An 82-year-old male presented with a two-month history of hoarseness.
A 2 cm pedunculated lesion was removed from the base of his epiglottis
. Microscopy showed a polypoid atypical spindle cell lesion. Multiple
levels failed to reveal an invasive squamous cell carcinoma. On the ba
sis of haematozylin and eosin stained sections the main differential d
iagnosis was a pseudosarcoma with an overlying dysplastic squamous muc
osa or infiltrating spindle cell carcinoma. Immunohistochemistry showe
d positive staining for vimentin but no convincing staining with antib
odies to cytokeratin and EMA. Ultrastructural analysis also failed to
reveal epithelial characteristics. Ploidy analysis by static cytophoto
metry of the spindle cell proliferation revealed an aneuploid stem lin
e with a DNA index of 1.67. On the basis of this the process was felt
unlikely to be reactive and a diagnosis of a spindle cell squamous car
cinoma was made. This diagnosis was subsequently supported by a clinic
al recurrence of the nodule at a six-month follow-up.