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

Abstract

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.

Primary Pleural Malignant Mesothelioma with Delayed Metastasis to the Piriform Sinus: Report of a Case

“…While it is true that pan-CK staining is positive in synovial sarcoma, head and neck synovial sarcoma is rare, and it usually develops in younger patients. 7 Furthermore, synovial sarcoma is strongly positive for bcl-2 and CD99, 8 which were negative in our case. As a result, the tumor in our case was ultimately diagnosed as a malignant mesothelioma of the piriform sinus on the basis of (1) the patient's history of lung mesothelioma, (2) the tumor's macroscopic appearance, and (3) the focally positive reactions with calretinin and CK-5/6 on immunohistochemical analysis.…”

“…7 If so, sarcomatoid carcinoma would represent an epithelial neoplasm with divergent mesenchymal differentiation. 7 Histologically, the surface of sarcomatoid carcinomas is composed of carcinomatous elements, and the bulk of the tumors is formed by the spindle cell component, as is also seen in mesotheliomas. When the malignant surface epithelium is histologically evident, the diagno- Primary Pleural malignant mesothelioma with delayed metastasis to the Piriform sinus: rePort of a case sis of sarcomatoid carcinoma is easy.…”

“…Some reports have supported the hypothesis that these tumors are epithelial in nature and that they are exophytic polypoid lesions with a high predilection for the upper aerodigestive tract. 7 If so, sarcomatoid carcinoma would represent an epithelial neoplasm with divergent mesenchymal differentiation. 7 Histologically, the surface of sarcomatoid carcinomas is composed of carcinomatous elements, and the bulk of the tumors is formed by the spindle cell component, as is also seen in mesotheliomas.…”