Liposarcoma of the larynx: a multicentric or a metastatic malignancy

Liposarcoma of Larynx-A Case Report and Updated Review of Literature

Liposarcomas of the larynx is an extremely rare entity, and less than 50 cases have been published in English language literature. It is a malignant mesenchymal tumour arising from adipose tissue with a very high propensity for local recurrence. Well-differentiated liposarcomas are the most common variety but are challenging to diagnose because of their resemblance with benign tumors like lipoma and other malignant soft tissue sarcomas like myxoid chondrosarcoma. Therefore, immunohistochemistry (IHC) should be considered for confirmation. Wide local excision is the treatment of choice, and post-operative radiotherapy can be considered in cases of positive resection margins not amenable for revision surgery, high tumour grade, and myxoid variant. We are reporting a case of well-differentiated liposarcoma of the left aryepiglottic fold (AEF) in a 66-year-old man who was diagnosed to have a benign lipomatous lesion in the same location 3 years back. Based on the reports of the published cases, we are presenting a management algorithm for this entity.

A Rare Case of Low-Grade Dedifferentiated Liposarcoma Presenting as a Pharyngeal Polyp: Avoiding a Pitfall With Significant Repercussions

Dedifferentiated liposarcoma is a nonlipogenic sarcoma of variable histological grade that frequently arises in association with a well-differentiated liposarcoma. Dedifferentiation occurs in approximately 10% of well-differentiated liposarcomas and is most commonly encountered in the retroperitoneum. Dedifferentiated liposarcoma of the upper respiratory tract is an extremely rare occurrence. Herein, we report a very rare case of low-grade dedifferentiated liposarcoma of the pharynx that presented as a polyp mimicking a benign process clinically and microscopically. We discuss the relevant molecular findings and review the current literature.

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.

Well-differentiated liposarcoma of the epiglottis

OBJECTIVE

Liposarcomas of the larynx and its sub-sites are rare. Within this group of tumours, well-differentiated liposarcomas of the epiglottis have been only sporadically reported. In view of its infrequent presentation, difficulty still exists over the diagnosis of this pathological entity, together with uncertainty over its exact accepted management.

METHOD

We present the case of a well-differentiated liposarcoma of the epiglottis, and we review the associated English-language literature.

RESULTS

The reported patient underwent multiple attempts at surgical treatment prior to establishment of a firm diagnosis. In light of the diagnosis and other mitigating factors, a conservative approach was adopted.

CONCLUSION

A high index of clinical suspicion and detailed histological analysis are required when encountering a recurrent soft tissue lesion of the larynx. In the presented case, a multidisciplinary approach and conservative management plan were adopted, based on a holistic management approach and a review of the published literature.

High-grade liposarcoma metastatic to the gingival mucosa: case report and literature review

Liposarcoma is the most common family of soft tissue sarcomas and occurs most often in the extremities and retroperitoneum. Primary liposarcoma of any subtype is relatively rare in the tissues of the head and neck, and metastatic liposarcoma is even more unusual. This report describes a recent case of a metastatic high-grade liposarcoma presenting on the dental alveolus. English-language publications on metastatic liposarcoma to the head and neck region are reviewed with an emphasis on the types of therapies used and the resultant outcomes.

Liposarcoma of the larynx

OBJECTIVES

The objective was to review the presentation, diagnosis, treatment, and prognosis of patients with laryngeal liposarcoma (LLS). A case is reported, and a retrospective review of the English-language literature is presented.

METHODS

All published cases of LLS with adequate histopathologic documentation and clinical information were included for review.

RESULTS

Thirty cases of LLS have been reported. A majority of these patients are men between 40 and 70 years of age. The most common location of the tumor is the supraglottis, and the presenting complaints are similar to those of other laryngeal neoplasms. Although these neoplasms recur often and can cause significant morbidity, they are typically of low grade and rarely metastasize. The outcomes of this disease are generally good when it is treated with wide surgical excision.

CONCLUSIONS

Cases of LLS are extremely rare. Because the histologic changes are frequently subtle, LLS can be easily mistaken for a benign tumor. As a result, the diagnosis requires a high index of suspicion and diligence in examining biopsy specimens. Computed tomography and magnetic resonance imaging can assist in the diagnosis and surgical approach. Genetic and immunostaining analysis techniques may also prove to have valuable prognostic, diagnostic, and therapeutic implications for this disease. Wide surgical excision is the mainstay of treatment. The use of radiotherapy and chemotherapy in treating this cancer remains experimental, but might be considered on a case-to-case basis for palliation or to treat aggressive variants of the disease.

Bulky cervical liposarcoma associated with sleep apnea syndrome

Sarcomas of the head and neck are relatively infrequent tumors. Liposarcomas represent 10-16% of all soft tissue sarcomas and <5% of them arise from the head and neck. The retropharyngeal area is rarely involved. We present the case of a middle-aged male with clinical symptoms of sleep apnea. A fiber-optic examination revealed a soft submucosal lesion compressing the posterior pharyngeal wall, with partial obstruction of the airway tract. CT showed a large heterogeneous prevertebral mass (6 x 20 cm(2)) occupying the posterior mediastinum. A transoral submucosal biopsy was performed. Histological findings were compatible with a low-grade liposarcoma. The mass was removed in monoblock using a classical laterocervical neck incision. The surgical specimen weighed 500 g. After 24 months of follow-up no signs of tumor recurrence or sleep apnea syndrome were noted.

Dedifferentiated liposarcoma of the pyriform sinus: report of a case and review of the literature

Laryngeal and hypopharyngeal liposarcomas are extraordinarily infrequent tumors. To the best of our knowledge there are fewer than 40 well-documented cases reported to date. Almost all of them are well-differentiated liposarcomas, with only 2 laryngeal-hypopharyngeal dedifferentiated liposarcomas. Dedifferentiated liposarcoma is defined as a well-differentiated liposarcoma with areas of high-grade spindle cell nonlipogenic sarcoma. The well-differentiated areas may be of a lipoma-like, sclerosing, or mixed type, and the dedifferentiated areas most frequently are of malignant fibrous hystiocytoma-like type. Despite its commonly pleomorphic histology, dedifferentiated liposarcoma does not behave as aggressively as most pleomorphic sarcomas of adulthood; however, it has the capacity to metastasize, in contrast to its well-differentiated counterpart. We present a case of dedifferentiated liposarcoma arising in the pyriform sinus, an event only twice reported previously in the literature.

Upper aerodigestive tract liposarcoma: report on four cases and literature review

OBJECTIVE

To report on the clinical behavior, histopathology, treatment, and prognosis of laryngeal, hypopharyngeal, and cervical esophageal liposarcomas.

STUDY DESIGN

Retrospective reviews of pathology files and hospital records at a tertiary care hospital and a retrospective search of the English-language literature.

METHODS

Cases of upper aerodigestive tract (UADT) liposarcoma with adequate histopathologic documentation and clinical information were included for review.

RESULTS

Four cases of UADT liposarcomas were identified. The literature review revealed 26 cases of laryngeal liposarcomas, 7 cases of hypopharyngeal liposarcomas, and 6 cases of esophageal liposarcomas: the mean age at presentation was 55.8 years, the male:female ratio was 5:1, and 60% of the patients presented with dysphagia. Eighty-six percent of tumors had low-grade histologic findings. The recurrence rate after primary resection was 50%. Recurrence correlated with surgical procedure rather than with histologic subtype; 94.7% of recurrences happened after simple excision. Distant metastases occurred in three patients; two of them died of the disease.

CONCLUSIONS

The literature supports that UADT liposarcomas are rare and usually of low-grade histologic type. The rate of metastatic disease and tumor-related mortality is low. However, high recurrence rates have been noted, particularly when less radical surgery is employed.

[Liposarcoma of the larynx. Review of the literature apropos of a case]

Liposarcoma of the larynx is an uncommon tumor. Only 27 cases have been described in literature. We report a new case occurring in a 50-year-old patient. The treatment consisted of a total laryngectomy with lymph node dissection followed by adjuvant irradiation. Prognosis for laryngeal liposarcoma is better than that of non laryngeal liposarcoma. This tumor is at high risk of local recurrence and seldom has metastatic potential.

Laryngeal liposarcoma: report of a case

Laryngeal and hypopharyngeal liposarcomas are fairly rare tumors, with only 30 convincing cases reported to date. These tumors usually arise in the supraglottic area, and only two cases have been reported to affect the true vocal cord. They behave in an indolent fashion with multiple local recurrences and only rarely cause the patient's death. Our case highlights the natural history of this entity. A 62-year-old man presented because of air-way obstruction. A CT scan discovered a large 5 cm polypoid mass in the right aryepiglottic fold. The patient had already undergone three previous operations for the same reason in another clinic, with histopathological diagnoses of fibrovascular polyps. In the last recurrence, only a careful search for lipoblasts in the surgical specimen allowed us to identify this lesion as a low-grade well-differentiated liposarcoma. Complete resection was impossible in this case, despite total laryngectomy.

Liposarcoma of the larynx treated with radiotherapy

Liposarcoma of the larynx is an extremely rare malignancy. Only 18 cases have been reported in the literature. We herein report the first case of primary liposarcoma of supra-glottic larynx in a 53-years old male patient successfully treated with radiotherapy in August-September 1992. He currently remains free of the disease 4.5 years since the initial diagnosis.

Regional and distant metastases in laryngeal and hypopharyngeal sarcomas

Cervical node and distant metastases are the most important prognostic factors in malignant laryngeal neoplasms. Owing to the unusual occurrence of laryngeal sarcomas, the prevalence of their metastases has never been analyzed in detail. We reviewed the laryngeal sarcomas reported in the literature and noticed that both regional and distant metastases are rare events and variable for different histotypes. These observations have obvious therapeutic and prognostic implications.

Head and neck liposarcoma

BACKGROUND

Liposarcoma of the head and neck region represents approximately 1% of head and neck sarcomas. Therefore, there are few data on the natural history, presentation, treatment, and prognosis of this neoplasm.

METHODS

This study is a report of data from 76 patients with head and neck liposarcoma of whom 4 were treated at The Royal Marsden Hospital during the past 50 years.

RESULTS

The median age of patient presentation was the seventh decade (range, 6 months-86 years), and 65% of the patients were male. The commonest site of presentation was the neck (28%), followed by the larynx (20%) and pharynx (18%). Sixty-two percent of tumors were low grade (well differentiated and myxoid), and 38% were high grade (pleomorphic and round cell). The principal determinant of outcome was histologic grade. Five-year survival by life-table analysis was 67% overall and varied with tumor type as follows: well differentiated 100%, myxoid 73%, pleomorphic 42%, and round cell 0%. Site appears to have had some influence on prognosis. Oral liposarcoma had a poor prognosis with a 5-year survival of 50%, despite the low grade of all tumors; however, the 5-year survival for laryngeal (89%) and head (83%) liposarcoma was considerably better. Tumor size did not affect prognosis. The mainstay of treatment was surgical excision, used alone in 70% of the cases. Radiotherapy was used with other treatments in 25% of the cases. Prognosis was best for patients treated with surgery only (5-year survival, 83%), compared with those receiving surgery plus radiotherapy (5-year survival, 63%), chemotherapy (5-year survival, 33%), and radiotherapy alone (5-year survival, 0%).

CONCLUSIONS

Liposarcoma rarely involves the head and neck region. The prognosis for patients with this disease appears to be better than for those with liposarcoma arising elsewhere, particularly in the retroperitoneum. Prognosis is principally dependent on histologic grade. Complete surgical excision provides the most effective treatment.

Liposarcomas of the larynx and hypopharynx: a clinicopathologic study of eight new cases and a review of the literature

Laryngeal and hypopharyngeal liposarcomas were studied in seven men and one woman. Patient age ranged from 25 to 81 years, with a median of 64 years. Symptoms included dysphagia, airway obstruction, and the sensation of a foreign body in the back of the throat. Histologically, seven of the tumors were of the biologically favorable types, either representing well-differentiated (lipoma-like) liposarcomas or myxoid liposarcomas. One tumor was a pleomorphic liposarcoma. Six of the eight patients had one or more episodes of recurrent tumor. Surgery is the treatment of choice and can include conservative (organ-sparing) procedures. However, to eradicate the tumor completely and thereby prevent recurrent disease, open surgical approaches (i.e., lateral pharyngotomy), rather than endoscopic techniques should be employed. The morbidity rate for laryngeal and hypopharyngeal liposarcomas is high because these tumors tend to recur over extended periods of time. In this study, however, there were no instances of metastatic disease, and no deaths were attributed to liposarcoma. Prospectively, laryngeal and hypopharyngeal well-differentiated (lipoma-like) liposarcoma is a difficult clinical and histopathologic diagnosis to establish. Often, this diagnosis is made only after one or more episodes of recurrent disease.

Primary liposarcoma of the larynx. Case report and literature review

Laryngeal liposarcoma is an unusual tumor. Only 16 cases have been previously reported. We describe a new case of well-differentiated laryngeal liposarcoma and review the literature. The tumor was treated by surgical removal. Immunohistochemical study showed an immunophenotype consistent with liposarcoma. The case described is of the oldest patient (83 years old), the second to be found in a woman, and the second to be localized to one true vocal cord (according to the literature reviewed). The patient is still free of tumor 2 years later. The treatment and prognosis of liposarcoma of the larynx are discussed.

Liposarcoma of the larynx

Liposarcomas of the larynx are very rare. Only nine cases appear to have been recorded in the English literature. An additional case of liposarcoma of the larynx occurring in a young patient is reported and the relevant literature discussed.

Non-epidermoid carcinoma of the larynx: the Thomas Jefferson University experience

Nonepidermoid cancers of the larynx appear with consistency in large series of laryngeal tumors. We reviewed 1135 laryngeal cancers seen over a 24-year period at Thomas Jefferson University Hospital and found a 1.7% incidence. This is similar to several other large series. These patients are presented in terms of their sex, age, race, clinical presentations, therapies, and outcomes, and a review of these unusual tumors is given. The recognition of such lesions is important because many require different therapies and have different prognoses than their squamous cell counterparts. The relatively infrequent occurrence of these tumors makes the availability of controlled clinical studies extremely difficult.

Liposarcoma of the head and neck

Liposarcomas of the head and neck are rare. Two patients are described and 52 cases from the literature reviewed. The histological type of differentiation mainly determines the prognosis. Radical surgery is the form of treatment advised, but postoperative irradiation is also recommended. Experiences with chemotherapy are limited so far.

Electron microscopy in the diagnosis of liposarcoma and fibrosarcoma of the larynx

Electron microscopy (EM) was useful in establishing the final diagnosis in specific instances of liposarcoma and fibrosarcoma of the larynx. In the first case light microscopy revealed cells that met the histologic criteria of a low grade liposarcoma; EM revealed cells that displayed a varied ultrastructural differentiation; thus the tumor was classified as a mixed mesenchymal tumor rather than liposarcoma per se. In the second case, pathologic evaluation indicated a grade 2 fibrosarcoma. EM revealed malignant mesenchymal cells that closely recapitulated normal fibroblasts (no epithelial differentiation was present). This kind of information enables more accurate determination of the source of the primary lesion than results of light microcsopy alone.