2017 Volume 60 Issue 5 Pages 231-237
The patient was a 59-year-old man who had undergone total laryngotomy after chemoradiotherapy (NDP, 5-FU+RT40Gy/20Fr) for laryngeal cancer (involving the right glottis), stage pT3N2cM0. He presented to us with dysphagia 8 years after the operation.
Esophagogastroduodenoscopy (EGD) revealed a white tumor from remaining pharynx to cervical esophagus. CT revealed a tumor measuring 18mm×30mm×20mm in size with a clear border in the same area, and PET/CT showed enhanced accumulation (SUVmax 3.4g/ml) in the tumor. Fine-needle aspiration (FNA) cytology showed class III atypical cells. Based on the above findings, suspecting recurrence of laryngeal cancer or cervical esophageal cancer, we performed tumor resection and reconstruction using a pectoralis major muscle flap. Histopathological examination of HE-stained sections prepared from the resected specimen revealed highly dyskaryotic spindle cells in a storiform pattern Immunohistochemistry showed negative staining for CD68, AE1/3, S100 and Ki67, and positive staining for only SMA. From these findings, we made the final diagnosis of malignant fibrous histiocytoma (MFH). We suspected that the tumor represented a radiation-induced sarcoma in this case. Although radiation therapy is important treatment for head and neck cancer, this case underscores the need for recognition of side effect by radiation therapy.
