PMC10123895_01
Intraoral image with dorsal elevation of the soft palate demonstrating a submucosal retropharyngeal mass (green star)
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The patient was sedated and examination of the oral cavity revealed a large retropharyngeal mass (Figure 1).
Right lateral thoracic radiograph demonstrating a caudodorsal interstitial lung pattern
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A fine-needle aspirate of the mass was obtained and thoracic radiographs showed a caudodorsal bronchial lung pattern (Figure 2), prompting bronchoalveolar lavage (BAL) to be performed under general anaesthesia.
Contrast-enhanced CT multiplanar reconstruction using soft tissue windowing, demonstrating right-sided retropharyngeal mass (green marker)
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CT revealed a discrete right retropharyngeal/tonsillar mass with no local infiltration into the surrounding tissues, ipsilateral medial retropharyngeal lymphadenopathy and unspecific pulmonary changes (Figure 3).
PMC10123895_02
PMC10123895_03
Low-power microscopic view (x 40) of leiomyosarcoma infiltrating adjacent skeletal muscle (green arrow; haematoxylin and eosin stain). The inset represents a high-powered view (x 200) of mesenchymal neoplastic cells
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Neoplastic cells exhibited moderate to marked anisocytosis and anisokaryosis with a mitotic count of 1 per 10 high-power fields at x 200 magnification and an area of 2.37 mm   (Figure 4).
Low-power microscopic view (x 40) of the vimentin immunohistochemistry of leiomyosarcoma. The inset is a high-power view of the neoplastic cells (x 200). The brown colour indicates positive labelling of the neoplastic cells
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Immunohistochemistry revealed diffuse strong staining of the neoplastic cells with antivimentin (1:500 dilution [Monoclonal Mouse Anti-Human Vimentin Clone; Dako]), antidesmin (1:100 dilution [Monoclonal Mouse Anti-Human Desmin Clone; Dako]) and anti-alpha smooth muscle actin (1:100 dilution [Monoclonal Mouse Anti-Human Smooth Muscle Actin Clone; Dako]) antibodies at x 200 magnification (Figures 5 and 6), consistent with a leiomyosarcoma.
Low-power microscopic view (x 40) of the alpha smooth muscle actin immunohistochemistry. The inset is a high-power view of the neoplastic cells (x 200). The brown colour indicates strong and specific positive labelling of the neoplastic cells
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Immunohistochemistry revealed diffuse strong staining of the neoplastic cells with antivimentin (1:500 dilution [Monoclonal Mouse Anti-Human Vimentin Clone; Dako]), antidesmin (1:100 dilution [Monoclonal Mouse Anti-Human Desmin Clone; Dako]) and anti-alpha smooth muscle actin (1:100 dilution [Monoclonal Mouse Anti-Human Smooth Muscle Actin Clone; Dako]) antibodies at x 200 magnification (Figures 5 and 6), consistent with a leiomyosarcoma.
Low-power microscopic view (x 40) of the myoglobin immunohistochemistry. The inset is a high-power view of neoplastic cells (x 200). The neoplastic cells show negative immunohistochemistry labelling for myoglobin
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The neoplastic cells showed negative immunohistochemistry labelling for myoglobin (1:100 dilution [Monoclonal Mouse Anti-Human Myoglobin Clone; Dako]) (Figure 7).
Contrast-enhanced CT multiplanar reconstruction using soft tissue windowing demonstrating lack of tumour reoccurrence 7 months following the surgery. Green arrows show previous location of the mass
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CT 16-slice helical scans (Somaton Emotion; Siemens) of the head and thorax was performed. CT revealed no evidence of primary mass recurrence (Figure 8), static right retropharyngeal mild lymphadenopathy and a poorly defined, mildly contrast-enhancing soft tissue opacity within the cranial mediastinum (possible mildly enlarged mediastinal lymph node).