Oral and maxillofacial pathology
Sarcomas and sarcomatoid tumor after radiotherapy of oral squamous cell carcinoma: analysis of 4 cases

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Radiation-induced sarcoma (RIS) or postirradiation sarcoma has been reported rarely as a long-term complication of radiation therapy (RT). We report 4 cases of oral sarcomas or sarcomatoid tumors with a rather short latency period after radiotherapy of the prior OSCC. Histopathological evaluation and immunohistochemical study were performed using a panel of markers including vimentin, cytokeratin, S-100, desmin, myoglobin, HHF-35, p53, and p16. All reported cases were positive for vimentin and negative for cytokeratin. Two cases were positive for myoglobin, desmin, or HHF-35, and were probably myogenic origin. One case was possibly a fibrosarcoma and the subclassification of the other one was not specified. Diverse expression of p53 and p16 was further observed in these 4 cases. Report of the complicated clinical processes and the analysis of genetic markers of these cases provide useful clinical and pathogenetic insights of mesenchymal malignancies associated with a status post OSCC radiation.

Section snippets

Case Reports

Four patients (1 female, 3 male) with features of sarcomas or sarcomatoid change of tumors were treated at Taipei Veterans General Hospital (Taipei-VGH) from 1992 to 2003. Patients’ ages ranged from 52 to 62 years. All of the patients were irradiated for primary OSCC. After a variable period of latency, sarcomas or sarcomatoid tumors occurred in the previously irradiated field (Table I).

Immunohistochemistry

Surgical specimens from these 4 cases were processed routinely by tissue sectioning and evaluated by experienced oral pathologists. Hematoxylin and eosin (H&E) stain was used for evaluating the morphology of tumor cells. IHC was carried out using protocols previously established.10 The primary antibodies for IHC included those against cytokeratin (Signet, Dadhem, MA), vimentin, S-100, desmin, myoglobin, HHF-35 and p53 (Dako, Carpinteria, CA), and p16 (BioCare, Concord, CA). After rinsing with

Case 1

Histological observation revealed spindle and pleomorphic malignant cells with eosinophilic cytoplasm. IHC for cytokeratin was negative, but vimentin was positive. IHC for myoglobin, a striated muscle specific oxygen-binding protein, was positive. Although the IHC for HHF-35 was negative, the overall IHC is suggestive a rhabdomyosarcoma (Fig. 2, A).

Case 2

Histological evaluation of the buccal mucosa lesion revealed a diffuse infiltration of spindle-shaped tumor cells arranged in a fascicle pattern,

Discussion

The occurrence of sarcomas in the head and neck region is rare. According to the sarcoma database recorded by Patel et al.,11 only 4.2% of 3796 sarcoma patients had a lesion involving the head and neck. Among all malignant tumors in this area, sarcomas account for less than 1%. The etiology of sarcomas includes tumorigenic effects of prior radiation therapy and the spontaneous development of second malignancies in the form of sarcomas. In 1948, Cahan et al.12 described the criteria used for the

Conclusions

To implicate radiation therapy in the causation of tumors is difficult. When tumors occur that are histologically or phenotypically different from the primary cancer and having radiation history, the possibility of radiation-induced malignancy should be taken into consideration.

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    This article was sponsored by VGH93C230, NSC 93-3112B075, and CI937 grants, Taiwan, ROC.

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