Introduction: Submandibular region is surgically significant in the head and neck field and a mass in this region may have multiple differential diagnoses. Case Report: An elderly man came with a single 4×2. 5 cm swelling in the neck on the right side, just below the lower jaw, since one month. Ultrasound showed an irregular heterogeneous hypoechoic lesion in the right submandibular space measuring 37×23 mm with mild internal vascularity. The submandibular gland appeared separate but compressed. Fine needle aspiration was suggestive of Spindle cell neoplasm. The swelling was excised under general anesthesia. By histopathological examination, the lesion was diagnosed as anaplastic lymphoma kinase-negative inflammatory myofibroblastic tumor (IMT) based on focal immunoreactivity with cyclin D1. The patient then received radiotherapy 60 Gray divided into 30 fractions over 6 weeks. The case had no evidence of recurrence or residual disease six months post-surgery. Conclusion: Tumefactive Spindle-cell lesion in the head and neck can comprise inflammatory conditions, benign and malignant neoplasms or borderline neoplasms, such as nodular fasciitis and IMT. The definitive histologic diagnosis of IMT helps in tailoring the treatment modality based on its locally aggressive biologic potential.

Leiomyosarcoma (LMS) is an uncommon malignant Spindle cell tumor of the head and neck region. It is extremely rare in the oral cavity that arises from smooth muscle differentiation. It may arise as primary, radiation-associated, or metastatic tumor. The clinical appearance of these tumors can be deceptively benign and can be mistaken for non-malignant conditions. Here We present a case with atypical leiomyoma of the mandible in a 40-year-old man who referred with complaint of pain and swelling in his jaw. He underwent surgery and histology and immonohistochemestery studies confirmed the diagnosis. After 6 months recurrence occurred. Histologic examination confirmed leiomyosarcoma so he was managed with surgical excision followed by radiotherapy and chemotherapy without any recurrence or metastasis after 2 years of follow-up.

Spindle cell hemangioma (SCH), formerly called “Spindle cell hemangioendothelioma”, is a rare benign histological variant of hemangioma characterized by the presence of two contrast zones, the first zone exhibits large dilated cavernous space with slit-like vascular spaces may show clear endothelial vacuoles resembling fat cells. SCH is often considered as pseudosarcomatous entity; it imposes a diagnostic challenge for oral pathologists due to its resemblance with Kaposi sarcoma. A total of 13 cases of SCH have been reported in the head and neck region to date and only 6 cases have been reported inside the oral cavity. We present a rare case of SCH located on the hard palate, which imitated Kaposi's sarcoma on histopathological examination. The expressions of various markers including EGR, CD 31, and HHV 8 yielded the final diagnosis of SCH. The markers EGR and HHV 8 have never been used in intraoral SCH before to the best of our knowledge; hence, the present report highlights the use of immunohistochemistry for the diagnosis of SCH.

Spindle cell neoplasms are defined as neoplasms that consist of Spindle-shaped cells in the histopathology. Spindle cell neoplasms can affect the oral cavity. In the oral cavity, the origin of the Spindle cell neoplasms may be traced to epithelial, mesenchymal and odontogenic components. This article aims to review the Spindle cell neoplasms of the oral cavity with emphasis on histopathology.

Pseudotumour is a benign inflammatory lesion. Mycobacterial Spindle cell pseudotumour (MSP) is a rare pseudotumour. It is a benign proliferation of Spindle-shaped histiocytes containing acidfast mycobacterium, commonly reported in immunocompromised patients. MSP is usually associated with mycobacterium avium complex (MAC). Here, we present the case of a 38-year-old gentleman with acquired immune deficiency syndrome (AIDS) who presented with low-grade fever for 1-month duration. Clinically, he had generalised lymphadenopathy. Chest X-ray showed miliary infiltration in bilateral lung fields. Lymph nodal biopsy showed Spindle-shaped histiocytes filled with acid-fast bacilli on Ziehl-Neelsen (ZN) stain, suggestive of MSP. Immunohistochemical (IHC) stains were positive for CD68, S-100 and negative for CD31, which are consistent with MSP. Polymerase chain reaction (PCR) of the biopsy tissue was positive for MTB. Highly active antiretroviral therapy (HAART) was continued and antitubercular therapy (ATT) was started. The fever resolved within two weeks and there was a resolution of lymph nodal swelling by 6 weeks. The diagnosis of MSP associated with mycobacterium tuberculosis (MTB) makes our case interesting. It is of utmost importance to differentiate MSP from Kaposi’ s sarcoma (KS) and other pseudotumours and to know whether it is of tubercular or non-tubercular origin, as the treatment is entirely different.