Abstract

Malignant spindle cell tumors of the larynx are rare, of which the most common are spindle cell squamous carcinomas (SCSCs). Sarcomas are extremely infrequent in the larynx. Composite tumors, further, are quite unheard of except for rare case reports. We present here a case of a spindle cell malignancy in an elderly male, which posed a diagnostic difficulty due to its unique morphological and immunohistochemical features. The tumor was superficial, polypoidal with proliferation of malignant spindle cells and abundant mitoses under an ulcerated epithelium. Occasional squamous cell rests with keratin pearls were present. Cells were strongly immunoreactive for vimentin, smooth muscle actin and sparse cells were p63 positive. Desmin was negative. The dilemma in diagnosis was of a SCSC with smooth muscle differentiation against a composite tumor. The tumor also turned out to be positive for Epstein Barr Virus latent membrane protein-1 (EBV-LMP1), establishing a noteworthy association.