The epithelial origin of the spindle cells has been recently confirmed by both immunohistochemical and electron micrographic studies.1, 20 The mesenchymal component may show liposarcoma, rhabdomyosarcoma, leiomyosarcoma, or even chondro- or osteosarcoma differentiation. Oral spindle cell carcinomas usually are treated by surgical resection, alone or combined with radiotherapy. Some tumours are made up almost entirely of spindle cells. In some studies, 50% to 60% of affected patients are alive after 5 years.1, Adrián Mariño-Enríquez MD, PhD, Jason L. Hornick MD, PhD, in Practical Soft Tissue Pathology: a Diagnostic Approach (Second Edition), 2019. Mitotic figures are usually limited. Most cancers made up of spindle cells are called sarcomas. It can arise in any part of the body but is most common in the limbs (arms and legs). Thompson, in Head and Neck Pathology (Second Edition), 2013. (a) Polypoid and ulcerated tumor consisting of sheets of malignant spindle cells with moderate amounts of eosinophilic cytoplasm. It is more common in areas that have been exposed to the sun, although this is not always the case. Prognosis of the laryngeal SpCC is controversial, but it seems to be favorable for patients with no history of radiation, glottic location and polypoid appearance of the tumor. Oscar Lopez‐Nunez, Lea F. Surrey, Rita Alaggio, Karen J. Fritchie, Ivy John, Novel PPP1CB‐ALK fusion in spindle cell tumor defined by S100 and CD34 coexpression and distinctive stromal and perivascular hyalinization, Genes, Chromosomes and Cancer, 10.1002/gcc.22844, 59, 8, (495-499), (2020). Sclerotic fibrosis abruptly separates the spindle cell component into a lobular pattern. Tumors purely composed of pleomorphic spindle cells without any expression of keratin have been observed to recur as conventional SCC and serve to illustrate the profound divergence in differentiation morphologically as well as immunohistochemically shown by SCC cells.357. The dual-positive case was from the larynx, and the other HPV RNA-positive case was from the oral cavity. In a clinicopathologic review of 78 cases of pleomorphic carcinoma of the lung, 18% of patients had incidental findings on chest X-ray and spindle cell carcinoma was most frequently associated with giant cell carcinoma [1] . Spindle cell carcinoma and carcinosarcoma are rare, high-grade primary thymic epithelial neoplasms characterized by a spindle cell, sarcomatoid appearance. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. URL: https://www.sciencedirect.com/science/article/pii/B9780128012383650924, URL: https://www.sciencedirect.com/science/article/pii/B9780323552257000105, URL: https://www.sciencedirect.com/science/article/pii/B9780123864567040016, URL: https://www.sciencedirect.com/science/article/pii/B9781416039662000175, URL: https://www.sciencedirect.com/science/article/pii/B9781416025894000024, URL: https://www.sciencedirect.com/science/article/pii/B9781416040590500199, URL: https://www.sciencedirect.com/science/article/pii/B978032349714500003X, URL: https://www.sciencedirect.com/science/article/pii/B9780323547239000099, URL: https://www.sciencedirect.com/science/article/pii/B9781437726077000336, Modern Surgical Pathology (Second Edition), 2009, Brad W. Neville DDS, ... Angela C. Chi DMD, in, Color Atlas of Oral and Maxillofacial Diseases, Human Papillomavirus and Epstein–Barr Virus in Head and Neck Lesions, Modern Surgical Pathology (Second Edition), Squamous Cell Carcinoma of the Upper Aerodigestive System, Diagnostic Surgical Pathology of the Head and Neck (Second Edition), Surgical Pathology of the GI Tract, Liver, Biliary Tract, and Pancreas (Second Edition), Adrián Mariño-Enríquez MD, PhD, Jason L. Hornick MD, PhD, in, Practical Soft Tissue Pathology: a Diagnostic Approach (Second Edition), Endoscopic Ultrasonography in the Evaluation of Posterior Mediastinal Lesions. and down-regulation of microRNAs implicated in the induction of epithelial-mesenchymal transition. Spindle cell carcinoma exhibits a predilection for older adult males, with a peak in the fifth and sixth decades. Microscopic examination exhibits a proliferation of invasive spindle cells, typically accompanied by a squamous epithelial component (consisting of dysplastic surface epithelium, carcinoma in situ, or conventional invasive squamous cell carcinoma). Spindle cell carcinoma is an unusual variant of SCC where part, or all, of the tumor resembles a sarcoma (Figure 28). The other category of cell type is spindle cells tumors. Pulmonary Spindle Cell Carcinoma is classified as a sarcomatoid carcinoma of lung, which are aggressive tumors, along-with pleomorphic carcinoma, giant cell carcinoma, carcinosarcoma, and pulmonary blastoma; Spindle Cell Carcinoma of Lung is a type of sarcomatoid carcinoma that can develop anywhere in the lung. Spindle cell carcinoma. The cells are arranged in short, reticulated, intersecting and streaming fascicles or bundles. The former component may be very scant or limited to noninvasive areas of epithelial dysplasia or carcinoma in situ located at the surface of the tumor, and its identification may require extensive sampling for histologic examination. J.S. However, spindle cell tumors can appear on the skin of a dog or cat as well, and be rather frustrating. Within the oral cavity, frequently involved sites include the tongue, gingiva/alveolar mucosa, buccal mucosa, floor of the mouth, and lip. CASTLE: Similar to thymic carcinoma, the tumor is arranged in solid nests or lobules with an expansive or infiltrative growth of epithelioid cells into the surrounding thyroid parenchyma (Figure 24-88) or adjacent soft tissue and organs (larynx, trachea). Spindle cell sarcoma is a type of cancer which occurs on the connective tissues of the body. LewisJr., R.D. 2-35). These pale staining cells are cuboidal to columnar. The shape of the cancer cells is spindle and so it is named spindle cell sarcoma. It is important to discover spindle call sarcoma in the first stage as it can easily be treated … Combined chemoradiation therapy frequently shows similar findings but with a greater degree of mucosal and submucosal glandular atypia and distortion. Spindle cell sarcoma occurs more often in men than it does in women, and it is known to most commonly affect individuals past their fourth decade of life. But it may become impossible when the tumor is too close to vital organ, such as the lungs or the heart. These tumors can have a CT and endoscopic appearance that more closely resembles that of a posterior mediastinal mass than an esophageal wall mass.85–87 Esophageal spindle cell neoplasms are usually c-kit–negative leiomyomas, although occasionally they can be c-kit–positive gastrointestinal stromal tumors (GISTs).85,86 These tumors have an EUS appearance of a hypoechoic mass with some internal signal and occasional acoustic enhancement, which sometimes makes them difficult to distinguish from cysts.86 Because GISTs are highly metabolically active, they can often be diagnosed and followed with PET scans.88 Although leiomyomas generally are PET-negative tumors, there have been reports of PET-positive esophageal or posterior mediastinal leiomyomas.87 EUS FNA can be used to diagnose both posterior mediastinal leiomyomas and GISTs and can be considered when the distinction between a cyst and a GIST is uncertain. These demographics do not suggest a relationship with HPV, but do not exclude it. Spindle cells are often pleomorphic, with large hyperchromatic nuclei, prominent nucleoli, and numerous mitoses. In a cancer stem cell population, planar spindle orientation with symmetric cell division could increase the number of cancer stem cells by producing identical daughter cells with cancer stem cell phenotypes. This lesion shares a lot of overlapping features with SpCC, such as clinical presentation as a polypoid or pedunculated mass and histologic features such as spindle cells displaying mitotic figures lying in a myxoid or fibrous stroma; its differentiation from SpCC may prove to be extremely difficult. Those which are situated right next to an important artery or organ system may be inoperable. 2-34). They are found both in normal, healthy tissue and in tumors. Several other terminologies have also been used including polypoid squamous cell carcinoma, … Only after several recurrences, the lesion may reveal the more characteristic appearance of an SpCC (Fig. Cytokeratin expression can be demonstrated in spindle cells in 40%–85% of cases. McDowell's Herbal Spindle Cell Cancer Support Mix can be used in conjunction with other alternative medicines or with orthodox medical treatments such as surgery, radiation and chemotherapy. Therefore, in these cases, a diagnosis of SpCC does not apply. Although reported survival rates vary, one recent study based on epidemiologic data from the United States reported 5-year disease-specific survival of 39% for spindle cell carcinoma of the oral cavity. This discussion on SpCC and its differential diagnosis is finalized by remarking that SpCC sometimes may assume the appearance of an innocuous granulation tissue polyp. Figure 28. Spindle cell sarcoma is a rare malignant (cancerous) tumour which can develop in the bone or soft tissue. The elderly are more at risk for developing this illness than those under the age of 40, but it is known to strike younger patients as well. From: Modern Surgical Pathology (Second Edition), 2009, Nina Zidar, Nina Gale, in Encyclopedia of Cancer (Third Edition), 2019. Chernock, in Pathobiology of Human Disease, 2014. Once the cancer spreads into surrounding organs or tissue, it is often much harder to treat. Spindle cell carcinomas, although fundamentally differentiating into epithelial cells, lose much of these features and gain some features of mesenchymal cells. 9.9). Infiltrative borders, tumor necrosis, atypical or hyperchromatic nuclei, and mitotic activity may or may not be indicative of malignancy, and they should be interpreted according to the line of differentiation and other features of the lesion. Spindle Cell Squamous Cell Carcinoma (SCC) of Skin is a malignant tumor of skin that is typically seen with a higher frequency in immunosuppressed individuals. These tumours can be either benign (non-cancerous) or malignant (cancerous). Most of these tumors are associated with exposure to tobacco and alcohol, and as many as 15–20% are thought to be secondary to radiation exposure for some other cancers. Spindle Cell Carcinoma Spindle cell carcinoma (SpCC), also referred to as sarcomatoid carcinoma, is a biphasic tumor composed of conventional SCC and malignant spindle cells. Wikibuy Review: A Free Tool That Saves You Time and Money, 15 Creative Ways to Save Money That Actually Work. Squamous differentiation may be present including keratinization and intercellular bridges. The characteristic spindle cell phenotype of the neoplastic cells in SpCC is the result of epithelial-mesenchymal transition. Spindle cell carcinoma generally exhibits a worse prognosis than conventional squamous cell carcinoma. Whether or not the entire mass can be removed will depend on where the tumor is located. There is a component of SCC in situ at the base of the polypoid mass (arrow) confirming this to be a carcinoma and not a true sarcoma (2 ×). 16-4).21 In addition, most cases show squamous dysplasia in the overlying, or adjacent, mucosa, but this finding can be focal, and, thus, difficult to detect if only a limited number of tissue sections have been obtained. (A) Small islands and cords of squamous cell carcinoma and dense proliferation of neoplastic spindle cells. Recently, p63 has been reported as a useful marker for SpCC.364, As SpCCs may, in their spindle cell component, exhibit not only vimentin expression but also other mesenchymal filaments, especially myogenic markers, positivity for this marker does not rule out a diagnosis of SpCC.359 Even the absence of keratin positivity cannot be considered evidence against a diagnosis of SpCC, as this may be due to loss of reactivity for antikeratin antibodies due to fixation or embedding procedures or to a phenotypic change of the tumor cells. Nodular fasciitis may exhibit mitotic figures, but they are not atypical; moreover, no cellular pleomorphism is present. For a more extensive discussion of the histologic features of nodular fasciitis, inflammatory myofibroblastic tumor of the larynx, melanoma, and spindle cell sarcoma that may be helpful in the differential diagnosis, the reader is referred to their descriptions elsewhere in this book. Wilson T. Kwong, Thomas J. Savides, in Endosonography (Fourth Edition), 2019. Any sores that do not heal with proper treatment within three to four weeks should be examined by a doctor. Currently, there is ample evidence that SCC cells can exhibit differentiation toward cells with a mesenchymal phenotype. Very rare RMS with epithelioid and spindle cell morphology, female predominance, marked osseous predilection, ALK expression, EWSR1/FUS-TFCP2 gene fusions, and highly aggressive clinical behavior have recently been recognized with only 23 cases reported in the English language literature. Some of the most common varieties occur in the skin on areas which have been overexposed to the sun. Typically, spindle cell carcinoma can occur in any connective tissue in the body, although it is more common in some areas than others. In spindle cell tumors the important morphologic features to evaluate on hematoxylin and eosin–stained sections are similar to those for other mesenchymal neoplasms, including the following: Architectural arrangement of the tumor cells (growth pattern): long or short fascicles, whorls, sheets, or haphazard architecture, Interface between tumor and adjacent tissues: pushing/expansile or infiltrative borders, Amount and type of extracellular matrix: prominent, scant, or inconspicuous; collagenous, hyalinized, or myxoid, Intratumoral vascularity: well-developed or inconspicuous; muscular thick-walled or thin-walled vessels, hyalinized vessel walls, branching (hemangiopericytoma [HPC]-like) vessels, Cytomorphology: long or short spindle cells, uniformity or pleomorphism, amount and quality of the cytoplasm, nuclear features, degree of atypia. Wikibuy Review: a Free Tool that Saves you time and Money, 15 Creative Ways Save... 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