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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 34  |  Issue : 4  |  Page : 495-497

An unusual presentation of spindle cell tumor on palate: A case report


Department of Dentistry, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India

Date of Submission30-Mar-2022
Date of Decision29-Oct-2022
Date of Acceptance30-Oct-2022
Date of Web Publication09-Dec-2022

Correspondence Address:
Anantpreet Singh
Department of Dentistry, Guru Gobind Singh Medical College and Hospital, Faridkot - 151 203, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.jiaomr_107_22

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   Abstract 


Spindle cell tumors are rarely reported in the oral cavity. Since the subtypes of these lesions are very difficult to diagnose, immunohistochemistry is a useful diagnostic tool. Here, we report a case of benign spindle cell tumor on palate. A 49 year old male presented with irregular mass of approximately 2 × 2 cm on maxillary right posterior region of palate since 2 months. Excisional biopsy and immunohistochemistrydetermine it as benign spindle cell tumor.

Keywords: Benign, biopsy, immunohistochemistry, spindle cell
Key Message: Spindle cell tumors are usually malignant requiring wide surgical excision with or without radiotherapy-Immunohistochemical analysis of these lesions serves as a useful diagnostic aid for better treatment planning for these lesions.


How to cite this article:
Kaur J, Chopra R, Singh A. An unusual presentation of spindle cell tumor on palate: A case report. J Indian Acad Oral Med Radiol 2022;34:495-7

How to cite this URL:
Kaur J, Chopra R, Singh A. An unusual presentation of spindle cell tumor on palate: A case report. J Indian Acad Oral Med Radiol [serial online] 2022 [cited 2023 Jan 28];34:495-7. Available from: http://www.jiaomr.in/text.asp?2022/34/4/495/363010




   Introduction Top


Spindle cell lesions of head and neck vary greatly in terms of clinical and biological behavior. The lesions may be benign, simply reactive, or malignant in nature.[1] The benign spindle cell lesions can be misdiagnosed as malignant ones, particularly on a small biopsy.[2] Spindle cell lesions constitute less than 1% of all tumors in oral cavity. In the oral cavity, it has site predilection for the alveolar mucosa, tongue, buccal mucosa, and lower lip[3] while palate is rarely involved. Cytopathologic classification based on the predominance of spindle cell classifies the lesions into neural, myofibroblastic, muscle, fibroblastic, vascular, epithelial, odontogenic, and miscellaneous tumors.[4] Immunohistochemistry is a useful diagnostic tool to confirm the various subtypes.[5] We report a middle-aged male patient with spindle cell tumor on palate without any known predisposing factors.


   Case Report Top


Clinical history

A 49 year old male Punjabi farmer reported in Department of Dentistry with chief complaint of growth present on right side of his palate. The patient had noticed the lesion 2 months ago, and it has gradually reached the present size as painless growth without any associated tenderness or paresthesia. Medical history was non-contributory. There was no history of factors predisposing to any carcinomatous lesion such as alcohol intake, smoking, pre-existing squamous cell carcinoma, or radiation therapy.

Intra-oral findings

A large exophytic growth on hard palate corresponding to maxillary right second molar was observed [Figure 1]. The sessile lesion had an ulcerated surface and well-defined margins and measured approximately 2 × 2 cm in size not crossing mid-palatal septum. Patient had poor oral hygiene.
Figure 1: Showing lesion on palate

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Diagnostic assessment

The lesion was provisionally diagnosed as giant cell tumor or oral malignancy. Magnetic resonance imaging (MRI) reveals altered signal intensity lesion in the soft tissue of the hard palate and hypointense signal on T1 and T2 with mildly intense signal on short tau inversion recovery (STIR) sequences. Also, there was erosion of the adjacent part of maxilla and hard palate [Figure 2] with no evidence of any bone marrow edema. The hypointense nature of the mass suggested fibrous tissue within the lesion. Pre-operative hemogram was within normal limits.
Figure 2: Coronal section of MRI showing erosion of palate

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Surgical and therapeutic intervention

Informed consent was obtained for surgical excision of the lesion. The lesion was surgically excised under local anesthesia, and suturing was done to achieve primary closure.

Histopathological examination

The histopathological examination reveals acantholysis of squamous epithelium with nodular spindle cell proliferation [Figure 3]. Immunohistochemistry (IHC) showed immunoreactivity for Ki-67 in 2–3% lesional cells, and immunopositivity score 4+ was designated for vimentin in lesional cells [Figure 4]. Other IHC markers such as SMA, desmin, CD 34, S100, SOX-10, and beta-catenin were non-immunoreactive with score 0 in lesional cells. Based on these findings, diagnosis of benign spindle cell fibroblastic proliferation was made.
Figure 3: Showing acantholysis of squamous epithelium with spindle cell proliferation (hematoxylin and eosin stain)

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Figure 4: Showing immunoreactivity with vimentin

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Follow-up and outcome

Patient was regularly followed up for 6 months, and no reoccurrence was observed.

Timeline




   Discussion Top


Clinically, the lesion can be exophytic, sessile, with extensive surface ulceration with friable, fibrinoid necrosis of variable thickness as in the present case, but endophytic, pedunculated, polypoid, or nodular lesions have been reported too.[6] The predisposing factors include alcohol abuse, irradiation, and chronic trauma, but poor oral hygiene was the only factor identified in our case making the differential diagnosis including a number of benign and malignant tumors.

A dysfunction in cadherin–catenin complex and p53 gene mutations are responsible for the shift in the squamous cells to spindle type, with increased infiltrative behavior.[7] Histologically, spindle cell carcinoma exhibits both epithelial and sarcomatoid or spindle cell component. Immunohistochemistry reveals the histogenesis of the spindle cells within these tumors and nature of spindle cell carcinoma. Mesenchymal markers include vimentin, desmin, S-100, osteopontin, and BMP. Spindle cells positive for vimentin as in this case suggest that these cells have acquired mesenchymal properties through metaplastic changes.[3],[8]

Ki-67 score is defined as the percentage of total number of tumor cells with nuclear staining. In our case, based on the value of Ki-67 less than 15%, it was considered as low proliferating.[9] So the prognosis was deemed good with surgical excision only. In case of metastasis, wide excision including radical dissection is optimal treatment with or without radiotherapy. The reported recurrence rate after surgical excision is around 75%, and metastasis rate is around 35%.[6] Hence, long-term follow-up of the patient is suggested.


   Conclusion Top


Benign spindle cell tumors are rarely found on palate. As these lesions may not be diagnosed with routine histopathology, immunohistochemistry is recommended for optimal treatment planning. Early diagnosis is the key to treatment and good prognosis as deep invasion of lesion leads to poor prognosis.

Declaration of patient and patient perspective

Patient's informed written consent was obtained for using the relevant clinical details and images for publication in a medical journal without revealing his identity.

Though the patient was satisfied with the treatment outcomes, he felt that he should have visited the hospital earlier in initial stages of the growth. He also wanted his experience to be conveyed to others for early reporting to prevent discomfort and related complications.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Lewis JS. Spindle cell lesions-neoplastic or non-neoplastic? Spindle cell carcinoma and other atypical spindle cell lesions of the head and neck. Head Neck Path 2008;2:103-10.  Back to cited text no. 1
    
2.
Margo G. Differential diagnosis of benign spindle cell lesions. Surg Pathol Clin 2018;11:91-121.  Back to cited text no. 2
    
3.
Palla B, Suhaym O, Majeed N, Garzon S, Callahan N. Spindle cell variant squamous cell carcinoma of the oral cavity: Case presentation and review of literature. Oral Maxi Surg Cases 2020;6:1-5.  Back to cited text no. 3
    
4.
Surbhi, Metgud R, Naik S, Patel S. Spindle cell lesions: A review on immunohistochemical markers. J Can Res Ther 2017;13:412-8.  Back to cited text no. 4
    
5.
Shamim T. The spindle cell neoplasm of the oral cavity. Iran J Path 2015;10:175-84.  Back to cited text no. 5
    
6.
Wadhawan R, Saawarn N, Saawarn S, Sharma D. Spindle cell tumor in oral cavity: A rare case report. Int J Cont Med Surg Rad 2017;3:172-74.  Back to cited text no. 6
    
7.
Singh E. Spindle cell tumours of the head and neck-A taxonomic review. J Clin Diag Res 2018;12:19-27.  Back to cited text no. 7
    
8.
Ravindran R, Mohan V, Saji AM. Spindle cell carcinoma of maxilla: Case report of a rare entity and review of literature. Oral Max Path J 2013;4:379-84.  Back to cited text no. 8
    
9.
Jonat W, Arnold N. Is the Ki-67 labelling index ready for clinical use? Ann Onc 2011;22:500-2.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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