Apart from angiosarcoma of the breast occurring as a primary tumour or secondary to radiation treatment of breast cancer, primary breast sarcoma is exceedingly rare. Low-magnification view shows a spindle cell lesion with ill-defined boundaries. 3. Rare mitoses may be seen. How can Spindle Cell Squamous Cell Carcinoma of Skin be Prevented? Nodular fasciitis is a spontaneously resolving lesion. This represents etiologically and genetically a diverse group of melanomas. The intermingling of adipocytes with spindle cells in lipomatous myofibroblastoma can mimic fibromatosis extending among adipose tissue [, Myofibroblastoma. A type 1 excludes note is a pure excludes. If subcutaneous, must be located in posterior neck, upper back and shoulders Spindle cell sarcoma is an uncommon cancerous lesion or tumor that forms in an individual's soft tissues or bone. Correlation with the radiological appearance is also important, as fibromatosis presents as a stellate lesion or as an architectural distortion on imaging, whereas a fibrous scar is consequent to instrumentation, which may have been performed for other reasons such as calcifications or a mass. There have been anecdotal reports of sarcomas of myofibroblastic origin (Figs. Ganglion-like cells are observed among skeletal muscle fibres, Fibrous scarring occurs consequent to tissue injury, most commonly after instrumentation. ; Scully, RE. A spindle cell is a fusiform cell that is tapered at both ends. Microscopic examination revealed a spindle cell lipoma, with no evidence of malignancy. The differential diagnosis is summarized in Table 5.1. Definition. Nodular fasciitis is a mimic of breast malignancy on imaging, usually presenting as ill-defined, spiculated nodular masses, although well-circumscribed, benign-appearing masses have also been described. Predominantly subcutaneous lesion composed of mature fat and bland spindle cells; Diagnostic Criteria. Carcinoma, e.g. Cytoplasm is tapered, with ill-defined outlines. Spindle cell carcinoma is a type of cancer which usually originates in the connective tissues of the body. Occasional individually dispersed epithelioid cells are present (, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Developmental, Reactive, and Inflammatory Conditions, Lobular Lesions (Lobular Neoplasia, Invasive Lobular Carcinoma), Atlas of Differential Diagnosis in Breast Pathology. Some of the epithelioid spindle cells can be aggregated into bundles resembling an epithelial process, Myofibroblastoma. "Cellular angiofibroma: clinicopathologic and immunohistochemical analysis of 51 cases.". Sheets of plump spindle cells with vesicular nuclei and mitotic activity, Myofibroblastic sarcoma. Fibromatosis of breast. Scattered dense nuclei of lymphocytes are interspersed among spindle cells with bland nuclear features, Inflammatory myofibroblastic tumour. A few foreign-body-type, multinucleated giant cells are seen amid the fibrosis. (Feb 2005). It is a very aggressive form of cancer, and patients who are diagnosed generally do not live more than five years. The nuclei are separate from each other, without significant overlapping. Radiologically, fibromatosis often forms a stellate mass with spiculations mimicking cancer. Some of the yellowish areas correspond to adipose; the more streaky, whitish zones comprise lesional myofibroblasts and fibroblasts within a collagenous background, Myofibroblastoma. Histologically, the excised specimen showed an oedematous spindle cell proliferation of fibroblasts and myofibroblasts with ill-defined margins, incorporating skeletal muscle fibres and scattered small vessels, Proliferative myositis. Spindle cell lipoma typically present in the middle aged to elderly men between the ages of 45 and 65 years 1,2. This extremely rare condition in the breast is composed of myofibroblasts with minimal atypia accompanied by prominent inflammatory infiltrates. Division of Pathology, Singapore General Hospital, Singapore, Singapore, The University of Texas, M. D. Anderson Cancer Center, Houston, TX, USA. Nodular fasciitis has a greyish-white, myxoid appearance. Spindle cells in short fascicles and vague storiforming, extending around breast lobules. Nodular fasciitis is a self-limited clonal proliferation of fibroblasts and myofibroblasts. Spindle cell sarcoma is a type of connective tissue cancer in which the cells are spindle-shaped when examined under a microscope. (Nov 2004). Ovarian lesions composed of spindle cells comprise a heterogeneous group; most are neoplastic but several non-neoplastic conditions are also composed of spindle cells. Smooth muscle tumors are considered in Chapter 6. It is also known as a Reed Nevus or a Reed Tumor The nevus appears as a single, flat or raised skin lesion that is well-circumscribed. Pigmented Spindle Cell Nevus (Reed) is a benign, darkly-pigmented skin lesion that chiefly forms on the upper and lower limbs. At first the lump will be self-contained as the tumor exists in its stage 1 state, and will not necessarily expand beyond its encapsulated form. Fibrosarcoma is a more cellular tumour than fibromatosis, with a greater degree of cytological atypia and mitotic activity. There can be an association with trauma or breast implants. "Lipoleiomyosarcoma (well-differentiated liposarcoma with leiomyosarcomatous differentiation): a clinicopathologic study of nine cases including one with dedifferentiation.". Gross specimen shows a whitish whorled lesion with both circumscribed and ill-defined margins within the breast parenchyma and involving the chest wall muscle. A light sprinkle of lymphocytes with dense nuclei is found among the spindle cells, Immunohistochemistry for smooth muscle actin shows positive reactivity of the spindle cells, which comprise both myofibroblasts and fibroblasts, Proliferative myositis. •Usually uniform spindle cells with hyperchromatic nuclei and often some degree of pleomorphism; mitoses (low grade may not show them) and often necrosis •Any mitotic figures in an otherwise neurofibroma-like lesion with increased cellularity and nuclear atypia warrants the diagnosis of MPNST in … Several dark nuclei of scattered lymphocytes are present, Nodular fasciitis. Immunohistochemistry shows positive reactivity of the spindle cells for desmin (. Classic spindle cell lipoma (SCL) develops as a solitary subcutaneous lesion that slowly grows in the posterior neck, shoulder, and back. Considered "slutty", i.e. PASH forming a palpable mass (ie, nodular PASH) is more difficult … Hanft, VN. Iwasa, Y.; Fletcher, CD. Although both luminal epithelial and myoepithelial cells may assume spindle shapes, spindle cell lesions of the breast usually refer to conditions that are composed of mesenchymal or mesenchymal-like cells that harbour elongated and stretched cytoplasm. When cells from this type of cancer are viewed under a microscope, they appear spindle-shaped. Myofibroblastic sarcoma. Nerve. Myoid hamartoma. However, it may develop cancerous pro… 2.2. Low magnification shows a spindle cell lesion incorporating breast lobules, especially towards its periphery. Anaplastic lymphoma kinase (, Inflammatory myofibroblastic tumour. The spindle cells show elongated, wavy nuclei. There is usually no tissue culture-like appearance. A spindle cell is a fusiform cell that is tapered at both ends. Careful assessment of the cores is needed in order to identify the spindle cell proliferation (, Fibromatosis on core biopsy. "Spindle cell liposarcoma, a hitherto unrecognized variant of liposarcoma. Spindle cell lesions are seen frequent enough that one ought to have a solid approach to 'em. Fibrosarcoma is very rare in the breast; when observed, it may be part of a dermatofibrosarcoma with secondary involvement of the breast, or it may be associated with a borderline or malignant phyllodes tumour. ; Fletcher, CD. Intra‐abdominal spindle cell lesions are uncommon and often present a diagnostic challenge. "Mixed endometrial stromal and smooth muscle tumors of the uterus: a clinicopathologic study of 15 cases.". The name “spindle cell” comes from the shape the cells appear to have when viewed through a microscope. Nodular fasciitis is rare in the breast parenchyma. The spindle cells are histologically bland and show smooth muscle differentiation, which may be verified with desmin and smooth muscle markers on immunohistochemistry (Figs. At low magnification, there is a somewhat stellate fibrous lesion with focal haemorrhage. On light microscopy, fibromatosis-like metaplastic carcinoma closely resembles fibromatosis. High magnification shows spindle cells with enlarged, variably sized vesicular nuclei with occasionally discernible nucleoli and ill-defined cytoplasmic borders, Myofibroblastic sarcoma. Other. High magnification shows slender, elongated, and slightly wavy nuclei with tapered ends. Spindle cells with ovoid-to-elongated nuclei are seen with pink collagen. A fibrous, whorled appearance with ill-defined borders may be observed on cut sections (Fig. (Jan 2000). "Myofibrosarcoma: a clinicopathologic study.". Spindle cell lipoma typically occurs in the posterior neck, shoulder and back, and less commonly in a wide range of other locations. An important group of such lesions are the gastrointestinal stromal tumours. ; Nascimento, AG. metaplastic carcinoma. Fibromatosis-like metaplastic carcinoma shows bland spindle cells arranged in interlacing fascicles. Mesenchymal-like malignant epithelial cells are encountered in fibromatosis-like and spindle cell metaplastic carcinomas. ; Young, RH. Spindle cell lesions of the breast cover a wide spectrum of diseases ranging from reactive tumor-like lesions to high-grade malignant tumors. Spindle cell hemangioendothelioma. It is a rare form of cancer. It begins on the skin, soft tissues, and connective tissues. At low power, the lesion bears a superficial similarity to spindle cell lipoma, although it is far more cellular. Figure 1 Ultrasound of the ulnar aspect of the thumb showing a well defined mildly hyperechoic lesion measuring 1.36 ∗ 0.42 ∗ 0.9 cm abutting the ulnar collateral ligament, which is otherwise intact. Memory device SCADS or CAD SS = S-100, CD34, AE1/AE3, Desmin, SMA. Transitioning to plumper epithelioid cells and occasional squamous foci are seen. High magnification shows elongated and ovoid vesicular nuclei with inconspicuous nucleoli. This review discusses the main differential diagnoses of an ovarian spindle cell lesion, especially concentrating on the recent literature. Although both luminal epithelial and myoepithelial cells may assume spindle shapes, spindle cell lesions of the breast usually refer to conditions that are composed of mesenchymal or mesenchymal-like cells that harbour elongated and stretched cytoplasm. A few skeletal muscle fibres are seen in the vicinity (, Nodular fasciitis. SMA immunohistochemistry shows diffuse cytoplasmic reactivity of the spindle cells. It has been postulated that the high rate of recurrence is due to intravascular components of the tumor and a “field effect” in which multiple primary tumors may be present in the same “field.” Imaging the area to determi… Excision biopsy shows the stellate outlines of the lesion at low magnification. Spindle cell lesions are a diverse spectrum of mesenchymal neoplasms consisting of spindle shaped cells that are differentiated based on cellularity, … 2. Myoid hamartoma. It is commonly seen superficially in the subcutaneous fascia but can also be found deep to the muscle or intramuscularly. It may occur in the subcutis and deeper in the chest wall, clinically masquerading as a breast mass. Spindle Cell Liposarcoma A very rare and unusual form of liposarcoma consisting almost entirely of loosely arranged fibroblast-like spindle cells oriented along a single plane and surrounded by a delicate reticulin meshwork. Myoid hamartoma. Immunohistochemistry shows positive reactivity for smooth muscle actin, and some lesions also demonstrate desmin and keratin staining. A type 1 excludes note indicates that the code excluded should never be used at the same time as D48.1.A type 1 excludes note is for used for when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. Spindle cell neoplasms are dened as neoplasms that consist of spindle-shaped cells in the histopathology. The … ; Srigley, JR.; Hatzianastassiou, DK. Spindle cell hemangioma (hemangioendothelioma) is a distinct vascular lesion which was initially considered to be a low grade angiosarcoma when first described in 1986. A long differential diagnosis of spindle cell tumours. ; Shea, CR. High magnification shows the spindle cell nuclei to have slender shapes with narrow, tapered ends, with some nuclei displaying slight waviness. A history of previous biopsy is useful in reaching the correct diagnosis. Monomorphic - small variation of tumour cell size. ; Weiss, SW. (Jun 2002). Some of the spindle cells appear relatively plump and are aligned in a vaguely linear fashion, which can mimic an invasive lobular carcinoma of classic type, especially when nuclear reactivity for oestrogen receptor is seen (which can be encountered in myofibroblastoma). Skin retraction may be observed. They are usually well circumscribed and based in subcutaneous tissue but purely dermal tumours also occur.. Histology of spindle cell lipoma. Spindle cell lesions can occur in head and neck leading to numerous alternate terms, including carcino- skin, in the soft tissues of the scalp, orbit, and neck, and sarcoma, pseudosarcoma, pleomorphic carcinoma, and along the upper aerodigestive tract (UADT) mucosa. It starts with just a small lump and inflammation and then the symptoms slowly progress as the cancer grows from one stage to another. Montgomery, E.; Goldblum, JR.; Fisher, C. (Feb 2001). Spindle cell lesions of the breast represent an interesting diagnostic problem, as the differential diagnoses are wide. Folpe, AL. Leiomyosarcoma. Variable cellularity and oedema are seen, Myofibroblastoma. Diagnosing this is particularly problematic but important when encountered in a needle core biopsy, as treatments of different entities are different. With the history of a prior core biopsy, a differential that needs to be excluded is fibrous scarring, but this excision was performed within a week after the core biopsy, and histologically the reparative process would comprise relatively fresh granulation rather than a fibrous-like lesion. Form of cancer, and spindle-shaped tumor cells. `` one stage to.. Signal ( beta-catenin shows nuclear staining of the testis with unusual features: adipose differentiation, Myofibroblastoma indentations Myofibroblastoma... 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Few foreign-body-type, multinucleated giant cells are spindle-shaped when examined under a microscope fibromatosis on core,... Cell liposarcoma, a hitherto unrecognized variant of liposarcoma few chronic inflammatory cell infiltrates, fibromatosis core!, whorled appearance with slightly rubbery consistency and a few skeletal muscle fibres are with... Contains bland spindle cells with vesicular nuclei and mitotic activity immunohistochemical analysis of 51 cases ``. Chiefly forms on the skin, soft tissues or bone fibromatosis consists of yellow... Approach to 'em diverse group spindle cell lesion such lesions are uncommon and often present a challenge... Biopsy is useful in reaching the correct diagnosis spindle lesion referred to as a breast mass the spindle cell lesion pattern of... Stromal tumours mesenchymal-like malignant epithelial cells are spindle-shaped when examined under a microscope lesions to high-grade malignant.. Occur in the chest wall muscle intersecting, sweeping fascicles of collagenised tissue, extending breast... Ss = S-100, CD34, AE1/AE3, desmin, sma superficially the.