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Resnick KA, Monroe C, Siddiqi I, Tam E. Case report: Splenic inflammatory pseudotumor-like follicular dendritic cell sarcoma (IPT-like FDCS): a trial of immunotherapy and review of the literature. Front Oncol 2024; 14:1360726. [PMID: 38966066 PMCID: PMC11222608 DOI: 10.3389/fonc.2024.1360726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 05/20/2024] [Indexed: 07/06/2024] Open
Abstract
Inflammatory pseudotumor-like follicular dendritic cell sarcoma (IPT-like FDCS) is a rare malignancy with fewer than 150 cases in the literature. IPT-like FDCS follows an indolent course with most cases definitively managed with surgical resection. We present a case of IPT-like FDCS with multiple recurrences with a trial of immunotherapy. The patient initially presented with splenic involvement requiring splenectomy, subsequently recurring in the liver requiring hepatic resections. Afterwards, there was recurrence with pelvic/small bowel involvement for which treatment was trialed with ipilimumab and nivolumab. The patient progressed despite dual immune checkpoint inhibitor therapy requiring a small bowel resection. To date, this is the first case of immunotherapy use in IPT-like FDCS. Therefore, more evidence is needed to support additional treatments in recurrent IPT-like FDCS after resection.
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Affiliation(s)
- K. A. Resnick
- Department of Medicine, University of Southern California (USC)/Los Angeles General, Los Angeles, CA, United States
| | - C. Monroe
- Department of Hematopathology, Keck Medicine of USC, Los Angeles, CA, United States
| | - I. Siddiqi
- Department of Hematopathology, Keck Medicine of USC, Los Angeles, CA, United States
| | - E. Tam
- Department of Bone Marrow Transplant, USC Norris Comprehensive Cancer Hospital, Los Angeles, CA, United States
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2
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Gao FQ, Zhang JM, Li CF. Paraneoplastic pemphigus misdiagnosed as juvenile dermatomyositis: A case report. Int J Rheum Dis 2023; 26:1826-1829. [PMID: 37166030 DOI: 10.1111/1756-185x.14684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/21/2023] [Accepted: 03/14/2023] [Indexed: 05/12/2023]
Abstract
Paraneoplastic pemphigus (PNP) is a rare autoimmune skin disease closely related to tumors, characterized by a maculopapular rash with mucosal pain, bronchiole occlusion, and respiratory failure may occur over time, even resulting in death. We report a rare case of a child with autoimmune PNP misdiagnosed as juvenile dermatomyositis (JDM), and summarize the key points of differentiation of clinical manifestations and auxiliary examinations of PNP and JDM. When the diagnosis is not clear because the patient has features not typical of JDM, then skin biopsy and other diagnostic studies should be considered prior to any immunosuppressive therapy, as this could potentially obscure and delay the diagnosis of malignancy.
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Affiliation(s)
- Feng-Qiao Gao
- Department of Rheumatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nan Li Shi Road No. 56, Beijing, 100045, China
| | - Jun-Mei Zhang
- Department of Rheumatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nan Li Shi Road No. 56, Beijing, 100045, China
| | - Cai-Feng Li
- Department of Rheumatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nan Li Shi Road No. 56, Beijing, 100045, China
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3
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Lu X, Wu Y, Gong J, Yu X, Zhang Y, Yang C. Pancreatic follicular dendritic cell sarcoma: one case report and literature review. J Int Med Res 2022; 50:3000605221142401. [PMID: 36539966 PMCID: PMC9791293 DOI: 10.1177/03000605221142401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Pancreatic follicular dendritic cell sarcoma (FDCS) is a rare neoplasm with unclear pathological characteristics. In this study, we report one case of pancreatic FDCS and review published cases to summarize the characteristics and treatment of pancreatic FDCS. A man in his early 30 s was admitted for jaundice, abdominal fullness, and weight loss for 15 days. Computed tomography revealed a large capsule solid mass in the pancreatic head together with a dilated bile duct and enlarged retroperitoneal lymph nodes. Serum biochemistry revealed high total bilirubin levels (313.9 μmol/L) and normal tumor marker levels. Pancreatoduodenectomy was performed, but no chemotherapy was administrated at the patient's behest. The pathologic diagnosis was pancreatic FDCS infiltrating the duodenal seromuscular layer and common bile duct. The patient presented with liver metastasis 3 months after surgery and died 8 months after surgery from multiorgan failure. Pancreatic FDCS is a rare disease with high invasiveness. Our previous case exhibited paraneoplastic syndrome together with this disease, and further investigation is needed to confirm whether paraneoplastic syndrome is a typical syndrome of pancreatic FDCS.
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Affiliation(s)
- Xiangyu Lu
- The Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Yilei Wu
- Department of Medical Records Statistics, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Jun Gong
- The Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Xiaojiong Yu
- The Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Yu Zhang
- The Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Chong Yang
- Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province & Organ Transplantation Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China,Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, China,Chong Yang, Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province & Organ Transplantation Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32# W. Sec 2, 1st Ring Rd., Chengdu, Sichuan 610072, China.
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4
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Ding F, Wang C, Xu C, Tang H. Case report: Hepatic inflammatory pseudotumor-like follicular dendritic cell sarcoma: A rare case and minireview of the literature. Front Med (Lausanne) 2022; 9:1002324. [PMID: 36425103 PMCID: PMC9679012 DOI: 10.3389/fmed.2022.1002324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022] Open
Abstract
Inflammatory pseudotumor (IPT)-like follicular dendritic cell sarcoma (FDCS) is a rare neoplasm referred to as the FDCS variant. Here we report a 66-year-old female patient suffering from hepatic IPT-like FDCS and summarize IPT-like FDCS reported in the literature. The patient presented with obvious abdominal pain without significant laboratory abnormalities and subsequently underwent surgical resection of a hepatic lesion. Postoperative pathological results demonstrated a vascular tissue-rich neoplasm (7.0-cm maximum diameter). The tumor cells expressed CD21 and CD35, and in situ hybridization detected Epstein–Barr virus-encoded RNA (EBER). Metastasis or recurrence was not detected during the 7-year follow-up.
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Affiliation(s)
- Fan Ding
- Center of Gallbladder Disease, East Hospital of Tongji University, Shanghai, China
- Institute of Gallstone Disease, Tongji University School of Medicine, Shanghai, China
| | - Chao Wang
- Department of Radiology, Nanxiang Hospital of Jiading District, Shanghai, China
| | - Chi Xu
- Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Organ Transplantation Institute, Sun Yat-sen University, Guangzhou, China
- Chi Xu,
| | - Hui Tang
- Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Organ Transplantation Institute, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Hui Tang,
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5
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Lynch HM, Beslow LA, Treat JR, Corcoran A, Lin JH, Gunawardena N, Maris JM, Behrens EM. Paraneoplastic myasthenia gravis and pemphigus associated with follicular dendritic cell sarcoma leading to cardiorespiratory collapse in a 7-year-old. Pediatr Blood Cancer 2022; 69:e29723. [PMID: 35484988 DOI: 10.1002/pbc.29723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Hayley M Lynch
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lauren A Beslow
- Division of Child Neurology, Departments of Neurology and Pediatrics, Perelman School of Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James R Treat
- Division of General Pediatrics, Department of Dermatology, Perelman School of Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aoife Corcoran
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jenny H Lin
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Perelman School of Medicine Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Naomi Gunawardena
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - John M Maris
- Division of Oncology and Center for Childhood Cancer Research, Department of Pediatrics, Perelman School of Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Edward M Behrens
- Division of Rheumatology, Department of Pediatrics, Perelman School of Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Zhuang JY, Zhang FF, Li QW, Chen YF. Intra-abdominal inflammatory pseudotumor-like follicular dendritic cell sarcoma associated with paraneoplastic pemphigus: A case report and review of the literature. World J Clin Cases 2020; 8:3097-3107. [PMID: 32775392 PMCID: PMC7385594 DOI: 10.12998/wjcc.v8.i14.3097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/09/2020] [Accepted: 06/28/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUD Follicular dendritic cell (FDC) sarcomas are rare neoplasms that occur predominantly in the lymph nodes. They can also occur extranodally. Extranodal FDC sarcomas most commonly present as solitary masses. Inflammatory pseudotumor (IPT)-like FDC sarcomas, a subcategory of FDC sarcomas, are rarer than other sarcoma subtypes. They are composed of spindle or ovoid neoplastic cells and exhibit an admixture of plasma cells and prominent lymphoplasmacytic infiltration. Paraneoplastic pemphigus (PNP), also known as paraneoplastic autoimmune multiorgan syndrome, is a rare autoimmune bullous disease that is associated with underlying neoplasms. PNP has a high mortality, and its early diagnosis is usually difficult.
CASE SUMMARY We describe a 27-year-old woman who presented with stomatitis, conjunctivitis, and skin blisters and erosions as her first symptoms of PNP with an intra-abdominal IPT-like FDC sarcoma. The patient underwent surgical tumor resection and received tapering oral corticosteroid treatment. She showed no recurrence at the 1-year follow-up.
CONCLUSION IPT-like FDC sarcomas are rare underlying neoplasms that have an uncommon association with PNP. PNP-associated FDC sarcomas predominantly occur in intra-abdominal sites and suggest a poor prognosis. Surgical resection is an essential and effective treatment for PNP and primary and recurrent FDC sarcomas.
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Affiliation(s)
- Jia-Yi Zhuang
- Department of Dermatology, Dermatology Hospital, Southern Medical University/Guangdong Provincial Dermatology Hospital, Guangzhou 510091, Guangdong Province, China
| | - Fang-Fei Zhang
- Department of Dermatology, Dermatology Hospital, Southern Medical University/Guangdong Provincial Dermatology Hospital, Guangzhou 510091, Guangdong Province, China
| | - Qing-Wen Li
- Department of Dermatology, Dermatology Hospital, Southern Medical University/Guangdong Provincial Dermatology Hospital, Guangzhou 510091, Guangdong Province, China
| | - Yong-Feng Chen
- Department of Dermatology, Dermatology Hospital, Southern Medical University/Guangdong Provincial Dermatology Hospital, Guangzhou 510091, Guangdong Province, China
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Streifel AM, Wessman LL, Schultz BJ, Miller D, Pearson DR. Refractory mucositis associated with underlying follicular dendritic cell sarcoma of the thymus: Paraneoplastic pemphigus versus malignancy-exacerbated pemphigus vulgaris. JAAD Case Rep 2019; 5:933-936. [PMID: 31687457 PMCID: PMC6820367 DOI: 10.1016/j.jdcr.2019.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
| | - Laurel L. Wessman
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | | | - Daniel Miller
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - David R. Pearson
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
- Correspondence to: David R. Pearson, MD, Department of Dermatology, University of Minnesota, 516 Delaware Street SE, Mail Code 98, Phillips-Wangensteen Bldg., Suite 4-240, Minneapolis, MN 55455.
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8
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Lu T, Song B, Pu H, Li X, Chen Q, Yang C. Paraneoplastic pemphigus and myasthenia gravis as the first manifestations of a rare case of pancreatic follicular dendritic cell sarcoma: CT findings and review of literature. BMC Gastroenterol 2019; 19:92. [PMID: 31200650 PMCID: PMC6570917 DOI: 10.1186/s12876-019-1008-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/31/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Follicular dendritic cell sarcoma (FDCS) is a rare neoplasm that originates from follicular dendritic cells in lymphoid tissue while paraneoplastic pemphigus (PNP) is an autoimmune blistering disease associated with neoplasms. Pancreatic FDCS associated with PNP and myasthenia gravis (MG) is even rarer and highly malignant. We present the clinical data, pathological materials and computed tomography (CT) features of a rare case of this disease. CASE PRESENTATION A 49-year-old woman presented with repeated ptosis of both eyelids, oral ulcers and erosions. Her laboratory results showed a slight elevation of CA125 and positivity of some autoimmune antibodies. CT revealed a round solid mass with central necrosis in the pancreatic tail. The solid component of the mass showed slight enhancement and serpentine feeding arteries in the arterial phase, moderate enhancement with a draining vein around the tumor in the portal venous phase and persistent enhancement in the delayed phase. Surgical resection was performed, and the pathological diagnosis was FDCS. However, the patient died of inability to excrete sputum and occlusion of the respiratory tract. CONCLUSIONS Pancreatic FDCS manifested as PNP and MG is very rare. Its CT features are not specific, and the disease should be differentiated from neuroendocrine tumors, solid pseudopapillary neoplasms and acinar cell carcinoma.
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Affiliation(s)
- Tao Lu
- 0000 0004 1770 1022grid.412901.fDepartment of Radiology, West China Hospital, Sichuan University, No. 37, Guoxuexiang, Chengdu, 610037 Sichuan China
- 0000 0004 1808 0950grid.410646.1Department of Radiology, Sichuan Academy of Medical Science and Sichuan Provincial People’s Hospital, 32 West Second Section, First Ring Road, Chengdu, 610072 Sichuan China
| | - Bin Song
- 0000 0004 1770 1022grid.412901.fDepartment of Radiology, West China Hospital, Sichuan University, No. 37, Guoxuexiang, Chengdu, 610037 Sichuan China
| | - Hong Pu
- 0000 0004 1808 0950grid.410646.1Department of Radiology, Sichuan Academy of Medical Science and Sichuan Provincial People’s Hospital, 32 West Second Section, First Ring Road, Chengdu, 610072 Sichuan China
| | - Xinglan Li
- 0000 0004 1808 0950grid.410646.1Department of Pathology, Sichuan Academy of Medical Science and Sichuan Provincial People’s Hospital, 32 West Second Section, First Ring Road, Chengdu, 610072 Sichuan China
| | - Qiqi Chen
- 0000 0004 1808 0950grid.410646.1Department of Rheumatology, Sichuan Academy of Medical Science and Sichuan Provincial People’s Hospital, 32 West Second Section, First Ring Road, Chengdu, 610072 Sichuan China
| | - Chong Yang
- 0000 0004 1808 0950grid.410646.1Department of Organ transplantation, Sichuan Academy of Medical Science and Sichuan Provincial People’s Hospital, 32 West Second Section, First Ring Road, Chengdu, 610072 Sichuan China
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Agaimy A. Paraneoplastic disorders associated with miscellaneous neoplasms with focus on selected soft tissue and Undifferentiated/ rhabdoid malignancies. Semin Diagn Pathol 2019; 36:269-278. [PMID: 30819530 DOI: 10.1053/j.semdp.2019.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A variety of soft tissue and visceral neoplasms have been associated with constitutional symptoms and signs including fever, fatigue, arthritis and laboratory abnormalities such as elevated erythrocyte sedimentation rate, leukocytosis with marked neutrophilia, anemia, thrombocytosis and others. This review addresses three main neoplastic categories that are associated with specific paraneoplastic phenomena: (1) neoplasms having in common the presence of diffuse mixed inflammatory infiltration (closely simulating an inflammatory pseudotumor) and frequently associated with constitutional symptoms; (2) neoplasms with undifferentiated, anaplastic or rhabdoid cell morphology (frequently SWI/SNF-deficient) associated with diverse paraneoplastic manifestations; and (3) paraneoplasia associated with neoplasms carrying specific gene fusions such as solitary fibrous tumor (STAT6-NAB2 gene fusions), infantile fibrosarcoma and congenital mesoblastic nephroma (ETV6-NTRK3 gene fusions), and angiomatoid fibrous histiocytoma (EWSR1-CREB1 & EWSR1-ATF1 fusions).
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Affiliation(s)
- Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Germany.
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Kartan S, Shi VY, Clark AK, Chan LS. Paraneoplastic Pemphigus and Autoimmune Blistering Diseases Associated with Neoplasm: Characteristics, Diagnosis, Associated Neoplasms, Proposed Pathogenesis, Treatment. Am J Clin Dermatol 2017; 18:105-126. [PMID: 27878477 DOI: 10.1007/s40257-016-0235-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Autoimmune paraneoplastic and neoplasm-associated skin syndromes are characterized by autoimmune-mediated cutaneous lesions in the presence of a neoplasm. The identification of these syndromes provides information about the underlying tumor, systemic symptoms, and debilitating complications. The recognition of these syndromes is particularly helpful in cases of skin lesions presenting as the first sign of the malignancy, and the underlying malignancy can be treated in a timely manner. Autoimmune paraneoplastic and neoplasm-associated bullous skin syndromes are characterized by blister formation due to an autoimmune response to components of the epidermis or basement membrane in the context of a neoplasm. The clinical manifestations, histopathology and immunopathology findings, target antigens, associated neoplasm, current diagnostic criteria, current understanding of pathogenesis, and treatment options for a selection of four diseases are reviewed. Paraneoplastic pemphigus manifests with clinically distinct painful mucosal erosions and polymorphic cutaneous lesions, and is often associated with lymphoproliferative neoplasm. In contrast, bullous pemphigoid associated with neoplasm presents with large tense subepidermal bullae of the skin, and mild mucosal involvement, but without unique clinical features. Mucous membrane pemphigoid associated with neoplasm is a disorder of chronic subepithelial blisters that evolve into erosions and ulcerations that heal with scarring, and involves stratified squamous mucosal surfaces. Linear IgA dermatosis associated with neoplasm is characterized by annularly grouped pruritic papules, vesicles, and bullae along the extensor surfaces of elbows, knees, and buttocks. Physicians should be aware that these autoimmune paraneoplastic and neoplasm-associated syndromes can manifest distinct or similar clinical features as compared with the non-neoplastic counterparts.
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