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

Clinical evolution of bladder carcinosarcoma: A case report and literature review

RATIONALE

Bladder carcinosarcoma (BC) is a malignant tumor composed of a mixture of malignant epithelial and stromal components. Carcinosarcoma mostly occurs in the upper respiratory tract and upper gastrointestinal tract and is less common in the urinary system. The incidence of malignant tumors of the urinary system is <3%. It rarely occurs in the bladder and accounts for approximately 0.31% of all malignant bladder tumors. A literature review and this report will help to further improve our understanding, diagnosis, and treatment of bladder carcinosarcoma (BC).

PATIENT CONCERN

We describe the case of an 80-year-old female patient who was admitted to the hospital with a history of intermittent hematuria for 3 years. Furthermore, total cystectomy was refused when a BC was diagnosed. Palliative resection surgery was necessary because of the recurrent hematuria and abdominal pain.

DIAGNOSES

Pathologically confirmed BC after surgery.

INTERVENTIONS

The patient's first transurethral resection of bladder tumor (TURBT) was diagnosed as BC. However, the patient refused a total cystectomy. Two months after intravesical treatment with epirubicin, bladder tumor recurrence was observed during follow-up cystoscopy. The patient underwent a second TURBT for hemostatic treatment due to persistent hematuria. Due to hematuria and abdominal pain, a third TURBT was performed to reduce tumor size and stop bleeding. Finally, tumor recurrence resulted in bilateral hydronephrosis, and the patient underwent bilateral renal catheter drainage guided by B-ultrasound.

OUTCOMES

Bladder carcinosarcoma caused uremia, electrolyte imbalance, and sepsis. Approximately 19 months after the discovery of the tumor, the patient died.

LESSONS

Radical bladder resection is recommended once a BC is diagnosed. By reporting the cases and reviewing the literature in the database, we will summarize the epidemiology, origin, etiology, clinical features, existing treatments, and prognostic factors of BC, and propose new prospects for BC therapy.

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.

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.

Epstein-Barr Virus-Associated Smooth Muscle Tumors of Larynx: A Clinicopathologic Study and Comprehensive Literature Review of 12 Cases

Laryngeal mesenchymal neoplasms are rare, with smooth muscle tumors comprising a small subset. Specifically, Epstein-Barr virus (EBV)-associated smooth muscle tumors are exceptionally rare, lacking a comprehensive evaluation of their clinical and histologic features. Two patients (a 59 year old male and 51 year old female) had received renal transplants 156 and 240 months, respectively prior to onset of laryngeal symptoms. Supraglottic polypoid masses were identified and removed conservatively. Histologically, the tumors were hypercellular, showing alternating light and dark areas, the latter composed of primitive appearing round cells, while a more characteristic spindled tumor cell population was noted in the remaining areas. Cytoplasmic vacuoles were noted adjacent to the nucleus. There was no tumor necrosis or pleomorphism, but increased mitotic figures (11-12/2 mm²) were seen, without atypical forms. The tumor cells were strongly immunoreactive with smooth muscle actin and smooth muscle myosin heavy chain and with Epstein-Barr virus encoded RNA (EBER) by in situ hybridization. These patients were reviewed in the context of a thorough English literature review, which demonstrates a wide age range at presentation without a sex predilection, but with most patients from specific ethnic groups (Chinese, Thai, Pilipino). Three-quarters of patients are part of multifocal disease and the majority are post-renal transplantation patients. Conservative management seems to yield the best overall outcome for these indolent tumors. In conclusion, EBV-associated smooth muscle tumors should be considered in any immunocompromised patient with a head and neck smooth muscle tumor, especially when EBER is documented by in situ hybridization. Conservative management may be employed, even when multifocal tumors are documented.

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.

Laryngeal Leiomyosarcoma: A Rare Case

Laryngeal leiomyosarcoma is a rare smooth muscle malignancy of the head and neck region. Diagnosis is based on immunohistochemistry. Here we present a case of laryngeal leiomyosarcoma that was diagnosed and treated in our center, focusing on the clinical features, histological diagnosis and management of this rare disease.

Leiomyosarcoma of Larynx as a Metachronous Tumor of Squamous Cell Carcinoma: An Unusual Case

Leiomyosarcomas (LMSs) are malignant tumors of smooth muscles accounting for 5-6% of all soft tissue sarcomas. They are mostly seen in the gastrointestinal tractus, the uterus, and the retroperitoneum. Soft tissue sarcomas comprise <1% of all laryngeal malignancies, most of which are chondrosarcomas. Laryngeal LMSs are rarely seen malignancies, which are published as case reports. We presented a case of laryngeal LMS, which was seen 4 years later in a laryngeal squamous cell carcinoma patient who underwent laryngeal laser microsurgery. We discussed the diagnosis and treatment algorithm in the light of the present literature.

[The presentation of laryngeal malignant tumors of mesenchymal origin]

Although laryngeal malignancies of mesenchymal origin (laryngeal sarcomas, LS) are extremely rare (1% of all laryngeal malignancies), the histological manifestations are very diverse. LS sign as a solid tumor covered with an intact mucosa.

THE AIM OF THE STUDY

was to evaluate retrospective data referring: epidemiology, clinical manifestations, treatment and early follow-up; based on medical record made in ORL, HNS Surgery Dpt of Holy Cross Cancer Centre in Kielce during 9-years period 2001-2009.

MATERIAL AND METHODS

The retrospective analysis of the group of 12 patients with LS was made. Studied characteristics were: age, sex, primary focus, histological outcome, treatment options and early follow-up.

RESULTS

Age of the group of 12 studied patients (10 M, 2 F) ranged from 48 to 84 (mean 69.8). LS accounted 1.2% (12/935) for all of laryngeal malignancies. The focus of origin were: glottis (6), epiglottis (5); subglottis (1). The most common histological types of LS at studied group were: neurosarcoma (2), fibrosarcoma (2), plasmocytoma (2), chondrosarcoma (1), malignant fibrous histiocytoma (1), sarcoma low grade (1), lymphoma malignum (1), liposarcoma (1) and haemangioendothelioma epithelioides vel plasmocytoma (1). Methods of treatment were: surgery (6); radiotherapy (1); chemotherapy (1); chemo- and radiotherapy (3); symptomatic treatment (1). The clinical results of treatment are: 9 patients are still alive (5 pts more than 5 years, 3 pts less than 5 years, 1 pts less than 2.5 years with residual disease); 3 patient died: 2 pts in 1st year from diagnosis, 1 pts after 3 years of treatment died of non-oncological causes.

CONCLUSIONS

1. LS are extremely rare and diversed histologically. 2. Immunochemical analyses are very important procedures used in diagnostics of these malignancies. 3. An individual approach is needed in diagnostic and therapeutic procedures of LS.

Epstein-barr virus-associated smooth muscle tumor of the larynx: report of a rare case mimicking leiomyosarcoma

We present a patient (male 54 years) with a history of renal transplant who 14 years post transplantation developed a symptomatic (stridor) laryngeal Epstein Barr virus (EBV)-associated smooth muscle tumor (EBV-SMT) in the absence of concomitant disease elsewhere. Nine years post transplantation the patient developed a subcutaneous EBV-SMT tumor located on the calf. The laryngeal tumor displayed low-grade nuclear atypia and was infiltrating into the surrounding soft tissue, focally ulcerating through the overlying epithelium. Histologic features included: neoplastic cells with myoid differentiation, a component of primitive appearing small mesenchymal cells with hyperchromatic nuclei, mitotic activity, intralesional small to medium sized blood vessels and T-lymphocytes. Both the myoid and small cell mesenchymal components strongly expressed smooth muscle actin and h-caldesmon, but not desmin, cytokeratins, CD34 or S-100 protein. There was strong positive nuclear reaction for EBV-RNA on in situ hybridization (EBER). No other tumor was detected on clinical and radiological examinations and no evidence of tumor in other sites, over 8 months of follow-up, till death was detected. This case emphasizes the importance of considering this pathologic entity when solitary smooth muscle actin-expressing tumors are encountered in the larynx of immunocompromised patients.

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.

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.

Treatment of unusual or rare laryngeal nonsquamous primary malignancies: radical (total/extended total laryngectomy) or conservative surgery?

PURPOSE

The most appropriate treatment of laryngeal nonsquamous malignancies is a controversial subject, mainly because of the limited number of cases diagnosed. Surgery, which is an obligatory choice in nearly all cases, is sometimes indiscriminately demolitive despite the relatively low locoregional aggressiveness that characterizes certain histotypes and locations. Even in extremely aggressive tumors, where the prognosis is almost invariably unfavorable because of distant metastasis, the suitability of radical surgery should be carefully assessed, especially considering the patient's remaining life quality. The aim of the present investigation was to evaluate the postsurgical oncological results in a series of consecutive patients with laryngeal nonsquamous primary malignancy.

METHODS

We analyzed retrospectively 29 consecutive patients with laryngeal nonsquamous malignancies of whom 10 underwent total laryngectomy and 19 conservative surgery (partial laryngectomies).

RESULTS

Of the 29 patients with of laryngeal nonsquamous malignancies, 16 were alive and free from disease after treatment, 5 died of other causes, 1 was lost at follow-up, and 7 died of the disease. Statistical analysis failed in disclosing a significantly different local recurrence rate after conservative surgery vs radical surgery after a mean follow-up period of 5.5 years.

CONCLUSIONS

From the preliminary data emerging from the study, it seems that in nonsquamous malignancies of the larynx, the surgical approach should be the most conservative surgery possible, tailored to neoplasm extent and patient conditions. Although cervical lymph node metastases are unusual, long-term follow-up is mandatory considering the relatively high incidence of distant metastases even after years.