Current topics and management of head and neck sarcomas

Figure 1. Pathological findings of alveolar rhabdomyosarcoma. (A) HE staining. Primitive, small, round cells appear to ‘float’ in a nest outlined by fibrous septa. (B) The nuclear expression of myogenin was 80%. (C) Desmin-positive cells are scattered. (D) The PAX3-FOXO1 fusion FISH probe. The fusion gene is detected as a yellow signal, with the green and red signals confocalized.

Figure 2. A case of alveolar rhabdomyosarcoma in a 6-year-old patient. (A–C) An invasive tumour located in the submandibular region. (D) After one cycle of VAC, the tumour dramatically shrunk. (E) After four cycles of VAC, the tumour was in complete remission on imaging. (F) Surgical specimen of a delayed primary excision (submandibular dissection). A few viable tumour cells were detected in the red lines. After DPE, VAC chemotherapy and postoperative radiotherapy were performed.

Figure 3. A 20-year-old woman with high-grade osteosarcoma of the mandible. (A) The tumour invaded to the masseter and pterygoid muscles. (B) Imaging results: after two cycles of MAP neoadjuvant chemotherapy. (C) Intraoperative photograph of segmental mandibulectomy. (D) Surgical specimen of segmental mandibulectomy. Viable tumour cells were detected in 70% of the area (red lines). After surgery, MAP chemotherapy and postoperative radiotherapy were performed.

Figure 4. A 32-year-old woman with Ewing’s sarcoma of the pharynx. (A) A submucosal tumour invading the anterior vertebral muscles was detected on the posterior wall of the pharynx. (B) After VDC-IE neoadjuvant chemotherapy, the tumour was in complete remission on imaging. (C) Partial pharyngectomy and free flap reconstruction were performed. The resected specimen revealed no viable tumour cells. After surgery, VDC-IE chemotherapy was performed.