Abstract
Upper aerodigestive tract (UADT) spindle cell squamous carcinoma (SCSC), also known as sarcomatoid carcinoma, is a high-grade subtype of conventional squamous cell carcinoma (SCC) that is histologically characterized by a combination of differentiated SCC in the form of intraepithelial dysplasia and/or invasive differentiated SCC, and the presence of an invasive (submucosal) undifferentiated malignant spindle-shaped and pleomorphic (epithelioid) cell component. Typically, SCSC presents as a superficial polypoid mass not infrequently with surface ulceration precluding identification of an intraepithelial dysplasia. Further, in many cases an invasive differentiated SCC is not identified. Adding to the complexity in such cases, is that immunohistochemical staining in a significant minority of cases is negative for epithelial-related markers but often the cells express mesenchymal-related markers. In such cases, differentiating SCSC from a reactive (benign) spindle cell proliferation or a mucosal-based sarcoma can be problematic, with treatment implications. Herein, we detail the clinical and pathologic features of laryngeal SCSC and discuss the rationale for diagnosing a carcinoma and avoiding a diagnosis of sarcoma. In our experience, such cases represent one of the more common mistakes made in laryngeal pathology. Yet, virtually all such lesions are SCSCs. The treatment and prognosis relies on the accuracy of this distinction.
Highlights
Squamous cell carcinoma (SCC) is the most common malignancy in head and neck pathology [1]
spindle cell squamous carcinoma (SCSC) occurs throughout the upper aerodigestive tract mucosa (UADT) but is most common in the larynx
Classic histologic features are those of a biphasic malignant neoplasm to include differentiated SCC in the form of intraepithelial dysplasia and/or invasive differentiated SCC, and the presence of a malignant spindle-shaped and
Summary
Squamous cell carcinoma (SCC) is the most common malignancy in head and neck pathology [1]. While conventional SCC accounts for the majority of cases, subtypes of SCC are seen in 10–15% of cases [2] These subtypes include verrucous carcinoma, papillary SCC, spindle cell squamous carcinoma (SCSC), basaloid SCC, and adenosquamous carcinoma [1]. While most of the immediately overlying surface was ulcerated, residual surface squamous and ciliated respiratory epithelium showed no evidence of intraepithelial high-grade dysplasia and there was no identifiable invasive conventional SCC component. In some areas, the malignant spindle-shaped cells were in direct contact with intact surface glottis squamous epithelium (Fig. 1c). Areas showing abrupt transition from intact benign ciliated respiratory epithelium to the malignant spindle-shaped cells were identified (Fig. 1d). Immunohistochemical staining showed the neoplastic cells to be positive for desmin, muscle specific actin and smooth muscle actin (Fig. 1e, f) but negative for cytokeratins
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