Well-differentiated liposarcoma of the epiglottis

Abstract

Liposarcomas of the larynx are very rare. A review of the English literature revealed only 28 published reports of tumours in this anatomical location. Diagnosis requires a high index of suspicion and careful histologic analysis. We present a case of a well-differentiated liposarcoma of the epiglottis, the tenth reported case at this laryngeal subsite. Initial biopsy specimens showed histological characteristics of a liposarcoma, which facilitated provision of optimal surgical treatment after careful analysis of published literature.

Well-differentiated liposarcoma of the epiglottis

“…2,3 The term well-differentiated liposarcoma is preferred in the larynx due to the tendency of the lesion to recur. 2,3 Certainly, one common feature of all previously reported cases is local recurrence despite complete surgical excision, as seen in our case. Distant metastasis has been reported, but there is debate as to whether this was due to the multi-centric nature of the disease or due to true metastasis.…”

“…The most commonly used imaging modality described in previous case reports is computed tomography. 3,5 Other reports describe the use of thyroid isotope scanning, 6 antero-posterior laryngography 4 and barium swallow. 5 However, these investigations only show the presence of a lipomatous mass in the larynx, with no specific defining features.…”

“…The extent of the surgery is also dictated by the size of the original mass. 3 In addition, it is difficult to assess the adequacy of complete resection, due to the macroscopic appearance of the tumour as well as the necessarily piecemeal nature of tissue removal. 1 However, more extensive surgery is associated with higher morbidity rates.…”

“…Identifying the subtle changes associated with liposarcoma requires a high index of clinical suspicion by the histopathologist, and entails an extensive search of the specimen. In fact, morphologically well-differentiated liposarcomas occurring in more superficial planes are referred to as atypical lipomas 2 , 3 . The term well-differentiated liposarcoma is preferred in the larynx due to the tendency of the lesion to recur 2 , 3 .…”

Clinicopathological features of atypical lipomatous tumors of the laryngopharynx

“…The proportion of ALT among all liposarcomas is about 40%-45%, and ALTs are further subclassified into three variants, namely the lipoma-like, sclerosing, inflammatory, and spindle cell variants. Liposarcoma of the laryngopharynx is very rare (Wenig et al, 1990;Wenig and Heffner, 1995;Wambeek and Mendelson, 1996;Fahmy et al, 1998;Mestre de Juan and Fernández-Aceñero, 1999;Mouret, 1999;Brauchle et al, 2001;Lippert et al, 2002;Powitzky et al, 2007;Luna-Ortiz et al, 2009). The largest series of laryngopharyngeal liposarcoma is reported by Wenig et al (1990) and Wenig and Heffner (1995), in which ten cases were clinicopathologically analyzed.…”