Abstract

Sarcomatoid carcinoma is a rare and aggressive form of squamous cell carcinoma (SCC), a biphasic tumor that has been shown to be a dedifferentiated monoclonal form of classic squamous cell carcinoma. The factors that contribute to proliferation of SCC to sarcomatoid carcinoma are not precisely known but some studies revealed the importance of anterior radiation therapy. This case report describes a 62 year old man, heavy smoker and alcohol drinker diagnosed with laryngeal neoplasm. The pathological diagnosis was well-differentiated SCC of the piriform sinus. Surgery was performed and the pathology report revealed medium differentiated SCC, pT4aN1M0. The patient underwent external radiotherapy (RT) with 66Gy/tumour bed in 33 fractions. At 4 months post RT the clinical exam revealed tumor recurrence near the tracheal stoma. A second surgery was performed and the pathology diagnosed a recurrence of SCC with sarcomatoid-looking areas, with two surgical margins being invaded by the tumor. Postoperative computer tomography (CT) of the neck showed no evidence of macroscopic disease. The next treatment approach was chemotherapy with 4 cycles of carboplatin paclitaxel but soon after, an inoperable locoregional recurrence was diagnosed and he started treatment with Nivolumab followed by rapid locoregional progression. Squamous cell carcinoma with sarcomatoid dedifferentiation is a rare histology of laryngeal cancer, with an aggressive behavior that requires intense treatment and follow-up.