Sarcomas With Spindle Cell Morphology

In the days before the term “high-grade undifferentiated pleomorphic sarcoma” came into use, one of the most common sarcoma diagnoses was “malignant fibrous histiocytoma,” and before that, in an era before immunohistochemistry, “fibrosarcoma” was used to describe most sarcomas. “Spindle cell” is a descriptive phrase that denotes the cellular shape of many of the sarcomas encountered in the adult population. As a result, they are usually treated differently from small round cell sarcomas, and have different biological characteristics than those tumors and sarcomas with epithelioid morphology. As a very broad generalization, sarcomas with a spindle cell microscopic morphology occur in adults and are treated primarily with surgery and often adjuvant or neoadjuvant radiation as primary therapy. In comparison to small round cell sarcomas such as Ewing sarcoma, the use of adjuvant chemotherapy remains controversial, and the sensitivity of these tumors to chemotherapy in the metastatic setting is highly variable. In this article, we describe some of the clinical and biological characteristics of this group of sarcomas.