This is the first case report of sarcomatoid (spindlecellcarcinoma) of the ovary, which appears as a solid mass. Moreover, this case demonstrates that findings of malignant spindlecell proliferation does not imply that this entity is a sarcoma or malignant Mixed Müllerian Tumor (MMT). Additionally, careful tissue sampling and immunohistochemical analysis to distinguish be- tween these different entities is mandatory.
Renal cellcarcinoma (RCC), the most common renal cancer among elderly individuals, gener- ally originates from renal tubules, particulary the proximal tubule. Among the 13 histological subtype of RCCs, clear-cell renal cellcarcinoma (ccRCC) is the most common. Mucinous tubular and spindlecellcarcinoma (MTSCC) is a rare subtype that was recently classified, predomi- nantly occurs in females, and is associated with a favorable prognosis. Although the origin of this tumor is unclear, it has been hypothe- sized to originate from the loop of Henle or the distal tubule . The histopathological findings have been well characterized, and include inter- connecting tubular and spindle cells with low- grade nuclear atypia and mucinous extracellu- lar matrix.
Abstract: The author reports a very rare case of spindlecellcarcinoma (SpCC) of the urinary bladder progressed from ordinary papillary transitional cellcarcinoma (TCC). A 63-year-old man complained of hematuria. A transurethral en- doscopic examination revealed a papillary tumor, and transuthetral resection of bladder tumor (TUR-BT) was per- formed and was diagnosed as ordinary papillary urothelial TCC. Since then, he was treated with TUR-BT eight times. Chemotherapy, radiation, radical cystectomy and lymph nodes dissection were performed 16 years after the first TUR -BT. However, he developed rectal mucosal metastasis. He is now alive 17 years after the first presentation. All the TUR-BT specimens were ordinary papillary TCCs without invasion (pTa). Immunohistochemically, the TUR-BT speci- mens were positive for pancytokeratin, high molecular weight cytokeratin (CK), CK 5/6, CK 7, CK 18, CK 19, CK 20, p53, p63, Ki-67 (10%), and negative for other antigens examined including vimentin. The cystectomy bladder speci- mens show broad ulcers and polypoid lesions, and malignant spindle cells (SpCC) invading into muscular layer were present. No TCC elements were recognized. The tumor cells were positive strongly for vimentin, and less strongly for pancytokeratin, high molecular weight cytokeratin, CK 5/6, CK 14, CK 18, p53, p63 and Ki-67 (95%), and negative for other antigens examined. The rectal metastatic lesion showed SpCC without TCC elements, and were strongly positive for vimentin, and weakly positive for pancytokeratin, S100 protein, p53, p63, Ki-67 (90%), neuron-specific enolase, CD56, KIT and PDGFRA. It was negative for other antigen examined. It is strongly suggested that the present SpCC were progressed from ordinary TCC.
Mucinous tubular and spindlecellcarcinoma of the kidney (MTSCC-K) is a rare pathological entity and has been described as a specific subtype of renal cellcarcinoma (RCC) in the 2004 World Health Organization classification . It is characteristically of elongated tubules lined by cords of spindle cells or cuboidal cells separated by mucinous extracellular matrix [2-4]. Though it was reported that MTSCCs showed a relatively good prognosis, the follow-up data is limited and the clinical behavior of this tumor remains to be established. And it’s necessary to gather more clinicopathological features of MTSCC-K for
squamous cellcarcinoma to sarcomatoid Genetically, the sarcomatoid & component in spindlecellcarcinoma. epithelial components of spindlecell According to shibuya etal the expression of carcinoma harbor similar mutations and have cadherin- catenin complex was regarded as concordant ploidy. P53 overexpressed in both hall mark of epithelial cell. It is believed that components. The tumour shows LOH dysfunctional cadherin catenin complex frequencies similar to those of poorly causes cells to shift in morphology from differentiated squamous cellcarcinoma. A squamoid to a more spindled type and permits specific marker on the short arm of a more infiltrative & diffuse pattern of chromosome 4 was shown to be more
Abstract: We report a unique case of mucinous tubular and spindlecellcarcinoma (MTSC) of the kidney with extensive sarcomatoid differentiation, multiple metastases, and a rapidly fatal clinical course. The patient presented with back pain and a pathologic L1 fracture. Diagnostic imaging revealed a large retroperitoneal mass arising from the left kidney and compressing the spinal cord. Radiotherapy and surgery were performed, but the patient died from disease progression three weeks postoperatively. MTSC is a recently recognized entity that is considered to be a low-grade carcinoma with a favorable prognosis. Our case demonstrates that although MTSC is usually a low-grade carcinoma, sarcomatoid differentiation may occur and lead to a fatal course, as in all other types of renal cell carcinomas. Adequate sampling and the exclusion of sarcomatoid differentiation in the spindlecell component are necessary for proper management and prognostication. To our knowledge, this is the first reported case of MTSC with sarcomatoid differentiation and a fatal outcome.
single. ii) Pathological characteristics: Tumor mass is usually localized in the renal parenchy- ma with most tumor lesions being away from the medulla, and thus in within non-central region. The cutting surface of the tumor lesion is gray or light brown. The tumor lesion is usu- ally homogeneous with micro focal hemor- rhage, but necrosis is rare and the border between the mass and surrounding tissue is clear, without an intact capsule. Microscopically: Multiple small and elongated branches arranged cord-likely tumor cells could be observed in lightly stained myxoid stroma and area of spindle cells could also be observed. PAS staining shows that the tubular was sur- rounded by the basilar membrane. The tumor cell is small with cubic or oval shape, less cyto- plasm that is transparent, pale and acidophi- lus. The nuclear grade of the tumor is usually low and size of nucleolus was low to medium. Necrosis is occasionally observed and foam cell infiltration and chronic inflammatory cell infiltration are common. Myxoid stroma stain- ing revealed acidic mucus with positive Alcian blue. Previous studies did report high nuclear grade MTSpCC [8, 9]. The main pathological characteristics were defined as enlarged nucle- us of tumor cells and obvious cell atypia. In addition, special MTSpCCs were also reported [10, 11]. However, the sarcomatoid area, such as fibrosarcoma-like, was observed besides the typical appearance of the tumor as described above. A large area of necrosis within the tumor lesion is common and tumor cell proliferation index is high. Cytokeratin CK7 and CK19, and Rcc could be expressed in both MTSpCC and renal cellcarcinoma. However CD10 is lowly expressed in MTSpCC, indicating that CD10 may be a useful marker to differentially diag- nose these tumors [12, 13]. iii) Electron micro- scopic examination shows epithelial differentia- tion of MTSpCC, but this technique has less application value compared to regular patho- logical examination. iv) Genetic test: FISH show losses on chromosomes 1 and 8, and gains of chromosomes 7 and 17 . A previous study  showed that high-grade mucinous tubular and spindlecellcarcinoma had a gain of chro- mosomes 1q, 7, 16, 19q, and Y, but loss of chromosomes 1p, 6p, 8p, 11q [del (11) (q23)], and 13. G-band karyotype showed gain of chro- mosomes 2, 3, 5, 7, 12, 16, and 20, but loss of chromosome 15. MTSpCC was defined by WHO Classification as a novel renal epithelial tumor; Figure 3. Electron microscopy. Microvilli were ob-
Spindlecellcarcinoma of head and neck, a subtype of squamous cellcarcinoma is a unique and rare neoplasm. It has a more aggressive behavior as compared to classical squomous cellcarcinoma warranting surgical interventions with wider surgical margins. Immunohistochemistry along with routine histopathology is essential in establishing the diag- nosis of spindlecellcarcinoma. We at Dr. B. Borooah Cancer Institute, Guwahati, a regional institute for treatment and research, hereby report 40 cases of such lesion with clinicopathological and immunohistochemical study. Out of total 40 cases included in the study group most of the cases were in the age group of 40 to 60 years. Commonest site of presen- tation was nasopharynx and buccal mucosa. 14 cases of the oral cavity (buccal mucosa, alveolus, oral tongue and hard palate) were treated with surgery. All the cases with disease of the larynx and hypopharynx were treated with radio- therapy and cases involving the nasopharynx received radiotherapy and chemotherapy. In the surgery group recurrence rate was found to be 71.4% and metastasis rate was 21.4%. Biopsy specimens were subjected to histopathological ex- amination followed by immunohistochemistry. Immunohistochemical analysis show concurrent presence of malignant epithelial and sarcomatoid spindlecell components by co-expression of cytokeratin (CK) and vimentin to various de- grees.
Mucinous tubular and spindlecellcarcinoma (MTSC) was first recognized as a specific entity in the World Health Organization 2004 classification. The “ classic ” tumor presentation includes an extracellular blue-gray mucinous/myxoid matrix accompanying the typical tubular and spindlecell epithelial components. Tubules are lined by cuboidal to columnar cells with bland nuclei, central small to medium sized nucleoli, and few to no mitoses. By expanding the histologic spectrum, a number of studies highlighted the distinction between MTSC and solid variant of papillary renal cellcarcinoma (sPRCC), although controversy still exists. Here, we evaluated two cases of MTSC and compared two cases of sPRCC by light microscopy, special staining, immunohistochemical staining and fluorescence in situ hybridization (FISH). We found that morphologic and immunophenotyping features showed more overlap between MTSC and sPRCC. In addition, gains of chromosomes 7 and 17 and loss of Y, which are characteristic of PRCC, were observed in two cases of sPRCC and one case of MTSC, suggesting that MTSC is similar to sPRCC or may be a subtype of PRCC.
Abstract: Mucinous tubular and spindlecellcarcinoma (MTSCC) is a rare and recently recognized subtype of renal cellcarcinoma (RCC). Apart from the classic morphology comprising conventional three components, there exist a large number of non-classic morphological variants of MTSCC, which make it necessity to differentiate from other RCC. Herein, we report two non-classic morphological variants of MTSCC. Case 1, a 85 years old man, showed numerous vacuoles among inherent components and cytoplasmic pallor/clearing within tubules mimicking con- ventional clear cell RCC with a 8.5 years follow-up, while Case 2 indicated a “mucin-poor” MTSCC associated with simultaneous conventional clear cell RCC at her age of 73 years. Until now Case 1 carries the longest disease-free survival reported in literature since MTSCC was defined and ranks the oldest since reported in literature, while Case 2 is the first report of “mucin-poor” MTSCC associated with simultaneous conventional clear cell RCC. Now, since no biomarkers or imagining tools but pathological examination can confirm the diagnosis of MTSCC, the management is always following the guideline of RCC in clinical practice. Generally, most reports consider it as a good prognosis disease, but sarcomatoid variant, even classic subtype can progress rapidly to life-threatening disease.
Abstract: Mucinous tubular and spindlecellcarcinoma of the kidney (MTSCC-K) is an unusual renal tumor. It is im- portant to increase the recognition of the clinicopathological features of MTSCC-K and improve its clinical and differ- ential diagnosis. This report described four cases of MTSCC-K with clinical, imaging, and pathological examination and showed that the tumor boundaries of MTSCC-K were clear, and tumor cells arranged into tubules and cord-like beams, between which was lightly stained myxoid stroma. The tumor cells were smaller and cube- or oval-shaped, with single small eosinophilic nucleoli, low-grade nuclei, and little nuclear fission. The myxoid stroma was scattered around lymphocytes and plasma cells. Immunohistochemical markers including CK7, CD117, EMA (epithelial mem- brane antigen), vimentin, and CK8/18, showed positive expression in tumor cells, but the tumor cells were negative for CD10 and villin. The proliferation index of Ki-67 was 5-10%. Since MTSCC-K is a rare low-grade malignancy, with unique histological and immunohistochemical characteristics, it is important for clinicians and pathologists to have a defined awareness of this tumor type in order to decrease the rate of misdiagnosis.
revealed papillary growth of mucin- secreting lining cells in the inner surface of the main cystic lesion. The cells occasionally invaded the superficial part of the cyst wall (Figure 3a) and associated mild cytological atypia was observed. However, no aggressively deep invasion of the cells was observed in the cyst wall. These features were categorized as a mucinous cystic tumor of border- line malignancy. On the other hand, the thickening of the cyst wall mainly consisted of monotonously prolifer- ating mononuclear spindle cells with severe nuclear aty- pia (Figure 3b). The mitotic index on average was about 4/10 high power fields (x 400). Relatively hypervascular stroma associated with endothelial proliferation was present at the periphery, at which the spindle cells dif- fusely invaded. There was no transition zone between the mucin-secreting lining cells and the spindle cells. Consequently, a so-called ‘collision tumor’ like appear- ance was observed. From these findings, we diagnosed the thickening as a mural nodule. Immunohistochemi- cally, the mucin-secreting lining cells of the inner sur- face showed positive stainability for CA19-9 and some epithelial markers such as keratin AE1&3 and keratin CAM5.2 (Figure 4). However, the spindle cells showed positive stainability for keratin AE1&3 and were negative for CA19-9 and keratin CAM5.2 (Figure 4). Both cells showed negative staining for Inhibinα, Estrogen receptor, Progesterone receptor, CD10, Calretinin, Smooth muscle actin and S-100. The Ki-67 index of the spindle cells was about 40%. Based on these data, the spindle cells, the major components of the mural nodule, were character- ized as an anaplastic spindlecellcarcinoma. We then determined the final pathological diagnosis of ovarian
A 55 year-old male patient with relapsing dyspnoe and five pneumonias within the last four years was referred to our ENT hospital with progressive dyspnoe and dyspho- nia for five months. The patient was a smoker with 30 pack years, no alcohol abuse. He did not show any other systemic symptoms. Flexible transnasal laryngoscopy showed a laryngeal mass without visible glottis. Subse- quently, microlaryngoscopy with laser resection of the ulcerated tumor (diameter 3 cm) was performed. The tumor originated from the right vocal fold. Histologically, a spindlecellcarcinoma (SPC) was diagnosed. In a second surgery no remnants were found. The cervical lymph nodes were unsuspicious in ultrasound and computerto- mographic investigation. Therefore, neck dissection was not carried out. The patient is free of disease seven months after surgery.
Results: Histologically, the cancer cells were composed of spindle cells and epithelial cells which form nests with prominent keratinization. Histological findings showed typical histology of the SpCC, however, as an uncommon finding, spatters of calcified, bone-like materials were observed in between the cancer cells. Immunohistochemistry revealed that cancer cells were positive for cytokeratins and vimentin to a varying degree and negative for Desmin, S-100, Osteopontin, BMP- 2 or BMP-4. These findings implied that the calcified materials were formed by metaplasia of the stromal cells.
Spindlecellcarcinoma (SpCC) or sarcomatoid carcinoma is a highly malignant variant of squamous cellcarcinoma which comprises 2% to 3% of all laryngeal cancers. It is considered to be a biphasic tumor that is composed of a squamous cellcarcinoma (in situ or invasive) and spindlecellcarcinoma with sarcomatous appearance. Most spindlecell 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 spindlecellcarcinoma 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.
effects of VEGF binding and subsequent VEGFR-2 auto-phosphorylation. In addition, Apatinib-mediated VEGFR-2 inhibition also appears to inhibit downstream phosphorylated extracellular signal-regulated kinase. Through this inhibition, Apatinib plays antiangiogenic and antitumor roles . Apatinib has been recommended as third-line treatment for metastatic gastric cancer patients, showed improved progression-free survival (PFS) and overall survival (OS) in pretreated patients with metastatic gastric cancer who had experienced treatment failure with two or more chemotherapy regimens . Moreover, the drug is currently being tested in patients with breast or lung cancers . In this study, we aim to present our initial clinical experience with Apatinib for an advanced spindlecellcarcinoma patient who experienced chemotherapy failure and describe its potential benefits and toxicity profiles (Hematological and non-hematological).
To our knowledge, this study is only the second to investigate CD10 and p63 expression in cutaneous SCSCCs. Our results show that p63 is a useful adjunct to the immunohisto- chemical evaluation of cutaneous spindlecell lesions, and in particular, the combination of p63 with a cytokeratin will distinguish SCSCCs from AFXs in the vast majority of cases. We also found that although CD10 is positive in the majority AFXs, it is not uncommonly positive in SCSCCs and can show a similar pattern of CD10 expression. Therefore the usefulness of CD10 in this differential diagnosis is limited.
logic appearance varies but usually includes an element of myofibroblast and fibroblast spindle cells, a colla- genous or myxoid matrix, and inflammatory cells consisting of plasma cells, lymphocytes, and eosinophils, which may mimic both sarcomas and spindle-cell carcinomas. The reported mitotic index ranges from 0 to 20 mitoses/10 high-power fields with most IMTs having a mitotic count of less than 5. Necrosis is usually quite rare to absent .
Spindlecell lipoma is an histological type of lipoma which are rarely found in the oral cavity. We describe two cases of intraoral spindlecell lipomas. The pa- tients were men and presented painless slow growing masses in the left cheek and hard palate, measuring 50 × 30 mm and 23 × 20 mm respectively. Microsco- pically, both lesions presented a solid proliferation of mature fat cells intermixed with bundles of connec- tive tissue. Cells were immunopositive for S100 pro- tein and CD34 (one case), with low mitotic activity (Ki-67). The final diagnosis was spindlecell lipomas. The lesions were excised and no recurrence was no- ticed after six months. Oral spindlecell lipomas are unexpected to occur in the oral mucosa, and the main differential diagnosis is well-differentiated liposar- coma/atypical lipoma. Lesions are treated with sur- gical excision and recurrences are rare.