Myocardial metastasis from ZEB1-and TWIST-positive spindle cell carcinoma of the esophagus:A case report

BACKGROUND Metastatic cardiac tumors are known to occur more frequently than primary cardiac tumors,however,they often remain asymptomatic and are commonly dis-covered on autopsy.Malignant tumors with a relatively high frequency of cardiac metastasis include mesothelioma,melanoma,lung cancer,and breast cancer,whereas reports of esophageal cancer with cardiac metastasis are rare.CASE SUMMARY The case of a 60-year-old man who complained of dysphagia is presented.Upper gastrointestinal endoscopy showed a submucosal tumor-like elevated lesion in the esophagus causing stenosis.Contrast-enhanced computed tomography showed left atrial compression due to the esophageal tumor,multiple liver and lung metastases,and a left pleural effusion.Pathological examination of a biopsy speci-men from the esophageal tumor showed spindle-shaped cells,raising suspicion of esophageal sarcoma.The disease progressed rapidly,and systemic chemotherapy was deemed necessary,however,due to his poor general condition,adminis-tration of cytotoxic agents was considered difficult.Given his high Combined Positive Score,nivolumab was administered,however,the patient soon died from the disease.The autopsy confirmed spindle cell carcinoma(SCC)of the esophagus and cardiac metastasis with similar histological features.Cancer stem cell markers,ZEB1 and TWIST,were positive in both the primary tumor and the cardiac metastasis.CONCLUSION To the best of our knowledge,there have been no prior reports of cardiac metastasis of esophageal SCC.This case highlights our experience with a patient with esophageal SCC who progressed rapidly and died from the disease,with the autopsy examination showing cardiac metastasis.

Spindle cell carcinoma of the breast as complex cystic lesion: a case report

Spindle cell carcinoma of the breast is a rare tumor. This tumor can proliferate rapidly and cause cystic changes because of internal tissue necrosis. We evaluated a 54-year-old woman with right breast lump. Mammography showed a category four mass with a diameter of 2.5 cm. Ultrasonography(US) revealed a complex cystic lesion, and fine-needle aspiration(FNA) cytology demonstrated bloody fluid and malignant cells. Partial breast resection and sentinel lymph node biopsy were performed. Immunohistology revealed spindle cells with positive results for cytokeratin(AE1/AE3) and vimentin, partially positive results for s-100, and negative results for desmin and α-actin. The pathological stage was IIA, and biochemical characterization showed that the tumor was triple negative. Six courses of FEC-100 chemotherapy(5-fluorouracil 500 mg/m2, epirubicin 100 mg/m2, and cyclophosphamide 500 mg/m2) were administered. Radiotherapy was performed. This case is discussed with reference to the literature.

Spindle Cell Carcinoma of the Head and Neck: A Clinicopathological and Immunohistochemical Study of 40 Cases

Spindle cell carcinoma of head and neck, a subtype of squamous cell carcinoma is a unique and rare neoplasm. It has a more aggressive behavior as compared to classical squomous cell carcinoma warranting surgical interventions with wider surgical margins. Immunohistochemistry along with routine histopathology is essential in establishing the diagnosis of spindle cell carcinoma. We at Dr. B. Borooah Cancer Institute, Guwahati, a regional institute for treatment and research, hereby report 40 cases of such lesion with clinicopathological and immunohistochemical study. Out of total 40 cases included in the study group most of the cases were in the age group of 40 to 60 years. Commonest site of presentation was nasopharynx and buccal mucosa. 14 cases of the oral cavity (buccal mucosa, alveolus, oral tongue and hard palate) were treated with surgery. All the cases with disease of the larynx and hypopharynx were treated with radiotherapy and cases involving the nasopharynx received radiotherapy and chemotherapy. In the surgery group recurrence rate was found to be 71.4% and metastasis rate was 21.4%. Biopsy specimens were subjected to histopathological examination followed by immunohistochemistry. Immunohistochemical analysis show concurrent presence of malignant epithelial and sarcomatoid spindle cell components by co-expression of cytokeratin (CK) and vimentin to various degrees.

Spindle cell carcinoma of the mandible:a case report

Spindle cell carcinoma is a rare highly malignant squamous cell carcinoma.Here,we describe a case of a 74-yearold Chinese female who presented with a 2-week history of pain and swelling in the left retromolar region.Surgical resection and titanium plate prosthesis were performed and histological analysis revealed spindle squamous cell carcinoma.

Spindle Cell Carcinoma of the Maxilla: A Case Report of Rare Entity

Spindle cell carcinoma also known as sarcomatoid carcinoma is a rare highly aggressive tumor which is histologically different from squamous cell ca and mesenchymal cancers. Only hands full of cases have been reported in literature since 1957 and hence no proper treatment protocol has been devised yet. We present such a case of thirty-four-year-old female who presented with spindle cell carcinoma of the maxilla at our department and was treated with extensive surgery followed by chemotherapy and radiation therapy. Spindle cell carcinoma is generally associated with poor prognosis and hence literature supports use of post operative Chemo and Radiotherapy for better result and decrease chance of local recurrence.

Lung carcinoma with spindle and/or giant cell： a clinicopathological analysis of 17 cases

Objective： Lung carcinoma with spindle and （or） giant cell （LCSG） is a rare epithelial malignant tumor. The aim of our study is to investigate the clinicopathological and prognostic characteristics of 17 cases of LCSGs. Methods： Among 421 patients underwent resection of lung carcinomas, 17 cases of LCSG were studied for clinical, gross and histological parameters. Follow-up information was obtained and analyzed to clarify prognostically significant parameters. Results： The LCSG patients consisted of 15 males and 2 females, with the age ranging from 45 to 78 years （median, 58 years）; 5 cases of stage Ⅰ, 3 of stage Ⅱ, 9 of stage Ⅲ by pathological TNM staging; 2 cases of exclusively spindle cell carcinoma, 5 cases of lung carcinoma with spindle cell, 10 cases of lung carcinoma with giant-cell carcinoma. Cough, chest distress, or chest pain were the most common presenting symptoms, occurring in 15 patients （88.2%）. Of 5 patients in stage Ⅰ, 4 were alive and free of relapse for more than 5 years. The difference in survival was statistically significant between LCSG and squamous cell carcinoma patients （median survival, 36 vs. 61 months; P = 0.027）. Lymph node metastasis and carcinoma with giant cell were the hazardous factors impacting postoperative prognosis of LCSG patients. Conclusion： LCSG patients in early stage may have an optimistic outcome. Lung carcinomas with giant cell displayed multiple cell components in histopathology, and poor outcome due to more lymph node involved.

Undifferentiated Pleomorphic Sarcoma of the Cheek with Surface Ulceration: Mimicking Spindle Cell Squamous Cell Carcinoma

Undifferentiated pleomorphic sarcoma (UPS), also called malignant fibrous histiocytoma (MFH), belongs to the soft tissue tumors and is more likely in elder patients. UPS currently accounts for approximately 18% of cutaneous soft tissue sarcoma except Kaposi sarcoma. The most common sites are the extremities and head and neck. UPS is rapidly enlarging, and easily invades subcutaneous tissue and muscle without overlying skin changes. UPS tumors, which are confined to subcutaneous tissue, have been reported to be less than 10%. On the other hand, the involvement of the epidermis, occasionally with ulceration, is rare. Here, we describe a case of UPS of the cheek with surface ulceration. An 83-year-old man presented with a 1-year history of a red nodule on his left cheek. The size of the nodule gradually increased. Clinical examination revealed a 55 × 45 mm red, hard mass in the center of his left cheek with a large cratershaped ulcer involving the subcutaneous tissue. The bottom of the ulcer contained necrotic tissue. No cervical lymph nodes were palpable. A biopsy revealed a high-grade, pleomorphic spindle cell neoplasm and frequent abnormal mitotic figures within the dermis. We temporarily diagnosed and suspected a soft tissue sarcoma, but we could not rule out spindle cell squamous cell carcinoma (SCSCC). The patient underwent tumor resection and skin grafting. The tumor had reached the muscle layer of his left cheek with invasion and ulceration of the overlying skin. Histopathological examination of the totally resected tumor revealed a neoplasm of mesenchymal origin, rich in cells with morphology and immunohistochemical characteristics compatible with UPS. Malignant cells were not found in the epidermis. Immunohistochemical analyses were positive for vimentin, α-anti-trypsin, α-smooth muscle actin (α-SMA), and CD10, and negative for cytokeratins (CAM5.2 and AE1/AE3), lysozyme, epithelial membrane antigen (EMA), CD34, S-100, desmin, and caldesmon. Two months after total resection, the tumor recurred, and the patient was treated with radiation therapy. However, he died 2 months later from multiple lung metastases. We thought that the metastases were from the UPS, because his prostatic carcinoma had not progressed. According to published literatures, the UPS rarely accompanies with surface ulceration. On the other hand, SCC commonly occurs on sun-exposed sites of the head and neck with surface changes including scaling, ulceration, crusting, and the presence of a cutaneous horn. In our case, it was very difficult to distinguish UPS from SCSCC by clinical examination and conventional histopathological staining (e.g. hematoxylin and eosin). Therefore, the immunohistochemistry was required to obtain the final diagnosis.

High spindle and kinetochore-associated complex subunit-3 expression predicts poor prognosis and correlates with adverse immune infiltration in hepatocellular carcinoma

BACKGROUND Spindle and kinetochore-associated complex subunit 3(SKA3)is a malignancyassociated gene that plays a critical role in the regulation of chromosome separation and cell division.However,the molecular mechanism through which SKA3 regulates tumor cell proliferation in hepatocellular carcinoma(HCC)has not been fully elucidated.AIM To investigate the molecular mechanisms underlying the role of SKA3 in HCC.METHODS SKA3 expression,clinicopathological,and survival analyses were performed using multiple public database platforms,and the results were verified by Western blot and immunohistochemistry staining using collected clinical samples.Functional enrichment analyses were performed to evaluate the biological functions and molecular mechanisms of SKA3 in HCC.Furthermore,the Tumor Immune Estimation Resource and single-sample Gene Set Enrichment Analysis(ssGSEA)algorithms were utilized to investigate the abundance of tumor-infiltrating immune cells in HCC.The response to chemotherapeutic drugs was evaluated by the R package“pRRophetic”.RESULTS We found that upregulated SKA3 expression was significantly correlated with poor prognosis in patients with HCC.Multivariable Cox regression analysis indicated that SKA3 was an independent risk factor for survival.GSEA revealed that SKA3 expression may facilitate proliferation and migratory processes by regulating the cell cycle and DNA repair.Moreover,patients with high SKA3 expression had significantly decreased ratios of CD8+T cells,natural killer cells,and dendritic cells.Drug sensitivity analysis showed that the high SKA3 group was more sensitive to sorafenib,sunitinib,paclitaxel,doxorubicin,gemcitabine,and vx-680.CONCLUSION High SKA3 expression led to poor prognosis in patients with HCC by enhancing HCC proliferation and repressing immune cell infiltration surrounding HCC.SKA3 may be used as a biomarker for poor prognosis and as a therapeutic target in HCC.

Renal mucinous tubular and spindle cell carcinoma: two cases report and review of the literature

We reported the clinical and pathologic features of two different types of renal mucinous tubular and spindle cell carcinoma (MTSCC). The first patient was incidentally discovered by health examination, with lower nuclear grade, no part and distant metastasis. The second patient presented with persistence hyperpyrexia, part and distant metastasis, and high nuclear grade. Surgery were both performed successfully. The first patient had no recurrences and no distant metastases. The second patient died of multiple organ failure 3 months postoperatively. Although MTSCC is usually a low potential malignancy carcinoma, high malignancy may occur and lead to a fatal course. So it needs a proper management and prognostication.

Rental Mucinous Tubular and Spindle Cell Carcinoma:Case Report

Mucinous tubular and spindle cell carcinoma(MTSCC)of the kidney is an uncommon recently recognized renal cell carcinoma.We reported A 60 year's old man who presented with right flank pain,abdominal swelling and one attack of hematuria.The intraoperative finding was a huge cystic swelling arising from the right kidney occupying almost all the abdominal cavity displacing the bowel to the left side of the abdomen.There was no ascites or evidences of metastasis.Right radical nephrectomy was done.Then the diagnosis of renal MTSCC was established.General condition of the patient was improved and one year prognosis was satisfactory.To our knowledge this is the first reported case of MTSCC in Sudan,and the outcome of treatment was satisfactory.

Renal cell carcinoma: Evolving and emerging subtypes

Our knowledge of renal cell carcinoma(RCC) is rapidly expanding. For those who diagnose and treat RCC, it is important to understand the new developments. In recent years, many new renal tumors have been described and defined, and our understanding of the biology and clinical correlates of these tumors is changing. Evolving concepts in Xp11 translocation carcinoma, mucinous tubular and spindle cell carcinoma, multilocular cystic clear cell RCC, and carcinoma associated with neuroblastoma are addressed within this review. Tubulocystic carcinoma, thyroid-like follicular carcinoma of kidney, acquired cystic disease-associated RCC, and clear cell papillary RCC are also described. Finally, candidate entities, including RCC with t(6;11) translocation, hybrid oncocytoma/chromophobe RCC, hereditary leiomyomatosis and RCC syndrome, and renal angiomyoadenomatous tumor are reviewed. Knowledge of these new entities is important for diagnosis, treatment and subsequent prognosis. This review provides a targeted summary of new developments in RCC.

Spindle cell tumor of the lung: A rare case

Spindle cell carcinoma of the lung is a rare,aggressive lung malignancy(non-small cell carcinoma)with a poor prognosis.This tumor accounts for approximately 0.4%of all lung malignancies,and due to its rarity,standard therapy is yet to be established for its management and treatment.The prevalence of this tumor is more common in males as compared to females(ratio of 4:1)and usually occurs in the sixth/seventh decade of life,more so in smokers.The authors report a case of a 79-year-old male patient who was incidentally detected and diagnosed with this rare lung carcinoma proven with a lung biopsy.

Sarcomatoid carcinoma of the pancreas: A case report

BACKGROUND Sarcomatoid carcinoma of the pancreas(SCP) is a rare and aggressive epithelial tumor that has both epithelial and mesenchymal features. It is characterized by sarcomatous elements with evidence of epithelial differentiation. And the term"sarcomatoid carcinoma" is often confused with "carcinosarcoma".CASE SUMMARY We present a case of SCP with lymph node metastasis in a 59-year-old male patient. He had experienced darkening of the urine, scleral icterus, and fatigue for 4 weeks. Computed tomography and magnetic resonance imaging revealed a mass in the pancreatic head, and laboratory tests revealed elevated serum bilirubin levels. The patient underwent pancreaticoduodenectomy after biliary decompression. Histologically, spindle cells with marked nuclear atypia and brisk mitotic activity arranged in a storiform or fascicular pattern were present in the bulk of the tumor. Immunohistochemical analysis found that the spindle cells exhibited strong diffuse positivity for epithelial markers, indicative of epithelial differentiation. Accordingly, the pathologic diagnosis of the pancreatic neoplasm was SCP.CONCLUSION Although sarcomatoid carcinomas and carcinosarcomas have different pathologic features, both have epithelial origin.

Multiple carcinosarcomas of the esophagus with adenocarcinomatous components: A case report

BACKGROUND Carcinosarcoma(spindle cell carcinoma) of the esophagus is an extremely rare event;the etiology and origins of this neoplasm have not yet been determined.Epithelial-mesenchymal transition(EMT) has been associated with invasion and metastasis, and may be related to the generation of a stem cell population within this tumor.CASE SUMMARY We present the case of a 61-year-old male with nausea and fever. Upper gastrointestinal endoscopy revealed the presence of type 1 and 0-Ⅱc lesions located 35 cm from the incisors toward the esophago-gastric junction.Thoracoscopic esophagectomy was performed. Macroscopic analysis revealed three polypoid lesions in the abdominal esophagus that accompanied the main lesion in the lower thoracic esophagus and 0-Ⅱc lesions that spread continuously with them. Histologically, the lesions included proliferating spindle cells. Adenocarcinomatous components were detected in a section near the foot, and squamous cell carcinoma was identified in the mucosa at the base of the tumor.The patient was diagnosed with multiple carcinosarcomas, staged at pT1b(SM3),pN1(#110, #7), cM0, Stage Ⅱ(sarcomatous metastasis to the lymph nodes).Spindle cells did not express E-cadherin but were positive for EMT markers,including zinc finger E-box-binding homeobox 1, TWIST, and snail family transcriptional repressor 2. The patient has experienced no recurrence at 5 years and 2 mo after surgery.CONCLUSION This report suggests that multiple sarcomatous tumors may be generated from primary squamous cell carcinoma via mechanisms related to EMT.

Fibromatosis-like metaplastic carcinoma of the breast:Two case reports

BACKGROUND Fibromatosis-like metaplastic carcinoma is classified as a rare type of metaplastic carcinoma of the breast by the 2012 WHO pathological and genetic classification criteria for breast tumors,which takes hyperplastic spindle cells as the main component and is often misdiagnosed as benign stromal proliferative lesions or benign mesenchymal tumors of the breast because of its mild morphology.Here,we collected the clinical data of 2 cases of fibromatosis-like metaplastic carcinoma of the breast and performed pathomorphological observation and immunohistochemical staining of the surgically resected specimens.According to the clinical features,imaging features,immunophenotype,diagnosis and differential diagnosis of 2 cases of fibromatosis-like metaplastic carcinoma of the breast,it was further differentiated.CASE SUMMARY Case 1:A 56-year-old postmenopausal female was admitted due to"right breast mass for over 1 year and local ulceration for over 1 mo".Physical examination showed a mass with a diameter of 4.5 cm×5.5 cm palpable at 2.5 cm from the nipple at 1 o'clock in the right breast.The skin on the surface of the mass ruptured about 3 cm,with a small amount of exudation and bleeding,less clear boundary,hard texture,fair activity,without obvious tenderness.No obvious abnormality was palpable in the left breast.No enlarged lymph nodes were palpable in the bilateral axillae and bilateral supraclavicular region.After removing the mass tissue,it was promptly sent to the pathology department for examination.Case 2:Female,52-years-old,premenopausal,admitted due to"right breast mass for more than 3 mo".Physical examination showed a 4.0 cm×4.0 cm diameter mass palpable at 2.0 cm of the nipple in the lower outer 7 o'clock direction of the right breast,with less clear boundary,hard texture,fair activity,no significant tenderness,no palpable significant abnormalities in the left breast,and no palpable enlarged lymph nodes in the bilateral axillae and bilateral supraclavicular region.The mass was resected and sent for pathological examination.Postoperative pathological examination revealed fibromatosis-like metaplastic carcinoma of the breast in both patient 1 and patient 2.No systemic therapy and local radiotherapy were performed after surgery,and no tumor recurrence or metastasis was observed.CONCLUSION Fibromatosis-like metaplastic carcinoma of the breast is a rare subtype of metaplastic carcinoma that is often misdiagnosed,and the diagnosis relies on medical history collection,complete sampling,and full use of immunohistochemical assessment.The risk of lymph node and distant metastasis is low,and the current treatment is based on complete surgical resection.The efficacy of systemic radiotherapy and chemotherapy is not clear.

Papillary thyroid carcinoma with nodular fasciitis-like stroma-an unusual variant with distinctive histopathology:A case report

BACKGROUND Papillary thyroid carcinoma(PTC)is regarded as a fairly common endocrine malignancy,which can be divided into different multiple variants due to wide morphologic differences.The majority of PTC variants have been reported,but PTC with nodular fasciitis-like stroma(NFS)is a rare pathological variant and has been infrequently reported in the relevant literature.This condition involves abundant reactive stromal components rich in spindle cells,which may account for 60%-80%of the tumor along with a typical papillary carcinoma.CASE SUMMARY A 44-year-old man presented with a 4-mo history of a palpable mass over the anterior aspect of the left neck,the tumor demonstrated gradual enlargement but was painless during the 4 mo prior to discovery.Thyroid function test results were normal.Physical examination showed an enormous and firm nodular mass in the left lobe of the thyroid gland extending to the level of the hyoid bone.Ultrasonography of the neck revealed a well-defined heterogeneous lesion measuring around 5.0 cm×4.0 cm with a hypoechoic complex nodule,decreased vascularity and speckles of microcalcification.The patient underwent left thyroidectomy with central compartment lymph node dissection.Final histopathological examination confirmed the diagnosis of PTC with extensive fibromatosis-like stroma combined with typical PTC.The patient was asymptomatic at the 3-mo follow-up.CONCLUSION PTC-NFS is a rare pathological variant and its diagnosis and prognosis may be similar to typical papillary carcinoma.

Clinical and CT imaging features of mucinous tubular and spindle cell carcinoma

Background There are relatively few reports focusing on clinical and multi-slice CT （MSCT） imaging findings of mucinous tubular and spindle cell carcinoma （MTSCC）.Our study aimed to characterize the clinical and MSCT imaging features of MTSCC.Methods The imaging findings in 17 patients with MTSCC by MSCT were retrospectively studied.MSCT was undertaken to investigate tumor location,size,density,cystic or solid appearance,calcification,capsule sign,enhancement pattern,and retroperitoneal lymph node metastasis.Results Tumors （mean diameter,（3.9±1.7） cm） were solitary （17/17）,solid （16/17） with cystic components （5/17）,had no calcifications （14/17）,had a poorly defined margin （14/17）,were centered in the medulla （15/17）,compressed the renal pelvis （7/17）,and neither lymph node nor distant metastasis was found.The attenuation of MTSCC tumors was equal to that of the renal cortex or medulla on unenhanced CT （32.3±2.6,36.3±4.6,33.2±3.9,respectively,P ＞0.05）,while tumor enhancement after administration of a contrast agent was lower than that of normal renal cortex and medulla during all phases （P ＜0.05）.Conclusion MTSCC tends to be a solitary,isodense mass with poorly defined margin arising from the renal medulla with enhancement less than the cortex and medulla during all phases.

手术及靶向治疗肺梭形细胞癌合并腺癌1例

1例74岁男性周围型肺癌患者行左上肺楔形切除+纵隔淋巴结摘除术,术后诊断为pT1bN1M0 IIB期肺梭形细胞癌合并腺癌,基因检测显示EGFR外显子19缺失突变,经过EGFR-TKI靶向药物治疗后病情控制稳定。

肉瘤样癌的病理诊断与鉴别诊断研究

目的 观察肉瘤样癌 (SC)病理形态学特点及免疫组化表达 ,探讨SC的诊断与鉴别诊断。方法 对 2 6例不同部位的SC作了光镜观察及免疫组化染色 ,5例作了透射电镜观察。结果 2 6例SC中 15例双相 (明确的癌和肉瘤样成分 ) ,11例单相 (完全为肉瘤样成分 ) ,肉瘤样成分为梭形细胞及多形性细胞。免疫组织化学观察结果 ,2 6例SC的CK或Keratin在两种成分中均呈阳性表达。Vimentin对明确的癌成分阴性 ,而绝大部分肉瘤样细胞强阳性 ,但其阳性强度及阳性细胞数量有明显不同。CD68和HMB 45均阴性。 5例电镜下瘤细胞间可见不同发育程度的桥粒连接 ,其中 1例有张力原纤维丝。结论 SC的病理形态学是复杂的 ,应当与恶性纤维组织细胞瘤 (MFH)、恶性黑色素瘤、纤维肉瘤、平滑肌肉瘤等鉴别。免疫组化及电镜技术对SC的诊断与鉴别诊断是很有帮助的。

乳腺梭形细胞/肉瘤样化生性癌临床病理和免疫表型分析

目的探讨以梭形细胞/肉瘤样成分为主的乳腺化生性癌(metaplastic breast carcinoma with dominant spindle cell/sarcoma-toid component,MBCSC)的临床病理及免疫表型特点。方法复习15例MBCSC的临床病理资料,并对其中12例肿瘤进行免疫组化染色(抗体包括上皮标记、肌上皮标记和肿瘤标记物)。同时就腋淋巴结状态,ER、PR和Her2的表达与浸润性导管癌做简要比较。结果本组MBCSC患者平均年龄41岁,均因发现乳腺包块就诊。多数肿瘤呈界限清楚的结节状。镜下8例肿瘤完全由梭形/肉瘤样细胞构成,6例以梭形/肉瘤样细胞为主伴少量浸润性导管癌(invasive ductal carcinoma IDC)成分,1例伴少量导管原位癌。肿瘤显示中-高级别组织学改变。11/12例(91.7%)MBCSC的梭形细胞/肉瘤样成分至少表达一种上皮标记,全部病例均至少表达一种肌上皮标记。本组MBCSC的腋淋巴结转移率和ER、PR、Her2的表达均低于对照组。结论 MBCSC在独特的组织病理学基础上呈现出肌上皮分化,其生物学特性如腋淋巴结状态和肿瘤标记物的表达与浸润性导管癌有所不同,提示其可以作为独立的病理亚型。系列上皮和肌上皮标记的免疫组化染色有助于MBCSC的病理诊断。