Airidas Brazlauskas1*, Gabija Gintautaitė1, Jolita Gibavičienė2, Ignas Karnas2
1Faculty of Medicine, Vilnius University, Vilnius, Lithuania
2 ENT, Head and Neck Surgery and Oncology Department, National Cancer Institute,
Background: Sarcomatoid or spindle cell carcinomas are rare malignancies which are considered as a poorly differentiated variant of squamous cell carcinoma composed of neoplastic cells that have a mesenchymal or sarcomatoid phenotype. Spindle cell carcinomas are an exceptionally rare occurrence in the larynx.
Case report: 53-year-old male was presented to the emergency department with severe dyspnea. Upon examination, a growth, completely blocking the airway was found. An emergency tracheostomy was performed, and a biopsy was taken. Histological features were not specific and differential diagnosis involved sarcoma and sarcomatoid carcinoma. 2 cycles of induction therapy were given, which generated a positive response. Transoral laser microsurgery resection with selective neck dissection was performed successfully. Post-operative histology confirmed spindle cell carcinoma and that resection margins were tumor-free. Post-operative radiotherapy was given, because of the following risk factors: poor differentiation degree and more than 2 positive lymph nodes.
Discussion: Spindle cell carcinoma is a poorly differentiated variant of squamous cell carcinoma and morphologically resembles sarcoma. The importance of a well-taken biopsy should be highlighted, as histological evaluation may be difficult, leading to misdiagnosis. Due to the very low incidence rate of sarcomatoid carcinoma of the larynx, there is no clear consensus for the most optimal treatment approach. Surgery is often the main treatment method; however, each case must be thoroughly examined on multidisciplinary tumor-boards to devise an optimal treatment plan.
Keywords: Laryngeal sarcomatoid carcinoma; Spindle cell carcinoma of the larynx; Transoral laser microsurgery; Induction chemotherapy.