Spindle cell lesions

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Spindle cell lesions are seen frequent enough that one ought to have a solid approach to 'em.

General DDx

Spindle cells should make think:

  • Nerve.
  • Muscle.
    • Smooth.
    • Skeletal.
  • Other.
    • Carcinoma, e.g. metaplastic carcinoma.

IHC

Basic panel

Dixon panel:[1]

  • CD34.
  • Desmin.
  • SMA.
  • S100.
  • AE1/AE3 (pankeratin).

Memory device SCADS or CAD SS = S100, CD34, AE1/AE3, Desmin, SMA.

Big panels

A MSH MFH panel

Others:

  • Beta-catenin - a small subset of soft tissue lesions:

DJH panels

MFH
  • Vimentin.
  • Keratin 5D3 - carcinomas.
  • Keratin LP34 - carcinomas.
  • EMA.
  • CD99.
  • MSA.
  • SMA.
  • Caldesmon.
  • CD34.
  • S-100 - neural tumours.
  • HMB45 - melanoma
  • Mart-1 - melanoma.
  • Tyrosinase.
  • MYF-4 - RMS.
  • Alpha-1-antichymotrypsin.
SRCT

Same as MFH panel plus the following:

See also

Treatment

  • It depends on the subtype.
  • Malignant lesions are usually sarcomas and treated with radiation and surgery.[7]

References

  1. BD. 1 April 2011.
  2. Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 108. ISBN 978-0470519035.
  3. Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 107. ISBN 978-0470519035.
  4. URL: http://ajp.amjpathol.org/cgi/content/full/160/3/759. Accessed on: 3 August 2010.
  5. 5.0 5.1 Ardeleanu C, Arsene D, Hinescu M, et al. (October 2009). "Pancreatic expression of DOG1: a novel gastrointestinal stromal tumor (GIST) biomarker". Appl. Immunohistochem. Mol. Morphol. 17 (5): 413–8. doi:10.1097/PAI.0b013e31819e4dc5. PMID 19417627.
  6. Ng TL, Gown AM, Barry TS, et al. (January 2005). "Nuclear beta-catenin in mesenchymal tumors". Mod. Pathol. 18 (1): 68–74. doi:10.1038/modpathol.3800272. PMID 15375433.
  7. Collini P, Sorensen PH, Patel S, et al. (August 2009). "Sarcomas with spindle cell morphology". Semin. Oncol. 36 (4): 324–37. doi:10.1053/j.seminoncol.2009.06.007. PMID 19664493.