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What Is Spindle Cell Carcinoma

Microscopic Pathology And Immunohistochemistry

Merkel Cell Carcinoma (weird palisading spindle cell morphology!) – Dermpath Dermatology Pathology

The low-grade fibromatosis-like spindle cell carcinoma tumor cells entrap normal breast glandular structures , and are highlighted by cytokeratin 14 , vimentin , and p63 immunohistochemical stains .

The spindle cells in FLSCC are typically negative for smooth muscle myosin heavy chain and epithelial membrane antigen, but epithelial membrane antigen positivity may be seen in the epithelial components. The proliferation indices of FLSCC with Ki-67 are usually less than 5%. Fibromatosis-like spindle cell carcinoma, and the majority of metaplastic carcinomas of the breast for that matter, are classically negative for estrogen receptor, progesterone receptor, and HER2/neu by immunohistochemistry.,

What Are The Possible Complications Of Spindle Cell Carcinoma Of Lung

The complications of Spindle Cell Carcinoma of Lung can include:

  • Dyspnea : If the cancerous tumor expands to block important, large, or small airways of the chest or lung
  • Hemoptysis : Individuals may cough-up blood, due to excessive amounts of blood in the airways
  • Pain: Advanced stages that has metastasized to the pleural cavity , invaded the chest wall, or other areas of the body may cause excessive pain
  • Pleural effusion : Excessive fluid accumulation, resulting from cancerous cells spreading inside the lungs, or outside of the lungs
  • Irreversible lung damage such as due to lung fibrosis
  • Development of pneumothorax
  • Paraneoplastic symptoms can also occur with recurrences – such symptoms may be an indicator of relapse
  • Recurrence following surgical removal of the tumor

Involvement of local and distant organs in lung cancer: It is common with Spindle Cell Carcinoma of Lung.

  • The tumor spreads through the lymphatic or circulatory system: When the spread occurs through lymph, often the mediastinal lymph nodes are affected. When through blood, other regions such as the brain, liver, adrenal glands, and other parts of the lungs are affected
  • Most cases are diagnosed during advanced stages. In general, the retroperitoneum and gastrointestinal tract may be affected causing pain at these locations
  • Loss of function of the organ/area to which cancer has spread due to systemic involvement, which includes frequent sites such as brain, adrenal gland, bone, and liver

Sinonasal Polyp With Stromal Atypia

Sinonasal inflammatory polyps are a common and easily diagnosable part of head and neck pathology. However, rare cases can have stromal cells with marked cytologic atypia and thus mimic true neoplasms such as a neurofibroma or embryonal rhabdomyosarcoma. Other tumors such as SpCC, in theory, can appear similar given the polypoid growth, occasional ulceration, and marked inflammation.

Typical IP are associated with long-standing rhinitis and allergy symptoms. They are non-neoplastic outpouchings of sinonasal mucosa with thickened, hyalinized basement membranes and a loose, edematous stroma with widely scattered fibroblasts and abundant mixed inflammatory cells, particularly eosinophils. Rare cases have marked cytologic atypia in the stromal fibroblasts . These patients have had the typical clinical history of chronic rhinosinusitis and have ranged in age from 4 to 47 years making them essentially no different than for typical IP.

Widely scattered atypical stromal cells in the submucosa of an inflammatory polyp with atypical stromal cells. The stroma in between the stromal cells is loose and edematous with chronic inflammatory cells, and the surface mucosa shows squamous metaplasia

On long-term clinical follow-up, no patient has had clinically malignant disease. Polyps have recurred in a subset, but these are again removed, and the patients are otherwise fine .

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Granulation Tissue Polyps And Contact Ulcers

Inflamed granulation tissue can be clinically and histologically concerning for malignancy. This is particularly true in cancer patients after radiation therapy . The pathologist sees many such biopsies in daily practice. Because of the heterogeneity of the clinical scenarios here, these lesions can be seen anywhere along the UADT. There are also specific clinical lesions, such as the laryngeal contact ulcer or so-called granuloma, that consist of inflamed granulation tissue . These are frequently seen in patients after intubation, with ongoing, severe gastroesophageal reflux disease , or with a history of overuse of their voice . They are almost always on the posterior true cord or vocal process of the arytenoids but rarely can be seen on other parts of the true cord .

Inflamed granulation tissue with an ulcerated surface and stellate, atypical stromal cells with round to oval nuclei, some with prominent nucleoli

Granulation tissue will resolve with the associated lesion over time. Contact ulcers will only resolve once the inciting cause is removed. If GERD is responsible, this must be treated. Surgical pathologists are good at recognizing the lesions as inflamed granulation tissue, but must be aware of contact ulcers as a specific entity to remind the clinician to treat any underlying cause .

How Is Spindle Cell Squamous Cell Carcinoma Of Skin Treated

Spindle Cell Squamous Carcinoma During BRAF Inhibitor ...

Early diagnosis and treatment of Spindle Cell Squamous Cell Carcinoma of Skin is important to avoid complications such as metastasis to other regions. The treatment measures may include:

  • In most cases, a wide surgical excision and removal of the entire tumor is a treatment option. This may be followed by radiation therapy and/or chemotherapy
  • Mohs micrographic surgery is likely the best option for these patients, again with follow-up radiation therapy or chemotherapy
  • If the tumor has metastasized , then a combination of chemotherapy, radiation therapy, and invasive procedures may be used to treat the tumor
  • Targeted therapy medications are generally used for locally-infiltrated or metastatic SCCs. This therapy can help destroy the tumor cells by acting against the proteins that are responsible for tumor growth. Pembrolizumab and cemiplimab may be appropriate
  • Large tumors after complete skin excision may need skin grafting or a flap to close the defect
  • Post-operative care is important until the surgical wound heals

Follow-up care with regular screening and check-ups are important and encouraged.

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What Are The Risk Factors For Spindle Cell Carcinoma Of Lung

The following risk factors may contribute towards Spindle Cell Carcinoma of Lung development:

  • Smoking: Smoking cigarettes, cigars, or pipes, increase the risk due to damaging chemicals being inhaled into the lungs. Prolonged smoking damages the lung, resulting in reduced clearance of the chemical carcinogens that accumulate in the lungs. This can lead to an increased risk of developing lung cancer
  • Exposure to secondhand smoke: Individuals, who do not smoke, but live with smokers, also have an increased risk
  • Air pollution: Exposure to polluted air may increase any individuals risk. This is true, especially in the case of smokers, who are exposed to air pollution, than non-smokers
  • Exposure to asbestos and other harmful chemicals: Prolonged exposure to asbestos and other harmful chemicals including arsenic, chromium, nickel, and tar
  • Individuals who are immunocompromised those with weak immune systems

Although, in general, physicians believe that certain factors may increase an individuals risk for lung cancers and these include:

Note:

  • Pulmonary Spindle Cell Carcinomas are also known to arise in individuals who are non-smokers
  • Preinvasive lesions have not yet been associated with this carcinoma, although carcinoma in situ has been reported

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

Spindle Cell Carcinoma And Carcinosarcoma

Spindle cell carcinoma and carcinosarcoma are rare, high-grade primary thymic epithelial neoplasms characterized by a spindle cell, sarcomatoid appearance. Spindle cell carcinomas are characterized by a proliferation of spindle cells with varying degrees of atypia and mitotic activity, often exhibiting transitions with areas displaying the features of conventional spindle cell thymoma .62 The neoplastic cells in these tumors represent spindled epithelial cells by immunohistochemical markers, unlike thymic carcinosarcoma, in which a combination of true sarcomatous and carcinomatous elements is seen.20,21,65 The diagnosis of carcinosarcoma requires the demonstration of a true sarcomatous component admixed with the malignant epithelial elements. In a few reported cases of carcinosarcoma of the thymus, the spindle cell component has displayed features of rhabdomyoblastic differentiation by immunohistochemistry or electron microscopy.65 The majority of cases, however, are composed of poorly differentiated carcinomatous elements admixed with a poorly differentiated spindle cell sarcomatous component.

Pieter J. Slootweg, Mary Richardson, in, 2009

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What Causes Spindle Cell Melanoma

The exact cause of spindle cell melanoma is unknown. Spindle cell melanoma shares some common mutations with conventional melanoma.

  • Approximately 30% of spindle cell melanomas contain BRAF mutations the V600E substitution mutation is the most common.
  • NRAS and KIT mutations are rarely seen .

An association between spindle cell melanoma and lentigo maligna has been observed in sun-exposed areas .

Symptoms Of Sarcoma In Dogs

Sarcomatoid SCC (Spindle Cell Squamous Cell Carcinoma): 5-Minute Pathology Pearls

The spindle cell sarcomas may be felt as lumps under the dogs skin. The sarcomas may be smaller or larger, mostly solid, but there are a fewtumors that may be filled with fluid.

The spindle cell sarcomas may not grow for extended periods of time, but this doesnt mean the tumor is not cancerous.

In addition to the lumps that you may feel, you may observe your pet lack energy and is also depressed.

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Differential Diagnosis Of Mucosal Spindle Cell Lesions

The majority of spindle cell lesions presenting at UADT mucosal sites are straightforward to diagnose. However, there are some lesions that are quite difficult to classify. With a keen eye to the H& E morphology, attention to the clinical scenario, and judicious use of immunostains , one can work through these difficult cases.

Most Common Symptoms Of Spindle Cell Sarcoma

Spindle cell sarcoma is an uncommon cancerous lesion or tumor that forms in an individual’s soft tissues or bone. The most prominent locations for spindle cell sarcoma to develop are in the limbs, but it can form in any part of the body. 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. The only known cause of spindle cell sarcoma is previous therapy or treatment with the use of radiation. MRI scans, x-rays, PET CT scans, CT scans, and tissue biopsies are utilized in the diagnosis of spindle cell sarcoma. Treatment for spindle cell sarcoma heavily relies on surgical excision of the tumor, but chemotherapy may also be used in some cases.

While symptoms vary according to the location of the tumor, there are several general signs of spindle cell sarcoma.

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How Bad Is Spindle Cell Sarcoma

The American Cancer Society reports that about 13,000 new cases of soft-tissue sarcoma will be diagnosed in 2018. The Cunningham family, son Tristin, Sherie, JC and daughter Dara. Sarcomas can be quite serious. They can cause loss of a leg or arm, and have about a 30 percent mortality rate in advanced stages.

Additional And Relevant Useful Information For Spindle Cell Carcinoma Of Lung:

Spindle cell carcinoma of the breast looks alot like Lyme ...
  • Lung cancer incidence is around 35 cases per 100,000 populations: The incidence of lung cancer in non-smokers is 1-2 cases per 20,000 populations per year its incidence in smokers is 20-30 times higher than that of non-smokers
  • Smoking is highly-associated with squamous cell carcinomas and small cell carcinomas nevertheless, for all lung cancer forms, smoking is the single most important risk factor
  • Studies under WHO indicate that the number of Adenocarcinoma of Lung cases is increasing due to design changes to cigarettes, composition of certain contents, and even better filtration of smoke through the cigarette. This is researched to be due to increased nitrosamines being inhaled through tobacco smoke

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Spindle Cell Sarcoma Symptoms

The type and severity of symptoms of spindle cell sarcoma depends on the size, location, and stage of malignancy. Some patients have ulcerated mass on the exposed areas of the skin. The patient feels exhausted and tired.

The patient also has fever and unexplained weight loss. Other clinical manifestations include swelling and tenderness in the affected area, reduced mobility on the affected area, and bone pain.

Treatment For Spindle Cell Breast Cancer

First of all, diagnosis of spindle cell breast carcinoma usually requires a wide excisional biopsy because fine needle aspiration biopsies are unreliable. This is normal considering the mixed-element presentation of spindle cell breast tumors. It would be very easy to miss one of the elements and come up with a wrong diagnosis.

The treatment for most spindle cell breast carcinomas is either by surgical excision or mastectomy. Axillary node dissection is usually necessary for evaluative purposes.

Medics will utilize chemotherapy in most treatments of spindle cell breast cancer. In addition, adjuvant endocrine therapy with Taximofen is also useful. Post operative radiation therapy is used in most cases in the hopes of preventing local recurrence or metastasis.

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Signs And Symptoms Of Late Effects

You can talk to your doctor or CNS about the late effects of your particular treatment or surgery. They should be able to advise you on which late effects you are at risk from. However, the late effects of many cancer treatments still often go undiagnosed.

At your follow-up appointments you will be screened for late effects of your cancer treatment and surgery. It is also an opportunity to talk to your doctor about any signs or symptoms you may be suffering from and to discuss whether these are late effects.

If you were treated for cancer many years ago or are no longer having follow-up appointments, you should talk to your GP about late effects or contact a Late Effect Clinic.

Treatment Options For Spindle Cell Sarcoma

Atypical fibroxanthoma (AFX) vs mimics (spindle cell melanoma, squamous cell carcinoma, etc)

Due to the fact that the spindle cell sarcomas dont grow at a speedyrate, surgery is often the course of treatment chosen. Surgery can be advised if the spindle cell sarcoma is located in a single area and doesnt seem to affect neighboring organs. The vet will perform a few x-rays and ultrasounds to make sure the neighboring organs are not affected by the cancerous cells.

The surgery will involve general anesthesia and should be performed as soon as possible, to prevent the development of the tumor.

After the surgery, the vet will recommend a chemotherapy, which will put an end to the growing of cancerous cells. The dog should be checked periodically, as after the surgery the spindle cell sarcoma may grow back.

If the tumor is metastasized, surgery cannot be performed and the prognosis is poor.

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Cell Necrosis Is Commonly Seen

The spindle cells may appear benign, low-grade or they may have a high-grade sarcoma-like appearance.

Malignant spindle cells will likely show atypical nuclei and evidence of high mitotic activity. Evidence of necrosis is evident in almost all spindle cell breast carcinoma tumors . Furthermore, there may be cysts that frequently contain elements of hemorrhage , necrosis and exudates. Cysts within spindle cell breast carcinoma tumors are often partially surrounded by tumor cells and granulation tissues.

Sinonasal Spindle Cell Carcinoma Presenting With Bilateral Visual Loss: A Case Report And Review Of The Literature

  • Affiliations: Department of Otolaryngology Head and Neck Surgery, Shuang Ho Hospital, Taipei Medical University, Taipei 110, Taiwan, R.O.C., Department of Otolaryngology, Taipei Medical University Hospital, Taipei 110, Taiwan, R.O.C.
  • Pages: 401-404
  • Copyright: ¬©Liuet al. This is an open access article distributed under theterms of CreativeCommons Attribution License.

  • This article is mentioned in:

    Abstract

    Introduction

    Spindle cell carcinoma , also known assarcomatoid carcinoma, pseudosarcoma and carcinosarcoma, is a rarevariant of squamous cell carcinoma , accounting for ~3% of allhead and neck SCCs . It is knownto be a biphasic tumor, with the epithelial component composed ofpoorly differentiated SCC and the mesenchymal component composed ofspindle cells . In the head andneck region, it commonly involves the larynx, while sinonasalinvolvement is more rare . Theclinical presentations of sinonasal SpCC resemble those ofrhinosinusitis and there is currently no treatment protocol forsinonasal SpCC . The present study reports a case ofsynchronous inverted papilloma of the sphenoid sinus and SpCCpresenting with bilateral visual loss.

    Case report

    Discussion

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    What Are The Risk Factors For Spindle Cell Squamous Cell Carcinoma Of Skin

    The risk factors for Spindle Cell Squamous Cell Carcinoma of Skin may include:

    • Individuals with weak immune system, which could be due to cancer treatment, AIDS, or those on immunosuppressant drugs after receiving an organ transplant
    • Exposure to intense sun for long periods during the course of work or due to regular participation in outdoor sports activities
    • Frequent use of tanning beds and tanning parlors
    • People living in geographical regions where hot-dry, desert-like climatic conditions prevail
    • Radiation therapy
    • Those with sensitive skin – individuals who get easily sunburned
    • Caucasians are more vulnerable to the malignancy when compared to other darker-toned individuals

    It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

    Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

    If Metastasis Occurs Survival Rates Are Less Positive

    Cureus

    A comparison of various case studies suggests that the mortality rate for spindle cell breast carcinoma ranges between 40% and 50%. The average survival time after diagnosis is between 11 and 18 months.

    Higher tumor grade tends to correlate with poorer survival for spindle cell carcinoma of the breast with an absence of complete microscopic circumscription and the size of tumors which eventually recur, as significant negative prognostic indicators.

    Some women even with grade tumors succumb to spindle cell breast carcinoma. However, studies also show that as many as 33% of women with spindle cell breast cancer may survive completely free of metastatic or recurrent disease.

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