540 CLINICOPATHOLOGICAL CONSULTATION REGIONAL AND DISTANT METASTASES IN LARYNGEAL AND HYPOPHARYNGEAL SARCOMAS PIERO NICOLAI, MD BRESCIA, ITALY GIUSEPPE CARUSO, MD LUCA O. REDAELLI DE ZINIS, MD KENNETH O. DEVANEY, MD PORDENONE, ITALY BRESCIA, ITALY CHICAGO, ILLINOIS ALESSANDRA RINALDO, MD MARCO BERLUCCHI, MD ALFIO FERLITO, MD PADUA, ITALY BRESCIA, ITALY UDINE, ITALY Cervical node and distant metastases are the most important prognostic factors in malignant laryngeal neoplasms. Owing to the unusual occurrence of laryngeal sarcomas, the prevalence of their metastases has never been analyzed in detail. We reviewed the laryngeal sarcomas reported in the literature and noticed that both regional and distant metastases are rare events and variable for different histotypes. These observations have obvious therapeutic and prognostic implications. From the Department of Otolaryngology, University of Brescia, Brescia (Nicolai, Redaelli de Zinis, Berlucchi), the Division of Otolaryngol- ogy, San Vito al Tagliamento, Pordenone (Caruso), the Department of Otolaryngology, University of Padua, Padua (Rinaldo), and the Depart- ment of Otolaryngology–Head and Neck Surgery, University of Udine, Udine (Ferlito), Italy, and the Department of Pathology, University of Chicago, Chicago, Illinois (Devaney). Supported by The Laryngeal Cancer Association, Italy. CORRESPONDENCE — Alfio Ferlito, MD, Dept of Otolaryngology–Head and Neck Surgery, University of Udine, Policlinico Città di Udine, Viale Venezia 410, 33100 Udine, Italy. According to the revised World Health Organiza- tion classification in Histological Typing of Tumours of the Upper Respiratory Tract and Ear, 1 laryngeal and hypopharyngeal sarcomas include fibrosarcoma, malignant fibrous histiocytoma, liposarcoma, leio- myosarcoma, rhabdomyosarcoma, angiosarcoma, Kaposi sarcoma, malignant hemangiopericytoma, malignant nerve sheath tumor, alveolar soft part sar- coma, synovial sarcoma, Ewing sarcoma, chondro- sarcoma, and osteosarcoma. Electron microscopy and, more recently, sophisticated immunohistochem- ical methods have improved the accuracy of the his- tologic diagnosis of these neoplasms. This has re- sulted in an apparent change in the overall incidence of laryngeal sarcomas and, more specifically, of some oncotypes. The incidence of laryngeal sarcomas was commonly considered in the past to exceed 1% of all laryngeal malignancies, and fibrosarcoma was re- peatedly identified as the most common among the sarcomas. However, both these concepts have been disproved by data that have recently appeared in the relevant literature. The aim of this review article is to analyze the laryngeal sarcomas, focusing on those with regional and/or distant metastases to elucidate their influence on treatment and prognosis of the disease. FIBROSARCOMA Fibrosarcoma was once regarded as the most com- mon malignant mesenchymal neoplasm of the lar- ynx. Indeed, it was generally held that at least one half of laryngeal sarcomas were fibrosarcoma. With the advent of the immunoperoxidase era, it is now apparent that most cases of alleged fibrosarcoma of the larynx are in fact spindle cell squamous carcino- mas or other malignant mesenchymal neoplasms such as malignant fibrous histiocytoma or mono- phasic synovial sarcoma. 2 Examples of pure laryngeal fibrosarcoma are ex- ceedingly rare 3 and, in most reports, so poorly docu- mented histologically that it is impossible to assess its natural history. Nageris et al 4 reported a case of fibrosarcoma of the larynx following radiotherapy for glottic squamous cell carcinoma without regional or distant metastases. The diagnosis was supported by immunohistochemical investigations. In any case, as the diagnosis of fibrosarcoma has been frequently uncorrected, it is not possible to evaluate the exact incidence of distant and nodal metastases. MALIGNANT FIBROUS HISTIOCYTOMA Malignant fibrous histiocytoma is a neoplasm of recent histopathologic delineation, and about 50 well-detailed cases in the larynx and hypopharynx have been reported in the literature. 5-9 The patients are usually adults, and there is no clear sex predilec- tion. Only twice has metastatic involvement of neck lymph nodes been observed. 10,11 One patient, a 58- Ann Otol Rhinol Laryngol 107:1998 Ann Otol Rhinol Laryngol 107:1998 REPRINTED FROM ANNALS OF OTOLOGY, RHINOLOGY & LARYNGOLOGY June 1998 Volume 107 Number 6 COPYRIGHT© 1998, ANNALS PUBLISHING COMPANY