Malignant transformation of an osteoblastoma of the mandible: case report and review of the literature

Benign osteoblastoma is a rarely seen tumor of the facial bones. The authors present a case of a 30-year-old man with a tumor of the mandibular body and ramus. The histopathological diagnosis was one of osteoblastoma. Postoperative recurrence with soft tissue infiltration suggested an osteosarcoma radiologically, but the histological examination again revealed the presence of an osteoblastoma. A second recurrence occured in the pharyngo-glossal region and this time the tumor was histologically diagnosed as an osteoblastoma, but with foci of well-differentiated osteosarcoma. The patient was given a course of radiotherapy, but clinical and radiological examination 8 months later revealed lung metastases and chemotherapy was started. Unfortunately, the patient died months later. While osteoblastomas are rare, and their sarcomatous change even rarer, our experience with this case lead us to suggest that a therapeutic preventative approach, involving both chemotherapy and total excision of the tumor, is the regime to adopt with osteoblastomas which involve soft tissues and have radiological features suggesting malignancy.     

Aggressive aneurysmal bone cyst of the maxilla confused with telangiectatic osteosarcoma

Aneurysmal bone cyst (ABC) is a benign, expansile lesion typically affecting the long bones and vertebrae of patients younger than 20 years. Approximately 2% of ABCs occur in the head and neck region, most commonly affecting the mandible. Although the most common co-existing lesion associated with ABCs is the giant cell tumor, ABCs can be radiologically confused with telangiectatic osteosarcoma in cases of aggressive behavior and rapid growth. Here, we report a case of an aggressive ABC of the maxilla confused with telangiectatic osteosarcoma in a patient who underwent several operations for an osteoblastoma that was diagnosed histopathologically. This case highlights the need for a differential diagnosis both radiologically and histopathologically, because ABCs can easily be interpreted as a giant cell tumor or an osteoblastoma, and, on occasion, can be mistaken for osteogenic malignancies.     

Osteosarcomas of the larynx

OBJECTIVES/HYPOTHESIS: The objective was to review the etiology, presentation, treatment, and prognosis in patients with osteosarcoma of the larynx using an illustrative case example. STUDY DESIGN: Case report and literature review. METHODS: A case is reported, and a review of all available published cases of osteosarcoma of the larynx is presented. RESULTS: Osteosarcoma of the larynx may be a difficult clinical diagnosis. To be able to reach the correct diagnosis, a high index of suspicion and due diligence in obtaining deep biopsy specimens are important. Treatment is primarily surgical. Outcomes for this disease are generally poor, with most patients dying of the disease as a result of pulmonary metastasis. CONCLUSION: Osteosarcoma of the larynx is a rare entity, with only 14 cases reported to date. Pathological confirmation of osteoid is required for diagnosis. It is likely that aggressive surgical intervention directed at complete tumor extirpation is the treatment of choice, although long-term prognosis is poor.     

Benign osteoblastoma of the temporal bone

Benign osteoblastoma is an uncommon tumor in the skull and particularly rare in the temporal bone. This article presents the clinical, radiologic, and pathologic findings of the fifth case known to involve the temporal bone, and only th second case limited to the temporal bone itself. Subtotal removal was performed following embolization of the tumor. The patient currently has no evidence of disease eighteen months following therapy. Benign osteoblastoma is rarely synchronously or metachronously associated with its malignant counterpart, osteosarcoma. Treatment should be conservative. Subtotal curettage is acceptable and often results in long-term resolution. Radiotherapy is not recommended unless the removal is incomplete and the consequences of local recurrence are serious, as in vertebral lesions. This lesion may be highly vascular, and preoperative embolization should be considered to minimize blood loss at surgery.     

Chondroblastic osteosarcoma of the larynx.

Osteosarcoma of the larynx is a rare lesion. Acceptable cases in the literature are difficult to find. We report a case in which total laryngectomy was carried out for a large, obstructing mass that arose from the cricoid cartilage. We present the histologic criteria for the diagnosis of chondroblastic osteosarcoma.     

Osseous tumors of the jaw

The osseous tumors of the jaw bones are relatively rare but very oft malignant. This work analyses the different epidemiological, clinical, radiological, histological and therapeutic features of the benign and malignant osseous tumors of the jaw bones, with regard to the most recent literature. The described benign tumors are the osteoma and osteomatosis, the osteoblastoma and osteoid osteoma, the desmo-osteoblastoma and the exostosis. The osteosarcoma is the unique malignant osseous tumor encountered.     

Carcinoid tumours of the larynx: report of two cases

Carcinoid tumour of the larynx is extremely rare. The increasing number of these lesions reported is due to the application of ultrastructural and immunological methods in the diagnosis. Two new cases of this malignant neoplasm are presented and discussed with particular reference to the difficulty in distinguishing carcinoids from other tumours of the larynx. The accurate pathological identification of the tumour is essential for treatment and prognosis.     

Squamous cell carcinoma of the larynx with osteosarcoma-like stromal metaplasia

Osseous or chondroid metaplasias are uncommonly found adjacent to laryngeal squamous cell carcinoma (SCC). These findings are less unusual in the spindle cell variant. We describe a moderately differentiated laryngeal SCC associated with osteocartilaginous metaplasia of the adjacent stroma which exhibited very similar morphologic changes and mitoses to an osteosarcoma. These uncommon findings can be more clearly understood if they are viewed as changes determined by the microenvironment of the tumour–host interface, as indicated in recent studies. Tumour cells seem able to regulate stromal development and differentiation via the release of growth factors and the induction of growth factor receptor expression on the cell surface. Irrespective of the limited number of reported cases, the association of SCCs of the larynx with osteocartilaginous metaplasia does not seem to support the adoption of treatments of choice that differ in approach to those for site- and stage-matched SCCs without osteocartilaginous metaplasia.     

Schwannoma of the larynx: case report

Neurogenous tumours of the larynx are extremely uncommon. We present a rare case of schwannoma of the larynx. Clinical findings are presented together with computed tomography (CT) and magnetic resonance images. The tumour was located in the right aryepiglottic fold of the larynx. CT showed a well defined and hypodense mass extending from the right aryepiglottic fold to the right vocal cord. The patient underwent an excision of the mass through a lateral thyrotomy and the tumour was completely removed. The diagnosis and treatment of this tumour are discussed. Received: 11 May 2000 / Accepted: 5 September 2000     

Multifocal presentation of cystadenolymphoma (Warthin tumor) in the parotid gland and larynx

Warthin's tumour of the larynx is an unusual finding. In present literature only four cases have been described. A fifth case of a 77-year-old woman suffering from Warthin's tumour of the left parotid gland and the left false cord is presented. Moreover, this patient had an inner and outer laryngocele. This combination of Warthin's tumour of the larynx with a laryngocele has not been described before in literature. The theories about the development of Warthin's tumours are discussed, in particular their relationship to the development of the branchial cleft apparatus.     

The rabbit VX2 tumour as a model for carcinomas of the tongue and larynx

Animal models of carcinomas can provide useful information for the evaluation of new treatments. In the rabbit, the VX2 tumour is a fast growing, transplantable squamous cell carcinoma. By implanting a cell suspension of the tumour into the tongue and/or the larynx, a useful new model for studying or treating tumours in this region has been developed. The tumours were evaluated histologically and showed features consistent with human carcinomas, including surface ulceration, lymphatic spread and encroachment of the airway. The VX2 tumours in these sites have features which offer advantages over existing models. These include the ability to study several sites of tumour growth in the same animal, to follow rapidly growing tumours, storage of the tumour in liquid nitrogen allowing experiments to be started when convenient, and the large size of the rabbit larynx which permits considerable tumour growth before airway embarrassment.     

Simultaneous typical carcinoid tumour of larynx and occult papillary thyroid carcinoma

Typical carcinoid tumour of the larynx is extremely rare. We report the case of a 43-year-old man initially diagnosed with typical carcinoid tumour of the larynx, presenting with a foreign body sensation in his throat. Coincidentally, an occult papillary thyroid carcinoma was diagnosed, following detection of a suspicious lymph node on pre-operative imaging studies, and confirmation by neck dissection and subsequent total thyroidectomy. Following surgery and radioiodine therapy for these cancers, the patient was alive, well and free of disease two years later. Typical carcinoid tumour of the larynx with a synchronous occult papillary thyroid carcinoma has not previously been reported. The optimal treatment strategy for this case is also discussed.     

Larynx lymphoepithelioma

We present a case of lymphoepithelioma of the larynx, a very rare tumour in this location. The relationship between lymphoepithelial carcinoma of the larynx and Epstein-Barr virus, is still controversial. We describe one new case of this tumour involving the supraglottis, and it's surgery and radioterapic treatment. The diagnostic problems and therapy associated with this rare tumour are discussed.     

Value of Papanicolaou exfoliative cytology in diagnosis of cancers of the upper aerodigestive tract]

Exfoliative cytology of the pharynx and larynx is a valid tool in the diagnosis of tumours. It is useful in the follow-up of chronic epithelial lesions of these regions and after tumour therapy. Cytological findings in group "Pap III" demand careful follow-up possibly with biopsy. For all other groups a biopsy is only indicated if there is a strong clinical suspicion of a tumour in the individual case. The simple technique of exfoliative cytology makes it an important part of aftercare of patients with malignancy, especially squamous cell carcinoma of the pharynx and larynx. The validity of the method depends on the care with which the specimen is taken and on the experience of the investigator.     

Schwannoma of larynx — a rare presentation

Neurogenous tumours of the larynx are extremely uncommon. Schwannoma of larynx is a variant of neurogenous tumour. The patient underwent microlaryngoscopic excision of that tumour. We present here the clinical findings of the case, along with direct laryngoscopic view, the photograph of the mass after removal and histological slide compatible with the diagnosis of schwannoma.     

An unusual case of laryngeal carcinoma

A 62-year-old male patient presented with carcinoma of the larynx which behaved in an atypical fashion clinically. It increased in size rapidly within a period of 5 weeks and clinically presented as a dumbell-shaped neck swelling over the thyroid alae. It had features on plain x-ray, tomography and CT scan which led to the diagnosis of chondrosarcoma of the larynx. After total laryngectomy, it turned out to be a squamous cell carcinoma of the larynx with some unusual histopathological features including bone formation in the tumour.     

Sarcomatoid salivary duct carcinoma of the larynx

The sarcomatoid variant is a rare subtype of salivary duct carcinoma that comprises epithelial and sarcomatoid components. The authors present the first reported case of sarcomatoid salivary duct carcinoma occurring in the larynx, which was successfully treated by partial laryngectomy with ipsilateral neck dissection, with no evidence of recurrence after five years. Microscopic analysis revealed a composite epithelial and sarcomatoid tumour. The epithelial component was characterized by papillary proliferation of glandular and ductal structures lined with multilayered epithelial tumour cells. The sarcomatoid component was characterized by pleomorphic spindle cells with cytologic atypia, accompanied by small lymphoid cells, extensive proliferation of blood vessels and focal myxoid changes. To the best of our knowledge, only one case of sarcomatoid salivary duct carcinoma outside a major salivary gland has been reported previously in the literature, and this is the first report of sarcomatoid salivary duct carcinoma arising from the larynx.     

Granular cell myoblastoma of the supraglottis

Granular cell myoblastoma is an unusual benign tumour, which, when occurring in the larynx usually affects the vocal cords and causes hoarseness. We present a case presenting with symptoms strongly suggestive of globus pharyngis. These tumours probably arise from neuroectodermal tissue, and the current nomenclature is a misnomer. Complete excision rather than biopsy is recommended, as biopsy material may be misinterpreted as squamous carcinoma. In this case, endoscopic removal of the tumour was successful in producing complete symptomatic relief.     

Haemangiopericytoma of the larynx

Haemangiopericytoma is an uncommon vascular tumour which has rarely been recorded in the larynx. The diagnostic and histopathological difficulties are discussed. A total laryngectomy was performed because of the size and site of the tumour, the associated risk of local recurrence and the high metastatic rate.     

Recurrence of a laryngeal spindle cell sarcoma with a transformation into a higher grade of malignancy

Primary malignant mesenchymal neoplasms of the larynx are rare. Sarcomas of the larynx account for <1% of all malignant laryngeal mesenchymal neoplasms. This report examines a case of a recurring laryngeal, initial benign-appearing mesenchymal tumour, which first changed its clinical phenotype without any histological signs of malignancy and later also its histological appearance with signs of malignancy. Finally, it even underwent a transformation into a higher grade of malignancy. In addition to this, the difficulties of allocating this tumour to the correct sarcoma subentity are shown.