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Clinicopathologic features and outcome of head and neck mucosal spindle cell squamous cell carcinoma

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Abstract

Spindle cell squamous cell carcinoma (SpC-SCC) is rare, accounting for 0.4–4% of head and neck (HN) SCCs. Better understanding of HN SpC-SCC clinicopathologic characteristics, especially features that predict outcome, is needed. We present a clinicopathologic review of 71 HN mucosal SpC-SCC from three tertiary centers. The patient population showed a median age of 63 years (range 20–91), slight male predominance (M:F = 1.6:1), and a preponderance of smokers/ex-smokers (45/71, 64%). Most lesions involved oral cavity (42/71, 59%), especially oral tongue (n = 18), and larynx (n = 20, 28%). Polypoid/exophytic growth and surface ulceration were seen in 60% and 86% of cases, respectively. Histologically, most tumors showed sarcoma-like pattern (65/70, 93%), the remaining exhibiting granulation tissue-like or fibromatosis-like patterns, and 5 lesions showed osteosarcomatous/chondrosarcomatous elements. Most tumors (53/71, 74%) showed a conventional SCC (C-SCC) component, keratinizing (86%) or non-keratinizing/basaloid (14%). Nodal metastases, seen in 22 (31%) of resection specimens, showed SpC-SCC and/or C-SCC histomorphology. By immunohistochemistry, 76% of lesions showed immunoreactivity for keratin and 62/60% of lesions were p40/p63 positive. Ki-67 proliferation index ranged from 5 to 70%. Follow-up was available on 69 patients, median of 1.1 years from the time of SpC-SCC diagnosis. The 3-, 5-, and 10-year disease-specific survival (DSS) was 62, 37, and 12%, respectively. AJCC pN stage was an independent prognostic factor for DSS and distant metastasis-free survival (DMFS), whereas the presence of C-SCC was independently associated with improved DMFS. HN SpC-SCC is rare and might be diagnostically challenging. AJCC pN stage and co-existing C-SCC component appear to be prognostically relevant.

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Funding

Research reported in this publication was supported in part by the Cancer Center Support Grant of the National Institutes of Health/National Cancer Institute under award number P30CA008748. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Pathology, University of Alabama At Birmingham, Birmingham, AL, USA

    Carlos N. Prieto-Granada & Todd M. Stevens

  2. Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Bin Xu, Bayan Alzumaili, Mohamed Rizwan Haroon Al Rasheed, Snjezana Dogan, Ronald Ghossein & Nora Katabi

  3. Department of Otolaryngology–Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Antoine Eskander & Danny Enepekides

  4. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Snehal G. Patel

Authors
  1. Carlos N. Prieto-Granada
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  2. Bin Xu
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  11. Nora Katabi
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Contributions

Carlos N Prieto-Granada: reviewing cases and drafting manuscript. Bin Xu: reviewing data, managing database. Bayan Alzumaili: editing manuscript. Mohamed Rizwan Haroon Al Rasheed: editing manuscript. Antoine Eskander: editing manuscript. Danny Enepekides: editing manuscript. Snehal G. Patel: editing manuscript. Todd M Stevens: editing manuscript. Snjezana Dogan: editing manuscript. Ronald Ghossein: reviewing cases, editing manuscript. Nora Katabi: designing study, reviewing cases, and editing manuscript.

Corresponding author

Correspondence to Nora Katabi.

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All procedures performed in this retrospective study involving human participants were approved by the Institutional Review Board (IRB) in our institution. The research did not involve animals.

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The authors declare no competing interests.

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Carlos N Prieto-Granada and Bin Xu are Co-first author

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Prieto-Granada, C.N., Xu, B., Alzumaili, B. et al. Clinicopathologic features and outcome of head and neck mucosal spindle cell squamous cell carcinoma. Virchows Arch 479, 729–739 (2021). https://doi.org/10.1007/s00428-021-03117-2

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  • DOI: https://doi.org/10.1007/s00428-021-03117-2

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