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.

Malignant fibrous histiocytoma

Work-up (MSH):

  • CD34 - GIST, angiosarcoma, solitary fibrous tumour/hemangiopericytoma, Kaposi sarcoma.
  • S100 - neural marker, sensitive for malignant melanoma, Langerhans cells, clear cell sarcoma.
  • Desmin - smooth muscle.
  • MIB1 - proliferation.
  • CD99 - immature T cells (thymus), small round cell tumours, synovial sarcoma, merkel cell carcinoma, osteosarcoma.[1]
    • Considered "slutty", i.e. non-specific, by Dr. Fletcher; useful if membranous stain pattern = Ewing sarcoma/PNET.
  • BCL2 - synovial sarcoma, small cell lymphomas, spindle cell lipoma.[2][3]
  • PGP 9.5.
  • SMMS - smooth muscle.
  • Caldesmon - muscle.
  • PDGFR - GIST.
  • DOG-1 - GIST (membranous, cytoplasmic),[4] normal pancreas (islets),[4] associated with BRCA1.

Others:

  • Beta-catenin - a small subset of soft tissue lesions:
    • Desmoidtype fibromatosis (~70%), solitary fibrous tumour & endometrial stromal sarcoma (~40%), synovial sarcoma (~30%).[5]

See also

References

  1. Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 108. ISBN 978-0470519035.
  2. Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 107. ISBN 978-0470519035.
  3. URL: http://ajp.amjpathol.org/cgi/content/full/160/3/759. Accessed on: 3 August 2010.
  4. 4.0 4.1 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.
  5. 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.