PMC9748085_01
Preoperative enhanced CT images showing a mass of irregular density (red arrow) located anterior to the carotid (yellow arrow) extending into both the left side of preepiglottic space (red arrow) (A) and the laryngeal cavity (blue arrow) (B).
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Afterward, enhanced computed tomography (CT) showed a mass of irregular density located anterior to the carotid and extending into both the laryngeal cavity and the left piriform fossa ( Figure 1 ).
(A) Preoperative fiberoptic laryngoscopy showed a smooth bulge in the left aryepiglottic fold, protruding into the laryngeal cavity, and the glottic fissure was invisible. (B) After the operation, normal laryngeal structures were observed using a fiberoptic laryngoscope, the glottic region was fully exposed, and there were no obvious abnormalities in the hypopharynx.
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A smooth protrusion in the laryngeal cavity was seen under fibro-laryngoscope ( Figure 2A ). A postoperative fiberoptic laryngoscopy revealed normal laryngeal structures ( Figure 2B ).
(A) Hematoxylin-eosin stain showing the mass consists of small round cells (hematoxylin-eosin, original magnification x200). (B) Immunohistochemistry revealed extremely positive CD99 staining (x 200). (C) The fusion of EWSR1 with FLI1 was positively detected by FISH in tumor cells (yellow arrow) (x 1000).
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Microscopically, it seemed to be nodular in distribution and was composed of diffuse small round or oval cytoplasm deficient cells with marked cellular heterogeneity, evident nuclear division and scattered necrosis ( Figure 3 ). Ewing sarcoma breakpoint region 1 (EWSR1) with Friend leukaemia integration-1(FLI1) was detected using EWSR1 and FLI1 probes (F.01253-01, GZLBP, Guangzhou, China) by fluorescence in situ hybridization (FISH), and there were positive findings in the tumor cells ( Figure 3C ). Everything mentioned above led to a diagnosis of ESS originating from the larynx.
Enhanced MR images showing no tumor recurrence in the precarotid (yellow arrow) and preepiglottic spaces (red arrow) (A) and the normal anatomy of the laryngeal cavity (blue arrow) (B).
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One year after the combined treatment strategy, enhanced magnetic resonance imaging (MR) revealed no evidence of recurrence ( Figure 4 ).