Abstract
Spindle cell carcinoma of head and neck, a subtype of squamous cell carcinoma is a unique and rare neoplasm. It has a more aggressive behavior as compared to classical squomous cell carcinoma warranting surgical interventions with wider surgical margins. Immunohistochemistry along with routine histopathology is essential in establishing the diagnosis of spindle cell carcinoma. We at Dr. B. Borooah Cancer Institute, Guwahati, a regional institute for treatment and research, hereby report 40 cases of such lesion with clinicopathological and immunohistochemical study. Out of total 40 cases included in the study group most of the cases were in the age group of 40 to 60 years. Commonest site of presentation was nasopharynx and buccal mucosa. 14 cases of the oral cavity (buccal mucosa, alveolus, oral tongue and hard palate) were treated with surgery. All the cases with disease of the larynx and hypopharynx were treated with radiotherapy and cases involving the nasopharynx received radiotherapy and chemotherapy. In the surgery group recurrence rate was found to be 71.4% and metastasis rate was 21.4%. Biopsy specimens were subjected to histopathological examination followed by immunohistochemistry. Immunohistochemical analysis show concurrent presence of malignant epithelial and sarcomatoid spindle cell components by co-expression of cytokeratin (CK) and vimentin to various degrees.
Highlights
Spindle cell carcinoma (SpCC) designates a rare variant growth pattern of squamous cell carcinoma (SCC) in which the spindle epithelial cell resembles a sarcoma on histological examination
It is known as pseudosarcoma, carcinosarcoma, sarcomatoid squamous cell carcinoma or polypoid squamous cell carcinoma
The predisposing factors are the same as SCC, including tobacco use, alcohol abuse, poor oral hygiene and previous irradiation to the site in which the tumor arise. It poses a diagnostic dilemma when confronted with malignant tumor with spindle cell morphology in the head and neck region, keeping in mind that it could be a variant of conventional SCC for therapeutic consideration
Summary
Spindle cell carcinoma (SpCC) designates a rare variant growth pattern of squamous cell carcinoma (SCC) in which the spindle epithelial cell resembles a sarcoma on histological examination. It is known as pseudosarcoma, carcinosarcoma, sarcomatoid squamous cell carcinoma or polypoid squamous cell carcinoma. The predisposing factors are the same as SCC, including tobacco use, alcohol abuse, poor oral hygiene and previous irradiation to the site in which the tumor arise It poses a diagnostic dilemma when confronted with malignant tumor with spindle cell morphology in the head and neck region, keeping in mind that it could be a variant of conventional SCC for therapeutic consideration
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