General
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• A variant of squamous cell carcinoma with spindle cell morphology, associated with poor prognosis

Terminology
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• Squamous cell carcinoma with sarcoma-like stroma, pseudosarcoma (Cancer 1983;52:890)
• Sarcomatoid squamous cell carcinoma

Epidemiology
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• Usually elderly females in 6th-8th decade, rarely young women (Gynecol Oncol 1993;49:100)

Sites
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• More common locations in female genital tract are cervix and vulva
• Very rarely occurs in vagina
• Can involve upper, mid or lower vagina (Cancer 1983;52:890, Gynecol Oncol 1993;49:100)

Etiology
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• High risk Human Papilloma virus (HPV) subtypes have a role in carcinogenesis

Clinical features
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• Pelvic pain, vaginal discharge (Cancer 1983;52:890)
• Vaginal bleeding and obstructive symptoms can occur due to mass effect

Diagnosis
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• Based on clinical, radiological and thorough pathological examination

Radiology
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• Imaging required to stage the disease and look for metastasis

Prognostic factors
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• Aggressive behavior compared to conventional squamous cell carcinoma
• May present with distant metastasis (Cancer 1983;52:890, Gynecol Oncol 1993;49:100)

Case reports
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• Squamous cell carcinoma with sarcomatoid variant (Acta Cytol 1989;33:142)

Treatment
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• Surgical excision followed by chemotherapy
• External beam radiotherapy and high dose brachytherapy (Cancer 1983;52:890, Gynecol Oncol 1993;49:100)

Gross description
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• Polypoid mass
• Fungating, necrotic and friable tumor
• Size varies from 2.0 to 5.0 cm (Cancer 1983;52:890, Gynecol Oncol 1993;49:100)

Micro description
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• Fascicles of plump spindle cells with homogenous to fibrillar cytoplasm, round to oval vesicular nuclei with multiple nucleoli and numerous mitotic figures
• Usually tumor will also have well to moderately differentiated squamous cell component, which can be easily missed on a biopsy
• Therefore thorough sampling recommended (Cancer 1983;52:890, Gynecol Oncol 1993;49:100)

Positive stains
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• AE1/AE3, vimentin (Gynecol Oncol 1993;49:100)
• p16

Electron microscopy description
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• Spindle cells contain bundles of tonofilaments and desmosomes (Gynecol Oncol 1993;49:100)

Differential diagnosis
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• Leiomyosarcoma
• MFH
• MMMT
• Sarcoma
• Spindle cell variant of malignant melanoma (Cancer 1983;52:890, Gynecol Oncol 1993;49:100)

Additional references
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• Int J Gynecol Pathol 2014;33:203

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