Carcinoma sarcomatoide de laringe. ¿Un reto histológico? / Sarcomatoid carcinoma of larynx. A histological challenge?

Introducción. El carcinoma sarcomatoide puede aparecer en cualquier parte del cuerpo, siendo las glándulas salivales mayores su principal localización en cabeza y cuello, pero en la laringe representa aproximadamente un 1%. Cuenta con componentes epiteliales y mesenquimales, lo que ha llevado a plantear múltiples teorías acerca de su origen. Por esto su diagnóstico anatomopatológico puede ser un reto. Caso clínico. Presentamos un caso clínico de un varón de 76años fumador que consulta por disfonía. Se observa una lesión en cuerdas vocales sin adenopatías ni metástasis. Se le realiza microcirugía laríngea con escisión completa de la lesión, y el diagnóstico anatomopatológico es de carcinosarcoma, mostrando positividad intensa y difusa para vimentina y focal para AE1-AE3, CK5 y p63. El paciente recibe tratamiento complementario con radioterapia. Discusión. El carcinoma sarcomatoide tiende a manifestarse con síntomas obstructivos como la disfonía. Su pronóstico depende del estadio y de si hay o no metástasis. Suelen ser positivos los marcadores epiteliales citoqueratina (AE1-AE3), antígenos de membrana epitelial (EMA), Ki 67 y marcadores mesenquimales como vimentina, desmina y S-100. En cuanto al tratamiento, se recomienda de entrada una biopsia por escisión seguida o no de radioterapia complementaria, aunque la radioterapia sola también ha tenido éxito (T2-T1). En estadios T3-T4 pueden ser tratados con resección local, laringectomía parcial, total con o sin vaciamiento, seguida de radioquimioterapia concomitante (AU)

Introduction. Sarcomatoid carcinoma can occur in any part of the body; in the head and neck it occurs most frequently in the major salivary glands, with only about 1% of cases found in the larynx. As it has both epithelial and mesenchymal components, there are many theories concerning its origin and it can prove a diagnostic challenge. Case report. A 76 year old male smoker presented with dysphonia. Vocal cord injury was found on examination but no lymphadenopathy or metastases were present. Laryngeal microsurgery was performed with complete excision of the lesion. Histopathology showed it to be a carcinosarcoma which showed intense and diffuse positivity for vimentin and focal positivity for AE1-AE3, CK5 and p63. The patient underwent radiotherapy as complementary treatment. Discussion. Sarcomatoid carcinoma usually presents with obstructive symptoms such as dysphonia. Prognosis depends on the stage and the presence or not of metastases. Both epithelial markers EMA, cytokeratin (AE1-AE3), epithelial membrane antigen, Ki 67 and mesenchymal markers such as vimentin, desmin, S-100 may be positive in these tumours. Recommended treatment for T2-T1 stages is an excisional biopsy which can be followed by adjuvant radiotherapy; radiotherapy alone has also been successful. T3-T4 stages can be treated with local excision, partial laryngectomy or total laryngectomy with subsequent ganglion emptying and concomitant radio and chemotherapy (AU)

[Sarcomatoid carcinoma of larynx. A histological challenge?] / Carcinoma sarcomatoide de laringe. ¿Un reto histológico?

INTRODUCTION: Sarcomatoid carcinoma can occur in any part of the body; in the head and neck it occurs most frequently in the major salivary glands, with only about 1% of cases found in the larynx. As it has both epithelial and mesenchymal components, there are many theories concerning its origin and it can prove a diagnostic challenge. CASE REPORT: A 76 year old male smoker presented with dysphonia. Vocal cord injury was found on examination but no lymphadenopathy or metastases were present. Laryngeal microsurgery was performed with complete excision of the lesion. Histopathology showed it to be a carcinosarcoma which showed intense and diffuse positivity for vimentin and focal positivity for AE1-AE3, CK5 and p63. The patient underwent radiotherapy as complementary treatment. DISCUSSION: Sarcomatoid carcinoma usually presents with obstructive symptoms such as dysphonia. Prognosis depends on the stage and the presence or not of metastases. Both epithelial markers EMA, cytokeratin (AE1-AE3), epithelial membrane antigen, Ki 67 and mesenchymal markers such as vimentin, desmin, S-100 may be positive in these tumours. Recommended treatment for T2-T1 stages is an excisional biopsy which can be followed by adjuvant radiotherapy; radiotherapy alone has also been successful. T3-T4 stages can be treated with local excision, partial laryngectomy or total laryngectomy with subsequent ganglion emptying and concomitant radio and chemotherapy.