|LETTER TO THE EDITOR
|Year : 2021 | Volume
| Issue : 4 | Page : 783-784
Sarcomatoid variant of squamous cell carcinoma of the head-and-neck: Need for aggressive management
Ravi Shankar1, Aseem Mishra2, Bhavya B Reddy3
1 Assistant Professor, Head and Neck surgery, Department of Surgical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre and Tata Memorial Centre, Varanasi, Uttar Pradesh, India
2 Associate Professor, Head and Neck surgery, Department of Surgical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre and Tata Memorial Centre, Varanasi, Uttar Pradesh, India
3 Senior Resident, Head and Neck surgery, Department of Surgical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre and Tata Memorial Centre, Varanasi, Uttar Pradesh, India
|Date of Submission||28-Oct-2021|
|Date of Decision||01-Nov-2021|
|Date of Acceptance||05-Nov-2021|
|Date of Web Publication||29-Dec-2021|
Mahamana Pandit Madan Mohan Malviya Cancer Centre, Tata Memorial Centre, Varanasi, Uttar Pradesh-221 005, India
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Shankar R, Mishra A, Reddy BB. Sarcomatoid variant of squamous cell carcinoma of the head-and-neck: Need for aggressive management. Cancer Res Stat Treat 2021;4:783-4
|How to cite this URL:|
Shankar R, Mishra A, Reddy BB. Sarcomatoid variant of squamous cell carcinoma of the head-and-neck: Need for aggressive management. Cancer Res Stat Treat [serial online] 2021 [cited 2022 Jan 21];4:783-4. Available from: https://www.crstonline.com/text.asp?2021/4/4/783/334191
The sarcomatoid variant of squamous cell carcinoma (SCC) is a rare, high-grade morphological variant of SCC. It typically presents as a fleshy polypoidal mass. Histopathological evaluation reveals proliferation of the sarcomatoid pleomorphic spindle cells and carcinomatous squamous cells. Both components usually abut one another. The spindle cell component may assume various histological patterns. The carcinomatous and sarcomatous components share a common tumorigenic pathway, with a phenotypic divergence. The cells acquire the mesenchymal phenotype through metaplastic changes. The two most common histological patterns of the sarcomatoid components are the pleomorphic (malignant histiocytoma-like) and spindle cell (fibrosarcoma-like) sarcomas.
Due to the controversy in the theories of the cell of origin and the varying clinical aggressiveness, it is known by various names such as spindle cell carcinoma, pseudosarcoma, fusiform carcinoma, polypoid carcinoma, pleomorphic carcinoma, etc. The three widely proposed theories of the pathogenesis of this tumor are as follows: (1) carcinosarcoma – collision tumor, (2) pseudosarcoma – SCC with an atypical reactive stroma, and (3) sarcomatoid carcinoma (dedifferentiation theory)-transformation of an epithelial cell to a spindle cell morphology. Recent studies on molecular pathogenesis have shown evidence of the monoclonal origin of a stem cell with an ability for divergent differentiation. Sarcomatoid carcinoma shows immunopositivity for cytokeratin and vimentin and immunonegativity for S100 and CD34. Early-stage tumors, depth of invasion and distant metastasis, and a polypoid configuration are found to be reliable prognostic factors. Sarcomatoid carcinomas are aggressive and have a higher incidence of metastasis and local failure.
The treatment involves multimodality curative intent therapies like radical surgery with neck dissection, usually followed by appropriate adjuvant therapy, with a good prognosis and disease-free survival benefits.
In the study by Chakraborthy et al. published in the last issue of the journal, the authors have emphasized the clinical presentation and intent of treatment with outcomes of sarcomatoid carcinoma, thus providing an understanding of the pattern of presentation and treatment given to patients along with their outcomes. Curative intent treatment was given to approximately 70% of patients. Almost 71% patients presented with Stage III-IV disease, which itself shows the aggressive nature of the disease. Almost 30% of the patients developed distant metastasis at a median follow-up of 29 months. This study emphasizes the importance of curative-intent treatment, like surgery with adjuvant therapy as indicated, by demonstrating a disease-free survival of 76.3 months versus 11.6 months for palliative intent treatment. However, the role and extent of adjuvant treatment yet remain to be defined for this subset of patients. Although contradictory studies exist regarding the benefit of adjuvant radiotherapy or a single modality treatment, multimodality, and timely aggressive treatment can produce acceptable disease-free survival and locoregional control outcomes.
This was a retrospective study with limited sample size. Given the rarity of the disease, it is difficult to conduct a randomized trial to assess the prognostic factors and appropriate treatment modalities. Sarcomatoid carcinoma is a biologically aggressive disease and its histology mimics that of sarcoma, and therefore, immunohistochemistry must be utilized for confirmation of the histology at the time of diagnosis. Given the biological aggressiveness of the disease, it is prudent to rely on the evidence generated by good retrospective studies to guide the management and err on the side of overtreatment.
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Conflicts of interest
There are no conflicts of interest.
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