Spindle-cell Eptdermoid Carcinoma

For several years the authors have been interested in certain peculiar tumors of the skin and mucous membranes which have been designated as spindle-cell epidermoid carcinomas. Most of these lesions have occurred in the zone including and surrounding the lip, and this particular group has been especially selected for the present study, although tumors of somewhat similar histology have been noted in other regions, namely the larynx, esophagus, lung, cervix, bladder, and urethra. We prefer not to include with them the peculiar sarcomatoid metaplasias observed in certain tumors of glandular organs, especially of the salivary glands, breast, and thyroid. These latter tumors are well known and are represented by numerous case reports in the literature. They have been variously interpreted as carcinomas with spindle-cell metaplasia, carcinosarcomas in the sense of true mixed tumors ab iwitio, carcinomas in which the epithelial proliferation supposedly excites a sarcomatous stromal growth. The concept of spindle-cell metaplasia in various types of epidermoid carcinoma is far from new. Such changes in structure were clearly recognized by Krompecher (1) as early as 1900. Krompecher spoke of tumors which “ aus langlichen spindeligen Zellen bestehen, welche einen intensiv farbbaren Kern aufweisen, demnach dunkel gefiirht erscheinen und sofort als gewucherte Cylinderzellen des Stratum Malpighii erkannt werden konnen. ” Moreover, he states that “diese spindelartigen Zellen bilden oft Strange, welche sich in den verschiedenartigsten Richtungen durchkreuzen, und so entstehen mitunter Bildcr, die uollkommen einern Spi~adelapllensarkonl yleicheft” (italics ours). Krompecher, while listing 29 cases, furnished details of but 21. In reviewing his dem-iptions it becomes apparent that few of his cases were of the exact type the present authors are describing. The majority represented peculiar changes in the structure of basal-cell epithelioma, as indeed Krompecher admits. He endeavored to explain the spindle-cell character by stating that only the cylindrical-cell layer of the stratum malpighii and its downward continuation about hair follicles and cutaneous glands proliferated. In a later paper Krompecher (2 ) described the transformation of parenchyma (epithelium) into stroma, a gradual metamorphosis of spindle-shaped basal cells into connective-tissue cells and fibrous tissue, and showed illustrations of the process in basal-cell epithelioma. He found analogies between the development of the spindle-celi ‘ ‘ stroma”