Squamous Cell Carcinoma of the Larynx with Sarcoma-like Stroma. a Clinicopathologic Assessment of Spindle Cell Carcinoma and "pseudosarcoma".

Spindle cell neoplasms of the upper respiratory tract and oral cavity are unique lesions which pose not only therapeutic problems for the clinician but also difficult interpretive problems for the pathologist. Because of their bizarre microscopic appearance they have frequently been interpreted as sarcomas; however, recent studies suggest that most of these neoplasms are squamous cell carcinomas with a spindle cell growth pattern. Because of the dispute as to whether the spindle cell component is stromal or epithelial in origin, and inflammatory or neoplastic, such lesions have occasionally been termed "pseudosar comas," "carcinosarcomas," or "spindle cell carcinomas." Many reports of these lesions have noted the paradox of long survival in patients whose tumors manifested microscopic features of malignancy. There have also been sporadic reports of "true sarcomas," usually fibrosarcomas, of the upper respiratory tract, often associated with a favorable outcome. Although authentic malignant mesenchymal neoplasms surely must arise in this location, it is reasonable to speculate whether or not most of these sarcomas are actually carcinomas with prominent spindle cell patterns. The larynx, typical of the upper respiratory tract, is often the site of such peculiar lesions. In the following study, the histologic spectrum of these neoplasms is presented, and the relation between their gross, microscopic, and clinical features is assessed.