Spindle cell squamous cell carcinoma exhibiting prominent neutrophil phagocytosis: a case report

Abstract

Background Spindle cell squamous cell carcinoma is an uncommon variant of squamous cell carcinoma; its diagnosis is sometimes challenging because it histopathologically resembles neoplastic or reactive spindle cell lesions of mesenchymal origins. Here, we report a rare case of spindle cell squamous cell carcinoma exhibiting prominent neutrophil phagocytosis. Case presentation A 69-year-old Japanese man presented with pain and a polypoid mass on the lower left gingiva. He had received chemoradiotherapy for squamous cell carcinoma of the buccal mucosa 15 years prior to this consultation. In addition, he was treated for mandibular osteonecrosis 6 years after chemoradiotherapy without evidence of cancer recurrence. A biopsy revealed atypical spindle or pleomorphic cells scattered in the edematous and fibrin-rich stroma; however, no malignant squamous components were apparent. These atypical cells frequently contained neutrophils within their cytoplasm that formed cell-in-cell figures. Immunohistochemically, the atypical cells were negative for cytokeratins, epithelial membrane antigen, and E-cadherin, but positive for p63, vimentin, and p53. Although these findings suggested spindle cell squamous cell carcinoma, it was difficult to reach a definitive diagnosis. Based on a clinical diagnosis of a malignant tumor, the patient underwent a hemimandibulectomy. The surgically resected specimen had a typical spindle cell squamous cell carcinoma histology consisting of biphasic spindle cells and conventional squamous cell carcinoma components. Moreover, the surgical specimen also exhibited spindle tumor cells that frequently included neutrophils, around which intense staining for lysosomal-associated membrane protein 1 and cathepsin B was observed. This suggested that the cell-in-cell figures represent active neutrophil phagocytosis by tumor cells, and not emperipolesis. Conclusion The presence of neutrophil phagocytosis may be a potent indicator of malignancy.

Sarcomatoid carcinoma: A rare biphasic variant of OSCC: A case report

“…Ezulia et al [3] have reported similar lesion in lower right alveolus which caused mild trismus similar to the present case. Yamazaki et al [6] presented a case report of pain and a polypoid mass on the lower left gingiva with associated trismus. Panoramic radiography showed bone resorption, exhibiting a moth-eaten appearance that involved the base of the mandible.…”

Classificatory updates in verrucous and cuniculatum carcinomas: Insights from the 5th edition of WHO-IARC head and neck tumor classification

“…The histological subtypes of OSCC comprise the following six distinct variants according to the WHO: Spindle cell carcinoma variant manifests as a biphasic tumor, comprising a SCC and a malignant spindle cell component with a mesenchymal appearance. This subtype is recognized for its aggressive behavior and rapid growth[ 4 ]. The Basaloid SCC variant is typified by a basaloid cell population and a diminished presence of squamous cells.…”