Department of Pathology, Moffitt Cancer Center, Tampa, FL, 33612, USA.
Head Neck Pathol. 2021 Mar;15(1):130-137. doi: 10.1007/s12105-020-01273-6. Epub 2021 Mar 15.
Upper aerodigestive tract (UADT) spindle cell squamous carcinoma (SCSC), also known as sarcomatoid carcinoma, is a high-grade subtype of conventional squamous cell carcinoma (SCC) that is histologically characterized by a combination of differentiated SCC in the form of intraepithelial dysplasia and/or invasive differentiated SCC, and the presence of an invasive (submucosal) undifferentiated malignant spindle-shaped and pleomorphic (epithelioid) cell component. Typically, SCSC presents as a superficial polypoid mass not infrequently with surface ulceration precluding identification of an intraepithelial dysplasia. Further, in many cases an invasive differentiated SCC is not identified. Adding to the complexity in such cases, is that immunohistochemical staining in a significant minority of cases is negative for epithelial-related markers but often the cells express mesenchymal-related markers. In such cases, differentiating SCSC from a reactive (benign) spindle cell proliferation or a mucosal-based sarcoma can be problematic, with treatment implications. Herein, we detail the clinical and pathologic features of laryngeal SCSC and discuss the rationale for diagnosing a carcinoma and avoiding a diagnosis of sarcoma. In our experience, such cases represent one of the more common mistakes made in laryngeal pathology. Yet, virtually all such lesions are SCSCs. The treatment and prognosis relies on the accuracy of this distinction.
上呼吸道（UADT）梭形细胞鳞状细胞癌（SCSC），也称为肉瘤样癌，是一种高级别亚型的常规鳞状细胞癌（SCC），其组织学特征是上皮内异型增生和/或侵袭性分化 SCC 的形式存在分化的 SCC 与侵袭性（黏膜下）未分化的恶性梭形和多形性（上皮样）细胞成分混合存在。通常，SCSC 表现为表面溃疡性的浅表息肉样肿块，通常没有上皮内异型增生。此外，在许多情况下，并未识别出侵袭性分化 SCC。在这种情况下，增加了复杂性的是，少数情况下免疫组织化学染色对上皮相关标志物呈阴性，但细胞通常表达间叶相关标志物。在这种情况下，区分 SCSC 与反应性（良性）梭形细胞增生或黏膜来源的肉瘤可能存在问题，这会对治疗产生影响。在此，我们详细描述了喉 SCSC 的临床和病理特征，并讨论了诊断癌和避免肉瘤诊断的基本原理。根据我们的经验，此类病例是喉病理学中最常见的错误之一。然而，几乎所有这些病变都是 SCSC。治疗和预后取决于这种区别的准确性。
