Alveolar soft part sarcoma of the head and neck. A disease of children and young adults

Rare Case Report of Alveolar Soft Part Sarcoma of the Orbit

Alveolar soft part sarcoma (ASPS) is a rare but distinct soft tissue tumor with unique histopathological and electron microscopic features. Orbital involvement is rare with only few reports published in the literature. ASPS have an indolent clinical course, but it is known to metastasize. Primary modality of treatment is surgery followed by adjuvant treatment. This case is a unique presentation with orbital mass with on and off bleeding. This is the largest orbital ASPS for which orbital exenteration was performed.

Alveolar soft part sarcoma with brain metastases

Metastatic tumors are the most common mass lesions in the brain. This case reports a rare form of sarcoma with metastasis to the brain. The appropriate management of a patient with metastatic alveolar soft part sarcoma to the brain is discussed. Author describes a 32-year-old gentleman diagnosed with primary tumor at gluteus and distant metastases at lower lobe of right lung and the brain. Histopathology proves diagnosis as alveolar soft part sarcoma. Craniotomy with excision of brain lesion was done. Repeated magnetic resonance imaging of the brain after 2 months showed rapidly growing new lesions. The next step of management was made by the oncology team as recurrence rate was high and due to multi-systemic involvement. Patient was planned for palliative chemotherapy and to be reassessed later. This case report discusses the appropriate approach to any form of brain metastases and the role of early follow-up especially after surgery for better outcome and choice of post operative management such as radiotherapy or chemotherapy or both for malignant tumors. Based on this report, it was concluded that every brain tumor patient should be frequently monitored even in the outpatient setting as most of them are metastatic and rapidly spreading. The patient should be considered for radiotherapy or chemotherapy or both after surgery if the histopathology result is suggestive of malignancy.

Management of recurrent alveolar soft-part sarcoma of the tongue after external beam radiotherapy with iodine-125 seed brachytherapy

BACKGROUND

Alveolar soft part sarcoma (ASPS) is a rare type of soft tissue sarcoma. The infrequency of ASPS is such that it accounts for <1% of all soft tissue sarcomas and <0.1% of sarcomas concerning the head and neck, primarily those involving the orbit (48%) and tongue (25%). Traditional chemotherapy or radiotherapy of ASPS is often associated with poor outcome, even after comprehensive interventions.

METHODS AND RESULTS

We performed iodine-125 ((125) I) seed brachytherapy under ultrasound guidance through a submandibular puncture in a 4-year-old boy with recurrent ASPS of the tongue. The prescription dose was 120 Gy; therefore, 35 (125) I seeds were implanted with 0.77 mCi per seed, the total amount of activity being 26.95 mCi. CT scans confirmed a complete response after the treatment.

CONCLUSION

Our patient now has a recurrent-free survival of >30 months, an amount of time longer than the median rate described in the literature.

Oral alveolar soft part sarcoma in childhood and adolescence: report of two cases and review of literature

Alveolar soft part sarcoma (ASPS) constitutes a rare soft tissue malignant neoplasm comprising less than 1 % of all soft tissue sarcomas. ASPS demonstrates a strong predilection for adolescents and young adults, with a female predominance reported. The head and neck region is the most commonly affected region in pediatric patients with the tongue and orbit affected most commonly. Herein we present the clinical, radiographic, histopathologic, immunohistochemical and molecular features of two examples of ASPS affecting the oral cavity of 4 and 13 year-old boys, along with a focused review of the literature on intraoral ASPS in pediatric patients.

Alveolar soft part sarcoma of the paranasal sinuses masquerading as a giant invasive pituitary adenoma

Alveolar soft part sarcoma (ASPS) is a relatively rare tumor that mostly presents as a slow growing mass in the deep soft tissue of the extremities. A substantial number of cases in children occur in the head and neck region; however, in any age group, it is very rarely reported in the sinonasal region. We report a case of ASPS of the paranasal sinuses with sellar extension in a 25-year-old man that masqueraded as a giant invasive pituitary adenoma. This is only the fifth case of sinonasal ASPS in literature. The clinical and radiological diagnoses were misleading, but an extensive pathology workup including electron microscopy helped reach an accurate diagnosis in this unusual case.

Soft tissue tumors of uncertain origin

Many soft tissue tumors of childhood lack obvious differentiation toward a defined mesenchymal tissue type or have a phenotype that does not correspond to any defined normal tissue. These challenging tumors are currently regarded as neoplasms of uncertain differentiation. Nonetheless, there have been great strides in the understanding of their pathologic and genetic features and biologic underpinnings. The application of new genetic information to the pathologic diagnosis among this group of tumors is an emerging area in diagnostic pediatric pathology. This article reviews the clinicopathologic features of tumors of uncertain and/or miscellaneous origin, with an emphasis on the unique aspects of these neoplasms in children and adolescents, use of diagnostic adjuncts, and differential diagnosis.

Oral metastasis of alveolar soft-part sarcoma: a case report and review of literature

Alveolar soft-part sarcoma (ASPS) is a rare malignant neoplasm with uncertain histogenesis and with a distinctive morphology. It has been described in the oral cavity, but this is the first report of ASPS metastasizing to the maxillary tuber region. A 27-year-old male patient, who was under chemotherapy treatment for ASPS of the thigh, presented in our dental clinic with a painless and pedunculated nodule on the right tuber maxillae. The nodule was erythematous with smooth and lobular surface, measuring 3 cm in maximum diameter. An incisional biopsy was performed and the diagnosis of metastatic ASPS was made. Histologically, the tumor was characterized by a proliferation of polyhedral cells in pseudoalveolar pattern. Tumor cells were large, showing granular cytoplasm, periodic acid-Schiff positive diastase-resistant intracytoplasmic material, and vesicular nuclei with prominent nucleoli. Unfortunately, the patient died 2 months after the diagnosis of the oral metastasis. Metastases of ASPS to the mouth are very rare and indicate a poor prognosis.

Alveolar soft-part sarcoma of the tongue: report of a case and review of the literature

Alveolar soft part sarcoma (ASPS) accounts for less than 1% of all sarcomas. More frequently encountered within the lower limbs, the authors present a 24-year-old male with ASPS presenting as an asymptomatic swelling of the lateral tongue. At 12 months post wide local excision of the lesion, the patient remains well with no evidence of local or regional recurrence. Histological and immunohistochemical features are diagnostic of ASPS. Whilst rare, head and neck surgeons should be aware of ASPS as a potential cause of slow growing lesions, as early surgical resection is vital in view of the propensity for metastatic spread.

Rare tumor of the tongue in a child: alveolar soft part sarcoma

Alveolar soft part sarcoma (ASPS) is a rare, malignant tumor of uncertain histogenesis that has no benign counterpart. In some cases, a structural rearrangement of chromosome 17 involving band q25 has been reported. The neoplasm occurs most frequently in female adolescents and young adults, where it arises predominantly in the extremities. In contrast, the most common sites of occurrence in infants and children are the orbit (41%) and the tongue (25%). The primary therapeutic option is a complete surgical excision. Because of the indolent growth and lack of pain associated with the mass, 20% of patients have metastases at the time of initial diagnosis. Median survival time reported for all sites of the body is 79 months. When ASPS presents in the tongue region, however, the patients involved are usually children and have a better prognosis than patients affected in the extremities. The utility of adjuvant chemotherapy or radiation therapy in children is open to question. Because metastases may occur after several decades, children with ASPS should be followed throughout adolescence and well into adulthood. Only 10 cases of ASPS occurring in the tongues of children younger than 5 years of age were indexed by MEDLINE between 1952 and 2006. Here, we describe the 1st case consistent with typical ASPS of the tongue in 15 years at our hospital. The patient is a 2-year-old girl who has been disease-free for 32 months.

Alveolar soft part sarcoma of tongue base - A rare presentation of a rare tumor

Alveolar soft part sarcoma is a rare, aggressive malignancy of uncertain histologic origin and enigmatic clinical behaviour. It has a characteristic histopathological picture, with a propensity for vascular invasion and distant metastasis. We report a case of alveolar soft part sarcoma involving the tongue base in an adolescent female. She underwent laser assisted excision of the tongue base tumour followed by post-operative radiotherapy. The clinical presentation, histopathological picture, immunohistochemical & cytogenetic studies, radio-imaging, management protocols and prognosis of this tumor have been discussed.

Oral alveolar soft-part sarcoma: review of literature and case report with immunohistochemistry study for prognostic markers

OBJECTIVE

To describe a case of alveolar soft-part sarcoma (ASPS) affecting the tongue of a child and to study prognostic imunohistochemical markers for the disease.

STUDY DESIGN

Tissue sections were incubated with primary antibodies reactive to neuron-specific enolase (NSE), vimentin, desmin, S-100 protein, cytokeratins AE1-AE3, EMA, neurofilament, synaptophysin, and muscle-specific actin (MSA), and for prognostic markers, including Ki-67, p53, bcl-2, bax, and nm23.

RESULTS

Histologically, the tumor showed a proliferation of large polygonal cells with PAS-positive diastase-resistant intracytoplasmatic material, arranged in an alveolar growth pattern. Diffuse positive reaction for neuron specific enolase (NSE), focal reactivity for desmin and S-100 protein, strong positivity for nm23 and bax, but weak reaction for p53 and Ki-67 were found. No bcl-2-positive cells were noted.

CONCLUSION

These immunohistochemical findings may reflect the less aggressive behavior of ASPS in oral tissues.

Lingual alveolar soft part sarcoma; 14 cases: novel clinical and morphological observations

AIMS

Alveolar soft part sarcoma (ASPS) is a rare sarcoma in the buttocks or thigh of young adults, often with metastases to lung, brain, or bone. This study examines the morphological and clinical features of lingual ASPS.

METHODS AND RESULTS

Fourteen cases, in eight males and six females (ages 3-21 years, median 5 years), ranged from 8 to 50 mm, median 25 mm. All tumours were intramuscular, circumscribed and multinodular. Tumours from all but the oldest patient exhibited a predominantly solid (non-alveolar) growth pattern. Vascular invasion was common. Crystals varied in number from none or extremely rare to nearly 100% of tumour cells. Immunohistochemical results: Fifty percent desmin positive, all focally smooth muscle antigen (SMA) positive; negative for vimentin, neural/melanocytic, myoid, histiocytic, and epithelial markers. All tumours were surgically excised; only two patients received chemotherapy. Follow-up on 10 patients showed that all patients were alive without disease (4-32, median 22 years). Only one patient had a microscopic metastasis to lung (3 years) but was without disease at 11 years.

CONCLUSIONS

Lingual ASPS is a tumour of childhood with a distinctive, predominantly solid growth pattern. Despite typical vascular invasion, the early diagnosis and small tumour size may explain its relatively good outcome.

Alveolar soft part sarcoma: report of a case occurring in the sinonasal region

A primary alveolar soft part sarcoma arising in the nasal-paranasal sinuses region is quite rare. In this report, a 14-year-old boy with typical features of alveolar soft part sarcoma of the nasal and paranasal sinuses is presented. Treatment was surgical excision of the mass combined with radiotherapy. There has been no recurrence or metastasis as of 2 years after treatment.

Alveolar soft-part sarcoma responsive to intensive chemotherapy

Alveolar soft-part sarcoma (ASPS) is a very rare malignant tumor, usually of the extremities, and is seen most often in adolescents and young adults. Surgical excision of the primary and pulmonary metastases has resulted in prolonged survival in some patients, but adjuvant radiation and/or chemotherapy are generally thought to be ineffective. The authors describe a 13-year-old patient with ASPS of an extremity who presented with multiple bilateral pulmonary metastases at diagnosis. Following intensive multiagent chemotherapy, pulmonary metastases showed in vivo evidence of tumor death. The patient has remained disease-free for 10 years following treatment.

[Alveolar soft tissue sarcoma]

Alveolar soft part sarcoma is a malignant soft part tumor the etiology of which has not yet been clarified. Histopathological examinations show an alveolar or pseudoglandular pattern. PAS-positive, diastase resistant intraplasmic inclusion bodies are characteristic for this tumor which occurs in the head and neck region; mainly the tongue and the orbita. Primary therapy includes total resection which can later be combined with radiotherapy or chemotherapy. The present study involves a 17 year old patient. We totally removed the tumor and then used radiotherapy. The postoperative examinations over 3 years showed neither local recurrence nor distant metastases.

Distinctive soft tissue tumors of the head and neck

Among soft tissue tumors as a whole, those in the head and neck region are relatively uncommon, and the proportion of all soft tissue sarcomas that arise in this region is <or=5-10% (although this figure is higher in children). With the exceptions of nasopharyngeal angiofibroma and sinonasal hemangiopericytoma, most mesenchymal lesions are not truly distinctive to this site. This overview focuses on tumors that show a relative predilection for this region, including principally benign fibroblastic/myofibroblastic lesions, nerve sheath tumors, vascular tumors (both benign and malignant), and small round cell sarcomas, especially rhabdomyosarcoma in young patients. Important generalizations to bear in mind include the facts that (1) among spindle cell malignancies in the head and neck of adults, spindle cell carcinoma and melanoma are by far more common than sarcomas; (2) because of anatomic constraints and dramatic clinical presentation, the index of clinical suspicion for malignancy is often high; (3) certain subsets of benign mesenchymal lesions in this anatomic region frequently show pseudosarcomatous morphology; and (4) the ability to define or obtain an adequate surgical resection margin in this region is often very limited, hence issues of local control may supercede the importance of overall biologic/metastatic potential in some cases.

Alveolar soft part sarcoma of the head and neck region

Alveolar soft part sarcoma is a soft tissue malignancy most often found in the extremities of young adults; when these tumors arise in the head and neck area, they usually appear in the orbit or the tongue. Their initial behavior is relatively indolent, but over time a sizable number of these tumors recur locally and metastasize; as such, they are best regarded as fully malignant neoplasms. The derivation of these tumors remains uncertain: while some have suggested that these are tumors of muscle origin and others have postulated a neuroendocrine origin, the evidence accumulated to date is conflicting, and so these neoplasms continue to be regarded as tumors of uncertain origin. Surgical excision is the mainstay of therapy.

Alveolar soft-part sarcoma: a review of the pathology and histogenesis

The descriptive designation, alveolar soft-part sarcoma, continues to be used for this uncommon soft-tissue malignancy because an acceptable hypothesis for its histogenesis has not been advanced, despite studies with electron microscopy and immunohistochemistry. These techniques have, nevertheless, provided significant information that is useful in the differential diagnosis of the tumor and pertinent in speculation concerning its nature. The most intriguing ultrastructural feature is the secretory process that culminates in the formation of the distinctive cytoplasmic crystals. Myogenic differentiation has been favored in a number of recent reports on the basis of immunohistochemical findings and the presence of the crystals does not rule out the possibility, but accounts of immunoreactivity for the myogenic regulatory protein MyoD1 have not been confirmed in subsequent studies or in the authors' own staining of six cases.

Radiation therapy for alveolar soft-part sarcoma

A clinical experience with radiotherapy in 18 patients with alveolar soft-part sarcoma is presented. Adjuvant radiotherapy was associated with prolonged local control in six of six patients without metastatic disease at diagnosis; later one patient relapsed systematically. Meaningful palliation was achieved in all patients with extra-skeletal (and possibly skeletal) metastatic disease. Radiation therapy may be beneficial for patients with alveolar soft-part sarcoma by enhancing local control achieved with limited surgery, by retarding progression of metastatic deposits, and by providing meaningful palliation.