Correspondence Address:
Kavita Mardi
Type VI, Set No 14, IAS Colony, Maheli, Shimla - 171 009, Himachal Pradesh
India

Full Text

Sir,

Postoperative/posttraumatic spindle cell nodules were first described in 1990 by Vekemans et al. in urinary bladder.[1] They described it as a reactive lesion that occurs weeks to months after transurethral resection of the prostate (in men) or bladder lesions in the area of surgery. These tumors have similar features as inflammatory myofibroblastic tumor, but with a history of surgery. Though these lesions have been most frequently described in the lower genitourinary tract,[2] rare cases have been reported in other sites such as oral cavity, breast, and skin. Extensive literature search revealed only two cases of postoperative spindle cell nodule in the oral cavity [3],[4]

A 27-year-old male presented with a nodule at a site of laceration in the buccal mucosa since 1 month. On examination, there was a polypoidal mass measuring 10 mm in diameter in the buccal mucosa. Excision biopsy of the mass was done. Microscopic examination of the polypoidal mass was composed of cellular, fascicular growth pattern of plump, or elongated spindle cells which infiltrate with the invasion of underlying muscle and fat and focal destruction of muscle [Figure 1]. These spindle-cell proliferations are composed of bland-looking spindle cells with an indistinct cell border, eosinophilic cytoplasm, and oval nuclei. The nucleoli were inconspicuous [Figure 2]. Mitotic counts were 2–3 per high power field, but no atypical mitotic figures were found. A few atypical stromal cells were present in the myxoid areas. Delicate network of small blood vessels in edematous or myxoid stroma with red blood cell extravasation was noted. No necrosis or significant pleomorphism was noted. On immunohistochemical study, the spindle cells were positive for vimentin [Figure 3].{Figure 1}{Figure 2}{Figure 3}

There has been controversy with regard to whether lesions containing spindle cell nodules are reactive or neoplastic.[2],[3],[5]ALK gene rearrangement and immunohistochemical positivity for ALK were found in approximately 50% of cases, suggesting that postoperative spindle cell nodules are neoplastic. However, the history of trauma or surgical treatment and the microscopic findings of high vascularity and inflammation support that the nodules are a reactive process.[2] Immunohistochemically, these lesions are immunoreactive for vimentin, actin, and desmin, with no labeling for keratin.

In conclusion, this lesion, which histologically mimicked a sarcoma, appears to represent a reactive process similar to that described as postoperative spindle cell nodules of the genitourinary tract. Recognition of this type of benign spindle cell proliferation at traumatized sites in the oral cavity is important if misdiagnosis and subsequent aggressive therapy are to be avoided. Awareness of this entity along with clinicopathologic features makes it possible to recognize it as a benign lesion rather than the malignant lesions for which it can be mistaken.

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