Spindle cell hemangioma is an uncommon benign vascular tumor of the oral cavity. Approximately 1520% of sarcomas occur within the head and neck. The majority of ovarian spindle cell lesions fall into the broad category of fibromatous neoplasms whereas others in the sex cordstromal group may also be composed of spindle cells, including thecomas, granulosa, and sertolileydig cell tumors and rarer neoplasms, such as sclerosing stromal tumor and signetring stromal tumor. Since there is a lower incidence of this neoplasm, histopathological diagnosis can be challenging, especially in the oral region 8. Spindle cell carcinoma is an unusual variant of squamous cell carcinoma. Some are malignant while many others are benign or simply reactive in nature. The region commonly referred to as the head and neck includes the upper aerodigestive tract oral cavity, paranasal sinuses, pharynx, larynx, cervical esophagus, thyroid, associated lymph nodes, soft tissues, and bone.
Head and neck histopathology reporting guide if a neck dissection is submitted. Spindle cell sarcoma is a type of connective tissue cancer in which the cells are spindleshaped when examined under a microscope. Examples include dermatofibrosarcoma protuberans, desmoplastic melanoma, malignant fibrous histiocytoma, leiomyosarcoma, malignant peripheral nerve sheath tumor, and spindle cell squamous cell. The most common site of origin in head and neck region is larynx particularly vocal. The mass developed 5 years earlier and enlarged after repeated ethanol injections. The tumors generally begin in layers of connective tissue such as that under the skin, between muscles, and surrounding organs, and will generally start as a small lump with inflammation that grows. Clinicopathological and immunohistochemical analysis of spindle. Atypical spindle cell lesions of the skin libre pathology. It was excised endoscopically, and the patient was free of disease after. Spindle cell definition of spindle cell by medical. Spindle cell melanoma refers to invasive melanomas in which the tumor is.
The lesions may ulcerate and cause scarring of skin the treatment of choice is a surgical excision with clear margins followed by radiation therapy or chemotherapy, as decided by the healthcare provider. Histologically, the tumor is a nonencapsulated, wellcircumscribed dermal tumor consisting of spindle cells in fascicles or in a storiform arrangement. Spindle cell carcinoma spcc of the head and neck is a biphasic neoplasm described by virchow in 1865 1. Sarcomatoid spindle cell carcinomas of the head and neck are unusual variants of squamous carcinoma commonly reported in the larynx but also described in other mucosal sites such as gingiva, tongue, hypopharynx and nasal cavity 1 2345678910111214151617. A spindleshaped cell characteristic of certain tumors. Of two specimens with positive margins, one was in the patient who had received palliative surgical therapy. Spindle cell squamous cell carcinoma of skin dovemed. They range from lesions which are mainly adipose tissue with scant spindle cell areas to those with very little fat and predominantly spindled cells fat free variant. There are various causes of cystic lesions in the head and neck, including congenital lesions, infectiousinflammatory conditions, lymphatic malformations, trauma, lymphadenopathy, and neoplasm 16. Spindle cell carcinoma of the head and neck makes up 3% of all squamous carcinomas in the region and may occur at any site but is most common in the larynx. Mixed epithelioid and spindle cell melanoma epithelioid cell melanoma spindle cell melanoma amelanotic melanoma. The purpose of this study was to investigate the ct and mr imaging features of scl in the head and neck. Spindle cell lesions of head and neck include a diverse group of.
Spindle cell lipomas are composed of two cell types. The cells are spindled, simulate a sarcoma but stain for cytokeratin, and usually are more aggressive than nonspindle cell carcinomas. Epidermal growth factor receptor expression in spindle. Unlike the development of squamous cell carcinoma, the development of sarcomas is unrelated to smoking and alcohol use. Spindle cell lesions of head and neck include a diverse group of clinically and biologically. Spindle cell squamous cell carcinoma of skin may appear as skin lesions, commonly on sunexposed areas, mostly the head and neck region. The diagnosis of lesions with spindle cell morphology is often difficult. For biopsies from the head and neck assessment is further complicated by the range of tissues present at this site, and. Immunohistochemistry along with routine histopathology is essential in establishing the diagnosis of spindle cell carcinoma.
These masses typically arise in males aged 4070 years and originate most frequently in the subcutaneous tissue of the upper back, posterior neck, and shoulders. Contents introduction causes for development of spindle cell tumors various classifications proposed for spindle cell lesions clinical and histological features of individual tumor approach for diagnosis of spindle cell tumors 4. For biopsies from the head and neck assessment is further complicated by the range of tissues present at this site, and the limited amount of material which may be available for study. It has a more aggressive behavior as compared to classical squomous cell carcinoma warranting surgical interventions with wider surgical margins. Second primary spindle cell carcinoma of oral cavity and.
Immunohistochemistry along with routine histopathology is essential in establishing the diag. Lineage mesenchymal, epithelial, lymphoproliferative. Clinical, pathologic, and biologic implications of these lesions when they arise in the mucosae of the upper aerodigestive tracts of the head and neck are presented. Learn distinctive features of select spindle cell tumors for accurate identification. Cases of cutaneous sft that have been reported to date show benign behaviors. The histological diagnosis of spindle cell lesions can be challenging in any. Spindle cell hemangioma in the mucosa of the upper lip. Sarcomatoid carcinoma carries a poorer prognosis despite aggressive surgical intervention and concurrent adjuvant therapies. Spindle cell lipomas scl are relatively rare, slow growing, benign lipomatous tumors. Request pdf spindle cell lesions of the head and neck.
Specimen margins were free of tumors in 11 patients. In the oral cavity some of the pigmented lesions are physiologic, but most are considered pathologic. We present a case of sch in the upper lip of a 41yearold woman. Spindle cell lesions of the head and neck are quite diverse with great.
Spindle cell melanoma frequently presents as a nonspecific amelanotic nonpigmented nodule on the patients trunk, head, or neck 1,3. Spindle cell lipoma scl is an uncommon benign lipomatous tumor, most commonly occurring in the posterior neck and shoulder. Spindle cell carcinoma of the larynx and hypopharynx. Spindle cell neoplasms are defined as neoplasms that consist of spindleshaped cells in the histopathology. The intriguing array of spindle cell lesions occurring, especially in the head and neck region, poses a critical diagnostic challenge not only to the histopathologist but also ultimately to the clinicians for planning an appropriate treatment protocol. A striking feature of this set of acral spindle cell lesions is that the dermal spindle cells stain strongly for cd34 in all cases studied so far. The diverse tissues in this anatomic region give rise to a broad spectrum of tumors and tumorlike conditions.
Spindle cell carcinoma of head and neck, a subtype of squamous cell carcinoma is a unique and rare neoplasm. Spindle cell lesions of the head and neck are quite diverse with great clinical and biological heterogeneity. The head and neck is an embryologically and anatomically complex area, with a number of important structures and organs lying in close proximity to one another. Spindle cell hemangioma sch is a unique benign vascular lesion. Ct n 5 and mr n 3 images of seven patients five men and two women. This is one of the few series devoted to head and neck ks showing high prevalence of hivpositivity, but also unusual presentations in hivnegative patients with primary origin in the skin of the ear and the auditory canal. Spindle cell carcinoma spcc is an uncommon head and neck squamous cell carcinoma scc variant consisting of spindled andor pleomorphic cells with epithelial differentiation. Sarcomatoid carcinomas are biphasic tumors proven to be monoclonal dedifferentiated forms of conventional squamous carcinomas. Pigmented lesions of the head and neck t here is a wide spectrum of pigmented lesions which present an oral mucosa or skin in the head and neck area.
Usually there is a relatively even mixture of these components, but there is considerable variation in individual tumors. Our patient was free of lymph node metastasis but mandibular bone was invaded. The overwhelming majority of cystic neck lesions in. Atypical spindle cell lesions of the skin are uncommon but seen with enough frequency that one ought to be familiar with them spindle cell lesions of the skin directs here. Spindle cell squamous cell carcinoma spcc is a poorly. Original article spindle cell carcinoma of head and neck. Clear cells, clear cell tumors, mechanism of clearing, physiological clear cells. Sarcomatoid carcinoma is a different entity from the conventional scc of the head and neck. Cutaneous and superficial soft tissue spindle cell proliferations with cd34 expression represent a unique heterogeneous group of lesions. It usually presents as a polypoid mass and often at an early stage due to local obstruc tive symptoms. What are the clinical features of spindle cell melanoma. Spindle cell carcinoma is a rare biphasic tumor consisting of epithelial and.
Some tumors have almost no mature fat, and these relatively fat free tumors can cause diagnostic difficulty. The mass was elastic firm, mobile, bluish in color, and well demarcated in magnetic. Benign and lowgrade spindle cell tumors basicmedical key. This study evaluates their clinicopathologic characteristics in head and neck mucosal sites and the problems in distinguishing them from other spindle cell tumors. Spindle cell rhabdomyosarcoma of the anterior mandible. Pdf spindle cell carcinoma of head and neck, a subtype of squamous cell carcinoma is a unique and rare neoplasm. A diagnostically challenging spindle cell carcinoma of the. An association between spindle cell melanoma including desmoplastic melanoma and lentigo maligna has been observed in sunexposed areas 5.
Spindle cell lipoma an overview sciencedirect topics. Spindle cell carcinoma of the head and neck region. Spindle cell carcinoma spcc is a rare and unusual biphasic. Cutaneous and superficial soft tissue spindle cell proliferation is a commonly encountered diagnostic problem in the daily practice of pathologists and dermatopathologists. It usually presents as a polypoid mass and often at an early stage due to local obstructive symptoms. This classification was based on the predominance of spindle cells in the histopathology of the lesions of the oral cavity. Fibrosarcomas represent the other end of the spindle cell lesion spectrum in that they are soft tissue malignancies of fibroblastic origin. Microscopically the tumor shows spindle cells and poorly defined vascular slits with scattered hemosiderin and extravasation of red blood cells. The histological diagnosis of spindle cell lesions can be challenging in any site, but in this region is particularly so, due to the variety of structures from which they can arise. Spindle cell carcinoma of the head and neck is a rare entity and the evidence of optimal management is lacking.
The objective of our study was to report the treatment and outcomes of 15 patients treated in a single institution over a seven year period. Ks should be included in the differential diagnosis of difficulttoclassify spindle cell lesions at this uncommon location. It remains a great challenge for clinical oncologists. The head and neck region is the most common site of cutaneous sft, although it can involve any area of the body. 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. Br premalatha et al clear cell tumors of the head and neck. Cutaneous spindle cell carcinoma describes a heterogenous group of tumors that share an atypical spindle cell morphology and infiltrative growth pattern. The most common spindle cell lesion presenting along the uadt mucosa is spindle cell carcinoma spcc, which has many unique and challenging clinical and pathologic features.
The head and neck region is the most common site of. The classic spindle cell lipoma is composed of bland spindled cells intermixed with mature adipose tissue figure 1. Spindle cell squamous carcinomasarcomatoid carcinoma. Spindle cell lesions sarcomatoid carcinomas, nodular fasciitis, and fibrosarcoma of the aerodigestive tract, part 14 head neck 1982. Spindle cell lesions in the head and neck region have higher site predilection to skin, scalp soft tissue, orbit, neck and the upper aerodigestive tract 8. Epidermal growth factor receptor egfr is expressed by 90 % of conventional scc, and high level expression is associated with a poorer prognosis. The histogenesis of these tumors is controversial, as is the prognosis for patients with spindle cell carcinoma of the head and neck when compared with all squamous cell carcinomas of these sites. For biopsies from the head and neck assessment is further complicated by the range of tissues present at this site, and the limited amount of. Spindle cell lipomas have a wide variety of appearances.
357 430 1074 293 508 1449 1067 594 46 692 959 1517 838 1135 1582 511 869 1104 1288 1445 1397 1226 1567 904 540 1131 1196 221 134 121 945 1387 533 730