Carcinosarcoma of the larynx consisting of squamous cell carcinoma and inflammatory myofibroblastic tumor components.

OBJECTIVE: Carcinosarcoma is a rare malignant tumor with both carcinomatous and sarcomatous components. Carcinosarcoma can appear in various organs, but its occurrence in the head and neck, particularly larynx, is extremely rare. Furthermore, its response to treatment has not been well established. METHODS: We report the case of a 79-year-old man with a 6-month history of hoarseness who presented with a mass having a polypoid appearance at the anterior commissure of the larynx. Further analyses revealed carcinosarcoma in the larynx that consisted of squamous cell carcinoma and an inflammatory myofibroblastic tumor (IMT). RESULTS: The tumor was excised at the first hospital visited. Because pathological examination revealed an IMT and positive margin, the patient was referred to our hospital. A front lateral vertical partial laryngectomy was performed for further treatment. Histological examination demonstrated a biphasic component, consisting of squamous cell carcinoma (SCC) and IMT. CONCLUSIONS: IMT rarely occurs in the head and neck region. Moreover, to best of our knowledge, no carcinosarcoma cases consisting of SCC and IMT in the larynx have been reported in the literature. The prognosis of carcinosarcoma is considered to be dependent on the type of malignant mesenchyme, and surgical excision with wide margins is generally used to treat IMT. Therefore, the treatment of laryngeal carcinosarcoma consisting of IMT can be best accomplished with complete excision of the tumor.

Soluble EMMPRIN (extra-cellular matrix metalloproteinase inducer) stimulates the migration of HEp-2 human laryngeal carcinoma cells, accompanied by increased MMP-2 production in fibroblasts.

The basement membrane functions as a barrier against the invasion of cancer cells. It is therefore important to investigate the mechanism of basement membrane degradation by matrix metalloproteinases (MMPs). Previously, cancer cells were long considered to be the major source of MMPs; however, current evidence indicates that most MMPs in cancer tissue are produced by stromal rather than cancer cells. A glycoprotein highly expressed on the cancer-cell membrane, EMMPRIN (extra-cellular matrix metalloproteinase inducer), exhibits the potential role of the MMP inductor in stromal cells. Depending on the cell type, EMMPRIN can stimulate the production of MMP-1, MMP-2, and MMP-3. We here report that soluble full-length EMMPRIN is liberated from HEp-2 human laryngeal epidermoid carcinoma cells, probably via microvesicle shedding. Soluble EMMPRIN stimulates human fibroblasts to produce MMP-2, after which the augmented migration of HEp-2 cells occurs, as observed in an invasion chamber assay with separately cultured fibroblasts. An anti-EMMPRIN function-blocking antibody reduced MMP-2 activity in the conditioned medium and inhibited the migration of HEp-2; obviously, EMMPRIN activity contributes to cancer-cell migration. We postulate that soluble EMMPRIN probably triggers the promotion of cancer invasion in vivo.