Laryngeal Squamous Cell Carcinoma with Osteosarcomatous Differentiation and Involvement of Thyroid Cartilage Mimicking S
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SINE QUA NON RADIOLOGY-PATHOLOGY
Laryngeal Squamous Cell Carcinoma with Osteosarcomatous Differentiation and Involvement of Thyroid Cartilage Mimicking Sarcoma Arising from Thyroid Cartilage Paul Escher1 · Lihong Bu2 · Zuzan Cayci3 · Bevan Yueh4 · Faqian Li2 Received: 1 November 2019 / Accepted: 18 December 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Basaloid squamous cell carcinoma (BSCC) with a spindle cell component of the head and neck is an uncommon entity. In this case, we present a radiology–pathology correlation of a rare laryngeal BSCC with sarcomatous transformation and osteosarcomatous differentiation involving the laryngeal cartilage, which thus mimicked clinically and radiographically osteosarcoma or chondrosarcoma with calcification. Microscopic examination revealed predominantly BSCC with extensive osseous metaplasia among sheets and nests of basaloid tumor cells. There were also small foci of osteosarcoma, undifferentiated pleomorphic sarcoma, and spindle cell carcinoma. The presence of squamous cell carcinoma (SCC) in-situ, small areas of conventional SCC and diffuse positivity of p40 in conventional and basaloid squamous components confirmed that this tumor was indeed derived from surface squamous epithelium. Awareness of the broad differentiation potentials of SCC can avoid misdiagnosis of SCCs as sarcoma. This case emphasizes the importance of radiologic–pathologic correlation in definitive diagnosis and clinical management of laryngeal malignancies. Keywords Squamous cell carcinoma · Larynx · Osteosarcoma · Sarcomatous transformation · Sarcomatoid carcinoma · Spindle cell carcinoma
History
Radiologic/Clinical Findings
A 61-year old man with a 40 pack-year smoking history, 8 drink/week drinking history, and history of chewing tobacco use presented to an otolaryngologist outside our institution with hoarseness and dysphagia. His past medical history was remarkable only for hypertension and hyperlipidemia.
Contrast-enhanced CT scan performed at the outside institution showed a mass centered around the right aryepiglottic fold and pyriform sinus with destruction of the right thyroid cartilage. There was extralaryngeal extension of the mass, as well as areas of increased density similar to adjacent bone and ossified thyroid cartilage indicating calcification and/ or ossification within the center of the mass (Fig. 1). The cricoid and thyroid cartilages also demonstrated ossification. The position of the tumor centered around the laryngeal cartilage and the presence of scattered calcifications were felt to be most consistent with chondrosarcoma. There were multiple enlarged right cervical lymph nodes but no apparent distant metastasis. Biopsy at the outside institution was signed out as a poorly differentiated squamous cell carcinoma (SCC). Upon referral to our institution, fiber optic laryngoscopy showed a white exophytic tumor filling 75% of the supraglottis.
* Faqian Li [email protected] 1
University of Minnesota Medical School, Minneapolis, MN, USA
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