Case Of Spindle Cell Carcinoma Research Articles

Transcription factors Snail, Slug, Twist, and SIP1 in spindle cell carcinoma of the head and neck

Spindle cell carcinoma (SpCC) is a biphasic tumor composed of squamous cell carcinoma (SCC) and malignant spindle cells. There is mounting evidence that epithelial-mesenchymal transition (EMT) plays an important role in the pathogenesis of SpCC. Transcription repression has recently emerged as a fundamental mechanism triggering EMT in experimental models. Our aim is to analyze the expression of transcription repressors Snail, Slug, Twist, and SIP1 in SpCC of the head and neck in comparison to SCC, matched for location and stage. Thirty cases of SpCC and 30 cases of SCC of the head and neck were included. Snail, Slug, Twist, and SIP1 expression was analyzed on mRNA and protein levels, using real-time reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry. By RT-PCR, we found upregulation of mRNA for transcription factors Snail, Slug, Twist, and SIP1 in SpCC when compared to SCC. This upregulation was statistically significant for Slug, Twist, and SIP1 but nonsignificant for Snail. Immunohistochemistry was performed for Snail, Slug, and SIP1 and demonstrated a positive reaction for Slug and SIP1 in all cases and for Snail in two thirds of SpCC cases. Our finding of upregulation of all four tested transcription factors supports the hypothesis that EMT plays an important role in the pathogenesis of SpCC of the head and neck.

TEMPORAL CHANGES OF INTERMEDIATE FILAMENT PROTEINS IN OBSTRUCTION-INDUCED DETRUSOR REMODELING

Because frequency, immunohistochemical, and clinical features of lung spindle cell carcinoma (SpCC) are unknown, the author retrospectively surveyed and re-examined the 718 lung malignancy samples in our hospital. As the results, three cases of SpCC were found; thus the incidence of SpCC was 0.4% of all lung malignancies. Clinically, the age of the patients was 53, 70 and 75 years. Two patients were smokers and another ex-smoker. The SpCC was initially detected by routine chest X-ray examination in all cases. All cases were peripheral tumors, and the size was 4 cm, 5 cm, and 5 cm in diameter. All cases were treated by chemotherapy, and operations were not performed for various reasons. The survival period was 8, 16 and 25 months. Histologically, all the three SpCC consisted of only malignant spindle cells with hyperchromatic nuclei and mitotic figures. Immunohistochemical results were as follows: pancytokeratin (3/3), high molecular weight cytokeratin (0/3), CK5/6 (0/3), CK7 (2/3), CK14 (1/3), CK18 (3/3), CK19 (1/3), CK20 (0/3), epithelial membrane antigen (0/3), vimentin (3/3), thyroid transcriptional factor-1 (0/3), p63 (1/3), CEA (0/3), surfactant apoprotein A (0/3), desmin (0/3), S100 protein (0/3), α-smooth muscle actin (0/3), CD34 (0/3), p53 protein (3/3), chromogranin (0/3), synaptophysin (0/3), neuron-specific enolase (0/3), CD56 (0/3), CD56 (0/3), KIT (0/3) and platelet-derived growth factor-α (0/3). These results suggest that SpCC of the lung shows no differentiation. One case of the three SpCC was positive for p63, suggesting that it may be derived from spindle cell differentiation of poorly differentiated squamous cell carcinoma. In summary, the present study showed the frequency (0.4%) of SpCC of the lung of all lung malignancies. Clinical features of the three SpCC were described. Further, the three cases of SpCC were immunohistochemically investigated.

A spindle cell carcinoma presenting with osseous metaplasia in the gingiva: a case report with immunohistochemical analysis

BackgroundSpindle cell carcinoma (SpCC) is a rare, high malignant variant of squamous cell carcinoma (SCC), which shows biphasic proliferation of conventional SCC component and malignant spindle shape cells with sarcomatous appearance.MethodsA case of Spindle cell carcinoma with bone-like calcified materials, occurring at the mandibular molar region of 71-years-old Japanese male patient was presented with gross finding, histological findings and MRI image. To identify the characteristics of the bone-like materials, immunohistochemistry were performed.ResultsHistologically, the cancer cells were composed of spindle cells and epithelial cells which form nests with prominent keratinization. Histological findings showed typical histology of the SpCC, however, as an uncommon finding, spatters of calcified, bone-like materials were observed in between the cancer cells. Immunohistochemistry revealed that cancer cells were positive for cytokeratins and vimentin to a varying degree and negative for Desmin, S-100, Osteopontin, BMP-2 or BMP-4. These findings implied that the calcified materials were formed by metaplasia of the stromal cells.DiscussionBone-like materials formation by osseous and/or cartilaginous metaplasia of the stroma in the carcinoma has been reported. However, the detailed mechanism of these metaplasia and affection on the clinical feature, prognosis and therapies are not well established. In summary, we presented an unique case of SpCC, which has not been described in the literature.

Cadherin–catenin complex and transcription factor Snail-1 in spindle cell carcinoma of the head and neck

Spindle cell carcinoma (SpCC) is a biphasic tumor composed of squamous cell carcinoma (SCC) and a malignant spindle cell component. There is mounting evidence that SpCC is a monoclonal neoplasm originating from a stem cell giving rise to both components. We tested the hypothesis that spindle cell phenotype might be related to the cadherin-catenin complex, which forms adherens junctions between cells. We analyzed the immunohistochemical expression of E- and N-cadherin, alpha-, beta- and gamma-catenin, and Snail-1, a transcription repressor of E-cadherin, in 30 cases of SpCC, and 30 cases of SCC of the head and neck. In SpCC, cadherin and catenin expression was similar in the SCC component, whereas in the spindle cell component, loss of E-cadherin and neo-expression of N-cadherin was found in 19 cases, loss of cadherins in seven, and their co-expression in four cases. Catenin expression were altered in 18 SpCCs. Snail-1 was found in 19 SpCC cases. In SCC, E-cadherin and catenins were expressed in all cases, and N-cadherin focally in five cases. Snail-1 was observed in the stroma. To summarize, in SpCC, there is an altered expression of the cadherin-catenin complex, associated with morphological transition from epithelial to spindle cell phenotype. These features are reminiscent of epithelial-mesenchymal transition (EMT). Our study thus indicates that EMT might play an important role in the pathogenesis of SpCC. This conclusion is further supported by our finding of Snail-1 expression, a potent inducer of EMT, in more than half SpCC cases.

A Case of Spindle Cell Carcinoma Originating from the Maxillary Sinus

Spindle cell (sarcomatoid) carcinoma of the upper respiratory tract is a rare malignancy, and its diagnosis, treatment, and prognosis still remain controversial. Histopathologic examination of this uncommon tumor shows surface epithelialcarcinoma and an underlying spindle-shaped proliferation. In the head and neck region, it is found predominantly in the larynx and oral cavity. To our knowledge, spindle cell carcinoma of the paranasal sinus has been rarely reported. We report a 57-year-old woman with a spindle cell carcinoma originating from the maxillary sinus. She was treated with surgery and post operative radiotherapy. After 8 months of close follow-up, she shows no sign of recurrence or distant metastasis. We offer this case and a review of the related literature in an effort to increase awareness of this rare malignancy. (Korean J Otorhinolaryngol-Head Neck Surg 2008;51:747-50)

Spindle cell carcinoma of the larynx with a verrucous carcinoma component: Combined carcinoma of larynx

Squamous cell carcinoma (SCC) is the most common neoplasm of the larynx. There are three variants of SCC. Each variant presents distinctive biologic behaviors and clinical courses. Therefore reaching the exact diagnosis and distinguishing the variants is fateful. We describe a case of spindle cell carcinoma of the larynx with a verrucous carcinoma component. To our knowledge, this entity has never been documented before.

A Case of Spindle Cell Carcinoma of the Oral Cavity: With Special Reference to Cytopathological Features and Review of Literature

A Case of Spindle Cell Carcinoma of the Oral Cavity: With Special Reference to Cytopathological Features and Review of Literature

A 15-year-old girl with a spindle cell carcinoma of the parotid gland. A diagnostic challenge solved by immunohistochemistry and cytogenetic analysis

Spindle cell carcinoma is a rare neoplasm of the upper respiratory tract which occurs in adults, most commonly in the larynx. In the literature only one case of spindle cell carcinoma, located in the maxilla, has been reported in a child. We report the first presentation of a spindle cell carcinoma in a child, which was located in the parotid gland, together with the clinical course. The diagnostic challenge associated with this unusual disorder is elucidated, as well as the role of immunohistochemical and cytogenetic examination to define the nature of these lesions.

Breast spindle cell tumours: about eight cases

BackgroundBreast spindle cell tumours (BSCTs), although rare, represent a heterogeneous group with different treatment modalities. This work was undertaken to evaluate the utility of fine needle aspiration cytology (FNAC), histopathology and immunohistochemistry (IHC) in differentiating BSCTs.MethodsFNAC of eight breast masses diagnosed cytologically as BSCTs was followed by wide excision biopsy. IHC using a panel of antibodies against vimentin, pan-cytokeratin, s100, desmin, smooth muscle actin, CD34, and CD10 was evaluated to define their nature.ResultsFNAC defined the tumors as benign (n = 4), suspicious (n = 2) and malignant (n = 3), based on the cytopathological criteria of malignancy. Following wide excision biopsy, the tumors were reclassified into benign (n = 5) and malignant (n = 3). In the benign group, the diagnosis was raised histologically and confirmed by IHC for 3 cases (one spindle cell lipoma, one myofibroblastoma and one leiomyoma). For the remaining two cases, the diagnosis was set up after IHC (one fibromatosis and one spindle cell variant of adenomyoepithelioma). In the malignant group, a leiomyosarcoma was diagnosed histologically, while IHC was crucial to set up the diagnosis of one case of spindle cell carcinoma and one malignant myoepithelioma.ConclusionFNAC in BSCTs is an insufficient tool and should be followed by wide excision biopsy. The latter technique differentiate benign from malignant BSCTs and is able in 50% of the cases to set up the definite diagnosis. IHC is of value to define the nature of different benign lesions and is mandatory in the malignant ones for optimal treatment. Awareness of the different types of BSCTs prevents unnecessary extensive therapeutic regimes.

乳腺紡錘細胞癌の1例

乳腺紡錘細胞癌の1例

Spindle cell carcinoma of the larynx

Four rare cases of spindle cell carcinoma of the larynx are reported and the histo-pathological and immuno-histochemical findings are described. The spindle cell carcinoma involved the right vocal cord of an 88-year-old and an 86-year-old male patients and the anterior commissure of a 76-year-old and a 68-year-old male patients. Two patients underwent total laryngectomy, one patient extirpation under laryngomicrosurgery and one radiation therapy. All were well controlled thereafter and there was no recurrence. Surgery seemed to be the most satisfactory therapeutic approach and radiation therapy was effective in a patient with relatively small tumor. The histo-pathological and immuno-histochemical analysis in one patient revealed a sarcoma-like component of the carcinoma and the findings suggested that this was the result of a metaplastic change in the mesenchyme without inflammatory changes.

舌に発生した紡錘細胞癌の１例

Spindle cell carcinoma (SpCC) is a biphasic tumor consisting of a squamous cell carcinoma component and a sarcomatoid component of spindle cells. Without immunohistochemical or ultrastructural study, it is difficult to differentiate the sarcomatoid component of SpCC from sarcoma.We describe a case of spindle cell carcinoma arising as a polypoid mass in the tongue of a 74-year-old woman. The mass was successfully differentially diagnosed on immunohistochemical analysis. Pathological analysis of the tumor revealed three components of squamous cells, histiocyte-like cells, and spindle cells. Immunohistochemical characterization of tumor cells was done with antibodies to keratin, vimentin, smooth muscle actin, desmin, and 5-100 protein to differentiate SpCC from melanoma and leiomyosarcoma. The histiocyte-like cells and spindle cells were positive for keratin and vimentin, and negative for smooth muscle actin, desmin, and 5-100 protein. Given these findings, we diagnosed SpCC. In the 7 months following surgery, there has been no local recurrence or metastasis.

上顎歯肉に生じた紡錘細胞癌の１例

A case of spindle cell carcinoma in the maxilla is reported. The patient was an 88-year-old woman. She was referred to our department because of swelling of the maxillary gingiva. A soft mass (35×30mm) with a rough surface was present in the left upper molar region. Since the tumor was diagnosed as a spindle cell carcinoma on histological examination of biopsy specimens, surgical excision was performed with the patient under general anesthesia. Histologically, the tumor contained squamous cell carcinoma and sarcomatoid regions with spindle-shaped tumor cells. The sarcomatoid regions were closely associated with those of squamous cell carcinoma. Immunohistochemical techniques were used to distinguish between epithelial and mesenchymal properties, and keratin was found in the sarcomatoid regions.Although no cancer was evident at the surgical margins, bilateral metastases were present in the cervical lymph nodes 2 weeks after operation. Neck dissection was performed. Soon after the operation, however recurrence and metastasis developed at the surgical margin of the initial operation and the left parotid area and disease progressed rapidly. General condition deteriorated and cachexy worsened. She died 8 weeks after the second operation.

乳腺紡錘細胞癌の1例

乳腺紡錘細胞癌の1例

A CASE OF SPINDLE CELL CARCINOMA OF THE BREAST

We experienced a rare case of spindle cell carcinoma of the breast. A 46-year-old woman was admitted to the department because of a left breast lump. She underwent a modified radical mastectomy with a preoperative diagnosis of normal type breast carcinoma. The tumor was pathologically diagnosed as spindle cell carcinoma. The spindle cell component was immunoreactive for vimentin and EMA (epithelium membrane antigen). No metastases were found in the axillary lymph nodes. The pathological stage was t2n0m0. The patient has been free from recurrence, as of 14 months after the operation. Spindle cell carcinoma of the breast is an uncommon tumor. Histologically, its dominent component consists of sheets of spindle-shaped cells and includes contiguous carcinoma components. Despite its sarcomatous features apparently, spindle cells are derived from epithelial cells of the mammary glands. A total of 62 cases collected from the Japanese literature including this case were reviewed clinicopathologically. Spindle cell carcinomas were thought to be bigger in size than normal type breast carcinomas. Otherwise, lymphogenous metastases occurred infrequently. Many cases have cystic lesions. Therapy and prognosis of the disease are still controversial, but many patients experienced hematogenous metastases in their early stages. Strict observation and careful treatment would be mandatory for the disease.

舌へん平上皮癌治療後，反対側口底部に生じた紡錘細胞癌の１例

舌へん平上皮癌治療後，反対側口底部に生じた紡錘細胞癌の１例

上顎洞に生じた紡錘細胞癌の１例

Spindle cell carcinoma is considered a subtype of squamous cell carcinoma that has a sarcomatoid appearance. In the head and neck region, cases of spindle cell carcinoma of the larynx have occasionally been reported. However, spindle cell cacrcinoma of the maxillary sinus is extremely rare. We describe a case of spindle cell carcinoma of the maxillary sinus in a 53-year-old woman. Surgical treatment was performed under the clinical diagnosis of a maxillary neoplasm. During the operation, a biopsy specimen was taken, and the histopathological diagnosis was a spindle cell carcinoma. The lesion was removed under general anesthesia. Radiotherapy and chemotherapy were additionally given to prevent recurrence and metastasis of the tumor.There has been no evidence of recurrence as of 5 years 6 months after surgrey.

Spindle Cell Carcinoma of the Tongue: Case report and immunohistochemical study.

Spindle cell carcinoma is a rare malignant tumor which is generally considered to be a variant of squamous cell carcinoma. A case of spindle cell carcinoma of the tongue occurring in a 50-year-old Chinese male is reported. Immunohistochemical technique was used as an adjunct to the diagnosis of this unusual type of carcinoma. The immunohistochemical expression of keratin was recognized in the spindle cells, as well as in the carcinomatous cells. Moreover, the spindle cell component expressed vimentin. These findings suggest an epithelial origin with squamous differentiation and mesenchymal participation in the genesis of spindle cell carcinoma. Additionally, the differential expression of low and high molecular weight keratin was demonstrated. The possible causes of coexpression of keratin and vimentin are also briefly reviewed, which may be because some epithelial tumor cells were transformed into mesenchymal (vimentin-positive) spindle cells; or due to dedifferentiation, with regression to vimentin, an embryonal type of intermediate filament; or attributed to the cellular adaptation to environmental influences; or be related to reduced cell-to-cell contact.

P53 and K-ras mutational genotyping in pulmonary carcinosarcoma, spindle cell carcinoma, and pulmonary blastoma: implications for histogenesis.

In an attempt to understand the molecular pathogenesis of biphasic pulmonary neoplasms, the authors studied 25 cases of carcinosarcoma, spindle cell carcinoma, and pulmonary blastoma using a combined immunohistochemical and topographic genotyping approach for the presence of p53 abnormalities within the different epithelial and mesenchymal components of these tumors. Genotyping involved a search for point mutational damage in p53 exons 5-8, which was correlated with p53 immunoreactivity. This analytical approach demonstrated p53 missense point mutations in four of nine cases of spindle cell carcinoma with a 100% concordance rate between p53 immunopositivity and the presence of DNA mutational damage. One of six carcinosarcomas, heterologous in type, exhibited a p53 mutation. The concordance rate among carcinosarcomas was also 100%. However, the concordance rate among classic biphasic pulmonary blastomas was only 43%, with one of seven cases demonstrating a p53 mutation by DNA genotyping. The lack of concordance in pulmonary blastomas was possibly due to the existence of genotypically distinct subsets of tumor cells likely bearing mutations among largely nonmutated cells. In a similar fashion, among three well-differentiated fetal type adenocarcinomas, no p53 mutations were detected despite the presence of focal p53 immunopositivity in one of the cases. No K-ras mutations were detected in any of the 25 tumors examined. Monoclonal histogenesis from a single totipotential cell in a subset of these neoplasms (six of 22 cases) was supported by the finding of p53 overexpression and identical p53 mutational genotype in both the epithelial and spindle elements of the tumors. Furthermore, the finding of a small percentage of p53-positive tumor cells within one or both components suggests late acquisition of p53 mutational change in a subset of pulmonary blastomas.

SPINDLE CELL CARCINOMA OF THE BREAST WITH LOCAL RECURRENCE AND LUNG AND ILEAL METASTASIS-A CASE REPORT-

We experienced a rare case of spindle cell carcinoma of the breast. A 45-year-old woman complaining of a left breast tumor with pain was admitted to our hospitaI. Radical mastectomy was performed with a preoperative diagnosis of sarcoma. However, local recurrence, as well as bilateral lung and ileal metastasis, subsequently occurred. Each was resected at the time it was found, but the patient died approximately two years and two months after the first operation. We had difficulty in making the diagnosis, because metastasis to the ileum of spindle cell carcinoma had not been reported previously. According to the Japanese literature on cases dying of this disease, distant metastasis is more frequent than local recurrence. Further-more, with recurrence, the prognosis is worse than with common breast carcinomas. Spindle cell carcinoma presents many problems regarding therapy and prognosis. Further accumulation and analysis of cases is thus necessary.