Soft-tissue sarcomas in the head and neck: 25 years of experience

[Current Therapy Standards for Soft Tissue Sarcomas in the Head and Neck Area - Part 1]

The present work discusses soft tissue sarcoma in the head and neck area, due to the new published German S3-Guideline "adult soft tissue sarcoma". The head and neck surgeon plays the central role in the diagnosis and treatment of the vast majority of cases. It is crucial to admit the patients immediately to specialized centers for diagnoses and specific treatment. Regarding correct diagnostic procedures, in contrast to squamous cell carcinoma, a larger accidental excisional biopsy within the tumor tissue is strongly prognostic negative. After confirmation of histology and tumor extension, it is mandatory to discuss the interdisciplinary treatment concept. If possible, introduction of the patient in ongoing clinical studies is key.

Epithelioid Sarcoma of the External Auditory Canal: An Uncommon Tumor at an Unusual Site and a Brief Overview of the Literature

We present a case (41 years old pregnant female) with epithelioid sarcoma arising in the left external auditory canal. On immunohistochemistry, the tumor cell diffusely expressed cytokeratins and showed patchy expression of ERG and CD34. The neoplastic cells demonstrated uniform loss of INI1-expression. Epithelioid sarcoma arising in the external auditory canal is rare. Awareness that ES may rarely arise at unusual sites is of critical importance in order to apply a broad enough panel in the immunohistochemical study, so a misdiagnosis of carcinoma can be avoided.

Role of Surgery in Rhabdomyosarcoma of the Head and Neck in Children

OBJECTIVES

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children. The goal of this research is to analyze the role of surgery in the management of pediatric parameningeal (PM) and non-PM head and neck RMS (HNRMS).

STUDY DESIGN

Retrospective review.

METHODS

Retrospective chart review of patients <20 years of age treated for HNRMS between 1970 and 2015. Clinical presentation, tumor characteristics, treatment, recurrence, follow-up, and outcome data were collected.

RESULTS

Of 97 patients with HNRMS, 56% were male. Overall median (IQR: interquartile range) age at diagnosis was 5.8 (3.3-9.8) years. Sixty-five patients (67%) had PM tumors. Of 75 patients with histologic subtype identified, 51 (53%) had embryonal and 20 (21%) alveolar RMS. Almost all patients received chemotherapy (99%) and radiotherapy (95%). Forty-four patients (45%) underwent surgery. Surgery was more likely to be conducted in patients with lesions of a non-PM site. Median follow-up time was 3.4 years (IQR: 1.1-10.8). In 5 years of follow-up, 20% (17 of 85) died and 29% (20 of 70) had recurrence. The estimated 5-year survival rate was 72% (95% CI, 57.8, 81.5%). Surgery was associated with a reduced risk of mortality after accounting for TNM stage 4 and tumor site (adjusted HR 0.24; 95% CI, 0.07, 0.79; P = .02). The association between surgery and risk of mortality was similar in PM and non-PM tumors.

CONCLUSION

A multimodal protocol for treatment including chemotherapy, surgery, and radiotherapy is the mainstay for management of children with HNRMS. While surgery is more commonly used to treat non-PM HNRMS, patients who are able to undergo surgery have significantly higher 5-year survival.

LEVEL OF EVIDENCE

4 Laryngoscope, 131:E984-E992, 2021.

Classification and Clinicopathologic Study of Orofacial Mesenchymal Tumors: A Retrospective Study

Aim:

To determine the prevalence of orofacial mesenchymal neoplasms and classify them using the WHO criteria while appraising its applicability.

Materials and Methods:

This was a retrospective study involving a total sample of 192 entries diagnosed as mesenchymal tumors for the period 1990-2018 at the Oral Pathology Department, University College Hospital, Ibadan. The histopathology records were examined and clinicopathological data were obtained. Hematoxylin and Eosin slides of the cases were assessed to confirm the diagnosis. Tumors were classified using the WHO 2013 classification. Data were analyzed and presented using descriptive statistics.

Results:

Orofacial mesenchymal tumors constituted 7.9% of 2402 biopsies. There were 26 diagnoses in 161 tumors of the WHO classification. Male-to-female ratio was 1.1:1. Peak age group was in the third decade. Soft tissue tumors were 61.5%, while bone tumors were 38.5%. Benign tumors constituted 49.5%, while sarcomas and intermediate tumors were 45.8% and 4.7%, respectively. The mandibular region (29.7%) was the most commonly affected site. Adipocytic and osteogenic tumors were the most prevalent tumors in the soft tissue and osteoarticular series, respectively, representing 19.8% and 32.3% of all cases, while orofacial sarcomas constituted 3.6% of all lesions seen.

Conclusion:

The findings in this study are in line with those of previous studies. However, the WHO classification may not be suited for the orofacial region. Crafting of a classification system for mesenchymal tumors of the orofacial region would thus be necessary.

The occurrence and pattern of head and neck sarcomas: a comprehensive cancer center experience

PURPOSE

This study aimed to analyze the demographics, clinicopathological, treatment, and survival characteristics of head and neck sarcomas diagnosed in a reference center in the Brazilian Northeast.

MATERIALS AND METHODS

This retrospective cohort study reviewed the clinical records of patients with head and neck sarcomas. Epidemiologic data consisted in clinical location, age, gender, histopathological diagnosis, clinical TNM staging and treatment. Outcome variables were local recurrence and survival. The statistical analyses were performed by a binary logistic regression analysis. The survival analysis was assessed through the Kaplan-Meier curve.

RESULTS

Sixty-nine patients with head and neck sarcomas (male 39; female 30) were analyzed. The most common histologic subtypes were rhabdomyosarcoma, dermatofibrosarcoma, and pleomorphic sarcoma. The mean age of the patients at the time of diagnosis was 38.1 years old. A total of 31 patient died (sarcoma-related death) up to the end of the follow-up, with a mean follow-up rate of 1.63 years. A multivariate analysis revealed that anatomical site, treatment modality, histopathological diagnosis, and clinical stage of the disease were associated with specific survival, reaching statistical significance.

CONCLUSION

This study demonstrates the impact of important clinical-pathological parameters on the overall prognosis of head and neck sarcomas.

Prevalence of Head and Neck Sarcoma in a Major Cancer Center in Iran- A 10-Year Study

INTRODUCTION

Sarcomas are rare malignancies with aggressive biological behavior. They are categorized into soft and hard tissue types. The main objective of this study was to analyze the prevalence of head and neck sarcomas (HNS) among the Iranian population.

MATERIALS AND METHODS

The pathology files derived from Iran National Tumor Bank of Cancer Institute in Imam Khomeini Hospital, affiliated to Tehran University of Medical Sciences, Tehran, Iran, served as the source of the materials for this study. All cases diagnosed with head and neck sarcoma were included in the study. The recorded data included the patient's age, gender, tumor location, and rates of recurrence and metastasis.

RESULTS

Investigation of the pathology files of the patients referring to the center under study during a 10-year period resulted in the identification of 183 HNS cases, 96.17% of which were primary. Generally, the prevalence of this disease was at its highest level in patients within the age range of 30-60 years with a male to female ratio of 1.4. The recurrence and metastasis rates of HNS were 32.38% and 5%, respectively. Osteosarcoma was detected as the most common type of sarcoma. Soft tissue sarcomas constituted 69.3% of the lesions with a male predilection. The patients afflicted with this type of sarcoma had a mean age of 45.88 years. Furthermore, hard tissue sarcomas comprised 30.68% of the sarcoma cases with a mean age of 36.22 years and a female predilection. The commonest lesion was osteosarcoma, and the most typical location was the mandible.

CONCLUSION

In the current study, head and neck sarcomas were most often observed in patients within the age range of 30-60 years with a male predilection. Osteosarcoma was identified as the most common type of sarcoma. Studies addressing rare lesions with a large sample size facilitate the recognition of the demographic data and histopathologic variation which may contribute to a correct diagnosis.

Multimodality treatment of head-and-neck soft-tissue sarcomas and short-term outcomes: Analysis from sarcoma medical oncology clinic

BACKGROUND

Head-and-neck soft-tissue sarcomas (HNSTS) are extremely rare and lack definite guidelines.

METHODS

We retrospectively analyzed consecutive adult patients with HNSTS who presented to our sarcoma medical oncology clinic from January 2016 to October 2017.

RESULTS

There were a total of 30 patients. Unresectable localized disease was seen in 13 (43%) patients, metastatic disease 10 (34%) patients, while resectable disease in 7 (23%) patients only. Among unresectable localized disease, 3 (25%) patients could be converted to resectable disease after neoadjuvant therapy. Median follow period was 11 months. Progression-free survival was 19 months in patients with resectable disease and 6 months in patients with the unresectable/metastatic disease. Median OS was not reached.

CONCLUSION

Unresectable HNSTS has a poor outcome. Neoadjuvant therapy can be tried in selected cases for achieving respectability or for vital organ preservation until robust data are available. A multidisciplinary approach for local control is crucial in managing unresectable HNSTS.

Head and Neck Sarcomas: A Review of Clinical and Imaging Findings Based on the 2013 World Health Organization Classification

OBJECTIVE

Head and neck sarcomas are a complex, heterogeneous group of tumors that present a diagnostic challenge to radiologists because they have many overlapping imaging features. The purpose of this article is to review the imaging and clinical features and highlight distinguishing features of head and neck sarcomas.

CONCLUSION

An understanding of characteristic imaging and clinical features of head and neck sarcomas is important for the radiologist to narrow the differential diagnosis and help guide management.

Surgical Interventions for Advanced Parameningeal Rhabdomyosarcoma of Children and Adolescents

Owing to its rarity, rhabdomyosarcoma of the head and neck (HNRMS) has seldom been discussed in the literature. As most of the data is based only on the retrospective experiences of tertiary healthcare centers, there are difficulties in formulating a standard treatment protocol. Moreover, the disease is poorly understood at its pathological, genetic, and molecular levels. For instance, 20% of all histological assessment is inaccurate; even an experienced pathologist can confuse rhabdomyosarcoma (RMS) with neuroblastoma, Ewing’s sarcoma, and lymphoma. RMS can occur sporadically or in association with genetic syndromes associated with predisposition to other cancers such as Li-Fraumeni syndrome and neurofibromatosis type 1 (von Recklinghausen disease). Such associations have a potential role in future gene therapies but are yet to be fully confirmed. Currently, chemotherapies are ineffective in advanced or metastatic disease and there is lack of targeted chemotherapy or biological therapy against RMS. Also, reported uses of chemotherapy for RMS have not produced reasonable responses in all cases. Despite numerous molecular and biological studies during the past three decades, the chemotherapeutic regimen remains unchanged. This vincristine, actinomycin, cyclophosphamide (VAC) regime, described in Kilman, et al. (1973) and Koop, et al. (1963), has achieved limited success in controlling the progression of RMS. Thus, the pathogenesis of RMS remains poorly understood despite extensive modern trials and more than 30 years of studies exploring the chemotherapeutic options. This suggests a need to explore surgical options for managing the disease. Surgery is the single most critical therapy for pediatric HNRMS. However, very few studies have explored the surgical management of pediatric HNRMS and there is no standard surgical protocol. The aim of this review is to explore and address such issues in the hope of maximizing the number of options available for young patients with HNRMS.