Spindle Cell Carcinomas of the Upper Aerodigestive Tract

Abstract

A 65-year-old male with a two-month history of cough and hoarseness underwent direct laryngoscopy which showed a 1.5 cm diameter polypoid glottic mass. A polypectomy was performed revealing spindle cell carcinoma.

The World Health Organization (2005) defines a spindle cell carcinoma as “a biphasic tumor composed of a squamous cell carcinoma, either in-situ and/or invasive, and a malignant spindle cell component with a mesenchymal appearance, but of epithelial origin.”¹ Spindle cell carcinomas go by a variety of synonyms such as sarcomatoid carcinoma, spindle cell squamous carcinoma and carcinosarcoma.

The larynx is a preferred site of involvement where they often present as polypoid masses.^1,3 Microscopic examination often shows predominance of the sarcomatoid, spindle-cell component, which can range from fairly bland, reactive-looking fibroblastic-proliferation-like processes, to cytologically malignant and mitotically active proliferations that mimic other spindle-cell sarcomas such as leiomyosarcoma, fibrosarcoma or malignant fibrous histiocytoma.^1,2,3 (Figure 1, double arrows)  The squamous cell carcinoma component may be in the form of an overlying carcinoma-in-situ, or of a focal keratinizing invasive squamous cell carcinoma that requires multiple sections to disclose.^1,2  (Figure 1, single arrow) Cytokeratin-reactivity in the spindle cells, which may be quite focal as in this case, points to their epithelial derivation.^1,2,4 (Figure 2)

Favorable prognostic findings include polypoid morphology and, like conventional laryngeal squamous cell carcinomas, a low-stage and a glottic site of origin. Reported 5-year survival rates range from 65 – 95%.¹