They range from lesions which are mainly adipose tissue with. Spindle cell carcinoma an overview sciencedirect topics. One challenging feature of head and neck pathology is that a dizzying array of spindle cell lesions occur here ranging all the way from reactive. Pathology outlines spindle cell squamous cell carcinoma. For biopsies from the head and neck assessment is further complicated by the range of tissues present at this site, and the limited amount of.
Spindle cell neoplasms are defined as neoplasms that consist of spindleshaped cells in the histopathology. Following is a list of malignant spindle cell tumors. The entities, both benign and malignant, that compose the spindle cell lesions of the breast will be discussed. Lesions that can resemble spindle cell sarcomas include ancient schwannoma, nodular fasciitis, and postoperative spindle cell nodules. Elucidating the dermal spindle cell and other cutaneous. Although nonepithelial extraskeletal tumors are in the minority among head and neck lesions, they are by no means rare. Spindle cell carcinoma spcc, also known as sarcomatoid carcinoma or pseudosarcoma, of head and neck is a rare neoplasm. The purpose of this study was to investigate the ct and mr imaging features of scl in the head and neck. Clear cells, clear cell tumors, mechanism of clearing, physiological clear cells.
Spindle cell carcinomas of the head and neck rarely harbor. There is a 70% to 80% predominance in men aged 69 to 77 years, with lesions primarily occurring in sunexposed areas of the head and neck. The tumors generally begin in layers of connective tissue such as that under the skin, between muscles, and surrounding organs, and will generally start as a small lump with inflammation that grows. Ten males and one female aged 4278 years median, 51 years. Spindle cell neoplasms can affect the oral cavity and it is often very difficult for the oral pathologists to differentiate it from other similar microscopic simulates. Less than 4% of schwannomas involve the nasal cavity and paranasal sinuses. It usually presents as a polypoid mass and often at an early stage due to local obstruc tive symptoms. In the oral cavity, spindle cell squamous cell carcinoma of the tongue is an aggressive variant of squamous cell carcinoma, which usually. Spindle cell carcinoma of the oral cavity and oropharynx. Spindle cell lesions of the breast university of utah. Spindle cell lesions can occur in head and neck skin, in the soft tissues of the scalp, orbit, and neck, and along the upper aerodigestive tract uadt mucosa.
In this issue, we have managed to touch on each entity that falls under this large umbrella. Risk factors for spindle cell carcinoma of the upper aerodigestive tract include tobacco use, alcohol. Pdf spindle cell carcinoma of head and neck, a subtype of squamous cell carcinoma is a unique and rare neoplasm. Spcc is extremely rare in the head and neck region, especially in the paranasal sinuses. A median period of 4 months between time of onset and time of. Laboratory medicine and pathobiology university of toronto disclosure.
It has been reported that the larynx, oral cavity, and pharynx are the sites of. Tumors of the mammary gland, afip atlas of tumor pathology, series 4, first edition, 2009. They are usually well circumscribed and based in subcutaneous tissue but purely dermal tumours also occur histology of spindle cell lipoma. It is most frequently encountered in the larynx, and also occurs in the nasal cavity, hypopharynx, oral cavities, esophagus, trachea, skin and breast. The histological diagnosis of spindle cell lesions can be challenging in any site, but in this region is particularly so, due to the variety of structures from which they can arise. Clinicopathological and immunohistochemical analysis of spindle.
Earlier, it was called giant cell reparative granuloma, a misnomer, or even giant cell lesion. Although both luminal epithelial and myoepithelial cells may assume spindle shapes, spindle cell lesions of the breast usually refer to conditions that are composed of mesenchymal or mesenchymallike cells that harbour elongated and stretched cytoplasm. Furthermore, biopsies are often small due to the inaccessibility of many head and neck sites. Spindle cell carcinoma is thought of as a malignant epithelial tumor with spindle cell morphology. Spindle cell sarcomatoid carcinomas of the larynx lester dr.
Professor of pathology and translation molecular pathology section chief of breast pathology 23rdannual seminar in pathology outline morphologic features of spindle cells lesions differential diagnosis case presentations. Br premalatha et al clear cell tumors of the head and neck. We report two cases of laryngeal spindle cell tumors. New advances in the molecular classification of pediatric. Most of them arise along the vestibular portion of the eighth cranial nerve acoustic neurinoma. Kaposi sarcoma ks of the head and neck area is uncommon with limited published case series. Melanin in phagocytes and in epithelioidappearing tumor cells with vesicular nuclei. In the oral cavity, the origin of the spindle cell neoplasms may be traced to. In a previous series of laryngeal malignancy, about 1%. Some head and neck squamous cell carcinoma variants can be human papillomavirus hpvrelated and have improved outcomes. Spindle cell lipoma more abundant adipose tissue and mast cells solitary fibrous tumor bland spindle cells admixed wthin, or less frequently, thick collagen hemangiopericytomalike vascular pattern desmin. A taper gradually decreases toward one end of the crosssection or width image. The head and neck is an embryologically and anatomically complex area, with a number of important structures and organs lying in close proximity to one another. Case 5 58 yo female with 3 cm slow growing mass in the right breast over the past 3 years.
Spindle cell lesions of the head and neck region are diverse in nature by means of clinical and biological heterogeneity. Pathology outlines benign stromal spindle cell tumors. However, lawrence and cottell16 had 44 patients with no cases exhibiting the spindle cell variant. Atypical fibroxanthoma arising within erosive pustular. Head and neck kaposi sarcoma lester dr thompson, md. Headneck cytopathology miscellaneous lesions 24th annual seminar in pathology pittsburgh, april 2017 p. They rarely originate from the peripheral facial nerve or other nerves within the parotid gland.
Spindle cell squamous carcinomasarcomatoid carcinoma. Spindle cell carcinoma of head and neck, a subtype of squamous cell carcinoma is a unique and rare neoplasm. Topics nonlymphoid small cell cytoplasmicpoor nonlymphoid large cell cytoplasmicrich cystic spindle cell when it comes to fna. Spindle cell lesions of head and neck include a diverse group of. A comprehensive morphological and immunohistochemical analysis was done. Utility of alk1 protein expression and alk rearrangements in distinguishing inflammatory myofibroblastic tumor from malignant spindle cell lesions of the urinary bladder. It has a more aggressive behavior as compared to classical squomous cell carcinoma warranting surgical interventions with wider surgical margins. The workup of spindle cell lesions of the breast requires the judicious use of immunohistochemical stains to arrive at the correct diagnosis, especially on coreneedle biopsy. Spindle cell lesions of the head and neck are quite diverse with great clinical and biological heterogeneity. Cytomorphologic features that distinguish schwannoma.
Cutaneous spindle cell squamous carcinoma is an uncommon variant of squamous cell carcinoma, in which a keratinocytes infiltrate dermis as single cells with elongated nuclei, not as cohesive nests or islands, and b there are no minimal signs of keratinization of conventional squamous cell carcinoma am j dermatopathol 2008. The histological diagnosis of spindle cell lesions can be challenging in any. In some cases, the dignity is difficult to determine. Two cases of spindle cell carcinoma of the head and neck. The tumor can arise anywhere within the upper aerodigestive tract, with a predilection for the larynx and oral cavity. The lesions may ulcerate and cause scarring of skin the treatment of choice is a surgical excision with clear margins followed by radiation therapy or chemotherapy, as decided by the healthcare provider. We sought to determine if spindle cell carcinomas are. Alternative epithelial markers in sarcomatoid carcinomas.
Some are malignant while many others are benign or simply reactive in nature. Masson trichrome stain helps differentiate myofibroma from. Spindle cells can have pointy ends typical for nerves or rounded ends typical for muscle, i. International journal of health sciences and research. Spindle cell carcinoma represents a rare variant of squamous cell carcinoma, characterized by spindled tumor cells that simulate a sarcoma but are epithelial in nature. In literature the treatment of spindle cell sarcoma follows same footsteps as that of squamouscell carcinoma of similar stage with wide surgical excision being the preferred choice of treatment table 1. Pathology and laboratory medicine mount sinai hospital assistant professor. Patients and methods this prospective study included 72 patients with intraoral lesions. Tumors composed of benign spindle cells, with variable lines of differentiation first described by toker cancer 1981. Spindle cell carcinoma spcc, also known as sarcomatoid carcinoma, is a rare malignancy of the head and neck regions. For the 19 sarcomatoid carcinomas spindle cell carcinomas, all four markers stained the spindle cell component of some of the tumors see table 2. These granulomas occur in the jaws and have giant cells as their characteristic microscopic feature, with a background of ovoid to spindleshaped mesenchymal cells.
Malignant phosphaturic mesenchymal tumor of the larynx. Spindle cell lipomas have a wide variety of appearances. A number of entities arising in the head and neck region can fall into this category, but the most common are spindle cell. Metastatic zosteriform squamous cell carcinoma in an.
Originally presented on february 09, 2015 in park city, utah. Spindle cells definition of spindle cells by medical. Though few lesions are found to be malignant, several others are benign or. This classification was based on the predominance of spindle cells in the histopathology of the lesions of the oral cavity. The spindle cell neoplasms of the oral cavity ncbi. Spindle cell lipoma typically occurs in the posterior neck, shoulder and back, and less commonly in a wide range of other locations. Webpathology is a free educational resource with 10274 high quality pathology images of benign and malignant neoplasms and related entities. Kaposi sarcoma ks of the head and neck area is uncommon with limited published. Sarcomatoid spindle cell carcinomas of the head and neck are unusual variants of squamous carcinoma commonly reported in the larynx but also described in other mucosal sites such as gingiva, tongue, hypopharynx and nasal cavity 1 2345678910111214151617. Clinicopathological analysis of 11 cases kaposi sarcoma ks of the head and neck area is uncommon with limited published case series. Spindle cell carcinoma of the head and neck makes up 3% of all squamous carcinomas in the region and may occur at any site but is most common in the larynx. Twentyfive to 45 percent of all schwannomas occur in the head and neck. These masses typically arise in males aged 4070 years and originate most frequently in the subcutaneous tissue of the upper back, posterior neck, and shoulders.
Spindle cell sarcoma is a type of connective tissue cancer in which the cells are spindleshaped when examined under a microscope. Request pdf spindle cell lesions of the head and neck. Nevertheless, in comparison to squamous cell carcinoma, within the. Spindle cell carcinoma is an uncommon variant of squamous cell carcinoma characterized by spindled or pleomorphic cells which appear to be a true sarcoma but are actually epithelial. Immunohistochemistry along with routine histopathology is essential in establishing the diag. Spindle cell lipomas scl are relatively rare, slow growing, benign lipomatous tumors. We report two cases of spindle cell carcinoma spcc, one of the maxillary sinus and another of the larynx. Spcc is known as a high malignant variant of squamous cell carcinoma, which is composed of conventional squamous cell carcinoma component, either insitu andor invasive and malignant spindle component with sarcomatous appearance. Purpose this study was carried out to assess the diagnostic accuracy of cytology in the oral lesions and to address the cytologic.
Diagnosis of highly vascularized tumors in the head and neck is challenging, especially because of the difficulty in differentiating cellular sfts from other tumors that have prominent vascularization. Diagnostic accuracy and pitfalls of fine needle aspiration. A spindle cell is a fusiform cell that is tapered at both ends. Case 1 is a spindle cell carcinoma spc in a 55 yearold male patient and case 2 an inflammatory myofibroblastic tumor imt in a 34 yearold female patient. Compare with previous photos showing deeply stained pleomorphic nucleoli. As discussed, lesions arising in the head and neck are considered uncommon, and malignant lesions of the head and neck are indeed rare. Ct n 5 and mr n 3 images of seven patients five men and two women. Headneck cytopathology miscellaneous lesions topics. Spindle cell squamous cell carcinoma of skin dovemed. Spindle cell lipoma scl is an uncommon benign lipomatous tumor, most commonly occurring in the posterior neck and shoulder. Differential diagnosis of laryngeal spindle cell carcinoma. Spindle cell squamous cell carcinoma of skin may appear as skin lesions, commonly on sunexposed areas, mostly the head and neck region. Cytological features and differential diagnoses of spindle cell sarcomas. The ohio state university wexner medical center columbus, ohio u.
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