J Korean Assoc Oral Maxillofac Surg.  2016 Aug;42(4):221-226. 10.5125/jkaoms.2016.42.4.221.

Spindle cell carcinoma of the tongue combined with double primary cancer of the thyroid gland: a case report

• Kim TH
• Kim CH

• KMID: 2350075
• DOI: http://doi.org/10.5125/jkaoms.2016.42.4.221

Abstract

Spindle cell carcinoma (SpCC) is referred to as a variant of oral squamous cell carcinoma. It is also known as "sarcomatoid squamous cell carcinoma" because it consists of normal squamous carcinoma cells with spindle-shaped cells that appear similar to a sarcoma. The term, "second primary tumor" (SPT) or "double primary tumor", is proposed for a second tumor that develops independently from the first. SPTs can present as either synchronous or metachronous lesions. Synchronous SPTs are defined as tumors occurring simultaneously or within 6 months after the first tumor. The patient in this case, whose primary tumor was in the tongue, was diagnosed with SpCC with metastases to both neck lymph nodes. This case also exhibited a second primary cancer as a synchronous lesion in the thyroid gland, which is uncommon. All carcinomas, both in the tongue and thyroid gland, were removed surgically, and especially in the tongue, an anterolateral thigh free flap was performed successfully to replace the defect.

Keyword

Spindle-cell carcinoma; Second primary tumor; Synchronous cancer

MeSH Terms

Carcinoma
Carcinoma, Squamous Cell
Epithelial Cells
Free Tissue Flaps
Humans
Lymph Nodes
Neck
Neoplasm Metastasis
Neoplasms, Second Primary
Sarcoma
Thigh
Thyroid Gland
Thyroid Neoplasms*
Tongue*

Figure

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  Fig. 1 Primary tongue cancer presenting as a lobulated hypermetabolic lesion (maximum standardized uptake value [SUVmax] 8.7) in and around the anterior tongue and a focal mild hypermetabolic lesion (SUVmax 2.9) at the right cervical level I showed right neck lymph node metastasis in preoperative positron emission tomography and computed tomography (PET/CT).

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  Fig. 2 A focal hypermetabolic lesion (maximum standardized uptake value 8.4) at the left cervical level III assumed to be a metastatic lymphadenopathy in preoperative positron emission tomography and computed tomography (PET/CT).

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  Fig. 3 A focal hypermetabolic lesion (maximum standardized uptake value 4.4) with calcification in the left thyroid gland suspected of being synchronous primary thyroid carcinoma in preoperative positron emission tomography and computed tomography (PET/CT).

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  Fig. 4 Intra-operative photograph right after a subtotal glossectomy and modified radical neck dissection with visor flap.

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  Fig. 5 Defect reconstructed with anterolateral thigh free flap.

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  Fig. 6 Presence of both poorly-differentiated sarcomatoid changes of cells and keratinized pearls (arrows) which are characteristic features of squamous cell carcinoma (H&E staining, ×100).

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  Fig. 7 Typical cells of papillary carcinoma are predominantly seen in this specimen; some normal thyroid gland cells are noted in the right upper corner (H&E staining, ×100).

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