Case No |
Clinical features |
1 Fig. 1 |
2 |
3 |
Age/Sex |
41/F |
24/F |
47/M |
Clinical presentation |
Jugal swelling |
Jugal swelling |
Visual blur |
Location of lesion |
Masseter muscle |
Masseter muscle |
Orbit |
Histological type |
Synovialosarcoma |
Rhabdomyosarcoma |
Fibrosarcoma |
Treatment |
Wide surgical exision+chemotherapy |
Chemotherapy+Radiation therapy |
Wide surgical exision+Radiation therapy |
Metastasis |
No |
No |
No |
Follow-up |
Duration(months) |
6 |
18 |
36 |
Result |
Increased size of primary tumor |
Recurrence |
No recurrence |
Case No |
Clinical features |
4 |
5 |
6 |
Age/Sex |
67/F |
44/M |
26/M |
Clinical presentation |
Cervico thoracic swelling |
Gingival swelling |
Gingival swelling |
Location of lesion |
fat |
Upper gum |
Upper gum |
Histological type |
Liposarcoma |
Undifferenciated sarcoma |
Fibrosarcoma |
Treatment |
Wide surgical exision+Radiation therapy |
Chemotherapy+Radiation therapy |
Wide surgical exision |
Metastasis |
No |
No |
No |
Follow-up |
Duration(months) |
9 |
12 |
6 |
Result |
Pulmonary recurrence |
Increased size of primary tumor |
Local recurrence +Hepatic and lung metastases |
Case No |
Clinical features |
7 |
8 |
9 |
10 |
Age/Sex |
35/M |
38/H |
67/F |
36/H |
Clinical presentation |
Facial pain |
Hoaresness |
Diplopia |
Temporal swelling |
Location of lesion |
Parotid |
Larynx |
Orbit |
Temporal muscle |
Histological type |
Liposarcoma |
Synovialosarcoma |
Liposarcoma |
Synovialosarcoma |
Treatment |
Wide surgical exision |
Wide surgical exision+Chemotherapy |
Wide surgical exision+Radiation therapy |
Wide surgical exision |
Metastasis |
No |
Yes(pulmonary metastases) |
No |
No |
Follow-up |
Duration(months) |
24 |
36 |
36 |
36 |
Result |
Local Recurrence |
No recurrence |
No recurrence |
Local recurrence |
* Histopathologic types were:
- Synoviolasarcoma in 3 cases
- Liposarcomas in 3 cases
- Rhabdomyosarcoma in 1 case
- Fibrosaroma in 1 case
- Undifferenciated sarcoma in 1 case.
* The tumor size averaged 5 cm in greatest dimension (range,
2.5–8 cm).
* Tumor locations were:
- The masseter muscle in 2 cases,
- The larynx in 1 case,
- The parotid in 1 case,
- The upper gum in 2 cases,
- The orbit in 2 cases,
- The temporal muscle in 1 case,
- The fat in one case.
* The shapes and margins of the tumors were round or ovoid,
and they had lobulating or irregular contours.
* Contrast-enhanced CT scans showed heterogenous tumor enhancement with necrosis in all cases.
* MR imaging findings :
- High signal intensity on T1- and T2-weighted images compared with surrounding structures
- Vascular signal voids.
- Gadolinium-enhanced MR images showed strong enhancement and central necrosis.
- Local tumor invasion to surrounding structures was seen in four cases.
* One patient (laryngeal lesion) presented with lung metastasis.
* Local recurrence was seen in 4 cases.
* Progreesion (increasing of primary tumor size) was seen in 2 cases.
CT scan showed multiple metastatic nodules in both lungs in one patient.
Imaging features suggesting the diagnosis include :
- Large tumor size
- High signal intensity on T2-weighted images
- Flow voids in the tumor
- Strong enhancement are highly suggestive of the diagnosis.
CT and MRI are complementary technics,
and both studies are often required for acurate tumor staging:
- CT scan depicts better bone involvement and tumor calcification.
Contrast administration is usually required to fully appreciate the relationship of the tumor with adjacent vessels.
- MRI is superior to CT for the evaluation of tumor extention to soft tissue (tumor margins can be difficult to distinguish from the fascia of adjacent musculature on CT scans and resolution may be limited by bone artefacts).
- Intracranial extension is better delineated on MRI.
Imaging findings can suggest the diagnosis, yet definitive one requires histologic evaluation of a representative biopsy specimen.
Classical treatment modalities of head and neck sarcomas include surgery,
radiotherapy and/or chemotherapy.
The treatment protocole depends on several parameters such as histologic type,
stage,
location,
size and patient's age.
Due to the anatomical complexity and surrounding vital structures in the head and neck region,
wide excision with adequate margin is not possible in all cases,
thus resection of gross tumor with post-operative adjuvant therapy is usually the treatment of choice.
Prognosis and patients survival depends on local control and distant metastasis (especially to the lungs).