Pathologic Features

Macroscopically, SpCCs are usually exophytic polypoid or pedunculated tumours, with frequent surface ulceration. Less often, SpCCs manifest as sessile, endophytic or ulcero-infiltrative tumours [31, 356].

Microscopically, SpCCs consist of a SCC component and a spindle cell component. The former is represented by in situ carcinoma or by an invasive SCC, and is often small, requiring multiple sections for demonstration (Fig. 1.14a) [210].

The spindle cell component usually forms the bulk of the tumour. Spindle cells are often pleomorphic, with large hyperchromatic nuclei, prominent nucleoli, and numerous mitoses (Fig. 1.14b). They are arranged in fascicles or whorls and can assume many histologic patterns, the most common being that of a malignant fibrous histiocytoma or fibrosarcoma [213, 356]. Foci of

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