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.

Managing spindle cell sarcoma with surgery and high-intensity focused ultrasound:A case report

BACKGROUND Undifferentiated pleomorphic sarcomas,also known as spindle cell sarcomas,are a relatively uncommon subtype of soft tissue sarcomas in clinical practice.CASE SUMMARY We present a case report of a 69-year-old female patient who was diagnosed with undifferentiated spindle cell soft tissue sarcoma on her left thigh.Surgical excision was initially performed,but the patient experienced a local recurrence following multiple surgeries and radioactive particle implantations.High-intensity focused ultrasound(HIFU)was subsequently administered,resulting in complete ablation of the sarcoma without any significant complications other than bone damage at the treated site.However,approximately four months later,the patient experienced a broken lesion at the original location.After further diagnostic workup,the patient underwent additional surgery and is currently stable with a good quality of life.CONCLUSION HIFU has shown positive outcomes in achieving local control of limb spindle cell sarcoma,making it an effective non-invasive treatment option.

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.

Type Ⅰ neurofibromatosis with spindle cell sarcoma: A case report

BACKGROUND Neurofibromatosis type Ⅰ(NF1) is the most frequent subtype of neurofibromatosis. Its related tumor-suppressor syndromes are characterized by a predisposition to multiple tumor types and other disorder presentations. In addition, the incidence of tumors is much higher in patients with neurofibromatosis type Ⅰ. However, there are very few reports at home and abroad on this topic. Here, we present a case of NF1 with spindle cell sarcoma.CASE SUMMARY A 50-year-old male was found to have a right axillary mass for 20 years.Specialist examination found cafe-au-lait spots on many parts of the skin,rounded nodules in the skin, a bulge in the right armpit, touching a lump(10 cm× 6 cm, hard, unclear boundary, poor mobility, local tenderness). The anterior side of the thigh felt weakened on the opposite side;in the right groin a swollen lymph node(hard, clear border, good mobility, local tenderness). According to the results of positron emission tomography/computed tomography, puncture pathology and immunohistochemistry, genetic testing, a diagnosis of NF1 with spindle cell sarcoma was confirmed. According to the genetic testing result, the patient was given a targeted treatment with crizotinib.CONCLUSION Surgery, chemotherapy and radiotherapy are the main treatment methods of NF1. However, with the continuous progress of molecular biology research,molecular targeted therapy may bring benefits for patients.

Large retroperitoneal atypical spindle cell lipomatous tumor,an extremely rare neoplasm:A case report

BACKGROUND Atypical spindle cell lipomatous tumor(ASLT)is a rare soft tissue neoplasm with a low potential for malignancy.ASLT frequently occurs in the limb and limb girdles.However,large retroperitoneal ASLTs are extremely rare.There was no concrete case report of retroperitoneal ASLTs.CASE SUMMARY An 18-year-old woman presented with abdominal pain and a palpable mass.Abdominal computed tomography revealed a large fatty mass that was approximately 30 cm in size and filled the entire abdominal cavity.Surgical excision was indicated.The tumor did not invade the adjacent organs.The pelvic cavity was then too narrow to dissect smoothly.The mass was successfully excised without tumor rupture or adjacent organ injury.Microscopically,the neoplasm was a well-differentiated adipocytic neoplasm.Immunohistochemical staining showed that the spindle cells were positive for CD34 and desmin,in addition to multifocal positivity for S100 protein.These histological features were consistent with an ASLT.The patient’s postoperative course was uneventful.At the 12-mo followup,no evidence of recurrence or metastasis was observed.CONCLUSION To the best of our knowledge,our study is the first concrete report of a large retroperitoneal ASLT in the English literature.In the large retroperitoneal ASLT located in the pelvic cavity,which made it too narrow and tight to dissect,complete excision is difficult but very important because of recurrence risk.Although large retroperitoneal ASLTs are considered extremely rare,their detection is important for accurate evaluation and management.Owing to their significant rarity,retrospective multicenter case studies are required to determine the clinicopathologic characteristics.

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.

Reed Nevus (Pigmented Spindle Cell Nevus) in an 11-Month-Old Japanese Infant

Reed nevus (pigmented spindle cell nevus) is a nevus with the histopathological features of abundant melanin, monomorphic spindle-epithelioid melanocytes, spindle cell nests confined within the epidermis and papillary dermis, and occasional upward interepidermal progression of melanocytes. Here, we reported an unusual case of Reed nevus in an 11-month-old Japanese male infant. Infantile Reed nevus should be included as a differential diagnosis for nevus pigmentosus in infancy.

A Giant Spindle Cell Lipoma of the Parotid-Masseter Lodge (A Case Report)

Background: The spindle cell lipoma is a rare benign tumor that originated from subcutaneous adipose tissue. It is a slow growing lesion and may become voluminous causing the patient an aesthetic disfigure. The diagnosis is made by the histological examination combined with immunohistochemical analysis. Radiological features present a variety of description because of the proportions difference of spindle cell lipoma components, but imaging is useful to determine the mass extents. The treatment of this kind of benign tumors is surgery which must be completed without need for other therapy. Aim: This case report highlights the exceptional location of spindle cell lipoma in the soft tissues of the parotid-masseter lodge, which may raise differential diagnosis problems with a primary parotid gland tumor. Case Presentation: A 58-year-old man, with no medical history, was presenting a swelling of the parotid region, growing progressively for 6 years, without other associated sign. The patient benefited from a careful physical examination. A computed tomography and magnetic resonance imaging were carried out. Clinical and radiological findings were suggesting a benign tumor occupying the left parotid-masseter lodge. The patient went through a surgical excision of the tumor. Histological and immunohistochemical features revealed a classic shape of spindle cell lipoma. After one year of follow-up, we notice a good recovery without local recurrence. Conclusion: Surgeons and pathologists have to keep in mind the possible development of spindle cell lipoma in any subcutaneous site even if unusual one.

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.

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.

Effect of Spindle Checkpoint on Akt2-mediated Paclitaxel-resistance in A2780 Ovarian Cancer Cells

Recent evidence has suggested that Akt2 plays an important role in the protection of cells from paclitaxel （PTX）-induced apoptosis and control of the cell cycle. In addition, some scholars suggested that the PTX sensitivity depends on a functional spindle assembly checkpoint. In the present study, we investigated the role of the Akt2/Bubl cross-talking in apoptosis and cell cycle after exposure of the A2780 ovarian cancer cells to paclitaxel （PTX）. Recombinant expression plasmid WT-Akt2 was transfected into A2780 cells by lipofectamine2000, and then the expression level of Akt2 gene was detected by using RT-PCR and Western blotting. Cell apoptosis and cell cycle were detected by flow cytometry and Hoechst 33342 staining after treatment with PTX. Moreover, we compared the expression level of Bubl in different groups by Western blotting. Our study showed that up-regulation of Akt2 contributed to A2780 ovarian cancer cells overriding PTX-induced G2/M arrest, and inhibited Bubl expression. Our findings might shed light on the molecular mechanism of PTX-induced resistance in ovarian cancer and help develop novel anti-neoplastic strategies.

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 Lipoma of the Oral Cavity: A Clinico-Pathologic Analysis of 35 Reported Cases

Spindle-cell lipoma (SCL) is a variant of lipoma, usually presenting in the neck or trunk. SCL of the oral cavity is rare. Some cases of oral SCL have been reported;however, the clinico-pathologic characteristics of oral SCL are still unknown. Here we report on 2 cases and review 33 cases of oral SCL published in the literature. The patients were 23 men and 12 women, with a mean age of 55 years (range 23 - 88 years);there were no children. Tumor sites included: tongue (n = 13), cheek/buccal mucosa (n = 11), floor of mouth (n = 5), lip (n = 2), hard palate (n = 2), alveolar ridge (n = 1), and maxilla (n = 1). The mean tumor size was 20.87 mm (range 3 - 50 mm), smaller than extra-oral lesions. Thirty-three patients (94%) presented with a single lesion that was circumscribed and composed of mature adipocytes admixed with bland spindle cells. The spindle cells were strongly immunoreactive for CD34, whereas the adipocytes were negative. The main differential diagnosis is atypical lipoma/well-differentiated liposarcoma. All lesions underwent local excision and recurrences are rare. Oral SCL do not seem to differ from their extra-oral counterpart, which are much more common and larger in size. SCL should be included in the differential diagnosis of oral cavity mesenchymal tumors.

Phosphorylated vasodilator-stimulated phosphoprotein is localized on mitotic spindles of the gastric cancer cell line SGC-7901

AIM: To elucidate the localization of vasodilator stimulated phosphoprotein (VASP), a cytoskeletal organizing protein and a substrate of protein kinases A and G in mitotic gastric cancer cells. METHODS: Immunofluorescence microscopy was used to observe the localization of a-tubulin, VASP and Ser157 phosphorylated VASP (p-VASP) in interphase of mitotic gastric cancer of the cell line SGC-7901. RESULTS: Immunofluorescence staining showed that p-VASP but not VASP was co-localized with a-tubulin on spindle poles and fibers in prophase, metaphase and anaphase of the mitotic process of the gastric cancer cell line SGC-7901. H89, an inhibitor of protein kinases A and G, had no effect on the localization of p-VASP on the spindles. CONCLUSION: VASP may play a role in assembling and stabilizing the mitotic spindle of cells, and phosphorylation of the protein is the precondition for it to exert this function.

Mycobacterial spindle cell pseudotumor of lymph nodes after receiving Bacille Calmette-Guerin (BCG) vaccination

Primary mycobacterial spindle cell pseudotumor ( MSP) of the lymph nodes is rare, and is usually found in patients with acquired immunodeficiency syndrome ( AIDS) , HIV + or after an organic transplantation. The histological presentation in this population is spindle cell proliferation referred to as mycobacterial pseudotumor. Here is a first report concerning the mycobacterial spindle

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 lipoma of the mandibular mucogingival junction: a case report of unusual oral neoplasm

Spindle cell lipoma（SCL） is a benign lipomatous neoplasm typically located in the posterior neck and back of older males. It presents as a well-circumscribed mass in the buccal mucosa, tongue, floor of the mouth or hard palate. There are only two case reports of SCL in the gingiva and alveolar ridge. Here, we report a case of SCL in the mandibular mucogingival junction of a 68-year-old male. Clinical,histopathological and immunohistochemical findings are presented. Although oral SCL is rare, it should be considered in the differential diagnosis of spindle cell neoplasms occurring in the oral cavity.

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

有锭子的客观的肺癌并且(或) 巨大的房间(LCSG ) 是一个稀罕上皮的恶性瘤。我们的学习的目的是调查 clinicopathological 和 LCSG 的 17 个案例的预示的特征。在 421 个病人之中的方法经历了肺癌的切除术， LCSG 的 17 个案例为临床、粗野、组织学的参数被学习。后续信息被获得并且分析重要参数到 clarify prognostic 联盟者。结果 LCSG 病人由 15 男性和 2 女性组成了，与从 45 ～ 78 年的年龄(中部， 58 年) ；舞台的 5 个案例我， 3 阶段 II，由病理学的 TNM 阶段的 9 阶段 III；2 个案例只锭子房间癌，有锭子房间的肺癌的 5 个案例，有巨大房间的癌的肺癌的 10 个案例。咳嗽，胸悲痛，或胸痛是最普通的主要症状，发生在 15 个病人(88.2%) 。在舞台的 5 个病人我， 4 是活并且没有为超过 5 年的恶化。在幸存的差别在 LCSG 和有鳞的房间癌病人之间是统计上重要的(中部的幸存， 36 对 61 个月；P = 0.027 ) 。有巨大的房间的淋巴节点转移和癌是影响 LCSG 病人的手术后的预后的危险因素。在早舞台的结论 LCSG 病人可以有乐观结果。有巨大的房间的肺癌由于包含的更多的淋巴节点在组织病理学说，和差的结果显示了多重细胞成分。