What is the pathological cause of spindle cell sarcoma?

When spindle cell sarcoma occurs, attention should be paid to the understanding of pathological factors, because this type of cell sarcoma can pose a great threat to physical health, so more attention should be paid to the understanding of pathological factors, and active treatment should be carried out after the disease is identified.

(1) First, based on the location of the tumor and the patient's age, a preliminary analysis is conducted to determine whether sarcoma, carcinoma, or malignant melanoma is more likely. Poorly differentiated soft tissue sarcomas and malignant peripheral nerve tumors mostly occur in deeper tissues of the human body, such as muscles, retroperitoneum, pelvis, mediastinum and visceral organs, and are not closely related to the skin or mucosal epithelium covering the surface of the tissues. Poorly differentiated spindle cell carcinomas are often seen in organs and tissues covered with squamous epithelium or transitional epithelium, such as the nasopharynx, esophagus, and bladder. The tumors are closely related to the epithelium and ulcers are formed. In addition, spindle cell carcinoma can also be seen in organs such as the lungs and thyroid. Malignant melanoma is more common in the skin and mucosa of ectodermal origin. Sarcoma is more likely to be considered in children and adolescents under 20 years old, while both sarcoma and cancer are possible in adults.

(2) Soft tissue tumors with a large number of giant cells and odd-shaped cells are generally not fibrosarcomas, but should be considered as rhabdomyosarcoma, liposarcoma, malignant fibrous histiocytoma or leiomyosarcoma, followed by malignant peripheral nerve sheath tumors.

(3) The morphology and arrangement of spindle cells can provide clues to the tumor tissue type to a certain extent. For example, the cytoplasm of fibrosarcoma cells is usually not as rich as that of myogenic cells, the cytoplasm width usually does not exceed the width of the nucleus, and the cell boundaries are not as clear as the latter; while myogenic tumor cells can be long spindle-shaped or ribbon-shaped. Longitudinal fibrils can be seen in the cytoplasm, and the cytoplasm of rhabdomyosarcoma has stronger eosinophilic staining. The spindle cell bundles of fibrosarcoma are mostly arranged in a herringbone pattern; the spoke-like structure is more common in malignant fibrous histiocytoma, and can also be seen in other spindle cell sarcomas, but less frequently and less typical. Nuclear palisade is sometimes seen in malignant nerve sheath tumors and moderately differentiated leiomyosarcomas, although it is not as obvious as in the corresponding benign tumors.

(4) Carefully look for evidence of the transition of spindle cells to cells of other morphologies. If evidence of excessive differentiation to rhabdomyoblasts, lipoblasts, etc., or bidirectional differentiation (synovial sarcoma, malignant mesothelioma) can be found in sarcomas dominated by spindle cells, the classification diagnosis should be made based on the direction of differentiation.