Case Report: Rapid recurrence and nodal metastasis of laryngeal spindle cell squamous cell carcinoma initially underestimated on superficial sampling

Laryngeal spindle cell carcinoma (SpCC) is an uncommon but aggressive variant of squamous cell carcinoma. Superficial biopsy or intraoperative frozen section may sample only the epithelial component and therefore underestimate the true histology. We report a 71-year-old woman who underwent CO2 laser excision under suspension laryngoscopy for a laryngeal lesion. The initial permanent section showed moderately differentiated squamous cell carcinoma, with the stage documented as T3N0M0. Eight months later, she developed local recurrence with bilateral cervical lymph node metastases. Salvage total laryngectomy with bilateral neck dissection revealed carcinosarcoma/spindle cell carcinoma. Retrospective review of the first paraffin specimen and additional immunohistochemistry still failed to identify a definite spindle-cell component. The patient declined adjuvant therapy and died 12 months after the definitive diagnosis. This case illustrates a diagnostic trap in polypoid laryngeal lesions: when clinical or imaging findings do not match superficial pathology, deeper sampling, targeted immunohistochemistry, and closer radiologic follow-up are warranted. For advanced lesions or cases in which SpCC is suspected, initial management should prioritize oncologic safety.