Rath Rachna, Das Bijay K, Das Sn, Baisakh Manas
Department of Oral and Maxillofacial Pathology, SCB Dental College and Hospital, Cuttack, India.
Consultant Oncopathologist, Apollo Hospitals, Bhubaneshwar, Odisha, India.
J Oral Maxillofac Pathol. 2014 May;18(2):256-61. doi: 10.4103/0973-029X.140772.
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. Overlapping spectrum of clinico-radiographic and microscopic features further compounds this problem. In such situations, the aid of ancillary techniques like immunohistochemistry (IHC) is sought to clinch the diagnosis. But is the diagnosis based on IHC most decisive? Probably the answer lies in the Pandora's Box. This paper analyzed the potential doubts, apprehensions and the reliability that is singularly based on the morphological spindle appearance of an abnormal cell that has deviated from the usual clinical and microscopic presentation and thus posed a diagnostic dilemma warranting more questions than the answers. We review the etiopathogenesis of this entity and its differential diagnosis from few other spindle cell lesions of head and neck with special reference to use of immunohistochemical markers, with a case study.
尤其是在头颈部出现的一系列令人着迷的梭形细胞病变，不仅给组织病理学家带来了严峻的诊断挑战，最终也给临床医生制定合适的治疗方案带来了挑战。临床影像学和微观特征的重叠范围进一步加剧了这个问题。在这种情况下，人们寻求免疫组织化学（IHC）等辅助技术来确诊。但基于免疫组织化学的诊断是最具决定性的吗？答案可能藏在潘多拉魔盒里。本文分析了基于偏离正常临床和微观表现的异常细胞形态梭形外观所产生的潜在疑问、担忧及可靠性，这构成了一个诊断困境，引发的问题比答案更多。我们结合一个病例研究，回顾该实体的病因发病机制及其与头颈部其他一些梭形细胞病变的鉴别诊断，并特别提及免疫组化标志物的应用。
