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Case Reports
. 2021 Mar;15(1):130-137.
doi: 10.1007/s12105-020-01273-6. Epub 2021 Mar 15.

The Most Common Mistake in Laryngeal Pathology and How to Avoid it

Amin Heidarian  1 , Bruce M Wenig  2
Affiliations
Case Reports

The Most Common Mistake in Laryngeal Pathology and How to Avoid it

Amin Heidarian et al. Head Neck Pathol. 2021 Mar.

Abstract

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.

Keywords: Immunohistochemistry; Larynx; Sarcomas; Sarcomatoid carcinoma; Spindle cell squamous carcinoma; Upper aerodigestive traact.

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Conflict of interest statement

All authors declare that he/she has no conflict of interest as it relates to this.

Figures

Fig. 1
Fig. 1
Spindle cell squamous carcinoma. a Polypoid neoplasm with intact attenuated surface squamous epithelium (top) exclusively comprised of a spindle-shaped cellular neoplasm with fascicular and storiform growth; b High-magnification shows the undifferentiated spindle-shaped and pleomorphic cells with marked nuclear pleomorphism and increased mitotic activity including atypical forms; c The malignant spindle-shaped cells are in direct continuity to the overlying intact squamous epithelium, the latter lacking dysplastic change; d Abrupt transition from intact benign ciliated respiratory epithelium to the malignant spindle-shaped cells with polypoid growth. The neoplastic cells are immunoreactive for e desmin and f smooth muscle actin. Of note, no immunoreactivity was present for epithelial markers (keratins, p63, p40) or for myogenin, MYOD1 and myoglobin
Fig. 2
Fig. 2
Spindle cell squamous carcinoma. Diagnostic biphasic cell components including: a high-grade intraepithelial dysplasia in association with the malignant spindle cells; and b Invasive keratinizing (differentiated) squamous cell carcinoma admixed with the malignant spindle cells. c Some cases are hypocellular and collagenized suggesting a nonneoplastic process at lower magnification; d At higher magnification there are areas with malignant cells including marked nuclear pleomorphism and hyperchromasia, and a mitotic figure (lower center)
Fig. 3
Fig. 3
Spindle cell squamous carcinoma. Immunoreactivity can vary from case to case but in most cases there is evidence of epithelial differentiation with staining for cytokeratins and/or p63. Staining is variable, including: a diffuse and strong cytokeratin (AE1/AE3/CAM5.2 cocktail) and b p63. In other cases the extent of immunoreactivity is limited, including: c focal cytokeratin (AE1/AE3/CAM5.2 cocktail) and/or d patchy p63 reactivity
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References

    1. Wenig BM. Squamous cell carcinoma of the upper aerodigestive tract: dysplasia and select variants. Mod Pathol. 2017;30(s1):112–8. doi: 10.1038/modpathol.2016.207. - DOI - PubMed
    1. Thompson LDR, Wieneck JA, Miettinen M, Heffner SK. Spindle cell (sarcomatoid) carcinoma of the larynx: a clinicopathoogic study of 187 cases. Am J Surg Pathol. 2002;26:153–70. doi: 10.1097/00000478-200202000-00002. - DOI - PubMed
    1. Ansari-Lari MA, Hoque MO, Califano J, Westra WH. Immunohistochemical p53 expression patterns in sarcomatoid carcinomas of the upper respiratory tract. Am J Surg Pathol. 2002;26(8):1024–31. doi: 10.1097/00000478-200208000-00007. - DOI - PubMed
    1. Lewis JE, Olsen KD, Sebo TJ. Spindle cell carcinoma of the larynx: review of 26 cases including DNA content and immunohistochemistry. Hum Pathol. 1997;28(6):664–73. doi: 10.1016/S0046-8177(97)90175-1. - DOI - PubMed
    1. Bishop JA, Montgomery EA, Westra WH. Use of p40 and p63 immunohistochemistry and human papillomavirus testing as ancillary tools for the recognition of head and neck sarcomatoid carcinoma and its distinction from benign and malignant mesenchymal processes. Am J Surg Pathol. 2014;38(2):257–64. doi: 10.1097/PAS.0000000000000119. - DOI - PMC - PubMed

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