Abstract
ABSTRACTSpindle cell squamous cell carcinoma of the tongue is a rare variant of squamous cell carcinoma. This paper reports the case of a spindle cell squamous cell carcinoma of the tongue, in a 64-year-old male patient, and presents a review of the etiopathogenesis, clinicopathological and immunohistochemical features and treatment of the malignancy. The patient presented for evaluation of a painful swelling on his tongue. Extraoral examination revealed palpable submandibular and superior cervical lymph nodes. Based on the presumptive diagnoses of squamous cell carcinoma or malignant salivary gland neoplasm, an incisional biopsy was performed. Histopathological analysis showed a proliferation of atypical spindle cells, exhibiting extensive pleomorphism. Tumor cells were positive for vimentin, P53 and alpha-smooth muscle actin, focally positive for epithelial membrane antigen and P63, and negative for pan-cytokeratin (AE1/AE3), CK7, CD138, CD34, CD56, and S-100. The positivity index for Ki-67 was approximately 40%. The diagnosis of spindle cell squamous cell carcinoma was established and the patient was referred to a head and neck surgery service. In the oral cavity, spindle cell squamous cell carcinoma of the tongue is an aggressive variant of squamous cell carcinoma, which usually presents as an exophytic mass located on the tongue of elderly males. Due to its distinct histopathological characteristics, immunohistochemistry is a valuable and helpful tool to establish the diagnosis of spindle cell squamous cell carcinoma of the tongue.
Highlights
Spindle cell squamous cell carcinoma (SpCSCC) is a rare and aggressive variant of squamous cell carcinoma (SCC).(1,2) The lesion reveals a biphasic aspect, characterized by proliferation of spindle cells with sarcomatous appearance associated with conventional SCC.(1,2)Due to its heterogeneous nature, SpCSCC may be a real diagnostic challenge, even when representative samples are obtained from incisional biopsies
The present study reported a case of oral SpCSCC and discussed aspects related to etiopathogenesis, clinicopathological and immunohistochemical features, differential diagnosis and treatment of the malignancy
Spindle cell squamous cell carcinoma is a rare malignancy, representing approximately 0.7% to 1.4% of oral SCC.(2) This neoplasm is recognized as an example of a true epithelial-mesenchymal transition in human cancers.(4) In the process of transformation of squamous cells into spindle cells, all criteria for epithelial-mesenchymal transition are fulfilled in SpCSCC. (1,4)
Summary
Análise clinicopatológica e imuno-histoquímica do carcinoma de células escamosas de células fusiformes da língua: um caso raro. Clinicopathological and immunohistochemical analysis of spindle cell squamous cell carcinoma of the tongue: a rare case. Foi realizada biópsia incisional com base nas hipóteses diagnósticas de carcinoma de células escamosas ou neoplasia maligna de glândula einstein (São Paulo). Devido às suas distintas características histopatológicas, a imuno-histoquímica é uma ferramenta valiosa e útil para estabelecer o diagnóstico de carcinoma de células escamosas de células fusiformes da língua. Descritores: Carcinoma de células escamosas; Boca/patologia; Neoplasias da língua/diagnóstico; Imuno-histoquímica with extensive discontinuous areas, varying degrees of dysplasia and foci of carcinoma in situ, but with no evident transition to the spindle-cell component (Figure 2)
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