Laryngeal sarcomas: A case series of 5 cases

Our plain-English summary of Laryngeal sarcomas: A case series of 5 cases, by B. AbdullGaffar, T. Keloth (Annals of Diagnostic Pathology, 2018).

The study

• Authors: B. AbdullGaffar, T. Keloth
• Journal: Annals of Diagnostic Pathology
• Published: 2018;37:35-41
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Primary sarcomas of the larynx are rare and miscellaneous. The most common is chondrosarcoma. Other sarcomas are very rare. Sarcomas can have heterogeneous morphologic features of spindle, small round, epithelioid, pleomorphic and giant cells. Laryngeal sarcomas may mimic carcinomas, lymphomas, small cell carcinoma, mesothelioma and melanoma. This imposes diagnostic challenges for unfamiliar pathologists particularly in small laryngeal biopsies. Our aim was to study the different types of sarcomas that can involve the larynx in our institution, to investigate their diagnostic challenges and potential pitfalls and to find helpful histologic clues to avoid misinterpretation and missed diagnosis. We performed a retrospective review study over 13 years. We retrieved 5 cases of laryngeal sarcomas. They included Kaposi sarcoma, low-grade chondrosarcoma, epithelioid angiosarcoma, polypoid leiomyosarcoma and small cell osteosarcoma. The age range was between 32 and 74 years with an average age of 52 years. The male to female ratio was 3:2. The Kaposi sarcoma and chondrosarcoma were correctly diagnosed. The angiosarcoma was initially missed as recurrent carcinoma. The leiomyosarcoma was initially inferred as polypoid sarcomatoid squamous cell carcinoma. The small cell osteosarcoma initiated the differential diagnosis of high-grade lymphoma, small cell carcinoma, undifferentiated carcinoma, Ewing sarcoma and rhabdomyosarcoma. An implementation of a panel of immunohistochemical markers guided by certain histomorphologic clues was helpful to make the correct diagnosis. Pathologists should be aware of the morphologic spectrum and different growth patterns of laryngeal sarcomas. Immunohistochemistry studies are essential. Correct diagnosis, classification and grading of laryngeal sarcomas are clinically important for the prognosis and appropriate management of patients.

Copyright © 2018 Elsevier Inc. All rights reserved.

In plain English

This article is a case series from the pathology section of Rashid Hospital in Dubai, United Arab Emirates. It does not study asbestos; mesothelioma appears only as a possible microscopic look-alike. The authors searched their institution's pathology records over 13 years (2005 to 2018). They found five patients with primary sarcomas of the larynx, aged 32 to 74 years (average 52), with a male to female ratio of 3:2. The tumors were a Kaposi sarcoma, a low-grade chondrosarcoma, an epithelioid angiosarcoma, a leiomyosarcoma and a small cell osteosarcoma. Two cases were diagnosed without difficulty. The angiosarcoma was first diagnosed as recurrent carcinoma, and the leiomyosarcoma as a sarcomatoid carcinoma. The osteosarcoma raised several possible diagnoses, including lymphoma and Ewing sarcoma. The HIV-positive patient with Kaposi sarcoma had a recurrent skin nodule after 6 months; the article states that two years later the patient died of AIDS-related complications. The other four patients were lost to follow-up. The authors concluded that immunohistochemistry studies are essential. They listed the small number of cases and the missing treatment and follow-up records as limitations.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review (case series) of pathology records and slides at one institution
• Who was studied: Five patients with primary laryngeal sarcomas at Rashid Hospital, Dubai, 2005 to 2018. They were aged 32 to 74 years (average 52), with a male to female ratio of 3:2.
• Exposure: No asbestos or other occupational exposure was studied. The study concerned how the tumor types were diagnosed.
• Main results:
  • The five sarcomas were a Kaposi sarcoma, a low-grade chondrosarcoma, an epithelioid angiosarcoma, a polypoid leiomyosarcoma and a small cell osteosarcoma.
  • The Kaposi sarcoma and the chondrosarcoma were diagnosed without difficulty.
  • The angiosarcoma was initially misdiagnosed as recurrent carcinoma.
  • After further staining, the final diagnosis for this case was epithelioid angiosarcoma.
  • The leiomyosarcoma was initially interpreted as polypoid sarcomatoid spindle cell carcinoma before the final diagnosis of leiomyosarcoma.
  • For the osteosarcoma case, the possible diagnoses considered included lymphoma, undifferentiated carcinoma, Ewing sarcoma, small cell carcinoma and rhabdomyosarcoma. The final diagnosis was the small cell variant of osteosarcoma.
  • The patient with Kaposi sarcoma was HIV-positive and had a recurrent Kaposi sarcoma skin nodule on the left leg after 6 months.
  • The article then states that two years later this patient died of AIDS-related complications. It does not say clearly whether the two years are counted from the diagnosis or from the recurrence.
  • The other four patients were lost to follow-up.
• The authors' conclusion: The authors concluded that a panel of immunohistochemical markers, guided by microscopic clues, helped reach the correct diagnosis, and that immunohistochemistry studies are essential.
• Limitations the authors state:
  • Small number of cases
  • No records of local treatment and no follow-up information for four of the five patients

Topics

The National Library of Medicine indexes this study under subjects our site covers: Throat and laryngeal cancer.

Medical terms in this study, explained in our Lexicon: Sarcoma, Epithelioid, Pleomorphic, Carcinoma, Mesothelioma, Sarcomatoid, Squamous Cell Carcinoma, Differential Diagnosis.

Related studies

• Diet and other risk factors for laryngeal cancer in Shanghai, China — W. Zheng, W.J. Blot, et al. (1992)
• Asbestos and laryngeal carcinoma — P.M. Stell, T. McGill (1973)
• Occupational exposure and laryngeal and hypopharyngeal cancer risk in central and eastern Europe — O. Shangina, P. Brennan, et al. (2006)
• Asbestos, dental X-rays, tobacco, and alcohol in the epidemiology of laryngeal cancer — M.W. Hinds, D.B. Thomas, et al. (1979)
• Exposure to cement dust, related occupational groups and laryngeal cancer risk: results of a population based case-control study — A. Dietz, H. Ramroth, et al. (2004)
• A case-control study of occupational risk factors for laryngeal cancer — P. Wortley, T.L. Vaughan, et al. (1992)

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