Elsevier

Annals of Diagnostic Pathology

Volume 37, December 2018, Pages 35-41
Annals of Diagnostic Pathology

Original Contribution
Laryngeal sarcomas: A case series of 5 cases

https://doi.org/10.1016/j.anndiagpath.2018.09.007Get rights and content

Highlights

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    Primary laryngeal sarcomas are rare and miscellaneous.

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    Low grade sarcomas can be confused with benign stromal tumors.

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    High grade sarcomas can mimic carcinomas and non-mesenchymal malignancies.

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    Certain histomorphologic features are helpful clues.

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    Immunohistochemical studies are mandatory to confirm the diagnosis.

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.

Introduction

Primary sarcomas of the larynx are rare, the most common of which is chondrosarcoma [[1], [2], [3]]. Other sarcomas are very rare. Different types of sarcomas have been described in the larynx [[1], [2], [3], [4], [5]]. Sarcomas can have various morphologic features demonstrating spindle, pleomorphic anaplastic, small round, epithelioid and giant cells. They can be confused with carcinomas, lymphomas, small cell carcinoma, mesothelioma and melanoma. This imposes diagnostic challenges for unwary pathologists particularly in small laryngeal biopsies [6]. Some low-grade sarcomas can be confused with benign stromal neoplasms and tumor-like nodules. An awareness of the different types of sarcomas that can involve the larynx, an attention to certain histomorphologic features and application of ancillary immunohistochemical studies assist pathologists to avoid potential pitfalls and reach the correct diagnosis. We performed a retrospective review study to investigate the different types of laryngeal sarcomas in our institution, to study their potential diagnostic challenges and to find helpful histologic clues to avoid potential pitfalls.

Section snippets

Materials and methods

We searched for laryngeal malignancies, mesenchymal neoplasms, stromal nodules and polyps using a computer-based search to retrieve all of the cases of primary sarcomas of the larynx in our institution over the past 13 years from 2018 to 2005. We reviewed the microscopic descriptions, final diagnoses and diagnosis comments from all the pathology reports. We selected cases with an established diagnosis of sarcoma. We also searched for reports describing undifferentiated carcinoma, spindle cell

Results

We found five cases of primary sarcomas of the larynx. The age range was between 32 and 74 years with an average age of 52 years. The male to female ratio was 3:2 (Table 1). The cases of primary laryngeal sarcomas included Kaposi sarcoma, chondrosarcoma, angiosarcoma, leiomyosarcoma and osteosarcoma (Table 2). Kaposi sarcoma (Fig. 1A, B) and chondrosarcoma (Fig. 1C, D) were histologically spotted and correctly diagnosed. The angiosarcoma was initially diagnosed as recurrent undifferentiated

Discussion

Albeit the larynx is a small tubular organ that connects the pharynx to the trachea, it is complex and divided into various compartments with different epithelial and stromal tissues. Different types of sarcomas that primarily involved the larynx have been reported in the literature [[1], [2], [3], [4], [5]]. The most common is chondrosarcoma [[1], [2], [3]]. Other reported sarcomas included leiomyosarcoma, osteosarcoma, angiosarcoma, Kaposi sarcoma, rhabdomyosarcoma, fibrosarcoma, synovial

Funding

This study was not funded.

Conflict of interest

No conflicts of interest to be declared by authors.

Ethical approval

This article does not contain any studies with human participants. As a retrospective review, informed consent was not obtained.

Financial and funding disclosure

No sources or grants of financial support from any institution to be disclosed. No conflict of interests to be disclaimed or financial disclosure to be declared.

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