Sarcomatoid carcinoma of the maxilla: a rare entity
Spindle cell carcinomas (sarcomatoid carcinomas) are rare tumours. It is a variant of squamous cell carcinoma which has spindled tumour cells, which simulate a true sarcoma, but are epithelial in origin. They are extremely uncommon in the head and neck region. As compared to squamous cell carcinoma of maxilla, this variant is associated with poor diagnosis and advanced disease at presentation, as is demonstrated in the present case reported in BMJ.

A 52-year-old woman presented with a 1 month history symptom of mobility of upper anterior teeth. Interestingly, she gave a history 2 years earlier of buccal space infection for which she underwent incision and drainage and extraction of the posterior teeth on that side due to mobility.

A history of mobility of tooth was significant as it started from the posterior region of left maxilla and gradually affected the anterior teeth. Also, a history of numbness of the upper lip since 2 months with no history of extraoral swelling was significant. An intraoral examination revealed a proliferative growth of about 3.5×1 cm in the left upper molar region with no signs of ulceration. OPG revealed an osteolytic lesion extending from the left maxillary tuberosity area to the right lateral incisor.

A CT scan revealed soft tissue density lesion in the left upper alveolar region with erosion of the floor and medial wall of the left maxillary sinus, left side of hard palate and left alveolar process. Multiple left-sided cervical lymphadenopathies were also seen.

An incisional biopsy revealed a hyperkeratinised, stratified squamous-type epithelium with long reteridges. The underlying connective tissue consisting of tumour mass was in close proximity to the surface epithelium. The tumour mass appears to be fibrocellular with large amount of spindle-shaped cells in a fascicular pattern and storiform pattern in few areas, also noted areas with large oval cells. IHC confirmed a diagnosis of a spindle cell lesion.

No treatment could be performed as the patient failed to report for admission and further treatment.

Learning points
• Adjuvant irradiation might be of benefit in cases where the surgical margins are positive or in patients with nodal metastasis at the time of diagnosis.

• Prognosis is related to location, tumour size, depth of invasion, stage of disease and with the presence of any keratin staining in the spindle cells.

• A tumour of the oral cavity and oropharynx is potentially aggressive and seems to recur and metastasize easily.

• The incidence of metastases was 36% and the 2-year survival rate was 55% in tumours involving the oral cavity.

• Radiation therapy is considered an acceptable alternative for inoperable patients.

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