A Century of Progress
in Head & Neck Cancer

July 26 – 30, 2014
Marriott Marquis
New York, NY
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Presentation: P0230
Topic: Poster Session
Type: Poster
Authors: Ezulia T, MD, Primuharsa Putra Sha, MD, MSurg, ORLHNS, Professor, Muhaizan Wm, MD, MPath, Kenali Ms, MD, MSurg, ORLHNS, Associate, Professor
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Institution(s): KPJ Healthcare University College
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Introduction:   Spindle Cell Carcinoma (SpCC) also known as sarcomatoid carcinoma, is a rare and peculiar biphasic malignant neoplasm that occurs mainly in the upper aerodigestive tract. It has spindled or pleomorphic  tumor cells which simulate a true sarcoma but of epithelial origin. World Health Organization (WHO) classification has placed this tumour under a highly malignant variant of squamous cell carcinoma and labelled it spindle cell carcinoma. It is potentially aggressive and have a propensity for recurrence and metastases. This makes accurate diagnosis critical. Immunohistochemistry along with routine histopathology is essential in establishing the diagnosis.

Material and methods: A 33 -years old lady presented with a rapidly enlarging fungating mass over right lower alveolar in the molar region of two month duration. It was associated with pain, odynophagia and some degree of trismus punctuated with occasional episodes of bleeding from the tumour. She had no history of any medical illness. Biospy was done in other hospital and reported as spindle carcinoma.

Clinically on examination she had foetor ex ore, and there was large fungating mass in the right lower alveolar measuring 4-5 cm in its largest diameter. The buccal mucosa and the floor of mouth in the vicinity of the tumour were spared. There were multiple small nodes palpable in the submandibular area. Other examinations were unremarkable.           

Results:  A pre-operative computed tomography (CT) of the neck showed a lytic lesion in the alveolar margin of right angle of mandible. It was associated with soft tissue swelling medially and laterally and had contrast enhancement. The lesion measured 39 x 28 mm (axial) and 33 mm (height). There were small lymph nodes noted on both sides of the neck with three small nodes on the right side showing central lucencies. She then underwent surgery to remove the tumour entailed: right segmental mandibulectomy along with the primary tumour and right modified neck dissection. However, the posterior end of the intraoral wound broke down and closure of the wound with a tongue flap was performed one week later. The tongue flap took well and the pedicle is still intact. Histopathological examination reported as spindle cell carcinoma.  She was then referred for adjuvant treatment in view of the primary nature of malignancy.

Conclusion:   SpCC  of oral cavity is potentially more aggressive than SCC and a high index of suspicion is the prerequisite for an early diagnosis. 

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