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Spindle cell carcinoma of head and neck: an immunohistochemical and molecular approach to its pathogenesis
  1. Ruchika Gupta1,
  2. Sompal Singh2,
  3. Suresh Hedau3,
  4. Sonu Nigam1,
  5. Bhudev C Das3,
  6. Ishwar Singh2,
  7. Ashish Kumar Mandal1
  1. 1Department of Pathology, Maulana Azad Medical College, New Delhi, India
  2. 2Department of ENT, Maulana Azad Medical College, New Delhi, India
  3. 3Division of Molecular Oncology, Institute of Cytology and Preventive Oncology (ICMR), New Delhi, IndiaDr A K Mandal, Department of Pathology, Maulana Azad Medical College, New Delhi 110091, India;
  1. Correspondence to:
 Dr Ruchika Gupta 162 Pocket-B, Sarita Vihar, New Delhi-110076, India; rucihka257{at}


Background: Spindle cell carcinoma (SpCC) is a rare microscopic type of cancer of the mouth and oropharynx. Although SpCC is thought to arise from squamous cell carcinoma (SCC), it carries a worse prognosis.

Aim: To find out the difference in immunohistochemical expression of cytokeratin, vimentin and smooth-muscle actin, and mutational alterations in the K-ras oncogene between the two tumours, in an attempt to characterise SpCC.

Methods: Immunohistochemical analysis was performed by standard avidin–biotin complex method in 35 cases each of SpCCs and SCCs. DNA extracted from paraffin wax-embedded tumours was used for PCR followed by single-strand conformation polymorphism for mutational analysis of K-ras exon 1 and exon 2.

Results: In the SpCC group, cytokeratin positivity was significantly higher in epithelial areas (52.2%) than in spindle cell areas (16.1%), whereas vimentin was more positive in spindle cell areas (18.7%) than epithelial areas (2.7%). Cells intermediate between epithelial and spindle cell areas were consistently positive for both cytokeratin and vimentin. Cytokeratin was found to be significantly more positive in SCC (72.6%) than the squamous component and spindle cell component of SpCC. In this study, no mutation was detected in the K-ras gene of either the SpCC or SCC group.

Conclusions: The spindle cell component of SpCC is intermixed with cells that are morphologically mesenchymal but express dual antigen-positivity characteristic of epithelial (cytokeratin) and mesenchymal (vimentin) cells. These, possibly, are cells in transition suggesting that SpCC may be a sarcomatous metaplasia of SCC.

  • dCTP, deoxycytidine triphosphate
  • SCC, squamous cell carcinoma
  • SpCC, spindle cell carcinoma

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  • Published Online First 26 May 2006

  • Competing interests: None declared.