CLASSIFICATION OF SPINDLE CELL LESIONS

CLASSIFICATIONS

Various classification have been proposed

I .Based on origin of the tissue: 16

Richard .C. K et al has done a study, to review and classify all spindle cell neoplasms

accessioned over the past 20 years and to classify equivocal or difficult-to-diagnose spindle

cell tumors with the assistance of immunohistochemistry by using a panel of current relevant

antibodies.

A. Neural tumors

1.Neurofibroma

2. Schwannoma

3. Traumatic neuroma

4. Palisaded encapsulated neuroma

5. Ancient schwannoma

6. Malignant peripheral nerve sheath tumor

B . Myofibroblastic tumors

1.Myofibroma

2.Inflammatory myofibroblastic tumor

3.Low-grade myofibroblastic sarcoma

C. Smooth Muscle tumors

1. Angiofibroma/Vascular leiomyoma

2.Leiomyoma

D. Fibroblastic tumors

1. Solitary fibrous tumor

2. Nodular fascitis

3. Fibromatosis

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 CLASSIFICATION OF SPINDLE CELL LESIONS

4. Desmoplastic fibroma

5. Fibrosarcoma

E. Vascular tumors

1. Vascular malformation.

2. Kaposi‘s sarcoma

F. Carcinoma

1.Spindle cell squamous cell carcinoma

G. Others

1. Sarcoma NOS/Atypical spindle cell neoplasm

2. Benign fibrous histiocytoma.

II .Based on the nature of the lesion Spindle cell lesions of the head and neck are quite

diverse with great clinical and biological heterogeneity. Based on the nature of the lesion,

James S. Lewis Jr, categorized lesion into malignant, benign and non neoplastic to help in

the differential diagnosis for spindle cell lesions presenting at UADT mucosal sites.

Classification based on the nature of the lesion17

Malignant Benign or low grade Non-neoplastic

Spindle cell carcinoma Nodular fasciitis Sinonasal polyp with

stromal atypia
Spindle cell melanoma Glomangiopericytoma Ulcer with granulation

tissue/radiation-induced

atypia
Spindle cell Inflammatory Vocal cord nodule with

myoepithelioma or myofibroblastic tumor stromal atypia

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 CLASSIFICATION OF SPINDLE CELL LESIONS

carcinoma
Kaposi‘s sarcoma Solitary fibrous tumor Contact ulcer
Other sarcomas: Ossifying and non- Giant cell

Angiosarcoma, Synovial ossifying fibroma

sarcoma, MPNST

III.BASED ON THE HISTOLOGICAL PATTERN18

Spindle cell tumours can have a variety of appearances and the architectural pattern can

provide valuable clues to the diagnosis of a challenging lesion. Head and neck tumours

composed of predominantly spindle cells may show the following histological patterns:

Monomorphic, Biphasic, Pleomorphic and Myxoid . On this bases Catriona E Anderson

classified into following.

1.SPINDLE CELL TUMORS SHOWING MONOMORPHIC PATTERN

Spindle cell tumour Site(s)

Mucosal and metastatic in neck nodes

i. Sarcomatoid squamouscarcinoma and salivary glands

ii.Melanoma Mucosal and metastatic in neck nodes

and salivary glands

iii. Leiomyosarcoma Mucosal and salivary glands
iv. Synovial sarcoma Neck soft tissues, sinonasal tract, oral

cavity, salivary glands

v.Malignant peripheral nerve sheath Cranial nerves (neck), sinonasal tract,

tumour nasopharynx, oral cavity

vi.Solitary fibrous tumour Oral cavity, nasal cavity,nasopharynx,

paranasal sinuses,salivary glands, larynx

vii.Cellular Schwannoma Sinonasal tract

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 CLASSIFICATION OF SPINDLE CELL LESIONS

Viii.Vascular leiomyoma Nasal cavity, paranasal sinuses

ixNasopharyngeal angiofibroma Nasopharynx
x. Desmoid-type fibromatosis Neck soft tissues, nasal cavity,maxillary

sinuses
xi.Myofibroma/myofibromatosis Oral cavity (tongue, buccal mucosa,

gingiva, palate), lip,mandible

xii.Myofibrosarcoma Neck, face and scalp soft tissues, oral

cavity, jaws,sinonasal tract,hypopharynx

and salivary glands

xiii.Myoepithelioma Salivary glands
xiv.Odontogenic fibroma Mandible, maxilla

2.SPINDLE CELL TUMOURS SHOWING A BIPHASIC PATTERN

Spindle cell tumour Site(s)

i.Sarcomatoid squamous carcinoma Mucosal and metastatic in neck nodes

and salivary glands

ii.Melanoma Mucosal and metastatic in neck nodes

and salivary glands

iii.Synovial sarcoma Neck soft tissues, sinonasal tract, oral

cavity, salivary glands

iv.Malignant peripheral nerve sheath Sinonasal tract, nasopharynx,cranial

tumour nerves
v.Carcinosarcoma Salivary glands

3.SPINDLE CELL TUMOURS SHOWING A MYXOID PATTERN

Spindle cell tumour Site(s)

i.Sarcomatoid squamous carcinoma Mucosal and metastatic in neck nodes and

salivary glands
ii.Melanoma Mucosal and metastatic in neck nodes and

salivary glands
iii.Leiomyosarcoma Mucosal and salivary glands

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 CLASSIFICATION OF SPINDLE CELL LESIONS

iv.Synovial sarcoma Neck soft tissues, sinonasal tract, oral

cavity, salivary glands

v.Malignant peripheral nerve sheath Sinonasal tract, nasopharynx, cranial

tumour nerves
vi.Schwannoma Sinonasal tract, larger nerves including

cranial nerves
vii.Myxoma Odontogenic myxoma in jaws, sinonasal

tract, larynx, soft tissues

viii.Inflammatorymyofibroblastic tumour Sinonasal tract, oral cavity, larynx.
ix.Nodular fasciitis Head and neck soft tissues, parotid
x.Myofibrosarcoma Soft tissues of the neck, face and scalp,

oral cavity, jaws, salivary glands

4.SPINDLE CELL TUMOURS SHOWING A PLEOMORPHIC PATTERN

Spindle cell tumour Site(s)

i.Sarcomatoid squamous carcinoma Mucosal and metastatic in neck nodes

and salivary glands

ii.Melanoma Mucosal and metastatic in neck nodes

and salivary glands

iii.Leiomyosarcoma Mucosal and salivary glands

IV. WORKING CLASSIFICATION , Thorakkal shamim19

NEURAL TUMORS VASCULAR TUMORS

Neurofibroma Hemangiopericytoma

Neurilemmoma (schwannoma) Kaposi sarcoma

Palisaded encapsulated neuroma Spindle cell hemangioma

Traumatic neuroma (amputation neuroma) EPITHELIAL TUMORS

Malignant peripheral nerve sheath tumor Spindle cell carcinoma

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 CLASSIFICATION OF SPINDLE CELL LESIONS

MYOFIBROBLASTIC TUMORS Pleomorphic adenoma

Myofibroma Malignant melanoma

Inflammatory myofibroblastic tumor ODONTOGENIC TUMORS

Low-grade myofibrosarcoma Ameloblastic fibroma

MUSCLE TUMORS Ameloblastic fibrosarcoma

Leiomyoma Central odontogenic fibroma

Vascular leiomyoma Desmoplastic ameloblastoma

Leiomyosarcoma MISCELLANEOUS TUMORS

Rhabdomyoma Benign fibrous histiocytoma

Rhabdomyosarcoma Malignant fibrous histiocytoma

FIBROBLASTIC TUMORS Synovial sarcoma

Solitary fibrous tumor Ossifying fibromyxoid tumor

Fibromatosis Giant cell angiofibroma

Nodular fasciitis Blue nevus

Desmoplastic fibroma

Fibrosarcoma

In this review working classification proposed by Thorakkal Shamim is followed.

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