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Difference between revisions of "Spindle cell lesions"
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'''[[Spindle cell]] lesions''' are seen frequent enough that one ought to have a solid approach to 'em. | [[Image:Malignant_peripheral_nerve_sheath_tumour_-_very_high_mag.jpg|thumb|right|250px|A spindle cell lesion ([[MPNST]]). [[H&E stain]].]] | ||
'''[[Spindle cell]] lesions''' are seen frequent enough that one ought to have a solid approach to 'em. | |||
A general introduction to ''spindle cells'' is found in the ''[[spindle cell]]'' article. | |||
==General DDx== | ==General DDx== | ||
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**Carcinoma, e.g. metaplastic carcinoma. | **Carcinoma, e.g. metaplastic carcinoma. | ||
===A long | ===A long differential diagnosis of spindle cell tumours=== | ||
Adapted from ''Miller'' with modifications:<ref name=miller>Miller RT. (Sep 2013). ''Atlantic Diagnostic Immunohistochemistry Symposium''. St. John's, NL, Canada.</ref> | |||
{| class="wikitable sortable" | {| class="wikitable sortable" | ||
! Tumour | ! Tumour | ||
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| | | | ||
|- | |- | ||
| [[Desmoplastic | | [[Desmoplastic mesothelioma]] | ||
| carcinoma | | carcinoma | ||
| | | | ||
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| | | | ||
|- | |- | ||
| [[Malignant | | [[Malignant phyllodes tumour]] | ||
| sarcoma | | sarcoma | ||
| | | | ||
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| | | | ||
|- | |- | ||
| [[ | | [[Malignant mixed Muellerian tumour]] | ||
| carcinoma | | carcinoma | ||
| | | | ||
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| [[Sclerotic "plywood" fibroma]] | | [[Sclerotic "plywood" fibroma]] | ||
| fibroblastic/myofibroblastic tumours | | fibroblastic/myofibroblastic tumours | ||
| | | <ref>{{Cite journal | last1 = Hanft | first1 = VN. | last2 = Shea | first2 = CR. | last3 = McNutt | first3 = NS. | last4 = Pullitzer | first4 = D. | last5 = Horenstein | first5 = MG. | last6 = Prieto | first6 = VG. | title = Expression of CD34 in sclerotic ("plywood") fibromas. | journal = Am J Dermatopathol | volume = 22 | issue = 1 | pages = 17-21 | month = Feb | year = 2000 | doi = | PMID = 10698210 }}</ref> | ||
|- | |- | ||
| [[Fibrosarcoma]] | | [[Fibrosarcoma]] | ||
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| [[Myofibroblastoma]] | | [[Myofibroblastoma]] | ||
| fibroblastic/myofibroblastic tumours | | fibroblastic/myofibroblastic tumours | ||
| | | superficial cervicovaginal myofibroblastoma<ref name=pmid15693885>{{Cite journal | last1 = Ganesan | first1 = R. | last2 = McCluggage | first2 = WG. | last3 = Hirschowitz | first3 = L. | last4 = Rollason | first4 = TP. | title = Superficial myofibroblastoma of the lower female genital tract: report of a series including tumours with a vulval location. | journal = Histopathology | volume = 46 | issue = 2 | pages = 137-43 | month = Feb | year = 2005 | doi = 10.1111/j.1365-2559.2005.02063.x | PMID = 15693885 }}</ref> | ||
|- | |||
| | |||
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|- | |- | ||
| [[Cellular Angiofibroma]] | | [[Cellular Angiofibroma]] | ||
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*Desmin. | *Desmin. | ||
*SMA. | *SMA. | ||
* | *[[S-100]]. | ||
*AE1/AE3 (pankeratin). | *[[AE1/AE3]] (pankeratin). | ||
Memory device ''SCADS'' or ''CAD SS'' = | Memory device ''SCADS'' or ''CAD SS'' = S-100, CD34, AE1/AE3, Desmin, SMA. | ||
===Big panels=== | ===Big panels=== | ||
====A MSH MFH panel==== | ====A MSH MFH panel==== | ||
*CD34 - [[GIST]], [[angiosarcoma]], [[solitary fibrous tumour]]/[[hemangiopericytoma]], [[Kaposi sarcoma]], [[DFSP]], [[PASH]]. | *CD34 - [[GIST]], [[angiosarcoma]], [[solitary fibrous tumour]]/[[hemangiopericytoma]], [[Kaposi sarcoma]], [[DFSP]], [[PASH]]. | ||
* | *S-100 - neural marker, sensitive for [[malignant melanoma]], Langerhans cells, [[clear cell sarcoma]]. | ||
*Desmin - smooth muscle. | *Desmin - smooth muscle. | ||
*MIB1 - proliferation. | *MIB1 - proliferation. | ||
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*Caldesmon - muscle. | *Caldesmon - muscle. | ||
*PDGFR - [[GIST]] | *PDGFR - [[GIST]] | ||
* | *[[DOG1]] - GIST (membranous, cytoplasmic),<ref name=pmid19417627>{{cite journal |author=Ardeleanu C, Arsene D, Hinescu M, ''et al.'' |title=Pancreatic expression of DOG1: a novel gastrointestinal stromal tumor (GIST) biomarker |journal=Appl. Immunohistochem. Mol. Morphol. |volume=17 |issue=5 |pages=413–8 |year=2009 |month=October |pmid=19417627 |doi=10.1097/PAI.0b013e31819e4dc5 |url=}}</ref> normal pancreas (islets),<ref name=pmid19417627/> associated with [[BRCA1]]. | ||
Others: | Others: | ||
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*Keratin 5D3 - carcinomas. | *Keratin 5D3 - carcinomas. | ||
*Keratin LP34 - carcinomas. | *Keratin LP34 - carcinomas. | ||
*EMA. | *[[EMA]]. | ||
*CD99. | *CD99. | ||
*MSA. | *MSA. | ||
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*CD30. | *CD30. | ||
*CD3. | *CD3. | ||
*CD20. | *[[CD20]]. | ||
*Desmin. | *Desmin. | ||
*CD31 - [[angiosarcoma]]. | *CD31 - [[angiosarcoma]]. | ||
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*[[Spindle cell]]. | *[[Spindle cell]]. | ||
*[[Epithelioid cell lesions]]. | *[[Epithelioid cell lesions]]. | ||
*[[Spindle cell lesions of the skin]]. | |||
==Treatment== | ==Treatment== | ||