Neha Bakshi, Shashi Dhawan, Seema Rao
Department of Histopathology, Sir Ganga Ram Hospital, Rajender Nagar, New Delhi, India.
Indian J Surg Oncol. 2021 Dec;12(4):699-705. doi: 10.1007/s13193-021-01418-1. Epub 2021 Aug 17.
Spindle cell squamous cell carcinoma (SCSCC) represents a rare, dedifferentiated form of conventional squamous cell carcinoma (SCC) with propensity for head and neck. Morphological heterogeneity of this tumor poses significant diagnostic challenge for pathologists. This study aimed to evaluate detailed morphological and immunohistochemical (IHC) characteristics of a series of SCSCC cases. All head and neck SCSCCs diagnosed over seven years were retrospectively analyzed to assess morphological features in detail with evaluation of possible differential diagnoses. Elaborate IHC panel was performed in each case. Eleven cases (8 males, 3 females) were included. Most patients were in 5th to 7th decade. Oral cavity ( = 6; 54.5%); oropharynx ( = 3; 27.3%), and larynx ( = 2; 18.9%) were involved. Tumors were polypoidal ( = 6), ulceroproliferative ( = 3), or ulceroinfiltrative ( = 2). Microscopically, epithelial ulceration was common (90.9%). Squamous differentiation was evident on light microscopy in 6 (54.5%) cases as surface dysplasia ( = 1; 9.1%), infiltrative tumor ( = 4; 36.4%), or both ( = 1; 9.1%). The spindled tumor component showed markedly heterogeneous morphology mimicking mesenchymal malignancies or benign mesenchymal proliferations. IHC for epithelial markers (CK, EMA, p40, and p63) established epithelial differentiation in 40% (2 of 5) cases where it was not evident morphologically. CK showed highest positivity followed by p40 and p63. Aberrant mesenchymal marker expression was variably seen. Morphological diagnosis of SCSCC is challenging with several histological mimics. Surface dysplasia and component of invasive SCC in a predominantly spindled tumor are important subtle morphological clues. Systematic morphological approach aided by IHC is helpful in clinching the accurate diagnosis.
梭形细胞鳞状细胞癌（SCSCC）是一种罕见的、去分化型传统鳞状细胞癌（SCC），好发于头颈部。该肿瘤的形态学异质性给病理学家带来了重大的诊断挑战。本研究旨在评估一系列SCSCC病例的详细形态学和免疫组织化学（IHC）特征。对七年来诊断的所有头颈部SCSCC进行回顾性分析，以详细评估形态学特征并评估可能的鉴别诊断。对每个病例进行了详细的IHC检测。纳入11例患者（8例男性，3例女性）。大多数患者年龄在50至70岁之间。病变部位包括口腔（6例；54.5%）、口咽（3例；27.3%）和喉（2例；18.9%）。肿瘤呈息肉样（6例）、溃疡增殖性（3例）或溃疡浸润性（2例）。显微镜下，上皮溃疡常见（90.9%）。6例（54.5%）病例在光镜下可见鳞状分化，表现为表面发育异常（1例；9.1%）、浸润性肿瘤（4例；36.4%）或两者兼有（1例；9.1%）。梭形肿瘤成分显示出明显的形态学异质性，可模仿间叶性恶性肿瘤或良性间叶性增殖。对于形态学上不明显的上皮分化，免疫组织化学检测上皮标志物（CK、EMA、p40和p63）在40%（5例中的2例）病例中证实了上皮分化。CK阳性率最高，其次是p40和p63。可见异常的间叶标志物表达。SCSCC的形态学诊断具有挑战性，存在多种组织学模仿。在以梭形细胞为主的肿瘤中，表面发育异常和浸润性SCC成分是重要的细微形态学线索。免疫组织化学辅助的系统形态学方法有助于做出准确诊断。
