Spindle-cell carcinoma

Mixed medullary and follicular cell carcinoma Spindle cell tumor with thymus-like differentiation Carcinoma showing thymus-like differentiation Thyroid adenoma and related tumors Follicular adenoma Hyalinizing trabecular tumor... 

Maeda, T., Adachi, ., Kajiyama, K., Sugimachi, K., Tsuneyoshi, M. Spindle cell hepatocellular carcinoma. A clinicopathological analysis of 15 cases. Cancer 1996 77 51-57... 

Spindle cell carcinoma Lung non-small cell carcinoma... 

Common in renal, endometrial, ovarian serous, salivary gland, follicular thyroid, and sarcomatoid (spindle cell) carcinomas, "basal-like" breast carcinomas, as well as in the epithelial and stromal components of malignant mixed mullerian tumors... 

Encoded by the MUCI gene on chromosome I and a derivative human antigen, EMA is a transmembrane glycoprotein of the breast mucin complex, and its expression is increased in carcinomas.Unlike normal breast, in which EMA is present on the apical cell membrane, neoplasms demonstrate EMA on the entire circumference of the cell membrane. Increased amounts of the large glycoprotein interfere with cell-to-cell and cell-to-matrix adhesion in neoplastic cells. The utility of EMA antibody is in the detection of epithelial differentiation, as a supplement to the cytokera-tins. Spindle cell, small cell, and large cell neoplasms may on rare occasion be stained with EMA but may be only focally positive for cytokeratins. 437... 

Smith KJ, Skelton 3rd HG, Morgan AM, et al. Spindle cell neoplasms coexpressing cytokeratin and vimentin (metaplastic squamous cell carcinoma). J Cutan Pathol. 1992 19 286-... 

Suster S, Moran CA. Spindle cell thymic carcinoma clinico-pathologic and immunohistochemical study of a distinctive variant of primary thymic epithelial neoplasm. Am J Surg Pathol. 1999 23 691-700. 

FIGURE 9.1 Spindle cell carcinoma demonstrating striking spindle cell morphology. (H E, x200 original magnification.)... 

The diagnosis of spindle cell carcinoma (SPCC) requires the identification of a component of squamous neoplasia or epithelial differentiation of the spindle cells. 

MMs are invariably positive for vimentin, which may be a pitfall in dealing with amelanotic spindle cell MMs. As a general rule, in diagnosing a spindle cell lesion of the sinonasal tract one must consider MM, spindle cell carcinoma, and a malignant myoepithelioma before soft tissue sarcomas. Rare MMs may also be focally positive for CAM 5.2 and EMA, which poses a problem when dealing with an epithelioid MM. 

Microscopically, small cell neuroendocrine carcinomas are identical to their pulmonary counterparts and, as such, are composed primarily of round to short spindle cells with sparse, poorly defined cytoplasm and hyperchromatic nuclei without nucleoli. Nuclear molding, frequent mitoses, necrosis, and single-cell apoptosis are common. 

Lassaletta L, Alonso S, Granell J, et al. Synchronous glottic granular cell tumor and subglottic spindle cell carcinoma. Arch Otolaryngol Head Neck Surg. 1998 124(9) 1031-1034. 

Muller S, Barnes EL. Basaloid squamous cell carcinoma of the head and neck with a spindle cell component. An unusual histologic variant. Arch Pathol Lab Med. 1995 119 181-182. 

Thompson LD, Wieneke JA, Miettinen M, et al. Spindle cell (sarcomatoid) carcinomas of the larynx a clinicopathologic study of 187 cases. Am J Surg Pathol. 2002 26(2) 153-170. 

Olsen KD, Lewis JE, Suman VJ. Spindle cell carcinoma of the larynx and hypopharynx. Otolaryngol Head Neck Surg. 1997 116(l) 47-52. 

IT. 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) 664-673. 

Gupta R, Singh S, Hedau S, et al. Spindle cell carcinoma of head and neck an immunohistochemical and molecular approach to its pathogenesis. / Clin Pathol. 2007 60(5) 472-475. 

Ordonez and coworkers,5 of 32 (15.6%) cases of anaplastic carcinoma exhibited TGB immunoreactivity in a small number of cells using both monoclonal antibodies and polyclonal antisera. In this series, positivity was present in 3 of 8 giant cell, 1 of 4 spindle cell, and none of 6 squamoid or 13 mixed variants. Examination of serial sections in these cases failed to reveal evidence of entrapped normal follicular cells or foci of differentiated thyroid carcinoma. Other authors, however, have failed to demonstrate any TGB immunoreactivity in anaplastic carcinomas except in foci of residual differentiated tumor. 

Most studies report TTF-1 positivity in more than 90% of pulmonary small cell NE carcinomas. In the study of Oliveira and colleagues, " TTE-1 was present in 19 of 20 (95%) well-differentiated pulmonary NE tumors (including typical and atypical carcinoids) and in 8 of 10 (80%) metastases of these tumors. On the other hand, Du and colleagues reported TTE-1 positivity in 28%, 29%, and 37% of typical carcinoids, atypical carcinoids, and large cell NE carcinomas, respectively. Interestingly, TTE-1 positivity was more commonly present in peripheral carcinoids of spindle cell type than... 

KER, keratin (mixture of monoclonal antibodies) EMA, epithelial membrane antigen VIM, vimentin CALRET, calretinin DES, desmin MSA, muscle-specific actin AFP, alpha fetoprotein SYN, synaptophysin CCA, chromogranin A MESOTH, mesothelioma SCYST, spindle cell yolk sac tumor LMS, leiomyosarcoma SPCCA, spindle cell carcinoma (either primary or metastatic) SYNSC, synovial sarcoma SPCNC, spindle cell neuroendocrine carcinoma FS, fibrosarcoma MFH, malignant fibrous histiocytoma. 

Moran CA, Suster S. Spindle-cell neuroendocrine carcinomas of the thymus (spindle-cell thymic carcinoid) A dinicopathologic and immunohistochemical study of seven cases. Mod Pathol. 1999 12 587-591. 

Vimentin is a 58-kD intermediate filament found predominantly in mesenchymal cells. However, vimentin is expressed in most spindle cell carcinomas and is reported by some to be expressed in a relatively high percentage of pulmonary adenocarcinomas. Thyroid transcription factor-1 (TTF-1), a 38- to 40-kD transcription factor member of the NKx2 family of home-odomain transcription factors, is expressed in thyroid and pulmonary epithelial cells. 49 TTF-1 binds to and activates the promoters for Clara cell secretory protein and surfactant proteins A, B, and As reported... 

Sarcomatoid carcinoma, also referred to as carcinosarcoma, spindle cell carcinoma, blastoma, and teratocarci-noma, are neoplasms of epithelial derivation that show variable differentiation. Sarcomatoid carcinoma has been reviewed conceptually by Wick and Swanson. Several studies have evaluated sarcomatoid carcinoma by immunohistochemistry using keratin antibodies and/ or electron microscopy. These studies concluded that the spindle cell component of the neoplasm was of epithelial derivation. In most instances, the spindle cells coexpress keratin and vimentin (Figs. 12.10 and 12.11) or occasionally keratin and other intermediate filaments such as desmin or actin. 

Pleomorphic carcinoma, as defined by Fishback and associates,is a neoplasm that occurs predominantly in older patients and is composed predominantly of spindle cells and large pleomorphic giant cells. In 78 cases, the authors found foci of squamous differentiation in 8% of cases, large cell undifferentiated carcinoma in 25% of cases, and adenocarcinoma in 45% of cases. The remaining 22% of the neoplasms were composed of neoplastic... 

FIGURE 12.10 This region of sarcomatoid carcinoma shows im-munostaining of the spindle cells for low molecular weight keratin. X400. 

Squamous carcinomas frequently show spindle cell features. The neoplastic spindle squamous cells often coexpress keratin and vimentin. Some spindle cell squamous carcinomas express predominantly vimentin and relatively small amounts of keratin. 

Sarcomatoid renal cell carcinomas can metastasize to the pleura in a macroscopic distribution identical to mesothelioma and very closely simulate a sarcomatoid mesothelioma.This tumor is considered as a pseu-domesotheliomatous carcinoma but not a primary pulmonary pseudomesotheliomatous carcinoma. The immunostaining pattern of such neoplasms can be identical to a sarcomatoid mesothelioma. The situation can be further complicated because sarcomatoid mesotheliomas can metastasize to the kidney. If an individual is known to have a sarcomatoid renal cell carcinoma and has a spindle cell neoplasm of the pleura, one must consider... 

Hammar SP, Hallman KO. Unusual primary Itmg neoplasms spindle cell and undifferentiated carcinomas expressing only vimentin. Ultrastruct Pathol. 1990 14 407-422. 

Addis BJ, Gorrin B. Pulmonary blastoma, carcinosarcoma and spindle cell carcinoma An immunohistochemical smdy of keratin intermediate filaments. J Pathol. 1985 147 291-301. 

Zarbo RJ, Grissman JD, Venkat H, et al. Spindle cell carcinoma of the upper aerodigestive tract mucosa An immunohistologic and ultrastrucmral smdy of 18 biphasic tumors and comparison with seven monophasic spindle cell tumors. Am J Surg Pathol. 1986 10 741-753. 

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