Oral Spindle Cell Sarcoma: A Rare Case Report and Review of Literature

Abstract

A 48-year-old male reported with a complaint of a swelling on the left side of the face since a month. Symptoms were progressive, with development of nasal congestion, dull aching left sided facial pain which aggravated on bending the head forward and difficulty in mouth opening. He also gave a history of concomitant use of cigarettes and smokeless tobacco for the last thirty years. Patient was a known Type II diabetic, on insulin therapy for the last three years. On extraoral examination, a well defined, non reducible, non fluctuant swelling was seen on the left cheek, measuring approximately 4×5 cm in size [ Panoramic radiograph and paranasal sinus view revealed haziness in relation to left maxillary sinus with erosion of lateral and medial sinus wall 5]. CBCT revealed opacification of the left maxillary sinus measuring approximately 31.7 mm (superioinferiorly) x 40.1 mm (mediolaterally) x 37.8 mm (anterioposteriorly) with few areas of calcification. Destruction of left infraorbital margin superiorly, lateral wall of the nasal cavity and ethmoidal air cells medially and lateral and posterior wall of left maxilla was appreciated. The periphery of the lesion was irregular with ill defined non corticated borders [Table/ Fig-6]. There was loss of supporting alveolar bone with destruction of lamina dura in relation to teeth 26,27,28. A radiographic diagnosis of malignant neoplasm originating in the left maxillary sinus was given.Histopathological examination of intraoral incisional biopsy revealed a highly cellular and vascular connective tissue lesion. Haphazard arrangement of few spindle to round shaped cells, marked cellular and nuclear pleomorphism and hyperchromatic nuclei, increased N:C ratio, multiple nucleoli, numerous abnormal mitotic figures and coarse chromatin were observed which were suggestive of dysplasia. Focal areas of hyalinisation were also noticed. Stroma showed numerous small to large endothelial lined blood vessels with red blood cells suggestive of a spindle cell lesion .IHC showed strong positivity for vimentin and negativity to pancytokeratin [Table/ Fig-8,9]. The patient was diagnosed with spindle cell sarcoma of the left maxillary sinus stage IVA (T4aN0M0). Further IHC analysis with the panel of markers for identification of the type of spindle cell lesion could not be carried out because of the financial constraints. Following the investigations, neo adjuvant ABSTRACTSpindle cell lesions of the head and neck region are diverse in nature by means of clinical and biological heterogeneity. Though few lesions are found to be malignant, several others are benign or merely reactive in nature. Although these lesions are fairly common occurring in other parts of the body, they are very rare in the oral cavity, accounting for less than 1% of all tumours in the oral region. Herein, a case of 48-yearold man who presented with a polypoid lesion of the maxilla has been reported. Histopathological examination and immunohistochemistry revealed spindle cell sarcoma of the left maxillary sinus. We prese...

The Heart of the Matter: A Unique Convergence of Cardiac Neoplasm, Hereditary Nonpolyposis Colorectal Cancer, and Spindle Cell Sarcoma

“…17 Histopathologic analysis allows for directed use of immunohistochemistry and molecular techniques that are instrumental in establishment of diagnosis. 18 Cardiac sarcomas typically have genetic profiles with recurrent alterations in MDM2, PDGFRA, or EGFR, which have potential as future therapeutic targets. 19 Immunohistochemistry can aid in the classification of cardiac sarcomas and distinguish benign from malignant lesions.…”