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Table of Contents
LETTER TO THE EDITOR
Year : 2021  |  Volume : 4  |  Issue : 4  |  Page : 783-784

Sarcomatoid variant of squamous cell carcinoma of the head-and-neck: Need for aggressive management


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 Submission28-Oct-2021
Date of Decision01-Nov-2021
Date of Acceptance05-Nov-2021
Date of Web Publication29-Dec-2021

Correspondence Address:
Ravi Shankar
Mahamana Pandit Madan Mohan Malviya Cancer Centre, Tata Memorial Centre, Varanasi, Uttar Pradesh-221 005, India
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_246_21

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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 20];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.[1] It typically presents as a fleshy polypoidal mass. Histopathological evaluation reveals proliferation of the sarcomatoid pleomorphic spindle cells and carcinomatous squamous cells.[2] 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.[3] Sarcomatoid carcinoma shows immunopositivity for cytokeratin and vimentin and immunonegativity for S100 and CD34.[4] 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.[5]

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.[5] 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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Barnes L, Eveson JW, Reichart P, Sidransky D. WHO Classification of Tumours. Pathology and Genetics of Head and Neck Tumours. Lyon: IARC Press; 2005. p. 122-8.  Back to cited text no. 1
    
2.
Thompson LD, Wieneke JA, Miettinen M, Heffner DK. Spindle cell (sarcomatoid) carcinomas of the larynx: A clinicopathologic study of 187 cases. Am J Surg Pathol 2002;26:153-70.  Back to cited text no. 2
    
3.
Manley BJ, Hsieh JJ. Sarcomatoid renal cell carcinoma: Genomic insights from sequencing of matched sarcomatous and carcinomatous components. Transl Cancer Res 2016;5:S160-5.  Back to cited text no. 3
    
4.
Viswanathan S, Rahman K, Pallavi S, Sachin J, Patil A, Chaturvedi P, et al. Sarcomatoid (spindle cell) carcinoma of the head and neck mucosal region: A clinicopathologic review of 103 cases from a tertiary referral cancer centre. Head Neck Pathol 2010;4:265-75.  Back to cited text no. 4
    
5.
Chakraborthy A, Thiagarajan S, Bal M, Chaukar D. Clinical presentation and pattern of care for sarcomatoid variant of squamous cell carcinoma of the head and neck region: A retrospective study. Cancer Res Stat Treat 2021;4:466-71.  Back to cited text no. 5
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This article has been cited by
1 Authors' reply to Paramanandhan et al. and Shankar et al.
Adhara Chakraborty, Shivakumar Thiagarajan, Devendra Chaukar
Cancer Research, Statistics, and Treatment. 2021; 4(4): 785
[Pubmed] | [DOI]



 

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