When exhaustive keratin staining was combined with EMA staining on laryngeal SpCC, Thompson etal. Osteoclast-like giant cells can be present, resulting in histologic features resembling those seen in giant cell tumor of bone.

The distinction lies squarely on histology, macroscopy, and clinical features. A clinicopathologic and immunohistochemical study of 84 cases. Batsakis JG. Tumors of the oral cavity and oropharynx typically present with just the complaint of a mass or with swelling, pain, a non-healing ulcer, dysphagia, or bleeding [2]. The sarcoma-like component may be nondescript, or resemble chondrosarcoma, osteosarcoma, rhabdomyosarcoma, or angiosarcoma. In this circumstance, knowledge of the radiological distribution of disease is helpful given that sarcomatoid carcinomas often present as large, bulky solitary lung masses with or without intrathoracic adenopathy. Based on the available findings, we can establish a link, not only between spindle cell neoplasms with or without morphologic differentiation toward adenocarcinoma or squamous cell carcinoma, but in addition, we can also properly categorize the giant cell component of these tumors (seeFig. Most of these tumors are associated with exposure to tobacco and alcohol, and as many as 1520% are thought to be secondary to radiation exposure for some other cancers. The pleomorphic spindle cells usually form the bulk of the lesion; they are arranged in fascicles or whorls. insertion velamentous cord types marginal eccentric ultrasound central radiology notes causes risks Once the spindle cell component of these tumors is identified, then the other component of giant cells also needs to be properly identified. official website and that any information you provide is encrypted In addition, although SpCC can have an associated chronic inflammatory infiltrate, it is rarely rich in plasma cells while this is a characteristic feature of IMT. Other studies have ranged from 60% to 90% [1, 3, 5, 7, 8]. 10.117). Nodular fasciitis may exhibit mitotic figures, but they are not atypical; moreover, no cellular pleomorphism is present. Sarcomatoid carcinomas develop mostly in men, at a mean age of 65 years at diagnosis.1114 Tobacco smoking is described in more than 80% of cases. There is often a mixture of different patterns [18]. The cellularity is moderately high, but overall loosely organized (Fig. Keeping this in mind, this review will cover SpCC of the UADT, drawing particularly from five main clinicopathologic studies encompassing 326 cases [15], review several selected non-neoplastic and benign/low grade lesions that can mimic it, and finally discuss how to differentiate SpCC from them. This review will focus on the clinical and diagnostic features of SpCC and the select non-neoplastic or benign lesions which are occasionally hard to distinguish from it. Sarcomatoid carcinoma of the head and neck: molecular evidence for evolution and progression from conventional squamous cell carcinomas. Because of the heterogeneity of the clinical scenarios here, these lesions can be seen anywhere along the UADT. Median overall survival ranges from 6 to 20 months in surgical series.1117 The main prognostic factor is staging.18, Metastatic sarcomatoid carcinomas are often treated as other NSCLC, with platinum-based chemotherapy considered standard as first-line treatment. Spindle cells always express vimentin and often other mesenchymal filaments, such as myogenic markers (smooth muscle actin, muscle specific actin, desmin). 2.29).567 The exophytic SpSCC of the larynx often presents at a low T stage providing a better prognosis then conventional SCC, when matched stage for stage.575,576, J.S. PMC legacy view The average size of laryngeal tumors is approximately 2cm, but lesions as small as 2mm have been reported [1, 5]. Similar to conventional SCC, there is a strong association with a history of cigarette smoking. Obtaining deeper levels on small biopsies may be helpful to identify this. Of note, none of the cases of SpCC arose less than 1year after radiation. We use cookies to help provide and enhance our service and tailor content and ads. They are non-neoplastic outpouchings of sinonasal mucosa with thickened, hyalinized basement membranes and a loose, edematous stroma with widely scattered fibroblasts and abundant mixed inflammatory cells, particularly eosinophils. Other tumors such as SpCC, in theory, can appear similar given the polypoid growth, occasional ulceration, and marked inflammation. These numbers are not significantly different for cases with a clearly-identifiable mixed component of squamous neoplasia and for those without. The term sarcomatoid carcinoma historically has been used to refer to spindle cell carcinomasthat is, carcinomas that have a sarcoma-like spindle cell morphology. However, this has never been demonstrated in head and neck cases. The site is secure. The atypical cells (inset) have large nuclei with vesicular chromatin and prominent nucleoli (200; inset 400). Sometimes SpCC exhibits acantholysis; in this way, spaces lined by pleomorphic cells are formed that may mimic angiosarcoma (Fig. Also, importantly, there is no subepithelial condensation that might mimic a cambium layer like that seen in a botyroid rhabdomyosarcoma [21, 22]. Immunostains for smooth muscle actin and muscle specific actin are typically strongly and diffusely positive in IMT. Batsakis and colleagues370 concluded that SpCCs manifest a biologic behavior that is more aggressive than most conventional SCCs. Pathologic quiz case 2: vocal nodule with atypical stromal cells. However, these cells are dispersed among a non-neoplastic background and not densely packed in whorls of fascicles as in SpCC, which identifies them as part of a stromal reaction. There may be a wide variety of architectural patterns including fascicular, storeiform, lace-like, or myxoid and on occasion, truly definable sarcomatous differentiation, such as osteosarcomatous, chrondrosarcomatous, or rhabdomyosarcomatous, may be seen [1, 2, 46, 8]. An additional epithelial marker, p63, was positive in 63% of 19 cases of SpCC [5] (Fig. 8). It is typically exophytic or nodular with smooth masses projecting into the lumen. 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 to malignant and very aggressive. Chernock, in Pathobiology of Human Disease, 2014. [12] where they describe ulcerated, tumefactive lesions of the postcricoid hypopharynx and right maxillary sinus. However, it may be ulcerated or show squamous metaplasia. Spindle cell carcinoma (SpCC), also referred to as sarcomatoid carcinoma, is a biphasic tumor composed of conventional SCC and malignant spindle cells. Spindle cell carcinoma generally exhibits a worse prognosis than conventional squamous cell carcinoma. There is abundant associated inflammation, consisting predominantly of plasma cells but also with lymphocytes and eosinophils [23]. Immunohistochemistry has been extensively analyzed in SpCC (Table2). Spindle cell carcinoma of the larynx: review of 26 cases including DNA content and immunohistochemistry. More recently, we have evaluated the IHC profile of 86 cases that had been diagnosed either as spindle cell carcinomas, sarcomatoid carcinoma, or pleomorphic carcinoma with the concept of identifying specific differentiation within the spindle cell component.85 The study included a wide panel of antibodies, including keratin CAM5.2, keratin 7, TTF-1, napsin A, keratin 5/6, p40, desmocollin 3, Sox2, calretinin, and D2-40. Weidner N, Askin FB, Berthrong M, Hopkins MB, Kute TE, McGuirt FW. Fechner RE. Sinonasal inflammatory polyps (IP) are a common and easily diagnosable part of head and neck pathology. Oral spindle cell carcinomas usually are treated by surgical resection, alone or combined with radiotherapy. Copyright 2022 Elsevier B.V. or its licensors or contributors. Nakayama M, Wenig BM, Heffner DK. All of the fibroblasts and endothelial cells are negative by immunohistochemistry for cytokeratins [7, 12] and p63 [7]. Greater than 90% of laryngeal and pharyngeal tumors present as polypoid and exophytic masses projecting into the lumen [1, 3, 5]. 2-34). With attention to the clinical scenario, careful evaluation the H&E morphologic features, and judicious use of immunostains, one can work through these difficult cases to arrive at the correct diagnosis.

Fig. 10.118).425 Microscopically, the identifiable epithelial elements, when present, may show squamous differentiation, glandular differentiation, or be undifferentiated, thus resembling large cell carcinoma (Fig. On long-term clinical follow-up, no patient has had clinically malignant disease. Most SpCC will have some foci of clear squamous differentiation.

There is an extensively ulcerated surface covered by fibrinopurulent material (Fig. These SpCC can closely mimick exuberant granulation tissue (a major pitfall for the surgical pathologist), particularly on frozen section. 1a). Myogenic differentiation in spindle cell (sarcomatoid) carcinomas of the upper aerodigestive tract. Sarcomatoid carcinomas were historically defined in the 1999 World Health Organization classification. This leaves a significant minority of cases where there is no definitive light or immunohistochemical evidence of epithelial differentiation. and transmitted securely. SpCC also shows features of epithelial-mesenchymal transition, e.g., up-regulation of transcription repressors (Snail, Slug, SIP and Twist etc.) Most IMT pursue a benign clinical course. However, by current standards, adequate IHC analysis was not performed. These data strongly argue that transcriptionally active HPV is rare in these tumors and, thus, not a significant contributor to their development or outcomes. Spindle cell carcinoma is an unusual variant of SCC where part, or all, of the tumor resembles a sarcoma (Figure 28). There are numerous atypical spindle cell lesions which can present along the UADT mucosa. In the larynx, true sarcomas (with the exception of chondrosarcoma) and benign mesenchymal tumors are very rare. FOIA The patient may complain of swelling, pain, paresthesia, persistent ulceration, or bleeding. The .gov means its official. The 31 cases of spindle cell carcinoma were tested for p16 immunohistochemistry and either RNA in situ hybridization or RT-PCR for high-risk HPV. 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. Typically, the spindle cell component is more haphazard than most true sarcomas, with any fascicle formation limited and irregular. The pathologic and clinical features can resolve this differential diagnosis. However, sarcomas in the head and neck area located at mucosal surfaces are extremely rare, and, when they do occur, an intervening fibrous layer usually separates the lesion from the overlying epithelium. However, if SpCC occurs intraosseously,366 its distinction from sarcomas with a spindle cell appearance may be extremely difficult or even impossible if immunohistochemistry or electron microscopy fail to reveal epithelial characteristics (Fig. enneking dunham resection pelvic