Diagnosing Hypocellular Collagenized Spindle Cell Squamous Carcinoma of the Head and Neck: A Rare Subtype with Misleading Histologic Features

Daniela Hoehn, MD, PhD, C. Cameron Yin, MD, PhD, Lei Chen, MD, Geoff Sheridan, BS, Bruce M. Wenig, MD, PhD


Spindle cell squamous carcinoma of the head and neck (SCSCHN) is a high-grade variant of squamous cell carcinoma (SCC) that is histologically characterized by the presence of a conventional SCC and an associated malignant spindle cell stromal component. Typically, the spindle cell infiltrate expresses epithelial markers such as cytokeratin and is hypercellular and pleomorphic and readily identifiable as malignant. However, the stromal component in the hypocellular collagenized variant of SCSC is very hypocellular with prominent collagenization. In addition, cytokeratin immunoreactivity can be absent in up to 40% of cases of SCSC, and the conventional SCC component may be absent. These features create diagnostic challenges, and literatures addressing these issues are lacking. We describe the clinical, pathologic and immunohistochemical features of three cases of hypocellular collagenized SCSCHN and discuss major differential diagnoses that will allow for its proper identification. 


spindle cell squamous carcinoma, head and neck, hypocellular collagenized, clinicopathologic

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