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

Primary sarcomas of the larynx: A report of three cases and literature review

Introduction. Primary sarcomas are uncommonly seen in larynx and comprise around 1% of all laryngeal malignant tumors. We present three cases of patients with different types of laryngeal sarcomas and discuss about diagnostic and treatment difficulties. Case outline. Each patient presented with hoarseness and shortness of breath. Computed tomography scans showed large transglottic tumors of the larynx with no signs of cervical lymphadenopathy and definitive diagnoses of sarcomas were made by pathologists. Each patient underwent total laryngectomy with clear resection margins. Patient with laryngeal leiomyosarcoma developed large locoregional relapse of malignant disease and pulmonary metastasis four months after surgery and patient with laryngeal osteosarcoma was diagnosed with inoperative locoregional relapse of malignant disease three months after surgery. Both patients died within six months after surgery. On the other hand, patient with laryngeal chondrosarcoma was disease-free during three-year follow-up. Conclusion. Primary laryngeal sarcomas have low incidence and they differ from SCC by their biological characteristics and behavior. Radical surgical resection remains the mainstay of treatment with uncertain outcome due to their high potential for recurrence or metastatic spread.

Leiomyosarcoma of the Tracheostomy Site in a Patient with History of Laryngeal Squamous Cell Carcinoma

Leiomyosarcoma (LMS) of the trachea is an extremely rare malignancy with only a few reported cases in English literature. As such the diagnosis can be frequently missed or delayed. We present a case of a 69-year-old male who underwent tracheostomy for airway obstruction secondary to glottic squamous cell carcinoma and treated definitely with radiation therapy. Subsequently, the patient developed LMS of the tracheostomy site. The case further details multiple risk factors that could contribute to development of LMS including radiation exposure, prior malignancy, and chronic inflammation. These risk factors have been well established for LMS in other sites but less so in the head and neck region, which is the subject of our discussion. We also review the current guidelines for head and neck as well as limb sarcomas and discussed role of surgery or radiation and their accompanying challenges in management of this rare malignancy.

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.

Kissing tumors; the concurrent diagnosis of leiomyosarcoma and squamous cell carcinoma of the esophagus

Background

Esophageal leiomyosarcoma (LMS) is a rare tumor that constitutes less than 1% of all malignant esophageal tumors. Concurrent occurrence of esophageal leiomyosarcoma with squamous cell carcinoma (SCC) is even rarer than isolated leiomyosarcoma.

Case presentation

In this report, we present a case of concurrent leiomyosarcoma and SCC in a 64-year-old woman presenting with vomiting and solid dysphagia, which has not been properly diagnosed following several referrals and diagnostic modalities. At last Exploratory laparotomy with gastric pull-up was performed in addition to radical laryngectomy with partial resection of the esophagus and subtotal thyroidectomy. Pathologic evaluation of the surgical specimen showed concurrent LMS (5.2 × 4.5 × 3 cm) and SCC (1.5 × 0.6 × 0.6 cm) at the same anatomical level in the proximal esophagus.

Conclusions

This study proposes the importance of using ancillary diagnostic tests such as immunohistochemistry (IHC) to diagnose less common cases such as concurrent LMS and SCC.

Twin pathologies: synchronous leiomyosarcoma and squamous cell carcinoma of the larynx

The synchronous discovery of leiomyosarcoma (LMS) and squamous cell carcinoma (SCC) of the larynx is extremely rare. We describe our experience of managing a patient with this unusual presentation. A 35-year-old man was initially diagnosed with advanced stage (T_4bN₁M₀) laryngeal LMS. Neoadjuvant sarcoma-directed chemotherapy and radiation therapy allowed a successful pharyngolaryngo-oesophagectomy to be performed in an otherwise inoperable cancer. Histological examination of the resection specimen revealed poorly differentiated SCC, indicating the underlying diagnosis was a sarcomatoid carcinoma of the larynx. Considering our limited experience of managing synchronous LMS and SCC of the larynx, it is important to carefully evaluate the natural history, route of spread and pathological characteristics of both tumours, when determining treatment.

Incidence and mortality of laryngeal cancer in China, 2008-2012

OBJECTIVE

To analyze the incidence and mortality rates of laryngeal cancer in China from 2008 to 2012.

METHODS

Incident and death cases of laryngeal cancer were retrieved from the National Central Cancer Registry (NCCR) database collecting from 135 cancer registries in China during 2008-2012. The crude incidence and mortality rates of laryngeal cancer were calculated by area (urban/rural), region (eastern, middle, western), gender and age group (0, 1-4, 5-9, …, 85+). China census in 2000 and Segi's world population were applied for age standardized rates. JoinPoint (Version 4.5.0.1) model was used for time trend analysis.

RESULTS

The crude incidence rate of laryngeal cancer was 1.86/100,000 ranked the 21st in overall cancers. The age-standardized incidence rates by China population (ASIRC) and by World population (ASIRW) were 1.22/100,000 and 1.23/100,000, respectively. The crude mortality of laryngeal cancer in China was 1.01/100,000 and it was the 21st cause of cancer-related death in overall cancers. Both the age-standardized mortality rates by Chinese standard population (ASMRC) and by world standard population (ASMRW) were 0.63/100,000. Incidence and mortality rates of laryngeal cancer were higher in males than in females and higher in urban areas than in rural areas. Middle areas had the highest incidence and mortality rates followed by eastern and western areas. Incidence and mortality rates of laryngeal cancer retained low level before age of 40 years old but increased greatly after and peaked in age group of 75. Incidence showed significant down trends in recent 10 years by 1.27% annually [95% confidence interval (95% CI): -2.2%, -0.3%]. Mortality declined in females sharply by 5.18% per year although stable in males and both sexes combined.

CONCLUSIONS

Appropriate targeted prevention, early detection and treatment programs should be carried out to control the local burden of laryngeal cancer.

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.