Five cases of spindle cell carcinoma of the head and neck region

Spindle cell carcinoma (SpCC) is a rare malignant tumor that accounts for about 1% of all laryngeal cancers. It is a variant of squamous cell carcinoma (SCC), and is characteristically a biphasic tumor consisting of SCC and malignant spindle cell components, with a mesenchymal appearance. Herein, we present five cases of SpCC of the head and neck diagnosed at our department between 2003 and 2017. The diagnosis of SpCC rests on the histological confirmation of epithelial differentiation. The characteristic transition between the surface epithelium and the spindle cell element was evident in three of our patients, and immunohistochemical staining for both epithelial and mesenchymal markers was positive in four. A complete excisional biopsy combined with immunohistochemical analysis would be ideal for accurate diagnosis. One of our patients had a history of radiation therapy, which is considered to be a risk factor for SpCC occurrence. According to reports published in the literature, the prognosis of patients with multiple cervical lymph node metastases is poor. The fact that two of our patients died within one year indicates that at least in some cases, SpCC is aggressive and carries an unfavorable prognosis. One patient with SpCC of the tongue, one of the oropharynx, and two of the larynx were treated by surgical resection, while the remaining one with SpCC of the epipharynx who received chemoradiation therapy is currently recurrence-free. Although several reports indicate that surgery offers the most favorable prognosis, the effects of chemotherapy or chemoradiation therapy on SpCC have not yet been clearly elucidated. Further investigation to determine the most suitable treatments and prognosis of SpCC is required.