Peripheral synovial sarcoma metastatic to the temporal bone

Peripheral synovial sarcoma rarely metastasizes to the head and neck. A case report of such an occurrence involving the ear is presented, along with a review of the subject. The case report is unique, as it is the only reported instance of synovial sarcoma involving the ear.     

Primary osteogenic sarcoma of the tongue.

A 56-year-old man presented with the difficulty of swallowing and respiratory distress due to a large tumour arising from the tongue and occupying the entire oral cavity. Histological examination revealed it to be an extraskeletal osteogenic sarcoma. The tumour was excised. After six weeks, he came back with massive local recurrence and bleeding from the tumour, but died despite chemotherapy. Review of the literature revealed only four other such cases of this rare tumour. A brief review of these four cases is also made.     

Alveolar soft part sarcoma of the tongue

In this report a 13-year-old girl with characteristic clinical and pathological features of alveolar soft part sarcoma of the tongue is presented. Alveolar soft part sarcoma is a rare malignant tumor of unknown origin. Forty eight cases of alveolar soft part sarcoma have so far been reported in the head and neck region. Median survival reported for all sites of the body is 79 months following various modes of therapy. In this case, the treatment was surgical excision of the mass combined with radiotherapy and chemotherapy. The patient has been asymptomatic for the past 12 months.     

Alveolar soft part sarcoma of the tongue

Alveolar soft part sarcoma is a rare malignancy. To our knowledge, 13 cases in the head and neck have been reported previously. It occurs more commonly in the extremities, where it is associated with a poor prognosis. Its clinical course resembles that of adenoid cystic adenocarcinoma in that late metastases often cause death in 10 to 15 years. A 5-year-old girl with alveolar soft part sarcoma was successfully treated with partial glossectomy and is free of disease at two-year follow-up.     

Early-onset postirradiation sarcoma of the tongue after pseudotumor phase

Radiation-induced sarcoma usually develops after an interval of more than 10 years from the completion of radiation therapy to the diagnosis of secondary sarcoma. However, the theory of radiation-induced transformation does not rule out postirradiation sarcomas with a short latency period. We experienced the case of a patient with postirradiation leiomyosarcoma of the tongue, which occurred 19 months after he had received chemoradiotherapy. Besides the short latency period, a pseudotumor stage developed between the time of radiation exposure and the development of leiomyosarcoma. In this article, we also describe an immunohistochemical approach to diagnose leiomyosarcoma and the efficacy of a gemcitabine and docetaxel regimen.     

Uncommon metastatic site of renal adenocarcinoma: the oral tongue

Primary tumours metastasizing to the tongue are very unusual and only anecdotal cases have been reported. An exhaustive literature review covering the period from 1970 onwards disclosed only 22 cases of renal adenocarcinoma metastasizing to the tongue. We report the case of an 87-year-old female patient with oral tongue, lung, liver, thyroid gland, pancreas and renal adenocarcinoma metastases. She had undergone contralateral nephrectomy for clear cell carcinoma 10 years before diagnosis of the metastases. The tongue lesion was surgically removed under local anaesthesia. Tongue metastasis of renal adenocarcinoma is usually a manifestation of widespread disease. The prognosis for patients with lingual metastasis of renal adenocarcinoma is poor, the mean interval from diagnosis of tongue metastasis to death being 5.8 months. In our patient, metastatic involvement of the tongue was detected approximately 5 months before death. Treatment of renal adenocarcinoma metastasis to the tongue is usually palliative and aims to provide patient comfort by means of pain relief and prevention of bleeding and infection. Surgical excision is recommended as the primary treatment, with emphasis on preservation of tongue structure and function. Recent data regarding immunotherapy or immunochemotherapy for metastatic renal adenocarcinoma are encouraging.     

Synovial sarcoma of the tongue. Case report and review of the literature

Primary synovial sarcoma of the head and neck is a rare entity, nevertheless the literature count on 80 published cases, among them 7 linguals. We contribute with another case: a synovial sarcoma of the tongue, in a 26-year-old man; having a biphasic tumor pattern, with two malignant constituents, epithelial and sarcomatous, similar to other of the same location. Laboratory tests: histochemical, immunohistochemical and electron microscopic were done in order to state the tumor's histogenesis. Our results suggest a pluripotential mesenchymal origin instead of a synovial origin, because the epithelial character of one of the tumor constituents was obviously epithelial.     

舌鳞状细胞癌颈部淋巴结转移的治疗

目的 分析舌鳞状细胞癌颈部淋巴结转移性的分布规律,探讨舌鳞状细胞癌cN0患者的颈部处理。方法 回顾性分析1975年1月-2000年12月初次在我院诊治的329例舌鳞状细胞癌患者的临床资料。cN0 179例,cN1 131例,cN2＋3 19例（2例出现双侧颈淋巴结转移）。在cN0患者中,肩胛舌骨肌上清扫或单纯颔下清扫20例,根治性颈清扫93例,扩大的肩胛舌骨上（包括Ⅳ区）清扫8例。在cN1患者中,30例接受颈部单纯放疗;肩胛舌骨肌上清扫6例,根治性颈清扫94例,扩大的肩胛舌骨上清扫1例。所有cN2＋3患者均行根治性颈清扫。结果 舌鳞状细胞癌颈部淋巴结隐性转移率为8．3％（10／121）,其中T1为1．3％（1／76）,T2为4．3％（4／93）,T3为44．4％（4／9）,T4 100％（1／1）。实际颈部淋巴结转移率为71．7％（81／113）。91例患者组织学检查发现颈清扫标本中淋巴结转移阳性,Ⅰ区淋巴结转移占39．6％（36／91）、Ⅱ区71．4％（65／91）、Ⅲ区19．8％（18／91）和Ⅳ区8．8％（8／91）。有2例患者发生对侧Ⅰ、Ⅱ和Ⅳ区的淋巴结转移。在cN0患者中,颈部单纯放疗的同侧颈部复发率为7．5％（3／40）,综合治疗为7．5％（6／80）,单纯手术为2．4％（1／41）,等待观察为16．7％（3／18）;颈部单纯放疗的5年生存率分别为42.0％,综合治疗为55．6％,单纯手术为79．6％,等待观察为48．6％。结论 Ⅱ区是舌鳞状细胞癌最易转移的部位,不主张对所有cN0患者实施择区性颈清扫,对T3和T4患者可考虑扩大的肩胛舌骨肌上清扫（Ⅰ～Ⅳ）。     

An unusual metastatic site of tongue carcinoma: shoulder muscles

The incidence of skeletal muscle metastases is reported to be less than 1% of metastases of haematogenous origin. Distant skeletal muscle metastases from head and neck squamous cell carcinomas are exceedingly rare. Only a case with tongue carcinoma metastasized to paravertebral muscles, has been reported so far. The reasons for the rarity of metastatic involvement of skeletal muscle are still unclear. The presence of skeletal muscle metastases in the setting of disseminated disease offers no hope for curative treatment. We report an unusual case of a 63-year-old patient with tongue carcinoma metastasizing to the left shoulder muscles. To our knowledge, this is the first such case to be reported in the English medical literature.     

Base of the tongue metastatic cancer from hepatocellular carcinoma: a case report

Although hepatocellular carcinoma (HCC) is a common malignancy in Taiwan, metastasis to the head and neck area is extremely rare. In this report, we document a case of HCC metastasis to the base of the tongue. The patient involved had been treated for HCC with chemoembolization and radiotherapy 3 years prior to being diagnosed with tongue base metastasis. Symptoms of the metastasis included frequent oozing from the tongue base tumor. The patient died 3 months after a palliative resection of the tongue. To our knowledge, this is the first clinical presentation of HCC metastasis to the tongue base documented in the English language. We also believe that this particular case is important because we predict that the advancement in HCC treatment modalities will allow enough survival time in patients to cause occult extrahepatic metastatic lesion to develop into a field of clinical significance.     

Post-irradiation malignant fibrous histiocytoma of the larynx: A case report with an unusual metastatic spread pattern

We report a case of a laryngeal malignant fibrous histiocytoma (MFH) that showed an uncommon clinical behavior. This tumor occurred in a 70-year-old male patient 5 years after radiation treatment for laryngeal squamous cell carcinoma, and unusual metastases were spread unusually to the pleural cavity.The interval between the end of radiotherapy and the onset of MFH can be justified by the development of laryngeal stenosis by fibrotic tissue as a late complication of radiotherapy.Laryngeal fibrosis after radiotherapy probably triggered the MFH.Neither computed tomography nor magnetic resonance imaging differentiate between fibrotic tissue and MFH, and only repeated biopsy was definitive to give us the correct diagnosis.     

Sarcomatoid carcinoma of the pyriform sinus with brain and subcutaneous metastases: an unusual metastatic spread pattern

A 63-year-old man presented a polypoid tumor in the laryngeal space involving the right pyriform fossa. The patient underwent a total laryngectomy with bilateral functional neck dissection, and the diagnosis of sarcomatoid carcinoma with malignant fibrous histiocytoma-like stroma was established. The tumor showed an uncommon behavior, with distant metastases to the brain and to the subcutaneous tissue of the abdominal wall. The patient died 1 year after the development of the metastases. Despite its polypoid pattern of growth, sarcomatoid carcinoma of the larynx may behave very aggressively. It is important for clinicians to be aware of the possibility of distant subcutaneous and brain metastases in sarcomatoid tumors of the laryngeal space. If such metastases develop, the prognosis is ominous, with an average life expectancy of 3 months. Received: 3 March 2000 / Accepted: 6 April 2000