Recurrence or Transformation? Spindle Cell Carcinoma After Oral Squamous Cell Carcinoma Treatment- A Case Report

Abstract

Background: Spindle Cell Carcinoma (SpCC) is a rare and aggressive variant of Squamous Cell Carcinoma (SCC) that can arise following the treatment of the original SCC. Its distinct histopathological features, such as spindle-shaped cells, complicate diagnosis, as they can resemble mesenchymal tumours. SpCC is characterized by rapid growth and a high potential for metastasis, posing significant clinical challenges.
Case Presentation: A 45-year-old male with a history of SCC on the right lateral border of the tongue underwent surgical resection and radiation therapy. One year later, a rapidly enlarging mass appeared at the tonsilo-lingual sulcus. Histopathology revealed spindle-shaped cells with both epithelial and mesenchymal features, confirming Spindle Cell Carcinoma.
Discussion: The transformation of SCC into SpCC after radiation or surgery may result from radiation-induced mutations in residual SCC cells. (1) Diagnosis is challenging due to the spindle morphology of SpCC, which can mimic mesenchymal tumours such as fibrosarcoma or malignant fibrous histiocytoma. (2) Immunohistochemistry plays a crucial role in distinguishing SpCC from other spindle cell neoplasms by detecting the co-expression of keratin and vimentin. (3)
Management and Conclusion: The patient was treated with wide surgical resection and radiation therapy for recurrent SpCC. Given its aggressive nature, SpCC requires close follow-up for recurrence and metastasis. SpCC after SCC treatment generally has a poor prognosis due to its high risk of recurrence and metastasis. (4) Early detection and aggressive treatment are critical for improving outcomes in these complex cases.