Prognosis and predictive factors

Favourable prognostic features are: low-stage, polypoid rather than endophytic growth, a glottic site of origin, relatively shallow depth of sarcomatoid process, and absence of prior radiation {172}. Although controversial, limited immunoreactivity for polyclonal cytoker-atin has been associated with significantly improved survival rates {1944,2604}. The reported 5-year survival is between 65 and 95% {168,2604}.

Fig. 3.21 Spindle cell carcinoma. A The ulcerated surface is subtended by a highly pleomorphic spindle cell population with atypical mitotic figures. B Transition between squamous cell carcinoma and spindle cell component. C Pure spindle cell component with marked cellular atypia mimicking a leiomyosarcoma. D Spindle cell component surrounding small nests of squamous cells mimicking synovial sarcoma.

Fig. 3.21 Spindle cell carcinoma. A The ulcerated surface is subtended by a highly pleomorphic spindle cell population with atypical mitotic figures. B Transition between squamous cell carcinoma and spindle cell component. C Pure spindle cell component with marked cellular atypia mimicking a leiomyosarcoma. D Spindle cell component surrounding small nests of squamous cells mimicking synovial sarcoma.

Fig. 3.22 Spindle cell carcinoma. A The surface epithelium blends imperceptibly with the spindle cell component. B Abrupt areas of squamous differentiation within a spindle cell carcinoma. C Metaplastic cartilage, including malignant transformation (left) and metaplastic osteoid, including malignant transformation (right) can be seen in spindle cell carcinoma. D Strong and diffuse immunoreactivity for keratin is seen in a majority of spindle cell carcinomas.

Fig. 3.22 Spindle cell carcinoma. A The surface epithelium blends imperceptibly with the spindle cell component. B Abrupt areas of squamous differentiation within a spindle cell carcinoma. C Metaplastic cartilage, including malignant transformation (left) and metaplastic osteoid, including malignant transformation (right) can be seen in spindle cell carcinoma. D Strong and diffuse immunoreactivity for keratin is seen in a majority of spindle cell carcinomas.

A. Cardesa N. Zidar L. Alos

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