SPINDLE CELL CARCINOMA OF LARYNX- A DISTINCT CLINICOPATHOLOGICAL AND HISTOLOGICAL ENTITY
Spindle cell carcinoma (SpCC) is a variant of squamous cell carcinoma with biphasic components and more aggressive behaviour. Its rarity and histopathological pattern pose a diagnostic challenge. Early diagnosis and treatment result in a decrease in local and distant metastasis. Case 1 is a 71-year-old female presented with hoarseness of voice and dyspnoea for 2 years without any risk factors. Fibre-optic laryngoscopy (FOL) revealed smooth polyp hanging from anterior two-third of the left vocal cord. Microlaryngoscopic excision revealed SpCC followed by post-operative radiotherapy and is currently
alive. Case 2 is a 72-year-old male presented with worsening stridor for 2 years post-excision of laryngeal nodule and history of smoking and hookah use for >20 years. He developed dysphonia after a few months with fixed hard level 3 nodes at the right side. FOL showed a polypoid mass extending from the left vocal cord into the supraglottis. Fine-needle aspiration cytology of the neck swelling confirmed the diagnosis of SpCC. Computerised tomography (CT) chest/abdomen showed distant metastasis. Palliative radiotherapy was given, but the patient died after 3 months due to locoregional failure. Case 3 is a 35-year-old male presented with a history of hoarseness for 3 years with no risk factors. FOL showed a 1.2-cm polypoid growth on the right vocal cord. Total laryngectomy was performed and histopathology showed SpCC. Radiotherapy was given and the patient is alive without disease with regular follow-ups. Smoking and alcohol are thought to be the contributing factors causing this disease. Biphasic nature of the tumour requires pathological sampling for diagnostic confirmation. Surgery combined with radiotherapy has a better survival outcome. SpCC is a rare tumour with a tendency for locoregional
recurrence. Surgery should remain the mainstay of treatment followed by post-operative radiotherapy for a better control.
Key words: Larynx, radiotherapy, spindle cell carcinoma
Völker HU, Scheich M, Höller S, et al. Differential diagnosis of laryngeal spindle cell carcinoma and inflammatory myofibroblastic tumor report of two cases with similar morphology. Diagn Pathol 2007;2:1.
Anderson CE, Al-Nafussi A. Spindle cell lesions of the head and neck: An overview and diagnostic approach. Diagn Histopathol 2009;15:264-72.
Thompson LD. Squamous cell carcinoma variants of the head and neck. Curr Diagn Pathol 2003;9:384-96.
Zarbo RJ, Crissman JD, Venkat H, et al. Spindle-cell carcinoma of the upper aerodigestive tract mucosa. An immunohistologic and ultrastructural study of 18 biphasic tumors and comparison with seven monophasic spindle-cell tumors. Am J Surg Pathol 1986;10:741-53.
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;26:153-70.
Lewis JE, Olsen KD, Sebo TJ. Spindle cell carcinoma of the larynx: Review of 26 cases including DNA content and immunohistochemistry. Hum Pathol 1997;28:664-73.
Lambert PR, Ward PH, Berci G. Pseudosarcoma of the larynx: A comprehensive analysis. Arch Otolaryngol 1980;106:700-8.
Miyahara H, Tsuruta Y, Yane K, et al. Spindle cell carcinoma of the larynx. Auris Nasus Larynx 2004;31:177-82.
National Cancer Institute. Cancer Facts. Head and Neck Cancer: Questions and Answers; 2012. Available from: https//www.cancer.gov/types/head-and-neck/head-and-factsheet.
[Last accessed on 2017 May 01].
Anand P, Kunnumakkara AB, Sundaram C, et al. Cancer is a preventable disease that requires major lifestyle changes. Pharm Res 2008;25:2097-116.
Aggarwal BB, Vijayalekshmi RV, Sung B. Targeting inflammatory pathways for prevention and therapy of cancer: Short-term friend, long-term foe. Clin Cancer Res 2009;15:425-30.
Luna-Ortiz K, Mosqueda-Taylor A. Supracricoid partial laryngectomy as a primary treatment for carcinosarcoma of the larynx. Ear Nose Throat J 2006;85:337-41.
Stomeo F, Rocca PC, Bozzo C, et al. Laryngeal true malignant mixed tumor. Head Neck 2009;31:556-60.
Ianniello F, Ferri E, Armato E, et al. Carcinosarcoma of the larynx: Immunohistochemical study, clinical considerations, therapeutic strategies. Acta Otorhinolaryngol Ital 2001;21:192-7.
Marioni G, Bottin R, Staffieri A, et al. Spindle-cell tumours of the larynx: Diagnostic pitfalls. A case report and review of the literature. Acta Otolaryngol 2003;123:86-90.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Authors retain copyright and grant the Journal of Cancer & Allied Specialties (JCAS) right-of-first publication. In addition, the work will be simultaneously licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International license. This license allows others to share the work in whole or part (for non-commercial purpose), with an acknowledgement of the work’s authorship and initial publication in JCAS.
Furthermore, authors are free to enter into separate contractual arrangements for the non-exclusive distribution of the journal’s published version of the work, with an acknowledgement of its initial publication in this journal.
Authors are permitted and encouraged to share their work online or in medical or scientific conferences prior to or during submission process.