経口切除を施行した咽喉頭脱分化型脂肪肉腫例

抄録

Liposarcoma is one of the most common soft-tissue sarcomas in adults, but the head and neck region, especially the larynx and hypopharynx, is rarely involved. We present a case of a dedifferentiated liposarcoma in a man of 80s. He presented at our ENT service with a three-month history of dysphagia and a one-month history of dyspnea. On endoscopic examination, a tumorous lesion was observed in the hypopharynx. A CT scan showed an abnormal lesion extending from the hypopharynx to the esophagus with a density greater than that of fat. A histological analysis showed variant cells that stained positive for CDK4 and MDM2, and negative for CD34. Taking these findings into consideration, we diagnosed the patient as having a dedifferentiated liposarcoma in the hypopharynx. Transoral videolaryngoscopic surgery was performed. The tumor occupied the arytenoid cartilage, piriform sinus and postcricoid area. As of six months postoperatively, the patient is now able to consume food orally. For patients with dedifferentiation-type liposarcoma of the laryngopharynx who do not wish to undergo a laryngectomy, oral resection is possible. When deciding on an operative strategy, the wishes of the patient, the patient’s age, the local existence of the lesion, and the pathology type should be considered, generally after an explanation of the risks has been given to the patient.