Case report Radiation-induced high-grade spindle cell sarcoma of - PDF document

Page 1 of 4 Case report Radiation-induced high-grade spindle cell sarcoma of the sternomastoid muscle: a case report Z Hamdoon 1,2,3 *, W Jerjes 1,4,5 , R Al-Delayme 1 , T Upile 4 , F Vaz 6 * Abstract long time after radiation therapy and The prognosis of patients with PIS Sarcomas developing as primary ma - be clinically aggressive, radiographi - is poor in general, regardless of the lignancies of the head and neck are a cally distinctive and require multidis - type and site, with most series re - rare complication after radiation ther- ciplinary management. porting overall five-year survival apy. This kind of sarcoma has variable rates of 10%–30% 1–8 . The prognosis Introduction clinicopathological appearances and appears to be related to site, reflecting behaviour. Radiation-induced spindle Although radiotherapy is known to the feasibility of surgical resectability. cell rhabdomyosarcoma of the ster - be an effective treatment modality in RIS of the extremities has the best All authors contributed to the conceptjon, design, and preparatjon of the manuscript, as well as read and approved the fjnal manuscript. nomastoid muscle is a very rare sar - the management of malignant dis- prognosis, whereas that involving the coma and has very seldom been ease, ionizing radiation can also in - vertebral column, pelvis, shoulder gir - described in the literature. duce malignant tumour formation 1–8 . dle and neck has the worst prognosis. Herein, we report on the develop - This has been shown by studies on Although adjuvant radiotherapy ment of a rapidly growing mass over the sequelae of human exposure to and/or chemotherapy have a role in the lateral side of the neck appearing radiation from atomic testing. The the treatment of these tumours, the after 7 years in a patient with a history first recorded case of a radiation- extent of adjuvant radiotherapy is of laryngeal carcinoma who received induced cancer was a squamous cell limited by the amount of radiation radiotherapy and chemotherapy. The carcinoma (SCC) that arose in the previously received, leaving surgery process of diagnosis and management hand of a 33-year-old technician who as the only treatment option for most using combined surgery and targeted had been testing roentgen tubes for of these tumours 2,3 . However, using brachytherapy are discussed. 4 years 2 . brachytherapy as an adjunctive to sur - The patient experienced discom - Radiation-induced sarcoma (RIS) gery to control residual sarcoma cells fort and oozing of the wound for up of the head and neck is a rare, is a novel method; to the best of our to 2 months after surgery; however, long-term complication of treatment knowledge, no study has been con - complete response with satisfactory with radiotherapy. Although there ducted using this modality. adaptation and shrinkage of the pec - are many case reports on RIS in This report describes a case of All authors abide by the Associatjon for Medical Ethics (AME) ethical rules of disclosure. toralis major pedicled muscle flap oc - the medical literature, these cases adult spindle cell RMS in a patient curred after a year. The patient has cannot provide reliable information who had previously undergone ra - been disease-free for 5 years post- on the outcome of pathology as there diotherapy, treated by combined sur - operation. are few reported series published gery and targeted radiotherapy Radiation-induced spindle cell with only a limited number of (brachytherapy) with a follow-up for Competjng interests: none declared. Confmict of interests: none declared. rhabdomyosarcoma of the sterno - cases. 5 years. mastoid muscle after treatment for Post-irradiation sarcoma (PIS) is Case report laryngeal carcinoma may occur a another name given to RIS; the histo- logical types include osteosarcoma, A 67-year-old Caucasian male was fibrosarcoma, angiosarcoma and ma - referred to the Head and Neck Unit, * Corresponding authors lignant schwannoma. Spindle cell University College London Hospital, Email: zaid19772000@yahoo.com, francis.vaz@uclh.nhs.uk rhabdomyosarcoma (RMS) is a rare London complaining of a painless PIS first described in children lump in the right side of the neck 1 Department of Oral and Maxillofacial Surgery, School of Dentistry, Al-Yarmouk University in 1992 as a neoplasm composed which had increased in size over College, Baghdad, Iraq mainly of fascicular spindle-shaped 7 months. The mass did not cause any 2 Unit of Oral and Maxillofacial Surgery, UCL cells that show immunohistochemical symptoms, including dysphagia or Eastman Dental Institute, London, UK 3 Department of Oral and Maxillofacial Surgery, and ultrastructural evidence of myo - speech or breathing problems. Past University of Mosul, Mosul, Iraq genic differentiation 1 . The aetiology medical history included hyperten - 4 Department of Surgery, UCL Medical School, of spindle cell RMS in adults is un - sion and hypothyroidism. The patient London, UK 5 Leeds Institute of Molecular Medicine, School known, with different subclasses. was a non-smoker, but chronic heavy of Medicine, University of Leeds, Leeds, UK Radiation-induced RMS is a rare vari - drinker (40 units/week for over 20 6 Head and Neck Centre, University College ant of this type of sarcoma. years). London Hospitals, London, UK Licensee OA Publishing London 2012. Creative Commons Attribution License (CC-BY) For citation purposes: Hamdoon Z, Jerjes W, Al-Delayme R, Upile T, Vaz F . Radiation-induced high-grade spindle cell sarcoma of the sternomastoid muscle: a case report. Head Neck Oncol. 2012 Oct 15;4(3):68.

Page 2 of 4 Case report The patient was previously diag - nosed with T3N0M0 laryngeal SCC 7 years prior to his presentation to the unit. His treatment involved radiotherapy (66 Gy) and chemo- therapy. On clinical examination, the mass was 8 × 5 cm in size and infiltrating deep into the sternomastoid muscle. There were no palpable lymph nodes. Magnetic resonance imaging (MRI) of the neck reported a fixed solitary mass in the right neck (levels II and III) arising from the sternomas - toid muscle, with heterogeneous high Figure 1: Pre-operative MRI coronal views of the radiation-induced high-grade All authors contributed to the conceptjon, design, and preparatjon of the manuscript, as well as read and approved the fjnal manuscript. signal intensity on T2-weighted im - spindle cell sarcoma of the sternomastoid muscle. ages and low signal intensity on T1- weighted images (Figures 1 and 2). The patient was examined under an - aesthesia that confirmed the find - ings; the endoscopic examination of the oropharynx and larynx was unremarkable. After an ultrasound- guided core biopsy, the diagnosis was confirmed histopathologically as radiation-induced high-grade spindle cell sarcoma. Agreement on the Multi-Discipline Meeting (MDT) was reached and the patient received single-agent doxoru - bicin for 3 cycles. This was followed with extended radical neck dissec - All authors abide by the Associatjon for Medical Ethics (AME) ethical rules of disclosure. tion with clear margins, which was successfully performed, followed by reconstruction with an ipsilateral pec - toralis major pedicled muscle flap and insertion of brachytherapy catheters Competjng interests: none declared. Confmict of interests: none declared. (Figure 3). Recovery after anaesthesia was uneventful. The patient complained of discomfort in the area of surgery, with clear fluid discharge from the chest (flap donor area) for up to 2 months, which healed later with simple conservative dressings. Macroscopically, a well-circum - scribed, but not encapsulated, solid, Figure 2: Pre-operative MRI axial views of the radiation-induced high-grade solitary red lesion was encased in spindle cell sarcoma of the sternomastoid muscle. thick fibromuscular tissue. Micro- scopic examination revealed elon - gated, spindle-shaped cells with with sparse polygonal or rounded desmin, which confirmed the myo - vesicular nuclei, numerous mitoses, rhabdomyoblasts with foci of sarco - genic nature. and a pale cytoplasm, forming long meric differentiation. Immunohisto- Radiation was given twice daily for fascicles. These cells were mixed logical staining was positive for 3 consecutive weeks. The patient had Licensee OA Publishing London 2012. Creative Commons Attribution License (CC-BY) For citation purposes: Hamdoon Z, Jerjes W, Al-Delayme R, Upile T, Vaz F . Radiation-induced high-grade spindle cell sarcoma of the sternomastoid muscle: a case report. Head Neck Oncol. 2012 Oct 15;4(3):68.