Sarcomatoid Lesions of Head and Neck Region: A Diagnostic Dilemma

Abstract

One challenging feature of head and neck pathology is that a dizzying array of sarcomatoid lesions occurs here ranging all the way from reactive to malignant and very aggressive. This makes accurate diagnosis critical. These lesions are quite diverse with great clinical and biological heterogeneity. Some are malignant while many others are benign or simply reactive in nature. For example; at mucosal sites, a well known lesion is spindle cell carcinoma (SpCC), which are overtly malignant, and the differential diagnosis then includes a number of different malignant spindle cell lesions. However, there are several benign or even non-neoplastic lesions that can sometimes be difficult to discern from SpCC, e.g. Nodular fasciitis, Proliferative myositis, Cellular schwannoma, Benign fibrous histiocytoma, Carcino sarcoma, Sarcomatoid melanoma. Fracture callus, etc.
 Aim of Study: There is a diagnostic challenge to the oral pathologists to differentiate dizzying array of sarcoma like lesions from other similar microscopic simulates ranging all the way from reactive to malignant and very aggressive. This article aims to review the sarcomatoid lesions of the head and neck region with emphasis on differential diagnosis histologically and immunohistochemicaly.

Clinical update on cutaneous and subcutaneous sarcomas

“…All high‐grade pleomorphic sarcomas have a 50–60% five‐year survival rate. Superficial location, modest size, and low grade are all good prognostic indicators 17,18 …”