Presentation
Progressive dysphagia and odynophagia. Poor oral intake with associated weight loss.
Patient Data
Heterogeneous lesion within the left hypopharynx causes significant positive mass effect upon the supraglottic larynx, which is narrowed and displaced to the right. The left aryepligottic fold is thickened, and the left pyriform recess is almost completely effaced. The soft tissue thickening extends superiorly from the left hypopharyngeal lesion into the posterior and left lateral walls of the oropharynx. The enhancing lesion involves the left carotid space, at least partially encasing the left internal carotid artery. The left prevertebral muscles appear invaded. No overt invasion of the pterygoid muscles.
Evidence of previous left neck dissection with left hemimandibulectomy and reconstruction. Thickening of bilateral platysma muscles and interstitial thickening in the subcutaneous tissues of the neck are in keeping with prior bilateral neck radiation therapy.
Case Discussion
A biopsy of the lesion was performed. It is noted that the patient had a previous history of left mandibular squamous cell carcinoma.
Histology:
MACROSCOPIC DESCRIPTION: "Left pyriform fossa": five pieces of cream tissue measuring 15x11x3 mm in aggregate.
MICROSCOPIC DESCRIPTION: "Left pyriform fossa": Sections of the squamous mucosa show moderately differentiated squamous cell carcinoma. The surrounding stroma shows sarcomatoid differentiation with marked atypia, apoptosis and mitoses. The squamous cell carcinoma is positive for p40, p63, MNF116, AE1/AE3 and CK5/6 but negative for p16. The sarcomatoid component is positive for vimentin, SMA and MNF116 (focal) but negative for desmin and other keratin markers.
Given the history of previous SCC of the mandible, the overall features favor a diagnosis of sarcomatoid carcinoma over carcinosarcoma.
DIAGNOSIS: Favor sarcomatoid carcinoma, p16 negative.