头颈部梭形细胞鳞状细胞癌20例临床病理特征分析

  目的  探讨头颈部梭形细胞鳞状细胞癌（spindle cell squamous cell carcinoma，SCSCC）的临床病理特征、免疫表型及其预后，以提高对该肿瘤的认识及诊断水平。  方法  回顾性分析2012年1月至2022年12月空军军医大学第一附属医院20例头颈部SCSCC患者的临床病理资料，观察其组织学形态、免疫表型，采用原位杂交法检测EBER表达情况，荧光原位杂交法检测MDM2基因扩增情况。  结果  20例头颈部SCSCC患者男女比例4∶1，中位年龄67岁。以喉部（35.0%）及鼻腔鼻窦（30.0%）最为多见。息肉状或外生性生长及表面溃疡分别见于61.5%及90.0%的患者。组织学特征方面，15例（75.0%）显示肉瘤样生长方式，其余可见肉芽组织样及血管肉瘤样生长。65.0%肿瘤含有普通型鳞状细胞癌成分，以高-中分化鳞状细胞癌最为常见（91.7%）。免疫组织化学方面，83.3%（15/18）患者表达AE1/AE3， p63及p40表达率分别为62.5%、66.7%。所有患者EBER均为阴性。Ki-67增殖指数范围10%～70%。33.3%（1/3）患者呈现MDM2基因扩增。18例患者中位随访时间18.3（1～92）个月，其中6例生存，12例死亡。  结论  头颈部SCSCC多见于老年吸烟男性，以息肉状生长为主，无HPV及EBV感染，确诊需综合临床、病理特征及免疫表型，手术切除为其主要治疗方法。

Clinicopathologic features and outcome of head and neck mucosal spindle cell squamous cell carcinoma

  Objective  To investigate the clinicopathological features, immunophenotype, and prognosis of head and neck spindle cell squamous cell carcinoma (SCSCC) to improve the understanding and diagnosis of this tumor.   Methods  Clinicopathological data collected from January 2012 to December 2022 at the First Affiliated Hospital, Air Force Military Medical University from 20 patients with head and neck SCSCC were retrospectively reviewed for histological morphology and immunophenotype. In situ and fluorescence in situ hybridization were performed to detect EBV-encoded ribonucleic acid (EBER) status and MDM2 gene amplification, respectively.   Results  The median age among the 20 SCSCC cases was 67 years with a male-to-female ratio of 4:1. Tumor locations were laryngeal (35.0%) and sinonasal (30.0%). SCSCC presented as polypoid or exogenous growths (61.5%), often with surface ulceration (90.0%). Histologically, sarcomatoid growth patterns were exhibited in 75.0% of the patients (n=15), while the remainder showed granular tissue-like or angiosarcomatoid patterns. Most tumors (65.0%) displayed components of conventional squamous cell carcinomas, with a predominant occurrence of high to moderate differentiation (91.7%). In terms of immunohistochemistry, AE1/AE3 was expressed in 83.3% (15/18) of cases, while p63 and p40 expression rates were 62.5% and 66.7%, respectively. All cases were negative for EBER. The Ki-67 proliferation index ranged 10%–70%. Overall, 33.3% (1/3) of the cases showed MDM2 gene amplification. Among these, the median follow-up time for 18 patients was 18.3 months (range: 1–92 months), with 6 survivors and 12 deaths.   Conclusions  Head and neck SCSCC is more prevalent among elderly male smokers, predominantly exhibits a polypoid growth pattern, and does not display human papillomavirus or Epstein–Barr virus infection. Diagnosis requires a comprehensive evaluation of clinical and pathological features and immunophenotype. Surgical resection is the primary treatment method.