Sarcomatoid (spindle cell) carcinoma of tongue: a report of two cases

Abstract

Sarcomatoid Carcinoma (SC) is an unusual and aggressive variant of squamous cell carcinoma, which frequently recurs and metastasizes; for this reason, the right diagnosis is very important. It is considered to be a biphasic tumor made up of cells from squamous and spindle cells carcinoma with a sarcomatous aspect, but of epithelial origin. The diagnosis often represents a clinical-pathological challenge where the study with immunohistochemical technique (IHC) is key to the histopathological diagnosis. The reported cases related to oral mucosa are limited. In this work we present two SC cases where the use of IHC allowed us to achieve a conclusive diagnosis.

Figure 1

Case one: endophytic tumor lesion with poorly defined margins.

Figure 2

Computed tomography (CT) finding of case one showed that a heterogeneous mass can be seen which spreads to the back of the tongue with extension to the floor of the mouth without reaching the sublingual space (black arrows). The CT confirmed the existence of metastatic lymph nodes (blue arrows).

Figure 3

Case one: histopathology of the lesion. (a-b) Hematoxylin-eosin staining. IHC for cytoqueratin AE1/AE3 (c-d); staining of all cells that comprise the neoplasm is shown, as with vimentin (e-f). Expression for EMA (g-h) in epithelial cells. No expression was observed in the neoplastic cells for S-100 (i-j) or smooth muscle actin alpha (k-l).

Figure 4

Case two: histopathology of the lesion. (a-b) Hematoxylin-eosin staining of CS. IHC staining for cytokeratin AE1/AE3 (c-d); intense staining was observed in all epithelial cells, and a diffuse staining in spindle cells. Vimentin staining (e-f) shows intense expression of epithelial neoplastic cells and spindle component. EMA intense expression in epithelial cells and weak staining for spindle cells (g-h). No expression was observed in the neoplastic cells for S-100 (i-j) or smooth muscle actin alpha (k-l).