What is a spindle cell proliferation?

Spindle cell proliferation is a term pathologists use to describe the growth or increase in the number of spindle-shaped cells seen under the microscope. Spindle-shaped cells are long and thin, resembling the shape of a spindle used in weaving, with tapered ends and elongated nuclei. This term is not a final diagnosis but rather a description of how the cells look. Spindle cell proliferations can occur in both non-cancerous (benign) and cancerous (malignant) conditions, so further testing is often needed to determine the exact diagnosis.

Where does spindle cell proliferation occur?

Spindle cell proliferation can occur in almost any tissue or organ in the body, including the skin, connective tissue, muscle, bone, and internal organs. Spindle-shaped cells are commonly seen in tissues made of connective tissue, such as fibroblasts (cells that make collagen), smooth muscle cells, and cells from the lining of blood vessels. Tumors made up of spindle cells can arise from these tissues or from other specialized cells that take on a spindle shape.

What causes spindle cell proliferation?

Spindle cell proliferation can be caused by a wide range of conditions, including:

• Reactive or inflammatory processes: Wound healing, scar formation, and certain chronic inflammatory conditions can produce spindle-shaped cells as part of tissue repair.

• Benign tumors: Examples include fibromas (tumors of fibroblasts), leiomyomas (tumors of smooth muscle), and schwannomas (tumors of nerve sheath cells).

• Malignant tumors (sarcomas): Many soft tissue sarcomas are made up of spindle cells, such as leiomyosarcoma, fibrosarcoma, and malignant peripheral nerve sheath tumor.

• Spindle cell variants of other cancers: Some cancers that usually appear as round or polygonal cells, such as melanoma or squamous cell carcinoma, can develop a “spindle cell” appearance in certain cases.

What does a spindle cell proliferation look like under the microscope?

When a pathologist examines a tissue sample under the microscope and sees an increased number of spindle-shaped cells, they may use the term spindle cell proliferation to describe the finding. However, this phrase alone does not provide a diagnosis—it is a morphologic description. To determine the cause, the pathologist will assess the arrangement of the spindle cells, how abnormal they look compared to healthy spindle cells (cytologic atypia), how quickly they are dividing (mitotic activity), and whether they are invading surrounding tissues.

What additional tests may be performed?

Because many different conditions can cause spindle cell proliferation, pathologists often perform additional tests such immunohistochemistry to identify the type of cell involved.

For example:

• SMA (smooth muscle actin) or desmin may be used to detect smooth muscle tumors.

• S100 or SOX10 may help identify nerve sheath tumors or melanoma.

• CD34 may highlight certain connective tissue tumors or vascular growths.

• Cytokeratin may identify spindle cell variants of carcinomas.

In some cases, molecular tests such as next-generation sequencing (NGS) are used to look for specific genetic changes that can confirm a diagnosis.

Why is spindle cell proliferation important?

Spindle cell proliferation is an important microscopic finding because it can be seen in a wide range of conditions—from harmless reactive processes to aggressive cancers. The context in which it appears, along with other microscopic features and special test results, determines the final diagnosis. Understanding the cause of spindle cell proliferation in your pathology report is essential for deciding whether treatment is needed and what type of treatment will be most effective.

Questions to ask your doctor

• What is causing the spindle cell proliferation in my biopsy?

• Is it a benign or malignant process?

• Were any additional tests performed to identify the type of cells?

• Do I need more tests, surgery, or follow-up monitoring?

• What does this finding mean for my prognosis?