Spindle Cell Carcinoma of the Lower Limbs: A Case Report

Case Report

Spindle Cell Carcinoma of the Lower Limbs: A Case Report

Niu F^1*, Lai W², Fu Q¹, Ma G² and Gao Y¹
¹Department of Orthopedics, Yangzhou Hospital of Traditional Chinese Medicine, China
²Department of Orthopedics, Xinyuan Hospital of Traditional Chinese Medicine, China

^*Corresponding author: Feng Niu, Department of Orthopedics, Yangzhou Hospital Of Traditional Chinese Medicine, 577 Wenchang West Street, Yangzhou, Jiangsu, 225002, P.R. China

Published: 23 Jul, 2016
Cite this article as: Niu F, Lai W, Fu Q, Ma G, Gao Y. Spindle Cell Carcinoma of the Lower Limbs: A Case Report. Clin Surg. 2016; 1: 1074.

Abstract

Spindle cell carcinoma of the leg is an unusual tumor. It is important to increase the recognition of the disease and improve the level of clinical diagnosis. The current study presents a case of spindle cell carcinoma with clinical, imaging and pathological examination. A 65-year-old female presented to the Xinyuan Hospital of Traditional Chinese Medicine suffering from a mass about 3.6 × 1.6 × 15.0cm on the back skin of her right leg for approximately one month. Imaging examination by leg computed tomography scan revealed a 9.2 × 4.0 cm solid mass infiltrated into the subcutaneous fat in the back skin of the right tibia. The patient underwent resection of the mass on March, 17, 2013. Patholocical examination showed the tumor was composed of small, elongated cords in a tightly packed arrangement. Tumor cells were smaller and cube-shaped or oval and lowgrade nuclei. Occasionally, necrosis and foam cell infiltration were observed. The tumor reappeared after one year later, a 6.0 × 7.0 × 15.0 cm mass appeared on the incision with bleeding after slight impact. The patient underwent resection of the recurrence tumor and VSD covered the defect of the skin on July, 10, 2014. The tumor reappeared again after 10 days and bleeded combined necrosis and foul smell. Continuing bleeding cause the hypoproteinemia and emaciation for 3 months. The patient cannot endure the miserable experience and asked amputation of the knee on Oct, 16, 2014. However, a new mass about 1.6 × 1.6 × 1.0 cm was found in the skin of the popliteal fossa. Patholocical examination showed the new mass was spindle cell carcinoma. However, subsequent chemotherapy, radiation and immunohistochemical markers weren’t underwent because of the patient’s personal economic reason. The patient is still alive after 7 months without evidence of disease, we don’t receive the recurrence report after the follow investigation until now.
Keywords: Spindle cell carcinoma; Lower limbs; Skin

Introduction

Spindle cell carcinoma is a rare epithelial tumor, believed to be a type of low-grade malignant tumor. The precise origin is unclear certain researchers have, The present study analyzed the clinical results of a patient who presented to the Xinyuan Hospital of Traditional Chinese Medicine (Xinjiang, China) suffering from the spindle cell carcinoma of the back skin on the right tibia, and performed a review of the relevant literature, to increase understanding of the tumor. Additionally the purpose of this study was to raise awareness of this tumor type for clinicians and pathologists in order to decrease the rate of misdiagnosis.

Case Report

Clinical results
A 65-year-old female presented to the Xinyuan Hospital of Traditional Chinese Medicine suffering from the mass about size 3.6 cms × 1.6 cms × 15.0 cms on the back skin of her lower right leg for approximately one month. Imaging examination by the computed tomography scan and revealed a 9.2 cms × 4.0 cms solid mass infiltrated into the subcutaneous fat in the back skin of the lower right leg. The tumor was well-circumscribed with the muscle and protruding outside the skin (Figure 1). Magnetic resonance imaging showed with signal intensity similar to the muscle on T1W1 (Figure 2) and slightly higher than that of muscle on T2W2 (Figure 3).

Surgical Procedures

The patient was underwent the first resection of the mass on the date of March, 17, 2013. The second resection of the recurrent mass was undergone on July, 10, 2014. The third operation was the knee amputation of the right knee on the Oct, 16, 2014 under general anesthesia.
Macroscopy
Dissection of the two resection specimen revealed than the tumor was bad-circumscribed, fragile and off-white, measuring size 10.0 cms × 6.5 cms × 6.5 cms. No areas of hemorrhage or necrosis were identified in the tumor. In addition, no invasion of the muscle. The tumor reappeared after one year later, a 6.0 cms × 7.0 cms × 15.0 cms mass appeared on the incision with bleeding after slight impact (Figure 4). The patient was underwent resection of the recurrence tumor (Figure 5) and VSD covered the defect of the skin on July, 10, 2014 (Figure 6). The tumor reappeared again after 10 days (Figure 7) and bleeding combined necrosis and foul smell (Figure 8). Continuing bleeding caused the hypoproteinemia and emaciation for 3 months, the tumor was about size7.0 cms × 9.0 cms × 16.0 cms. The patient asked for the amputation of the knee on Oct, 16, 2014 (Figure 9). However, a new mass about size 1.6 cms × 1.6 cms × 1.0cms which was similar with the original tumor was found in the subcutaneous fat of the popliteal fossa (Figure 10).
Microscopy
The tumor was composed of small, elongated cords in a tightly packed arrangement (Figure 11). Tumor cells were smaller and cubeshaped or oval and low-grade nuclei. Occasionally, necrosis and foam cell infiltration were observed (Figure 12).
Pathological results
The tumor was bad-circumscribed, measuring 3.6 × 1.6 × 15.0 cm. Invasion of the subcutaneous fat of the back skin of the tibia. Under the microscope (BX53, Olympus, Tokyo, Japan), the tumor observed to be composed of small, elongated cords or tubules.