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Case 402 - Discussion

Uploaded: 2010-07-27, Updated: 2010-07-27

 

Spindle Cell Squamous Cell Carcinoma

  • Commonly seen on the head/neck area of elderly patients. Tumor often consists of infiltrative spindle cells that mimic spindle cell melanoma, atypical fibroxanthoma or leomyosarcoma. A very important hint is that the spindle cells may continue with the dysplastic epidermis.

  • IPX: CK5/6+, but may be negative

  • DDX:

    • Spindle cell melanoma has to be ruled out. Tumor cells may show deep dermal infiltration with formation of vague fibrotic nodules and lymphocytic aggregation. Perineural invasion in common. S100+, other malanoma markers not very helpful.

    • Leiomyosarcoma: more broad, pink cytoplasm, blunt nuclei with perinuclear clearing, SMA+

    • Atypical fibroxanthoma: CD68+, S100-, CK-