Differential diagnosis

LOS must be distinguished from spindle cell carcinoma (SPCC) with heterologous osteoid production, since the spindle cell component of the latter tumour may be highly pleomorphic and focally produce osteoid {1604}. In contrast to LOS, SPCC is characterized by either 1) a concomitant squamous abnormality (dysplasia, carcinoma in-situ, or invasive SCC) or 2) evidence of epithelial differentiation in spindle cells. In addition, the malignant spindle cells of SPCC usually abut the overlying mucosa or merge with its basal layer in a feathering pattern, without the presence of a Grenz zone.

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