The pathology of head and neck tumors: Spindle cell lesions (sarcomatoid carcinomas, nodular fasciitis, and fibrosarcoma) of the aerodigestive tracts, part 14

The term spindle cell lesion, or tumor, is a purely descriptive one and if applied without further qualification is meaningless as a guide to therapy and prognosis. The three lesions presented in this report--sarcomatoid carcinomas, nodular fasciitis, and fibrosarcoma--serve to illustrate this point. One, the sarcomatoid carcinoma, is an epithelial malignancy in which the majority of the sarcoma-like spindle cells are believed to be variants of the epithelial cells. Nodular fasciitis, a self-limited and benign soft tissue lesion, is composed principally of myofibroblasts. Primarily an extramucosal lesion, it presents a pseudosarcomatous microscopic appearance. Fibrosarcomas represent the other end of the spindle cell lesion spectrum in that they are soft tissue malignancies of fibroblastic origin. Clinical, pathologic, and biologic implications of these lesions when they arise in the mucosae of the upper aerodigestive tracts of the head and neck are presented.