A case report of spindle cell (sarcomatoid) carcinoma of the larynx

Abstract

Spindle cell carcinoma (SpCC) or sarcomatoid carcinoma is a highly malignant variant of squamous cell carcinoma which comprises 2% to 3% of all laryngeal cancers. It is considered to be a biphasic tumor that is composed of a squamous cell carcinoma (in situ or invasive) and spindle cell carcinoma with sarcomatous appearance. Most spindle cell tumors are polypoid and pedunculated; they are often detected at an early stage, removed by polypectomy during diagnosis, and tend to have a very good prognosis. We present a case of spindle cell carcinoma in a 67-year-old Caucasian male who presented with progressive hoarseness of his voice, dysphagia, odynophagia and a 20-pound weight loss. The patient underwent direct laryngoscopy with excision of the malignant mass and received radiation therapy. His symptoms gradually improved, and he regained good control of his voice.

Figure 1

CT of the neck with contrast: There is 7 mm polypoid mass involving the anterior commissure of the vocal cords. The nasopharynx, and pharynx, peripharyngeal spaces appear unremarkable, as well as the parotid and submandibular salivary glands. There is no significant neck adenopathy noted.

Figure 2

Histological findings: loose myxomatous fibrous connective tissue containing both spindle-shaped cells as well as ovoid cells with hyperchromatic, pleomorphic nuclei with eosinophilic cytoplasm. In some areas, cells assumed a whirling interlacing pattern and at one margin dysplastic-stratified squamous epithelium characterized by cells with pleomorphic hyperchromatic nuclei.

Figure 3

Immunohistochemistry: cytokeratin AE1/AE3, strongly positive diffuse nuclear staining of neoplastic cells, Ck 5/6, strongly positive nuclear cytoplasmic staining of neoplastic cells, vimentin, strongly positive. Epithelial membrane antigens (EMA) was positive.