Spindle cell carcinoma of the oral cavity. A clinicopathologic assessment of fifty-nine cases.

The clinical features, histomorphologic characteristics, therapeutic results, and follow-up data for fifty-nine cases of spindle cell carcinoma of the oral cavity were analyzed. Circumstantial evidence favors a pathogenesis from metaplastic malignant epithelial cells for the spindle cell proliferation. These neoplasms occurred most frequently on the lower lip, tongue, and alveolar ridge in either polypoid, exophytic, or endophytic configurations. A male predominance was attributed to a military and veteran bias. Mean age at occurrence was 51 years for men and 67 years for women. Symptoms were infrequently reported. Histomorphologically, fasciculated, myxomatous, and streaming patterns of the spindle cells were observed, with variable mitotic activity, pleomorphism, benign and atypical giant cells, inflammation, vascularity, and infiltration. Follow-up data on forty-five patients revealed that only fourteen were alive and well, whereas twenty-five were dead of their disease. Mean survival time for those dead of the disease was under 2 years. Five-year survival was a significant indicator of cure. No clinical or histomorphologic characteristic other than distant metastasis was found to be a reliable prognostic indicator. Wide surgical excision, alone or with radical neck dissection, was the most successful therapeutic modality. Radiation was ineffective.