoplasms or non-lipogenic mesenchymal tumors. Cases of WDL/DL arising in the upper aerodigestive tract, exclusive of the cervical esophagus, were reviewed. Morphologic features, ancillary studies, including fluorescence in situ hybridization (FISH) studies for CPM/MDM2, and clinical data was catalogued. Eight WDL/DL (4 WDL, 4 DL); were identified in patients ranging from 32 to 77 years (median 52.5 years; 6 males, 2 females) with sites of origin including hypopharynx (5 cases), larynx (2 cases) and oral cavity (1 case). Six of the 8 cases were received for expert consultation, and the remaining 2 cases were initially misdiagnosed as benign lymphangiomatous or fibroepithelial polyps. Morphologically, 4 tumors had areas mimicking various non-lipomatous soft tissue tumors including nodular fasciitis, mammary-type myofibroblastoma, low-grade myofibroblastic sarcoma and undifferentiated pleomorphic sarcoma, 2 cases simulated benign hypopharyngeal polyps, and 1 lesion was notable for a dense lymphoplasmacytic infiltrate suggestive of hematolymphoid neoplasm or IgG4-related sclerosing disease. FISH showed amplification of CPM/MDM2 (8/8 cases). All cases (4/4) with longer than 1-year of follow-up recurred (45-118 months) with 1 tumor showing progression to DL. WDL/DL presenting in the upper aerodigestive tract are rare and diagnostically challenging. Awareness of the morphologic spectrum of WDL/DL coupled with appropriate use of MDM2 FISH is essential for accurate classification and management, as these tumors appear to have a high risk for local recurrence and eventual dedifferentiation in these anatomical locations.

Liposarcoma of the Arygepiglottic Fold: Teaching point: A mosaic tumor pattern mixing fatty and non-fatty enhancing components suggests liposarcoma, even in very rare locations such as neck spaces

Liposarcoma of the larynx and hypopharynx is very rare. Computed tomography (CT) and magnetic resonance imaging (MRI) examinations may synergistically disclose suggestive features of a fat-containing tumor with non-fatty enhancing sub-areas. Diagnosis relies on histological examination of a biopsic specimen. This rare pathology should ultimately be kept in mind when dealing with an laryngeal/hypopharyngeal mass.

Giant pedunculated oesophageal liposarcomas: A review of literature and resection techniques

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Giant oesophageal liposarcomas, a rare but important cause of oesophageal tumours.

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A review of the current literature focusing on resection techniques.

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Shift in the treatment paradigm in recent years to endoscopic resection techniques.

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Decision on type of resection technique depends on tumour characteristics and location.

Introduction and presentation of case

Liposarcomas are rare causes of oesophageal tumours, accounting for <1% of tumours. We present a case of a dedifferentiated oesophageal liposarcoma arising from a giant fibrovascular polyp for which resection was performed via a left cervical oesophagostomy with transgastric retrieval of tumour. We also review the existing literature focusing on discussion of resection techniques.

Discussion

To date, 62 cases of oesophageal liposarcoma have been reported in the literature. They usually occur in males (74.2%), with a median age of 66 years (range 38–84 years). Such tumours present most commonly with dysphagia (69.4%); usually arise from the cervical oesophagus (79%), and are well-differentiated. Treatment options include surgery and recently, endoscopic resection techniques such as submucosal dissection (ESD).

Conclusion

Giant oesophageal liposarcomas are very rare tumours. Such tumours are usually polypoid, arising from a pedicle. As such, resection techniques have shifted away from oesophagectomy to less invasive means such as endoscopic resection or oesophagostomy. Decision on type of resection technique depends on tumour characteristics and location; with the guiding principle being resection with clear margins in order to prevent local recurrence.

Dedifferentiated Liposarcoma in a Giant Esophageal Polyp: A Case Report and Review of the Literature

Soft tissue sarcomas represent an extremely rare cause of esophageal masses, and undifferentiated sarcomas are rarer. The proportion of dedifferentiated liposarcomas (DDL) is even lower. The case of a 58-year-old male who complained of dysphagia and was found to have an 18-centimeter long esophageal mass/polyp on esophagogastroduodenoscopy is presented. The lesion was resected endoscopically and a diagnosis of DDL was confirmed by fluorescence in situ hybridization. Due to its rarity, the treatment experience with esophageal DDLs is limited. However, based on our experience, endoscopic resection of the lesion can be considered as the treatment of choice when feasible. We performed a review of the literature to identify and analyze similar reported cases.

Dedifferentiated liposarcoma of the oral floor: A case study and literature review of 50 cases of head and neck neoplasm

Dedifferentiated liposarcoma (DDLS) has a relatively poor prognosis, however this neoplasm rarely occurs in the head and neck. To date, no definite protocol has been established for the diagnosis and treatment of head and neck DDLS. The present study reports the case of a 69-year-old male patient with DDLS of the oral floor. To the best of our knowledge, this is the first documented case of oral floor DDLS. In addition, this is the first reported case with the development of a second primary malignancy following the treatment of head and neck DDLS. A literature review of 50 cases of head and neck DDLS revealed that preoperative biopsy is not reliable for the diagnosis of these tumors and an accurate pathological diagnosis with total resection is preferred.

An atypical lipomatous tumor mimicking a giant fibrovascular polyp of the hypopharynx: A case report

RATIONALE

Giant fibrovascular polyps (GFVPs) found in the hypopharynx are exceedingly rare. These are benign tumors which are identified by CT or MRI and usually treated based on symptoms. Even more rarely, pathology may identify one of these masses as an atypical lipomatous tumor (ALT). This paper will present a case of an ALT of the hypopharynx that was originally classified as a GFVP, highlighting the difficulty in distinguishing between them and the importance of making the correct diagnosis.

PATIENT CONCERNS

An 84-year-old man presented to the emergency department with a 6-month history of a pedunculated hypopharyngeal growth, dysphagia, and intermittent dyspnea.

DIAGNOSES

The mass was characterized as a GFVP by barium swallow and MRI.

INTERVENTIONS

The hypopharyngeal mass was resected for obstructive symptoms and to confirm the diagnosis. Final pathology found the mass to be more consistent with an atypical lipomatous tumor (ALT).

OUTCOMES

The patient's dysphagia and dyspnea resolved. He was free of recurrence at 22 months postoperative.

LESSONS

Both GFVPs and ALTs are very rarely found in the hypopharynx but can be easily misclassified as one another. Imaging is useful to initially characterize the mass, but to definitively differentiate between them, pathological analysis is necessary. Although they are rare, it is important to consider both possibilities on the differential for hypopharyngeal masses. Further, accurate analysis is essential to distinguish between them because their definitive management and follow-up is different.

Liposarcoma of Hypopharynx and Esophagus: a Unique Entity?

PURPOSE

Liposarcoma is the most common soft tissue sarcoma in adults. It represents approximately 20 % of all mesenchymal malignancies. It most frequently involves retroperitoneum, trunk, and extremities. Hypopharyngeal and esophageal localization of liposarcoma is extremely rare.

METHODS

We performed a systematic review of literature and reported 26 and 33 cases of hypopharyngeal and esophageal liposarcoma. We analyzed natural history, imaging features, histology, treatment, and prognosis, with a specific focus to similarities and differences between tumors of hypopharynx and esophagus.

RESULTS

Hypopharyngeal and esophageal liposarcomas have more similarities than differences. Incidence has a peak at 6th and 7th decades. The diagnostic procedures are barium swallow, endoscopic examination, and CT/MR imaging. Well-differentiated liposarcoma represents the most frequent histological subtype. Surgical excision is the main treatment. Endoscopic resection can be useful for pedunculated tumors of hypopharynx and cervical esophagus. Differences between hypopharyngeal and esophageal liposarcoma are represented by local recurrence rate (greater for hypopharyngeal tumors), number of giant tumors, and time to recurrence (greater for esophageal tumors). Finally, liposarcomas of distal esophagus need more extended approaches.

CONCLUSIONS

Liposarcomas of hypopharynx and cervical esophagus could be considered a unique pathological entity, with similar features and treatment options. Survival rate is dependent on histological type and location. Local recurrence is common, especially for hypopharyngeal liposarcoma, while the risk of lymph node or distant metastasis is very low. Patients should undergo regular examinations to rule out local recurrence, also for a long time, especially for esophageal tumors.