Sarcomatoid carcinoma of the pyriform sinus: A rare malignancy in a rare location responsive to combination of chemotherapy and radiotherapy

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Sarcomatoid carcinoma (SaC) is a rare variant of squamous cell carcinoma with sarcomatoid features having biphasic characteristic malignant mesenchymal spindle cell and squamous cell component comprising of dysplasia, carcinoma in situ, or invasive carcinoma. Most information about this malignant entity in the head-and-neck region has emerged from larynx and oral cavity with an incidence of 0.5%–3% and 1%, respectively, with very few cases reported in hypopharynx. We hereby report such a case in a 76-year-old male who presented with dysphagia and swelling right side neck. Clinicopathological evaluation showed a localized SaC hypopharynx. In view of old age and comorbidities of hypertension and diabetes, no surgical intervention was contemplated, and he was treated with definitive concurrent chemo-radiotherapy (CCRT). A thorough review of the literature revealed that while earlier reported cases underwent upfront surgery followed by adjuvant RT or adjuvant CCRT, we treated this case with combination of chemotherapy and RT resulting in a significant therapeutic effect.