Marom, in Tumors and Tumor-Like Conditions of the Lung and Pleura, 2010 Mesenchymal Malignant Tumors of the Lung It is important that monophasic synovial sarcoma and the fibrosarcomatous (higher grade) variant of dermatofibrosarcoma protuberans should not be lost in this category, as these two diagnoses may have specific chemotherapeutic implications.Įdith M. Some likely represent MPNST, less than 40% of which express nerve sheath antigens, since electron microscopy, which might have been informative, is only infrequently used (or even available) for tumor diagnosis nowadays. Some of these tumors likely represent true fibrosarcomas or myofibrosarcomas, but diagnostic criteria are not adequately or fully defined in that regard as yet.
Histologic grade is variable, as also is the extent of collagenous matrix. Most have a fascicular growth pattern and either amphophilic or palely eosinophilic cytoplasm with tapering nuclei. The majority of unclassified spindle cell sarcomas, in this author's experience, arise in somatic soft tissue across a very broad age range. Fletcher MD, FRCPath, in Diagnostic Histopathology of Tumors, 2021 Unclassified Spindle Cell Sarcomas French’s laboratory, who also revealed NUT–bromodomain containing 4 gene ( BRD4) translocation, but the analysis was subsequently repeated in our laboratory (by G.P., M.C., and E.B.) successfully by using a commercially available dual-color break-apart probe kit (ZytoLight SPEC NUTM1 CE IVD, ZytoVision, Bremerhaven, Germany) ( Fig. 2 F).Christopher D.M. Owing to this unusual morphology, a FISH confirmation of the NUTC diagnosis was requested to Dr. A diagnosis of NUTC was definitively rendered by also reviewing bronchial biopsy samples it was staged as pT3N2 (IIIB, according to the TNM/American Joint Committee on Cancer criteria ) because of three N1 metastatic lymph nodes and one N2 metastatic lymph node.
Subsequent lobectomy with extended lymph node excision revealed a solid tumor with pushing edges of growth, spotty necrosis, and vascular invasion that was composed exclusively of spindle cells arranged in variably intertwining fascicles with up to 15 mitoses per 2 mm 2 but no signs of keratinization ( Fig. 2 A– D).Īccordingly, an IHC assay for NUT protein expression was carried out with the clone C52B1 (Cell Signaling Technology, Danvers, MA) in a 1:50 dilution for 60 minutes after pretreatment with ethylenediaminetetraacetic acid buffer pH9 for 88 minutes and use of the OptiView DAB IHC Detection Kit on the Ventana BenchMark Ultra (Hoffmann-La Roche AG, Basel, Switzerland), which showed widespread nuclear decoration in virtually all tumor cells ( Fig. 2 E) with a speckling appearance of the staining (see Fig. 2 E ). Bronchial biopsy samples were initially diagnosed as squamous cell carcinoma despite the fact that the patient was young and a nonsmoker. Briefly, a 30-year-old white male nonsmoker was admitted to the hospital for sudden thoracic pain owing to a 6.5-cm tumor involving the left lower lobe ( Fig. 1 A) with minimal homolateral pleural effusion and mediastinal lymph node involvement ( Fig. 1 B). Malignant tumors made of spindle cells in the lung usually comprise pleomorphic or spindle cell carcinoma, some intermediate- to high-grade neuroendocrine tumors, and (less frequently) sarcomas (either primary or metastatic), amelanotic melanoma, mesothelioma, or thymus-like tumors, whereas the existence of spindle cell–looking NUTC in the lung was unprecedented.
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