Page 79 - Revista Portuguesa - SPORL - Vol 41. Nº2

LIPOSARCOMA DE HIPOFARINGE: A PROPÓSITO DE UM CASO.
DISCUSSION.
Liposarcomo ot the hipopharynx has a male
predilection(9:i ratio), the age range of the
patients is from the fourth to the seventh decades
of lifeº. Most authors include liposarcoma of the
pyritorm sinus and larynx in the same category,
because of their clinical and pathologic similar-
ities”. The youngest patient (28 years old) has
been reported by Shah and Lowry‘2.The lesions
usually involve the hipopharynx and supraglot—
tic |arynx(epig|ottis, aryteniod eminence,
aryepiglottic told and false vocal cord), glottis
involvement is very infrequent(only two cases
have been reported to affect the true vocal
cords). Symptoms consist of hoarseness, dys-
phagia and a variable degree of airwoy of
obstruction lasting from several weeks to years.
Computed tomography and magnetic reso-
nance imaging are very useful in determining
tumor’s location and size, so an effective treat-
ment can be planned?
Location of the tumor is an important factor
for the prognosis of the patient, although prog-
nosis is usually worse in pyritorm sinus than it is
in larynx, hypopharynx and larynx liposarco-
mas seem to have better Iong-term outcome
than in other head and neck sites“.
The most reliable indicator for the clinical
behavior of liposarcoma is the degree of dif-
ferentiation. There are four histologic types,
according to the differentiation of the lipoblast,
degree of cellularity and pleomorphism of the
tumor”:
. WelI—differentiated, composed of mature-
-appearing tat containing variable num—
bers ot atypical cells, lipoblasts and ti-
brous tissue. Lipoblasts have different si-
zed cytoplasmic lipid droplets that indent
an enlarged and hyperchromatic nucleus.
These cells make the difference between
a well-ditferentiated liposarcoma and a
bening lipoma.
' Myxoíd, with myxoid matrix, small lipoblasts Posoperative radiation therapy has not been
and rich vascular network.
' Pleomorphic, they have much greater nu-
c|ear pleomorphism, with bizarre giant
cells.
º Dedifierentiated. The concept of this type
of liposarcoma was advanced by Evans3
for those tumors containing mixed areas
of welldifferentiated liposarcoma and
non-Iipogenic spindle cell or pleomorphic
sarcoma, with an abrupt transition (figure 3)
between both areas, either in the primary
or in the local recurrences. The dedifte—
rentiated areas may be very difficult to
distiguish from a well differentiated lipo-
sarcoma, specially in small biopsy sam-
ples. There seems to be a straight correla-
tion between mitotic activity in the dedif-
terentiated areas and biological behavi-
our of the tumor; although the whole
prognosis of this tumor is better than that
of other deditferentiated sarcomas. Only
2 deditterentiated liposarcomas of this
area have been discribed in the literature” ‘3.
NOTE NUCLEAR ATYPIA AND HIGH MITOTIC IATE.
Treatment approaches are variable, surgery
is the most appropriate, consisting of wide
local excision, conservation laryngeal
surgery(either supraglottic laryngectomy or lat-
eral pharyngotomy depending on the lesion) or
total laryngectomy may be necessary.
consistently employed, being used as an
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