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Differential diagnosis of laryngeal spindle cell carcinoma and inflammatory myofibroblastic tumor – report of two cases with similar morphology

Völker HU, Scheich M, Höller S, Ströbel P, Hagen R, Müller-Hermelink HK, Eck M - Diagn Pathol (2007)

Bottom Line: We found ulceration, mild atypia, and myxoid stroma.Other stainings with antibodies against p53, p21, Cyclin D1, or Rb did not result in additional information.The IMT recurred three months after first surgery, but no relapses were found eight months after resurgery.

Affiliation: Institute of Pathology, University, Josef-Schneider-Str,2, 97080 Würzburg, Germany. ullrich.voelker@mail.uni-wuerzburg.de

ABSTRACT

Background: Spindle cell tumors of the larynx are rare. In some cases, the dignity is difficult to determine. We report two cases of laryngeal spindle cell tumors.

Case presentation: Case 1 is a spindle cell carcinoma (SPC) in a 55 year-old male patient and case 2 an inflammatory myofibroblastic tumor (IMT) in a 34 year-old female patient. A comprehensive morphological and immunohistochemical analysis was done. Both tumors arose at the vocal folds. Magnified laryngoscopy showed polypoid tumors. After resection, conventional histological investigation revealed spindle cell lesions with similar morphology. We found ulceration, mild atypia, and myxoid stroma. Before immunohistochemistry, the dignity was uncertain. Immunohistochemical investigations led to diagnosis of two distinct tumors with different biological behaviour. Both expressed vimentin. Furthermore, the SPC was positive for pan-cytokeratin AE1/3, CK5/6, and smooth-muscle actin, whereas the IMT reacted with antibodies against ALK-1, and EMA. The proliferation (Ki67) was up to 80% in SPC and 10% in IMT. Other stainings with antibodies against p53, p21, Cyclin D1, or Rb did not result in additional information. After resection, the patient with SPC is free of disease for seven months. The IMT recurred three months after first surgery, but no relapses were found eight months after resurgery.

Conclusion: Differential diagnosis can be difficult without immunohistochemistry. Therefore, a comprehensive morphological and immunohistochemical analysis is necessary, but markers of cell cycle (apart from the assessment of proliferation) do not help.

Spindle cell carcinoma. 1a: Spindle cell lesion with myxoid stroma (HE ×200). 1b: Mild to moderate atypia in tumor cells with rare mitoses (HE ×400). 1c: Vimentin immunoperoxidase – strong expression in tumor cells (×400). 1d: Pan-cytokeratin AE1/3 immunoperoxidase (×400). 1e: smooth muscle actin immunoperoxidase (×400). 1f: Proliferation (Ki67) up to 80% (immunoperoxidase ×200).
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Figure 1: Spindle cell carcinoma. 1a: Spindle cell lesion with myxoid stroma (HE ×200). 1b: Mild to moderate atypia in tumor cells with rare mitoses (HE ×400). 1c: Vimentin immunoperoxidase – strong expression in tumor cells (×400). 1d: Pan-cytokeratin AE1/3 immunoperoxidase (×400). 1e: smooth muscle actin immunoperoxidase (×400). 1f: Proliferation (Ki67) up to 80% (immunoperoxidase ×200).

Mentions: In HE staining, an ulcerated spindle cell tumor with widely myxoid stroma changes was found. Tumor cells were arranged in an irregular pattern with different cell density (figure 1a). No PAS positivity was found, necrosis was absent. Spindle cells showed mild to moderate atypia with prominent nucleoli. Ten high power fields (HPF) contained a maximum of one mitosis (figure 1b), and no atypical mitoses were found. Focally, the tumor was scantily infiltrated by neutrophil granulocytes. The surface epithelium was only detectable on a small focus, herein no atypia was found in the surface epithelium. The results of immunohistochemical investigations are indicated in table 1. The tumor was strongly positive for vimentin (figure 1c) and different cytokeratins including the squamous differentiation marker CK5/6 (figure 1d). Only pan-cytokeratin MNF116 was negative in the tumor cells, but reacted with the surface epithelium. Smooth-muscle (sm)-actin (figure 1e) was coexpressed. The proliferation (determined by Ki67 staining) was up to 80 % (figure 1f). Due to these features a spindle cell carcinoma was diagnosed. Together with the clinical information, the tumor stage was pT2, cN0, cM0, and (after resurgery) R0.

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Differential diagnosis of laryngeal spindle cell carcinoma and inflammatory myofibroblastic tumor – report of two cases with similar morphology

Völker HU, Scheich M, Höller S, Ströbel P, Hagen R, Müller-Hermelink HK, Eck M - Diagn Pathol (2007)

Spindle cell carcinoma. 1a: Spindle cell lesion with myxoid stroma (HE ×200). 1b: Mild to moderate atypia in tumor cells with rare mitoses (HE ×400). 1c: Vimentin immunoperoxidase – strong expression in tumor cells (×400). 1d: Pan-cytokeratin AE1/3 immunoperoxidase (×400). 1e: smooth muscle actin immunoperoxidase (×400). 1f: Proliferation (Ki67) up to 80% (immunoperoxidase ×200).
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Figure 1: Spindle cell carcinoma. 1a: Spindle cell lesion with myxoid stroma (HE ×200). 1b: Mild to moderate atypia in tumor cells with rare mitoses (HE ×400). 1c: Vimentin immunoperoxidase – strong expression in tumor cells (×400). 1d: Pan-cytokeratin AE1/3 immunoperoxidase (×400). 1e: smooth muscle actin immunoperoxidase (×400). 1f: Proliferation (Ki67) up to 80% (immunoperoxidase ×200).
Mentions: In HE staining, an ulcerated spindle cell tumor with widely myxoid stroma changes was found. Tumor cells were arranged in an irregular pattern with different cell density (figure 1a). No PAS positivity was found, necrosis was absent. Spindle cells showed mild to moderate atypia with prominent nucleoli. Ten high power fields (HPF) contained a maximum of one mitosis (figure 1b), and no atypical mitoses were found. Focally, the tumor was scantily infiltrated by neutrophil granulocytes. The surface epithelium was only detectable on a small focus, herein no atypia was found in the surface epithelium. The results of immunohistochemical investigations are indicated in table 1. The tumor was strongly positive for vimentin (figure 1c) and different cytokeratins including the squamous differentiation marker CK5/6 (figure 1d). Only pan-cytokeratin MNF116 was negative in the tumor cells, but reacted with the surface epithelium. Smooth-muscle (sm)-actin (figure 1e) was coexpressed. The proliferation (determined by Ki67 staining) was up to 80 % (figure 1f). Due to these features a spindle cell carcinoma was diagnosed. Together with the clinical information, the tumor stage was pT2, cN0, cM0, and (after resurgery) R0.

Bottom Line: We found ulceration, mild atypia, and myxoid stroma.Other stainings with antibodies against p53, p21, Cyclin D1, or Rb did not result in additional information.The IMT recurred three months after first surgery, but no relapses were found eight months after resurgery.

Affiliation: Institute of Pathology, University, Josef-Schneider-Str,2, 97080 Würzburg, Germany. ullrich.voelker@mail.uni-wuerzburg.de

ABSTRACT

Background:

Background: Spindle cell tumors of the larynx are rare. In some cases, the dignity is difficult to determine. We report two cases of laryngeal spindle cell tumors.

Case presentation: Case 1 is a spindle cell carcinoma (SPC) in a 55 year-old male patient and case 2 an inflammatory myofibroblastic tumor (IMT) in a 34 year-old female patient. A comprehensive morphological and immunohistochemical analysis was done. Both tumors arose at the vocal folds. Magnified laryngoscopy showed polypoid tumors. After resection, conventional histological investigation revealed spindle cell lesions with similar morphology. We found ulceration, mild atypia, and myxoid stroma. Before immunohistochemistry, the dignity was uncertain. Immunohistochemical investigations led to diagnosis of two distinct tumors with different biological behaviour. Both expressed vimentin. Furthermore, the SPC was positive for pan-cytokeratin AE1/3, CK5/6, and smooth-muscle actin, whereas the IMT reacted with antibodies against ALK-1, and EMA. The proliferation (Ki67) was up to 80% in SPC and 10% in IMT. Other stainings with antibodies against p53, p21, Cyclin D1, or Rb did not result in additional information. After resection, the patient with SPC is free of disease for seven months. The IMT recurred three months after first surgery, but no relapses were found eight months after resurgery.

Conclusion: Differential diagnosis can be difficult without immunohistochemistry. Therefore, a comprehensive morphological and immunohistochemical analysis is necessary, but markers of cell cycle (apart from the assessment of proliferation) do not help.

View Similar Images In: Results  - Collection
View Article: Pubmed Central - HTML -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=1779261&rFormat=json&query=null&req=5