A Rare Case of Fibrosarcoma of Tongue

INTRODUCTION Fibrosarcoma accounts for 3 % of all Squamous cell carcinomas in the head and neck region first described by Virchow in 1865. Fibrosarcoma, a rare aggressive variant of squamous cell carcinoma is characterised by proliferation of epithelial and mesenchymal components. It may be due to Cigarette smoking, Alcohol abuse, Trauma and previous Radiation exposure to the affected area. Fibrosarcoma occurs commonly in 6-7th decade of life with strong male predominance. Presence of this tumor type in the tongue has rarely been reported. CASE REPORT 45 year old man presented to the General Surgery Out patient department with a polyp like growth over the right lateral border of the tongue since 1 month. Swelling had gradually grown in size following repeated trauma while chewing; associated with pain since 2weeks. Patient gave history of chewing Tobacco for 5years. He did not have other co-morbidities. On examination, irregular shaped ulceroproliferative growth of size 4x2cm was present in the right lateral border of tongue. It was firm in consistency. There were no palpable lymph nodes in the neck (group Ia, Ib, II) Following routine investigations patient underwent Excision and Biopsy. Based on HPE and IHC (Vimentin +ve), growth was reported to be a low grade Fibrosarcoma with positive margins. Patient underwent Revision surgery � Wide Local Excision / Glossectomy and Level I-III lymph node dissection. Margins and lymph nodes were free of tumor. Post-operative period was uneventful and patient undertook Radiotherapy. PET-CT was done post-RT which showed no obvious enhancing CT demonstrable lesion and no abnormal increased metabolic activity in the post-operative site. DISCUSSION Ewing (1940) described Fibrosarcoma, spindle cell sarcoma or fascial sarcoma under the term neurogenic sarcoma. Repeated trauma was considered as one of the factor because the predominant cells seen within the lesional tissue are fibroblasts. The most common location is lower extremities (45 %) followed by upper extremities (28 %), trunk (17 %) and head neck region (10 %). Grossly, tumor can be misdiagnosed as benign neoplasm as most of them are well encapsulated and circumscribed. Histopathologically, Fibrosarcoma has been classified as: 1. Adult Fibrosarcoma (variants such as classic type, mixoid type, fibromixoid type, sclerosing epitheloid type), 2. Juvenile / Infantile fibrosarcoma. Virtually all Fibrosarcoma stains positive for vimentin. These tumor cells are strongly negative for cytokeratins, neural markers (like S100 and neuron specific enolase), Desmin, SMA, CD68, CD 34. The treatment of choice for Fibrosarcoma is surgical excision with wide margin Fibrosarcoma may show recurrence after excision and spreads by both local invasion and hematogenous dissemination. The common sites of metastases are lungs and bones and rarely lymph nodes. In our case, the patient underwent surgical excision of tumor with wide margin and he is under continuous follow up with no recurrence has been reported so far CONCLUSION Tongue is a rare site for Fibrosarcoma. Immunohistochemistry is mandatory if there is a minute suspicion of epithelial component in the presence of malignant spindle cells on HistoPathological examination. Prognosis of the tumor is dependent on histological grade, tumor size and adequate surgical treatment with disease free margins. The 5-year survival rate for this disease is poor, ranging from 20 to 35 %. Early detection of this tumor may help reduce morbidity.