Rhabdomyoma of the larynx

Rhabdomyoma of the Larynx: A Case Report and Literature Review of a Rare Tumor in an Uncommon Location

OBJECTIVES

Laryngeal rhabdomyomas are extremely rare, benign striated muscle tumors that have been documented only ∼50 times in the literature. They can be subdivided into two types: fetal and adult types, with the adult type being more common. Common presenting symptoms include hoarseness or progressive dysphagia. Diagnosis is made via immunohistochemical and microscopic analysis. Management is typically surgical, most commonly endoscopic, or open resection.

METHODS

A comprehensive literature review was conducted with PubMed's MEDLINE index using the following search string: "rhabdomyoma" AND ("larynx" OR "laryngeal" OR "head" OR "neck"). After exclusion criteria were applied, a total of 58 cases were included. The purpose of our literature review was to elucidate information about age/gender, location, size, chief complaint and duration, treatment, and recurrence from each of the 58 cases to identify trends that could guide future diagnosis and management.

RESULTS

The average age at diagnosis of laryngeal rhabdomyoma was 52.6 years with a 2.22:1 male predominance. Hoarseness and/or dysphonia was the most common chief complaint (42/58 cases, 72%), followed by dysphagia (12/58 cases, 21%). Common treatment options included endoscopic excision (18/48 cases, 37.5%) or open surgical resection (10/48 cases, 21%). Tumor recurrence was reported in 5/40 cases (14%), most likely due to incomplete removal of the tumor.

CONCLUSIONS

Although laryngeal rhabdomyomas are rare, they should be considered in the differential diagnosis for patients with a submucosal laryngeal mass. Curative treatment is surgical via endoscopic resection. It is the preferred technique because of decreased morbidity compared to open resection. However, endoscopic resection was shown to have both higher rates of recurrence and shorter time to recurrence compared to open resection, necessitating frequent postoperative surveillance.

Recurrent adult-type rhabdomyoma: a rare differential diagnosis of "swellings in the masticatory muscle"

Rhabdomyomas are rare benign mesenchymal tumors with skeletal muscle differentiation and a predilection for the head and neck area. A 38-year-old man presented with persistent, slowly growing, painless swelling in the left inner cheek for 2½ years. The lesion was detected during routine dental examination and was considered to represent a mucocele. The mass was removed via a transoral surgical approach, followed by a local recurrence 6 months later that was again surgically removed. The patient is alive and well 2 months after last surgery. Adult-type rhabdomyoma is a rare, occasionally recurring, benign mesenchymal tumor that should be included in the differential diagnosis of submucosal swellings in the oral cavity including the masticatory musculature. Adult-type rhabdomyoma of the cheek and masticatory area are exceptionally rare with no more than 3 cases reported to date.

Extracardiac juvenile rhabdomyoma of the larynx: a rare pathological finding

The extracardiac juvenile rhabdomyoma is extremely rare in the field of Otorhinolaryngology. The tumour usually arises from the soft tissue of the face or from mucosal sites, especially the oropharynx and the oral cavity but only sporadic endolaryngeal cases have been described in literature so far with predominance of young males. Here, we describe the very rare case of endolaryngeal extracardiac juvenile rhabdomyoma in a 42-year-old male. Clinical examination showed a mass of the right vocal cord, resembling a cystic lesion. Microlaryngoscopy revealed a non-encapsulated lesion and histopathology including immunohistochemistry which consecutively led to the correct diagnosis. This case suggests that the endolaryngeal extracardiac juvenile rhabdomyoma can be easily confused with a vocal cord cyst. Malignant transformations have not been reported but recurrences have been described. When total excision cannot be accomplished, reoperation or narrow follow-up is indicated to prevent advanced revision surgeries.

Adult rhabdomyoma in the parapharyngeal space: report of 2 cases and review of the literature

Rhabdomyomas are rare benign mesenchymal tumors with skeletal muscle differentiation. They are less commonly encountered than are their malignant counterparts, rhabdomyosarcomas. Rhabdomyomas fall into 2 general categories: cardiac and extracardiac types. Extracardiac rhabdomyomas are among the rarest tumors in humans and can be subclassified as fetal, juvenile, and adult types depending on the individual tumor's degree of differentiation by light microscopy. Adult extracardiac rhabdomyoma has a strong predilection for occurrence in the head and neck, mainly in the area of larynx and pharynx. In this article, 2 cases of parapharyngeal rhabdomyoma are reported together with a review of the world literature.

Rhabdomyoma of the true vocal fold

Rhabdomyomas of the larynx are exceedingly rare. The incidence, sites of occurrence in the larynx, and treatment of these benign striated muscle tumors are reviewed. A case of rhabdomyoma involving the vocalis muscle is presented with magnetic resonance imaging and video-stroboscopic documentation.

Rhabdomyoma of the larynx: a review of the literature with a summary of previously described cases of rhabdomyoma of the larynx and a report of a new case

A review of extracardial rhabdomyomas of the larynx reported in the literature is presented. A new case is added (the largest described yet). The diagnosis was based on routine histological and immunohistological staining, and electron microscopy. The extracardial rhabdomyomas were divided into three types according to histopathological findings: (i) adult; (ii) foetal cellular type; and (iii) foetal myxoid. There are 23 well-documented cases (including this case) of extracardial rhabdomyomas of the larynx; 15 of the adult type, four of the foetal myxoid type and four of the foetal cellular type. The differential diagnosis and the requisite diagnostic procedure is discussed. The tumour is benign. The treatment is surgical excision. Although rare, its existence should be kept in mind in the differential diagnosis of laryngeal tumours.

Fetal rhabdomyoma of the head and neck: a clinicopathologic and immunophenotypic study of 24 cases

Twenty-four fetal rhabdomyomas (FRMs) of the head and neck occurring in 16 male and seven female patients (sex unknown in one), ranging from 3 days to 58 years of age (median, 4.5 years) are reported. Ten patients (42%) were < or = 1 year old, six lesions (25%) were congenital, and 11 lesions (46%) occurred in patients > or = 15 years of age. The median tumor size was 3.0 cm (range, 1.0 to 12.5 cm). The FRMs presented as well-defined, solitary masses arising within the soft tissue or mucosa (2:1) of the head and neck. The median follow-up in 15 cases was 48 months (range, 2 months to 52 years) after diagnosis. With the exception of one patient with a local recurrence, all patients were either alive and well or dead of unrelated causes. Eight cases, regarded as "classic" FRM, consisted predominantly of bland, primitive spindled cells associated with delicate, elongated skeletal muscle cells reminiscent of fetal myotubules that were haphazardly arranged in an abundant fibromyxoid stroma. The remaining 16 cases, designated as "intermediate" FRM, displayed both a greater degree and a greater number of cells with skeletal muscle differentiation as well as a variety of distinctive cytologic and architectural features. These included the presence of large, ganglion cell-like rhabdomyoblasts with vesicular nuclei and prominent nucleoli, interlacing ribbon or strap-like rhabdomyoblasts with deeply acidophilic cytoplasm, broad bundles of more delicate spindled rhabdomyoblasts arranged in fascicles simulating smooth muscle, an occasional plexiform pattern with infiltration of adipose tissue and skeletal muscle, focal intimate association with peripheral nerves, and rare areas of fibroblastic proliferation. Mitoses were not found in 19 of the 24 FRM cases, but in five tumors there were 1 to 14 mitoses/50 high-power fields. Marked nuclear atypia, anaplasia, and a "cambium layer" were uniformly absent. The FRMs typically stained for myoglobin, desmin, and muscle-specific actin with focal or rare staining for vimentin, smooth muscle actin, S-100 protein, glial fibrillary acidic protein, and Leu-7. Cytokeratin, epithelial membrane antigen, and CD68 antigen (with KP1) were not detected. This study expands on previous reports of FRM and demonstrates that it has both a broader age range and histologic spectrum than previously recognized. The mitotic rates of FRM as well as certain histologic features overlap with rhabdomyosarcoma; the lack of marked nuclear atypia is an important distinguishing feature.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult rhabdomyoma of the head and neck: a clinicopathologic and immunophenotypic study

Twenty-seven cases of adult rhabdomyoma (ARM) of the head and neck are reported. The 20 male and seven female patients ranged in age from 33 to 80 years (median age, 60 years). Symptoms included airway obstruction and a mass within the mucosa or soft tissue. Median tumor size was 3.0 cm (range, 1.5 to 7.5 cm). Seven patients (26%) presented with multinodular tumors and one tumor was multicentric. Follow-up was available in 19 cases and ranged from 2 months to 18.5 years after diagnosis (median, 6.0 years). Lesions recurred locally in eight cases (42%) 2 to 11 years after diagnosis (median, 6 years). One recurrence was multicentric. Histologically, ARM was composed of closely packed, large polygonal cells having abundant, eosinophilic, granular, or vacuolated glycogen-rich cytoplasm with focal cross-striations. Immunohistochemical stains confirmed skeletal muscle differentiation; the majority of tumors stained for myoglobin (21 of 21 tumors), muscle-specific actin (21 of 21 tumors), and desmin (19 of 21 tumors). Focal or rare immunoreactivity for vimentin (six of 17 cases), alpha-smooth muscle actin (17 of 20 cases), S-100 protein (14 of 21 cases), and Leu-7 (10 of 20 cases) also was detected. Cytokeratin, epithelial membrane antigen, glial fibrillary acidic protein, and CD68 antigen (with KP1) were not found. The characteristic histology and immunophenotype distinguish ARM from other lesions with which it is frequently confused, including granular cell tumor, hibernoma, oncocytoma, and paraganglioma. The expression of alpha-smooth muscle actin has not been reported previously in ARM; its presence could reflect aberrant expression of smooth muscle actin in skeletal muscle or possibly be a recapitulation of early skeletal muscle embryogenesis.

Rhabdomyoma of the larynx recurring after 12 years: immunocytochemistry and differential diagnosis

Rhabdomyoma is a rare tumor of skeletal muscle origin which can occur in different localizations. The head and neck region is a site of predilection for the adult type. Its absolutely benign behavior makes correct diagnosis crucial. In this study, a case of an extracardiac rhabdomyoma of the larynx was found to recur 12 years after initial treatment. Following its surgical removal, histology showed typical patterns of an adult type of rhabdomyoma with focal cross-striations. Immunocytochemically, all applied muscular markers were positive. Electron microscopy revealed muscular filaments with cross-striations and glycogen granules. These findings showed that immunocytochemistry plays an important role in differential diagnosis and the need for possible further treatment.

Immunochemistry and electron microscopy of head and neck rhabdomyoma

Rhabdomyomas are rare benign tumours originating in skeletal or cardiac muscle. Extracardiac tumours are usually situated in the head and neck. Four cases are presented, three arising in the larynx and the other in the cervical region. All four cases were studied by light and electron microscopy, and in three immunohistochemical staining for myoglobin, desmin, and vimentin was carried out to study the diagnostic features of the lesions and their histogenesis.