[Carcinosarcoma of the larynx and hypopharynx].

INTRODUCTION: A carcinosarcoma is an uncommon neoplasm with both malignant epithelial and malignant mesenchymal components. The tumor entity has been described in many epithelial organs. Manifestation in the larynx and the hypopharynx is rare. PATIENTS: This report recounts two patients, one with a carcinosarcoma of the vocal cords and the other with a hypopharynx tumour. On the background of the literature we discuss the peculiarities of histology, pathogenesis, clinical features and therapy. DISCUSSION: Carcinosarcomas of the larynx and hypopharynx are typically described in elderly men. Smoking, alcohol and previous irradiation of the head and neck are predisposing etiologic factors. Clinical symptoms correspond to other neoplasms of the area--a short anamnesis is typical. In most cases the endoscopy reveals the presence of an exophytic lesion with intact epithelial surface. Crucial for the diagnosis is the revelation of a carcinoma together with sarcoma in the histology and immunohistochemistry both in the primary and secondary side. The histogenesis of carcinosarcoma is not yet clear--it seems that a pluripotent cell produces both tumour components. Most authors recommend complete surgical excision of the primary, regional lymphadenectomy and postoperative irradiation. Despite of an often large tumor volume the preservation of the larynx seems to be possible in many cases, because exophytic tumours are pre-potent. Survival rates are similar to those of patients with squamous cell carcinoma.