Stromal Reaction

Fig. 1.14. Spindle cell carcinoma. a Squamous cell carcinoma in component: pleomorphic cells with large hyperchromatic nuclei. c association with pleomorphic spindle cells. b Pure spindle cell Positive staining for cytokeratin in spindle cells

Additional important prognostic features are: localisation and depth of the tumour [74, 77, 130, 233, 246], presence of extracapsular spread in lymph node metastases [85, 109, 155, 335], and pattern of tumour growth at the invasive front [57, 58, 76, 382].

The prognostic value of some other parameters, i.e. differentiation of the tumour [166, 280, 376] and DNA ploidy [23, 98, 350, 378], is controversial.

The treatment of choice is complete excision of the tumour. For small tumours at some locations, such as the glottic larynx, the primary treatment is radiation. In large tumours, surgery is usually followed by radiotherapy. Patients with advanced, unresectable tumours, with or without metastases, are treated by concurrent chemotherapy and radiotherapy [117].


Spindle cell carcinoma (SpCC) is a biphasic tumour composed of conventional SCC and a malignant spindle cell component. Synonyms for SpCC are sarcomatoid carcinoma, carcinosarcoma, collision tumour and pseu-dosarcoma.

It has been described in various sites of the body including the upper and lower respiratory tract, breast, skin, urogenital and gastrointestinal tracts, and salivary glands [31]. In the head and neck, SpCC occurs most frequently in the larynx [36, 108, 213, 356] and oral cavity [13, 96, 304], followed by the skin, tonsils, sinonasal tract and the pharynx [13, 375].

The histogenesis of this tumour is controversial, but there is mounting evidence that SpCC is a monoclonal neoplasm originating from a non-committed stem cell giving rise to both epithelial and mesenchymal components [66, 354].

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