Spindle cell lesions of head & neck

CONTENTS
Introduction
Spindle cells in normal tissues.
Spindle cell lesions of head & neck.
Conclusion
References

Introduction
Spindle cell
 Any of various cells that are shaped like spindles, being more or
less round in the middle with two ends that are pointed.
 A generic term for an elongated and/or fusiform cell, regardless of
origin.
Mosby's Medical Dictionary, 9th edition. © 2009, Elsevier

Spindle cells in normal tissues
FIBROBLASTS MYOFIBROBLASTS SMOOTH MUSCLE
SCHWANN CELL MYOEPITHELIAL CELL OSTEOCYTE

Spindle cell lesions of
Head & Neck

Spindle cell neoplasms are defined as neoplasms that consist of
spindle-shaped cells in the histopathology.
 The head and neck is an embryologically and anatomically complex
area, with a number of important structures and organs lying in close
proximity to one another.
 The histological diagnosis of spindle cell lesions can be challenging in
any site, but in this region is particularly so, due to the variety of
structures from which they can arise.
 Account for less than 1% of all tumors in the oral regions.

 Spindle cell tumor is not a specific diagnosis or a specific
type of cancer.
 Spindle cell tumor is a descriptive diagnosis based on the
presence of elongated/spindle cells under the microscope.

Origin Of Spindle Cells???
 Epithelial Origin
 Fibroblastic & Myofibroblastic Origin
 Muscle Origin
 Nerve Tissue Origin
 Adipocytic Origin
 Vascular Origin
 Bone Origin
 Odontogenic origin

Epithelial origin
 Spindle Cell Carcinoma
 Melanocytic nevus
 Mucosal Melanoma
Fibroblastic & myofibroblastic origin
 Nodular fasciitis
 Benign Fibrous Histiocytoma
 Fibromatosis
 Desmoplastic Fibroma
 Fibrosarcoma
 Pleomorphic sarcoma/ MFH
 Myofibroma
 Inflammatory Myofibroblastic Tumour
 Myofibrosarcoma
Muscle origin
 Leiomyoma
 Leiomyosarcoma
 Rhabdomyoma
 Rhabdomyosarcoma
Smooth muscle origin
Skeletal muscle
origin
Neural origin
 Palisaded encapsulated neuroma
 Neurilemmoma
 Neurofibroma
 MPNST
Adipocytic origin
 Spindle cell Lipoma
 Spindle cell Liposarcoma
Vascular Origin
 Spindle cell hemangioma
 Solitary fibrous tumour
 Angiosarcoma
 Kaposis’ Sarcoma
Bone Origin
 Fibroblastic Osteosarcoma
 Synovial sarcoma
Odontogenic origin
 Odontogenic Fibroma
 Odontogenic Myxoma
Salivary gland origin
 Myoepithelioma
 Myoepithelial
carcinoma

Epithelial Tumours
 Spindle Cell Carcinoma
 Melanocytic nevus
 Malignant Mucosal Melanoma

Spindle cell carcinoma
Variant of squamous cell carcinoma characterized by dysplastic surface squamous
epithelium in conjunction with an invasive spindle cell component which simulate a
true sarcoma but are epithelial in nature. (WHO;2005)
 3% of all squamous carcinomas in the head and neck region
 Etiology: still under debate.
 Other names: Carcinosarcoma, sarcomatoid carcinoma
Pseudosarcoma
Pleomorphic carcinoma
Metaplastic carcinoma
Polypoid SCC, Lane tumor

Pathogenesis
 ‘‘Collision’’ tumors where there are two separate neoplastic clones
combined in the same lesion.
 Spindle cells: anaplastic type of carcinoma cell.
 Squamous cell carcinoma ‘‘drives’’ the proliferation of a
pseudosarcomatous stromal response.
 EM & IHC analysis: spindle cells are of epithelial origin, with the ability to
produce mesenchymal intermediate filaments.
 Dysfunctional cadherin-catenin complex: tumor cells shift from a squamous
to a spindled type.
 Most of the cases: recurrences after radiotherapy for well differentiated
SCC: DEDFIFFERENTAITION

Clinical features
 Common sites: upper aero-digestive tract : larynx, oral cavity & esophagus.
 Oral cavity : lower lip, lateral posterior tongue & alveolar ridges.
 Typically appears as a pedunculated, polypoid mass; occasionally as sessile,
nodular, fungating mass or as an ulcer.
 Pain &paresthesia prominent features.
 Tumor grows rapidly, tends to metastasize early; diagnosed in a late stages.
 Mean age : 57 years; no sex predilection

Histopathologic features
(a) Spindled and pleomorphic tumor cells ‘‘dropping off’’ from squamous cell carcinoma in situ;
arrow indicates a tumor giant cell; (b) cellular spindle cell component of a spindle cell carcinoma
with fascicles of relatively regular cells with fusiform nuclei.

 Biphasic tumors.
 Conventional SCC admixed with spindled/pleomorphic tumour cells.
 Squamous cell component can range from varying grades of dysplasia to carcinoma-in-
situ or frank SCC with varying grades of differentiation.
 Spindle cells show a variety of architectural patterns : fascicles, a storiform pattern, a
‘herringbone’ pattern similar to fibrosarcoma, associated with dense collagen as seen in
fibromatosis or with a nodular- fascitis like appearance.
 Direct transition between the two cell types can be seen.
 Spindled component – may be bland and regular or markedly pleomorphic, mitotic
figures, multinucleated tumour giant cells.
 Metastatic lesions - only spindle cells, only squamous cells or combination.
 Bone, cartilage or muscle differentiation may be seen.

 Sometimes present as extensively ulcerated masses with tumor cells widely
spaced apart in a loose, pale or myxoid background.
 There are frequently abundant small vessels with plump endothelial cells and
numerous inflammatory cells, particularly neutrophils.
 Closely mimic exuberant granulation tissue

Immunohistochemistry
 AE1/AE3
 Cytokeratin, K1, K18
 Vimentin
 Carcinoembryonic antigen
 p63
 SMA -30%
 MSA -15%, desmin less than 2%
 S-100- 5%

Melanocytic nevus
 Malformation of the skin & mucosa that are congenital or developmental.
 Arise from the surface epithelium or from any of the connective tissue tissues.
 Common recognized nevus – ACQUIRED MELANOCYTIC NEVUS.
Represents a benign, localized proliferation of cells from the neural
crest called NEVUS CELLS.
 Neural crest origin.
 Ability to produce melanin.
 First cousins of melanocytes.

Clinical features
 Begin to develop on skin during childhood
 Before 35 years of age.
 Women > men; whites> blacks.
 Site : above the waist; H &N region.
 Clinical stages :
JUNCTIONAL NEVUS – sharply demarcated , brown or black macule (< 6 mm)
COMPOUND NEVUS – when nevus cells proliferate to produce a slightly elevated, smooth
surfaced, soft papule. Degree of pigmentation becomes less; appear brown or tan.
INTRADERMAL NEVUS – nevus gradually loses its pigmentation, surface- papillomatous,
hairs are seen growing from the center.
 Many of them involute & disappear.
 Intra –oral nevi : uncommon; palate, mucobuccal fold, gingiva

Histopathology
 Characteristic feature – benign, Unencapsulated proliferation of small, ovoid cells.(nevus
cells); lack the dendritic processes.
 Small, uniform nuclei, eosinophilic cytoplasm, indistinct cell borders; produce melanin
 Tend to get organized into small, round aggregates (theques)
 JUNCTIONAL NEVUS : theques of nevus cells found only on the basal layer of the
epithelium; junction of the epithelium – connective tissue interface.
 COMPOUND NEVUS : Nevus cells proliferate to drop off into the underlying connective
tissue; present along the junctional area & within the underlying connective tissue.
 INTRADERMAL/ INTRAMUCOSAL NEVUS: nests of nevus cells are no longer found in the
epithelium, but are found only within the underlying connective tissue.

Histopathology
 Superficial cells ( TYPE I: EPITHELIOD ) – appear larger & epitheliod; abundant cytoplasm,
frequent intra-cellular melanin & tendency to cluster into theques.
 Middle portion ( TYPE II: LYMPHOCYTIC- LIKE ) - less cytoplasm, seldom pigmented,
appear like lymphocytes.
 Deeper cells ( TYPE III : SPINDLE SHAPED ) - appear elongated; spindle shaped, like
schwann cells or fibroblasts.

Mucosal malignant melanoma
 Malignant neoplasm of neural crest derived melanocytic cells.
 Uncommon, accounting for less than 1% of head and neck melanomas.
 Most commonly occurs in the nasal cavity and paranasal sinuses, but may also
arise in the oral cavity, larynx and pharynx.
 Macroscopically, mucosal melanomas are often polypoid and pigmented
tumours.

 Histologically, ulceration is often present, although intact surface epithelium is
usually identifiable in some areas and pagetoid spread of melanoma cells may be
seen.
 Like cutaneous melanomas, the malignant cells can show a variety of appearances.
 Usually epithelioid or ovoid cells with large nuclei, prominent nucleoli &nuclear
pseudo-inclusions, cytoplasm will be uniformly eosinophilic or clear.
 Occasionally, the cells become spindle or desmoplastic in areas..
 Desmoplastic melanoma - prominent hyalinized stroma, are amelanotic and often
show perineural invasion.

S-100
HMB-45
 MART-1
Melan A

Fibroblastic & myofibroblastic origin
 Nodular fasciitis
 Benign Fibrous Histiocytoma
 Fibromatosis
 Desmoplastic Fibroma
 Fibrosarcoma
 Pleomorphic sarcoma/ MFH
 Myofibroma
 Inflammatory Myofibroblastic Tumour
 Myofibrosarcoma

Nodular fasciitis (Pseudosarcomatous fasciitis)
 A benign and reactive fibroblastic growth extending as a solitary nodule from
the superficial fascia into the sub-cutaneous fat and subjacent muscle.
 It is closely related to “ proliferative myositis” which occurs in muscle.
 Etiology : unknown; trauma ?? Because of the location of the lesions over
bony prominence (angle of the mandible & Zygoma ).
 Although considered a reactive condition, recent molecular studies suggests
that the cells are clonal, thus confirms that it is a benign neoplasm.

Clinical features:
 Trunk &extremities – most commonly involved.
 10 % - soft tissues of the head and neck region, usually
presenting as a rapidly enlarging mass.
 Rare cases : parotid gland.
 Occur in 3- 5th decade of life.
 Intra –oral sites: buccal mucosa, tongue and alveolar mucosa
 Occur mostly in areas which serve as sites of origin and
insertion of muscles of mastication.

The lesion will be well-delineated but not encapsulated proliferation
of spindle cells inside the lamina propria

A nodular growth contains plump fibroblasts with vesicular nuclei in a haphazard
to storiform arrangement.

Myxoid areas are often found, multinucleated giant cells are occasionally
Found originating from the adjacent muscle or fusion of macrophages.

Spindle shaped cells have large oval nuclei and discrete
pleomorphism

 Unencapsulated with an infiltrative margin.
 The component spindle cells are plump, often pleomorphic and arranged in a
‘tissue culture’ pattern, often with accompanying hemorrhage and scattered lymphocytes.
 Mitotic figures are usually present but abnormal forms will not be seen.
 HISTOLOGIC DD : FIBROMATOSIS : more infiltrative & show a fascicular growth pattern also
produces more collagen, less cellular & mitotic figures.
FIBROUS HISTOCYTOMA : More cellular with a storiform pattern, but may
not be as well- circumscribed as Nodular fasciitis.
FIBROSARCOMA: infiltrative and shows a herring-bone pattern, cellular
atypia ( nuclear pleomorphism & hyperchromatism, abundant mitoses.

 The spindle cells often show both a myofibroblastic and histiocytic
immunoprofile.
 SMA, MSA, vimentin and CD68 ( KP1) – positivity , Desmin – Negative
SMA

Benign Fibrous Histiocytoma
 Diverse group of tumors that exhibit both fibroblastic and histiocytic
differentiation.
 Cell of origin : still uncertain (may arise from tissue histiocyte, which then
assumes fibroblastic properties )
 Other names : Dermatofibroma
Sclerosing Hemangioma
Fibroxanthoma
Nodular sub-epidermal fibrosis

Clinical features
 Common site: skin of the extremities : DERMATOFIBROMA
 Oral cavity: rare, if present: Buccal mucosa & vestibule
 Frequently affects the older adults.
 Appears as painless nodular masses (few mm to cms) that may be ulcerated.
 Deeper tumors tend to be larger

Histopathology
 Fairly well-demarcated & often circumscribed at the periphery.
 Cellular proliferation of spindle shaped fibroblast cells with plump, vesicular nuclei
in storiform pattern (cart wheel or matlike ) with rounded histiocytic-like cells .
 Lipid containing xanthoma cells & Tuoton multinucleated giant cells with nuclei
pushed to periphery.
 A background of variably dense collagenous tissue & vascularity is seen.
 Mixed inflammatory cells present.

POSITIVE
▸Vimentin
▸CD 68
▸SMA / CD 34: diffuse
NEGATIVE
•S100
•CD117
•Desmin
•Leu7 (CD 57)
•Neurofilament
Vimentin

Fibromatosis
 Broad group of fibrous proliferations that have a biologic behavior & histopathologic
pattern that is intermediate between those of benign fibrous lesions & Fibrosarcoma.
 Show infiltrative, destructive and recurrent growth but no tendency to metastasize.
Types
Superficial Deep ( desmoid)
Palmar/plantar
Oral cavity
Sporadic
Familial adenomatous polyposis (FAP) associated
Multicentric (familial )
Abdominal
Extra -Abdominal
Intra - Abdominal
H &N region

Clinical features
 Presents as firm, painless mass which exhibit rapid growth.
 Most frequently occurs in children or young adults : JUVENILE FIBROMATOSIS
 Common site : para-mandibular soft tissue region.
 Tumor grow to a considerable size, resulting in facial disfigurement.
 Destruction of bone seen on radiographs.

Histopathology
 Non- encapsulated, poorly circumscribed, infiltrative lesion with a fascicular
growth pattern, usually striated musculature
 Cellular proliferation of spindle shaped cells that are arranged in streaming
fascicles & associated with variable amount of collagen.
 No atypia, mitotic figures.
 Slit like vascular spaces seen

 The spindle cells express vimentin, SMA and MSA
 Some show desmin expression, β- catenin (adenomatous polyposis coli (APC)
gene) positivity
β- catenin

Desmoplastic Fibroma
 Benign, locally aggressive tumor of fibroblastic origin.
 Osseous counter- part of the soft tissue Fibromatosis.
 Few cases reported to be associated with tuberous
sclerosis.
 Patients younger than 30 years of age; no sex predilection.
 Sites : mandible (body- ramus) affected more than maxilla.
 Slowly progressive, causing swelling of the jaws.
 Multilocular or unilocular radiolucency.
 Margins –well defined or ill- defined; bone expansion;
thinned out cortex
Clinical features
Radiographic features

Histopathology
 Consists of interlacing bundles & whorled aggregates of densely collagenous
tissue that contains uniform spindled and elongated fibroblasts
 Some areas shows hypercellularity with plump fibroblast nuclei & less collagen.
 No cytologic atypia or mitotic figures.
 Bone spicules may be present at the interface between the tumor and the
adjacent normal bone; but not an integral part of the lesion.

Interlacing bundles & whorled aggregates of densely collagenous tissue that
contains uniform spindled and elongated fibroblasts

Radiographic Differential diagnosis
 Odontogenic cysts
 Odontogenic tumors
 Malignancy arising from bone.
 Fibrosarcoma
 Odontogenic fibroma (presence of odontogenic rests)
Histopathologic DD

IHC
 The spindle cells express vimentin and SMA but are
negative for CD34.
 Oestrogen receptor positivity may be present and
some show desmin expression.

Fibrosarcoma
 Malignant tumor of fibroblasts.
 Once - most common soft tissue sarcoma.
 Most common in the extremities ( femur & tibia ); 10% occur in the H& N region.
 Two main types : primary & secondary.
 Also reported to arise from pre- existing lesions: fibrous dysplasia, chronic
osteomyelitis, bone infarct, Paget's disease & previously irradiated areas.

Clinical features
 Rare soft tissue and bone malignancy of H&N (nasal cavity, paranasal sinus,
nasopharynx)
 When occurs in bone, they may arise from periosteum, endosteum or PDL.
 More common in men than in women; fourth decade, also common in
children and young adults (infantile form; good prognosis)
 Present as slow- growing masses that may reach considerable size before
they produce pain; secondary ulceration seen as it enlarges.

Classification
I. ADULT – TYPE FIBROSARCOMA
a. Myxoid type (myxofibrosarcoma, low grade myxoid MFH)
b. Fibromyxoid type ( low grade fibromyxoid type/ fibromyxoid type with giant
rosettes.
c. Sclerosing epitheliod type
II. JUVENILE/INFANTILE TYPE FIBROSARCOMA.

Histopathology
 Uniform fasciculated growth Pattern
 fusiform or spindle-shaped cells that vary little in size and shape, have scanty
cytoplasm with indistinct cell borders, and are separated by interwoven collagen
fibers arranged in a parallel fashion.
 Mitotic activity varies & Multinucleated giant cells – rarely seen.

Histologic grading of fibrosarcomas is based on the cellularity and
differentiation, mitotic activity, and necrosis
 Low-grade (well differentiated) fibrosarcomas are characterized by a uniform, orderly
appearance of the spindle cells associated with abundant collagen

 In some cases the cells are oriented in curving or interlacing
fascicles, forming a classic herringbone pattern.
 In others, the cells are separated by thick, wire-like collagen
fibers. Secondary features are common.
 Low-grade fibrosarcomas may show focal chondro-osseous
differentiation.

Consists of closely packed, less well-oriented tumor cells that are small, ovoid or rounded, and
associated with less collagen.
The fascicular or herringbone growth pattern is less distinct, nuclei - more pleomorphic, mitotic
figures- more numerous, areas of necrosis and/or hemorrhage.
High-grade fibrosarcoma
(poorly differentiated)

Differential diagnosis
 Benign processes :nodular fasciitis to cellular benign fibrous histiocytoma and
fibromatosis.
 Malignant neoplasms: malignant peripheral nerve sheath tumor, malignant fibrous
histiocytoma, and monophasic fibrous synovial sarcoma.

Immunohistochemical findings
 Vimentin positivity
 In some fibrosarcomas, scattered cells stain for smooth muscle or muscle-
specific actin, reflecting focal myofibroblastic differentiation.
 The lack of cytokeratin immunoreactivity - distinction from monophasic
fibrous synovial sarcoma.
 Negative immunostaining for S-100 - distinguishes from spindle cell or
desmoplastic malignant melanomas.

Myxoid type of fibrosarcoma.
Spindle or stellate shaped cells deposited in a myxoid matrix composed of predominantly
of hyaluronic acid. The cells have slightly eosinophilic cytoplasm and indistinct cell borders;
the nuclei are hyperchromatic, are mildly pleomorphic, and have only rare mitotic figures.
DD
1: Nodular fasciitis
2: Myxoma
3: Nerve sheath Myxoma
4: Spindle cell lipoma
5. Myxoid liposarcoma
6. Extraskeletal myxoid chondrosarcoma

Fibromyxoid type of Fibrosarcoma
Composed of bland spindle-shaped cells with small hyperchromatic oval nuclei, finely clumped chromatin,
and one to several small nucleoli. The cells have indistinct pale eosinophilic cytoplasm and show only mild
nuclear pleomorphism with little mitotic activity. The cells are deposited in a fibrous and myxoid stroma that
tends to vary in different areas of the tumor

Sclerosing epithelioid type of fibrosarcoma
 The neoplastic cells are predominantly epithelioid in appearance and are arranged in a
variety of patterns, including nests, cords, strands, and occasionally acini or alveoli.
 The cells have oval to round angulated nuclei with finely stippled or vesicular chromatin,
small basophilic nucleoli, and scanty cleared-out or faintly eosinophilic cytoplasm.

Undifferentiated Pleomorphic sarcoma
 Once called as Malignant Fibrous Histiocytoma with both fibroblastic & histiocytic
features. (introduced in 1963)
 Most common soft tissue neoplasm in late adult life.
 Most lesions were later reclassified into other categories- liposarcoma,
leiomyosarcoma, rhabdomyosarcoma, myxofibrosarcoma, melanoma, anaplastic
carcinoma.
 5 histological variants : storiform- pleomorphic
myxoid
giant cell (malignant giant cell tumor of soft parts)
inflammatory (xanthosarcoma, malignant xanthogranulomas)
angiomatoid : seen in childhood

Clinical features
 Tumor of old age groups.
 Men > females
 Seen more in extremities & retroperitoneum, rare in H&N regions.
 Presents as an expanding mass that may or may not be painful or ulcerated.
 Nasal & para nasal sinus tumors : obstructive symptoms.
 Irregular nodular lesion, Unencapsulated, attached to surrounding tissues.
 Myxoid variant: soft in consistency
 Angiomatoid variant : superficially placed than other variants.
 Radiographic features: radiolucency with poorly defined margins.

Gross findings
 Typically, the lesions are solitary, multilobulated, fleshy masses 5–10 cm in
diameter when first detected.
 About two-thirds of these tumors are located in skeletal muscle, <10% are
confined to the subcutis.
A multinodular white mass with areas of hemorrhage and necrosis.

Histopathology
 Basic to all MFH - proliferation of pleomorphic spindle shaped cells
showing fibroblastic morphology. Abnormal & frequent mitotic figures,
necrosis & extensive cellular atypia.
Storiform-pleomorphic type, with
a predominantly storiform
pattern

Histopathology
 The myxoid type is characterized by
myxoid areas in association with cellular
areas indistinguishable from ordinary
MFH.

The giant cell type of MFH , also termed malignant giant cell tumor of soft parts is a
multinodular tumor composed of a mixture of spindled, rounded, and osteoclast-type giant cells

Inflammatory type of MFH - benign- and malignant-appearing xanthoma cells, the
latter often assuming a gigantic size with bizarre nuclei. Typically, these neoplastic cells
display phagocytosis of neutrophils. The inflammatory component is characteristically
prominent and usually consists of a mixture of acute and chronic inflammatory cells
with marked prominence on the former.
CD68 stain of an
inflammatory MFH with
staining of benign
xanthoma cells

Myofibroblastic Origin
 MYOFIBROMA
 INFLAMMATORY MYOFIBROBLASTIC TUMOR
 MYOFIBROSARCOMA

Myofibroblast…
 A myofibroblast is a cell that is in between a
fibroblast and a smooth muscle cell in
phenotype
 Developmental origin
Partial smooth muscle
differentiation of a fibroblastic cell
Loss of contractile phenotype of a
smooth muscle cell
Direct myofibroblastic
differentiation of a progenitor cell
resident in a stromal tissue
Epithelial to mesenchymal
transdifferentiation (EMT) of an
epithelial cell
Myofibroblasts are short, bipolar
or tripolar, spindle shaped or
stellate cells with long
cytoplasmic extensions,
containing sparse to moderate
amounts of acidophilic cytoplasm
with indistinct cell margins, and
ovoid, often indented, pale nuclei
containing a small nucleolus. They
have contractile elements and
synthesize collagen, fibronectin,
and laminin.

MYOFIBROMA/ MYOFIBROMATOSIS
 Myofibroma/ myofibomatosis are benign tumours of myofibroblasts which are
solitary or multicentric, respectively.
 These tumours show a predilection for the head and neck, with a particular
propensity for arising in and around the oral cavity
 More commonly described in childhood

Clinical features
 Rare neoplasms with predilection for H& N region.
 Most frequently in the first 4 decades of life (mean age:22 yrs)
 Site : mandible, tongue & buccal mucosa.
 Presents as painless mass that show rapid enlargement.
 Radiographs: radiolucent defects that are poorly defined, sometimes well-
defined & multilocular.
 Multicentric myofibromatosis : affects neonates & infants who have tumors of
the skin, sub-cutaneous tissue, muscle, bone & viscera.
 Number of tumors may vary from several to more than 100.

Histopathology
 Interlacing bundles of spindle cells with tapered or blunt ended nuclei and
eosinophilic cytoplasm.
 Nodular fascicles may alternate with more cellular zones- giving a biphasic
appearance.
 Centrally, the lesion is more vascular with hemangiopericytoma like appearance.

SMA POSITIVE
Positive for SMA, MSA and negativity for DESMIN which rules out
Leiomyoma & Leiomyosarcoma
DESMIN NEGATIVE

INFLAMMATORY MYOFIBROBLASTIC TUMOR
 Intermediate type of neoplasm consisting of variable numbers of inflammatory
cells and myofibroblastic spindle cells.
 Rare outside the lung, liver and orbit.
 Liston et al. in 1981 was the first to report IMTs of oral cavity in three children.
 Seen in the sinonasal tract, larynx, oral cavity and salivary glands.
 Other names : Inflammatory pseudotumor (IPT)
plasma cell granuloma,
Benign myofibroblastoma
Inflammatory fibrosarcoma
Histocytoma
Xanthomatous granuloma
Spindle cell pseudotumor

Histopathology
 Three main patterns:
 monomorphic spindle cells arranged in fascicles
 myxoid, nodular fasciitis-like areas
 hypocellular, hyalinized areas
 A variable infiltrate of inflammatory cells associated with the tumour cells

Spindle shaped cells with fasciculated architecture, hypocellular
fibrous areas with numerous plasma cells, and concurrent
Fascitis-like foci

 SMA
 MSA POSITIVE
 DESMIN
 ANAPLASTIC LYMPHOMA KINASE-1 (ALK-1) - 35 TO 60 % POSITIVE
SMA

LOW GRADE MYOFIBROSARCOMA
 Malignant tumour of Myofibroblasts.
 Indolent neoplasms but can recur and metastasize after a long period.
Clinical features
 Usually affects adults and is uncommon in children.
 Intra oral tumors- usually slows growing & asymptomatic.
 Oral cavity-the tonsil, mandible, maxilla

 Usually affects deep soft tissue sites and is more often poorly
circumscribed with fascicles and individual cells infiltrating between
muscle fibers, although focal circumscription is not unusual.
 The lack of significant atypia confuses with benign diagnosis such as
nodular fascitis, proliferative myositis, and Fibromatosis.

 A population of spindle-shaped cells showing vesicular nuclei with fine
stippled chromatin and a small nucleolus. The cytoplasm was pale and
eosinophilic with indistinct margins.
 The cells will be arranged in variably orientated short fascicles or
vaguely storiform whorls , extending between individual skeletal muscle
fibers.
 A mild degree of nuclear pleomorphism, anisonucleosis, and
hyperchromatism will be seen.
 A moderate amount of collagen was present in several foci, but a myxoid
or hyalinized stroma can also be seen.
 Occasional lymphocytes, plasma cells, and mast cells.

 SMA- POSITIVE
 Calponin- Diffusely Positive
 Desmin – Focal Positive
 h-caldesmon- Negative
 ALK – Negative

MUSCLE ORIGIN
Leiomyoma
Leiomyosarcoma
Rhabdomyoma
Rhabdomyosarcoma
Smooth muscle origin
Skeletal muscle origin

Leiomyoma
 Benign tumors of smooth muscle that most commonly occur in the uterus, GIT
and skin.
 Uncommon in the oral cavity probably because of the general absence of
smooth muscle except in the blood vessel walls and occasionally in the
circumvallate papillae of the tongue.
 3 types:
 Solid leiomyoma
 Vascular leiomyoma (angiomyoma / angioleiomyoma )
 Epitheliod leiomyoma

Clinical features
 Presents as slow growing, firm mucosal nodule; asymptomatic,
sometimes painful, 1-2 cm in diameter.
 Symptoms : sore throat or tumor in the throat
 Can occur at any age.
 Solid leiomyoma normal colour
 Angio leiomyoma bluish hue
 Sites: tongue, lips, palate & cheek.
 Intra-osseous cases – unilocular radiolucencies

Histopathology
 Well circumscribed tumors that consists of interlacing bundles of spindle
shaped smooth muscle cells.
 The nuclei are elongated, pale staining & blunt ended (cigar shaped)
 Angio-leiomyoma multiple tortuous blood vessels with thickened walls
caused by hyperplasia of their smooth muscle coats.
 Interwining bundles of smooth muscle may be found between the vessels
Special stains
Masson trichrome: to differentiate
between collagen & smooth
muscle.
Muscle: BRIGHT RED

IHC
SMA
MSA
Desmin
h-caldesmon
Vimentin
Actin
Myosin
Desmin

Leiomyosarcoma
 Malignant neoplasm of smooth muscle differentiation.
 Account for 5 - 10% of all soft tissue sarcoma.
 Common sites: uterine wall & GIT; Oral cavity – Rare.
 Develops either through malignant transformation of leiomyoma or de novo.
Clinical features
 Middle aged & older adults.
 Site : jaw bones, cheek & floor of the mouth.
 Appears as an enlarging, lobulated mass that may or may not be painful;
secondary ulceration.

Histopathology
 Fascicles of spindle shaped cells with abundant eosinophilic cytoplasm and blunt
ended, cigar shaped nuclei.
 Some tumors : rounded epitheliod cells with eosinophilic / Clear cytoplasm.
 Degree of pleomorphism varies.
 More than 5 or more mitosis per 10 high power field : MALIGNANT.
 PAS: POSITIVE (GLYCOGEN) & MASSON TRICHROME: CELL CYTOPLASM – BRIGHT RED
IHC
SMA
SMMS
Desmin
MSA (HHF 35)

Rhabdomyoma
 Benign neoplasm of skeletal muscle.
 Introduced by Zenker (1864).
Rhabdomyoma- TYPES
CARDIAC EXTRA- CARDIAC
1. ADULT TYPE
2. FETAL TYPE
3. GENITAL TYPE
4. RHABDOMYOMATOUS
MESENCHYMAL HAMARTOMA

Clinical features – Adult Rhabdomyoma
 Middle aged & older adults; 70 % occurs in men.
 Sites : pharynx, oral cavity, larynx
 Oral cavity – floor of the mouth, soft palate, base of the tongue.
 The tumor appears as a nodule or mass that grows to many centimeters;
sometimes multinodular in nature.
 Young children; male predilection
 Site : face &peri-auricular region, nasopharynx, but not in mouth.
Clinical features – fetal Rhabdomyoma

 Two related types: MYXOID TYPE AND INTERMEDIATE TYPE
 The myxoid type - primitive oval or spindle-shaped cells with indistinct cytoplasm,
interspersed immature skeletal muscle fibers reminiscent of fetal myotubes seen
during the seventh to tenth weeks of intrauterine life, and a richly myxoid matrix.
Histopathology- Fetal Rhabdomyoma
IHC
Desmin
MSA (HHF 35)

 The intermediate type - characterized by the presence of numerous differentiated
muscle fibers, less conspicuous or absent spindle-shaped mesenchymal cells, and
little or no myxoid stroma.
 The predominant cells are broad, strap-shaped muscle cells with abundant
eosinophilic cytoplasm, centrally located vesicular nuclei, and frequent cross-
striations reminiscent of the cells seen in adult rhabdomyomas; many of the cells
contain glycogen and are often vacuolated
Histopathology- Fetal Rhabdomyoma

Rhabdomyosarcoma
 Malignant neoplasm of skeletal muscle differentiation.
 More common in young children; 60% of soft tissue sarcomas in childhood.
 Only 2-5 % of soft tissue sarcomas in adults.
 35 % of cases – H & N; Genitourinary tract – 2nd most common site.
Clinical features
 Occurs during the first decade of life.
 Embryonal type – most common in the first 10 years of life. (60%)
 Alveolar type – between 10-25 years.(20-30%) H& N
 Pleomorphic type - < 5 % cases extremities

NATIONAL CANCER INSTITUTE
CLASSIFICATION OF
RHABDOMYOSARCOMA (1992)
Classification

Embryonal rhabdomyosarcoma, spindle cell type
 In 1992, Cavazzana et al. reported 21 ER composed predominantly (>80%) of
elongated spindle cells.
 Rare variant; 3 % of all RMS
 Male predilection; paratesticular location (38%) followed by H & N(27%)

 The tumor is composed almost exclusively of elongated fusiform cells with
cigar-shaped nuclei and prominent nucleoli.
 The tumor cells have eosinophilic fibrillar cytoplasm with distinct cellular
borders, closely resembling late-stage fetal myoblasts.
 Cytoplasmic cross-striations may be observed.
 The collagen-rich form is characterized by spindle cells separated by abundant
collagen fibers arranged in a storiform or whorled growth pattern.
 The collagen-poor form is a more cellular proliferation of cells arranged in
bundles or fascicles, reminiscent of leiomyosarcoma.
Histopathology

IHC
Desmin, titin, troponin D, myoglobin, MyoD1
and myf-4 (myogenin)
MyoD1 Myogenin

Neural Tumours
 Palisaded encapsulated neuroma
 Neurilemmoma
 Neurofibroma
 MPNST

Palisaded encapsulated neuroma
 Benign neural tumor with distinctive clinical & histopathological features.
 Represents one of the common superficial nerve tumors.
 Cause – uncertain ; trauma.
 Generally considered to be a reactive lesion rather than neoplasm.
Clinical features
 Striking predilection for the face; 90% of the cases.
 Nose & cheek – most common sites; oral cavity – hard palate & maxillary labial mucosa
 5- 7th decade of life.
 Smooth surfaced, painless, dome shaped papule or nodule (< 1cm)

Histopathology
 Well – circumscribed & encapsulated tumor.
 Lobulated appearance.
 Tumor consists of moderately cellular interlacing fascicles of spindle cells
that are consistent with Schwann cells.
 Nuclei – wavy & pointed; palisaded; no pleomorphism or mitotic activity.
IHC
S -100 POSITIVE

Neurilemoma
 Benign neoplasm that is derived from the proliferation of Schwann cells of the
neurilemma or nerve sheath.
 25- 48 % occur in H &N.
 Bilateral neurilemomas of the auditory- vestibular nerve-
NEUROFIBROMATOSIS TYPE II
Clinical features
 Slow growing, encapsulated tumor.
 As it grows, it pushed the nerve aside.
 Asymptomatic mass; pain & tender occur sometimes.
 Young & middle aged adults; few mm to several cms.
 Tongue – common site, centrally within the bone; bone expansion.
 Intra – osseous : posterior mandible; unilocular / multi-locular radiolucencies.

Histopathology
 Encapsulated tumor that shows two microscopic patterns in varying amounts:
 ANTONI A – streaming fascicles of spindle shaped Schwann cells.
cells form a palisaded arrangement around central, acellular, eosinophilic
areas: VERUCAY BODIES (reduplicated basement membrane & cytoplasmic processes)
 ANTONI B - less cellular & less organized
spindle cells are randomly arranged within a loose myxomatous stroma.
 Degenerative changes can be seen in some older tumors : ANCIENT NEURILEMMOMAS.
 Changes - hemorrhage, hemosiderin deposits, inflammation, fibrosis & nuclear atypia
S- 100

Ancient schwannoma
Ancient schwannoma with cyst formation and interstitial
hyalinization.

VARIANTS
Neuroblastoma-like schwannoma composed of rounded Schwann cells
forming rosettes (A). Other areas had a more conventional appearance
(B).

VARIANTS
Cellular schwannoma with long fascicles of Schwann cells
without Antoni B areas or Verocay bodies

VARIANTS
Plexiform schwannoma
involving the dermis

VARIANTS
Epithelioid schwannoma. Note the cohesive nests of
bland epithelioid cells S- 100

Neurofibroma
 Most common type of peripheral nerve neoplasm.
 Arises from a mixture of cell types; schwann cells & perineural fibroblasts.
 Appear as solitary or multiple lesions as part of the syndrome: NEUROFIBROMATOSIS
Clinical features
 Appears as slow growing, soft painless lesions that vary in size from small nodules to
large masses.
 Site : skin; oral cavity – tongue & buccal mucosa; centrally within the bone.
 Well demarcated or poorly defined unilocular or multilocular radiolucency.
 THREE GROWTH PATTERNS : Localized, Diffuse, Or Plexiform NF 1
normal individuals

Histopathology
 Interlacing bundles of elongated cells with wavy, darkly-stained nuclei.
 The cells are intimately associated with wire-like strands of collagen that have
been likened to “shredded carrots.”
 Small to moderate amounts of mucoid material separate the cells and collagen.
 The stroma of the tumor - mast cells, lymphocytes, and rarely xanthoma cells.
 Less frequently, the neurofibroma is highly cellular and consists of Schwann cells
set in a uniform collagen matrix devoid of mucosubstances.
S-100

Plexiform Neurofibroma
 Always develop during early childhood, often before the cutaneous
neurofibromas have fully developed.
 Involve an entire extremity give rise to the condition known as elephantiasis
neuromatosa, in which the extremity is enlarged.
 The overlying skin is loose, redundant, and hyperpigmented, and the
underlying bone may be hypertrophied.
 Macroscopically, plexiform neurofibromas are large lesions that affect large
segments of a nerve, distorting it and contorting it into a “bag of worms”

Histopathology
 The lesion consists of a tortuous mass of expanded nerve branches, which are
seen cut in various planes of section.
 In the early stages the nerves may simply have an increase in the endoneurial
matrix material, resulting in wide separation of the small nerve fascicles.
 With continued growth the cells spill out of the nerves into soft tissue, creating
a diffuse variant of neurofibromatous tissue such that NF1 lesions can have
both plexiform and diffuse areas.
 Unlike localized neurofibromas, they may display nuclear atypia. Because these
lesions are at greatest risk to undergo malignant transformation

Malignant peripheral nerve sheath tumor
 Malignancy of peripheral nerve origin.
 5 % of all soft tissue tumors.
 50% occur in patients with NF1.
 Common sites : proximal portions of the extremities & trunk.
 Oral cavity : mandible, lips & buccal mucosa.
 10 -15% - H & N.
 Young adults; NF -1 associated younger than the non associated.
 Enlarging mass showing rapid growth with associated pain.

Histopathology
 Fascicles of atypical spindle shaped cells.
 More irregular in shape with wavy or comma shaped nuclei.
 In addition to streaming fascicles, less cellular myxoid areas are also present.
 Some tumors show skeletal muscle differentiation (malignant triton tumor),
cartilage, bone or glandular structures.

Adipocytic origin
Spindle cell Lipoma
Spindle cell Liposarcoma

Spindle cell Lipoma
 Originally described as a distinct entity by Enzinger and Harvey in 1975.
 Usually arises in men; 45-60 years of age.
 Subcutaneous tissue of the posterior neck, shoulder, and back; oral cavity- rare.
 Slow growing, typically solitary, circumscribed or encapsulated, painless, firm
nodule, usually centered in the subcutaneous tissue

Histopathology
 Vary widely in its appearance.
 Some tumors are predominantly composed of mature adipose tissue with
only scattered spindle cell or pleomorphic elements.
 Other tumors are predominantly solid and lack any significant lipomatous
component

 The classic spindle cell lipoma consists
of a relative equal mixture of mature
fat and spindle cells.
 The spindle cells are uniform with a
single elongated nucleus and narrow,
bipolar cytoplasmic processes .
 The cells may be haphazardly
distributed but tend to be arranged in
short, parallel bundles.
 IHC- the spindle cells in spindle cell
lipoma are consistently positive for
CD34

Spindle Cell Liposarcoma
 A very rare and unusual form of liposarcoma consisting almost entirely of loosely
arranged fibroblast-like spindle cells oriented along a single plane and surrounded
by a delicate reticulin meshwork.
 At low power, the lesion bears a superficial similarity to spindle cell lipoma,
although it is far more cellular.

Vascular tumors
 Spindle cell hemangioma
 Solitary Fibrous Tumour
 Angiosarcoma
 Kaposis’s Sarcoma

Spindle cell hemangioma
 First described in 1986 as “spindle cell Hemangioendothelioma”; an acral
vascular tumor characterized by cavernous blood vessels and spindled areas
reminiscent of Kaposi sarcoma.
 Young adults ;subcutis of the distal extremities, particularly the hand.
 Occasionally associated with Maffucci syndrome, Klippel-Trénaunay syndrome.
 Most begin as a solitary nodule but have a remarkable tendency to give rise to
multiple lesions in the same general area.

Histopathology
 The lesions are composed of thin-walled cavernous vessels lined by flattened endothelial
cells and containing a mixture of erythrocytes and thrombi.
 Between the cavernous spaces are bland spindled areas reminiscent of Kaposi sarcoma.

Hemangiopericytoma - Solitary Fibrous Tumor
 First coined by Stout and Murray for tumors thought to originate from the
pericytes, a modified dendritic-like smooth muscle cell encircling blood vessels.
 In 1976, by Enzinger and Smith emphasized the staghorn, partially hyalinized
vessels surrounded by small rounded and fusiform cells.
 Hemangiopericytoma also coincided with the increasing popularity of the
diagnosis of solitary fibrous tumor (SFT), a pleural-based lesion first described
by Klemperer and Rabin.
 Had many overlapping features with classic hemangiopericytoma: CD34
immunoreactivity, paved the way for the popular belief that all
hemangiopericytomas were, or should become, solitary fibrous tumors.

Clinical features
 Slow growing, mucosal, painless or deep soft tissue mass
 Buccal mucosa – 75%; adults & rare in children.
 Nasal cavity & paranasal sinuses with the symptoms of nasal obstruction &
epistaxis.

Histopathology
 Well circumscribed lesions with variable microscopic appearance.
 The cellular end of this spectrum corresponds to “classic hemangiopericytoma”
and the hyalinized end to “classic solitary fibrous tumor.”
 Many cases have hybrid features.
 Classic hemangiopericytoma consists of tightly packed round to fusiform cells
with indistinct cytoplasmic borders which are arranged around an elaborate
vasculature.
 As a rule, the dilated, branching vessels divide and communicate with small or
minute vessels which may be partly compressed and obscured by the
surrounding cellular proliferation.
 Typically, the dividing sinusoidal vessels have a “staghorn” or “antler-like”
configuration

 In contrast, lesions having features of classic “solitary fibrous tumor” consist
principally of spindle cells.
 The arrangement of the cells varies from area to area in the same tumor.
 In some zones the cells are arranged in short, ill-defined fascicles, whereas in
others they are arranged randomly in what has been described as a
“patternless pattern.”
 Staghorn vessels, occasionally present, are not as striking as in classic
hemangiopericytoma.

Hemangiopericytoma like areas:
CD34
SFT
CD34 : 80-90%
CD99: 70%
bcl2 : 30%
EMA : 30%
ACTIN: 20%
NEGATIVE
Desmin
Cytokeratin
S-100
CD34

Angiosarcoma
 Rare malignancy of vascular endothelium which may arise from
either blood or lymphatic vessel.
 More than 50% - occur in H&N (scalp & forehead)
 Oral lesions- rare
 Older adult patients
 Early lesions – bruise – delay in diagnosis; lesion continues to
enlarge resulting in elevated, nodular or ulcerated surface.

Histopathology
 Vary from well-differentiated neoplasms with vascular channels lined by
atypical endothelial cells with few mitoses to poorly differentiated
neoplasms composed of solid sheets of epithelioid or spindle cells
exhibiting brisk mitotic activity.
 Poorly defined vascular spaces, multilayered endothelial lining, and
papillary projections into the vascular lumen may also be observed.
 Hemorrhage, necrosis, and lymphocytic infiltration are common
features.
 One hallmark of poorly differentiated angiosarcoma - presence of
fragmented erythrocytes in the intracytoplasmic vacuoles

Kaposi sarcoma
 Unusual vascular neoplasm that was described by Moritz Kaposi in 1872.
 Caused by HHV-8; more associated with HIV patients.
 Arises from endothelial cells; lymphatic origin.
4 CLINICAL PRESENTATION:
 Classic
 Endemic (African )
 Iatrogenic immunosuppression associated
 AIDS related.

Histopathology
The Earliest (patch) stage – a flat lesion characterized by a proliferation of miniature
vessels surrounding larger ectatic vessels

 Plaque stage produces slight
elevation of the skin.
 The vascular proliferation
usually involves most of the
dermis and may extend to the
subcutis.
 A discernible but relatively
bland spindle cell component,
initially centered around the
proliferating vascular
channels, appears at this
stage.
 In time, the spindle cell foci
coalesce and produce the
classic Nodular lesions of
Kaposi sarcoma.
▸CD34
▸CD31
▸Factor VIII
▸FLI-1

Intra-osseous
tumours
• Fibroblastic Osteosarcoma
• Synovial Sarcoma

Fibroblastic osteosarcoma
 Osteosarcoma – malignancy of mesenchymal cells that have the ability to
produce osteoid or immature bone.
 Variants : osteoblastic, chondroblastic, fibroblastic
 Minimal amount of osseous matrix with or without cartilage.
 Overall histological appearance is similar to fibrosarcoma or undifferentiated
pleomorphic sarcoma (malignant fibrohistiocytic tumour)

Synovial Sarcoma
 Synovial sarcoma is a clinically and morphologically well-defined entity that,
despite its name, is extremely uncommon in joint cavities and is encountered
in areas with no apparent relation to synovial structures.
 It occurs primarily in the para-articular regions of the extremities, usually in
close association with tendon sheaths, bursae, and joint capsules.
 Teenagers & young adults.
 Gradual enlarging mass associated with pain
 H &N region- paravertebral & parapharyngeal region.
 Oral cavity – tongue & cheek.

Histopathology
Two major categories of synovial sarcoma: biphasic and monophasic types.
 biphasic type, with distinct epithelial and spindle cell components in varying
proportions
 monophasic fibrous type
 rare monophasic epithelial type
 poorly differentiated (round cell) type.
 Cytokeratins
 EMA
 Bcl2
 S100
 CD99

Odontogenic origin
Odontogenic fibroma
Odontogenic Myxoma

Odontogenic Fibroma (OF)
 Tumors of odontogenic ectomesenchyme.
 Simple type: An expansile, non infiltrating connective tissue lesion
resembling a dental follicle
 It is relatively acellular, the fibers being quite delicate, and there is a
considerable amount of ground substance yielding a fibromyxoid quality.
 It may exhibit inactive-looking rests of odontogenic epithelium but they
are seldom numerous.
 WHO type: cellular connective tissue.
 It often occurs in fibroblastic strands that are interwoven with less cellular
areas in which numerous small blood vessels are present
 Foci of calcified collagenous matrix, resembling dysplastic cementum,
osteoid atubular dysplastic dentin
 Islands or strands of inactive-looking odontogenic epithelium are an
integral component

▸A myxoid tumour which is largely confined to the tooth-bearing areas
of the jaws
▸Posterior mandible
▸Odontogenic myxomas are locally aggressive, non-encapsulated, non-
metastasizing neoplasms that infiltrate bone marrow spaces.
▸Cut sections characteristically reveal a white-gray color in the mucoid
substance, which will stick to an instrument when touched.

Histolopathology
 Loose, abundant mucoid stroma that contains rounded, spindle-shaped, or
angular cells
 Cellular and nuclear pleomorphism is rare, as is mitotic activity
 Usually tumor cells are evenly spaced with in a fine fibrillar mucinous matrix
 The stroma may be relatively avascular or may exhibit delicate capillaries
 Vimentin
 Occasional positivity to S-100 protein
and muscle specific actin

Salivary gland origin
Myoepithelioma
Myoepithelial carcinoma

Myoepithelioma
 Myoepithelium -rich pleomorphic adenoma comprise a spectrum of benign myoepithelial
tumor with overlapping histologic features and similar clinical behavior and arise almost
exclusively in the normally or ectopically situated salivary glands.
 First used by Sheldon in 1943.
 Sites: parotid, palate
 < 1% of all major & minor salivary gland tumors.

Histopathology
 Composed exclusively of neoplastic myoepithelial cells.
 Predominantly spindle shaped cells or plasmacytoid.
 Epitheliod and clear cells are also present.
 Single cell type or combination of cell types predominates.
 Does not contain the chondromyxoid stroma of PA.

 ELLIS GL (1991) defined it as a malignant epithelial neoplasm whose tumor cells
demonstrate cytologic differentiation towards myoepithelial cells and lack ductal or acinar
differentiation.
 Intermediate to high grade carcinoma
 Patient complaints of a painless mass.

 General morphologic features resemble tumor cells in myoepithelioma.
 Tumor cells are spindle shaped or plasmacytoid; they will be intermixed or one
cell type predominates.
 Quite cellular ; suggestive sarcoma rather than carcinoma
 Stroma in other parts of the tumor may be conspicuous & myxoid.
 Distinguished from other benign tumors by their infiltrative & destructive
growth; increased mitotic activity & pleomorphism
 IHC: CYTOKERATIN, S100, SMA, GFAP.

Diagnosis of Spindle cell Neoplasm
Clinical
manifestation of
lesion
Histologic
architecture
+
IHC
DIAGNOSIS

Spindle cell neoplasm on biopsy
Malignant
Epicentre on Radiology
Intraosseous Mucosal
Sarcomatoid carcionoma
Melanoma
Sarcomas
Benign
Leiomyoma, Schwannoma, Solitary
Fibrous Tumour, Bening fibrous
Histiocytoma, IMFT, Neurofibroma,
Nodular fasciitis…
Osteosarcoma
Odontogenic tumours

Algorithm for mucosal malignant tumors
If in situ component, dysplasia, squamoid traits If absent –IHC to be done
Spindle Cell Carcinoma
S100,
HMB45,
Melan A
POSITIVE
S100 POSITIVE,
NEGATIVE
HMB45, melan A
SMA strongly and
diffusely
POSITIVE
CK, EMA, AE1/AE3,
HMWCK, p63
POSITIVE
CD - 34
POSITIVE –
Melanoma
Leiomyosarcoma
confirm with H-
caldesmon,
desmin
Spindle Cell
Carcinoma/
Myoepithelial
carcinoma
Vascular tumour
FLI-1 –specific for
Kaposis Sarcoma
Neurogenic
Sarcomas

SUMMARY
 Spindle cell lesions of head & neck are diverse & diagnostically challenging
 High index of suspicion of spindle cell carcinoma for any malignant tumor
with spindle cells
 Clinical correlation is valuable.
 PATHOLOGISTS SHOULD TAKE PARTICULAR CARE BEFORE RENDERING FINAL
DAGNOSIS.
 RULE OF THUMB –IN ADULTS MALIGNANT SPINDLE CELL ARE MORE LIKELY
TO REPRESENT CA OR MELANOMA THAN A TRUE SA

Spindle cell lesions of head & neck

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