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Yamada T, Ishido K, Kimura N, Wakiya T, Nagase H, Goto S, Yoshizawa T, Kijima H, Kato S, Hakamada K. Follicular dendritic cell sarcoma arising from the lymph node of the pancreatic head: a case report with literature review. Clin J Gastroenterol 2024:10.1007/s12328-024-01956-5. [PMID: 38532076 DOI: 10.1007/s12328-024-01956-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 03/13/2024] [Indexed: 03/28/2024]
Abstract
A 72-year-old man was referred to our hospital for the examination of a pancreatic head mass. Abdominal computed tomography revealed a contrasted 8-cm-diameter tumor extending from the dorsal pancreatic head to the porta hepatis. The preoperative diagnosis was challenging due to the absence of specific imaging findings and the inability to perform a biopsy. Positron emission tomography/computed tomography and diffusion-weighted imaging suggested a malignant tumor originating from the organs surrounding the pancreatic head. Subtotal stomach-preserving pancreaticoduodenectomy with regional lymph node dissection was performed, as dissection from the pancreatic head proved unfeasible. Pathological examination identified the tumor as an enlarged lymph node consisting of pleomorphic large cells forming clusters, positive for follicular dendritic cell markers cluster of differentiation (CD) 21 and CD23. No evidence of tumor capsule infiltration, other organ infiltration, or metastasis to other lymph nodes was observed. The final diagnosis was nodal follicular dendritic cell sarcoma (FDCS) originating from the pancreatic head lymph nodes. No recurrence occurred at 3 years postoperatively with no postoperative treatment. Intraperitoneal nodal FDCS is extremely rare, and occasionally, it can lead to postoperative recurrence and progression. It is crucial to differentiate neoplastic lymph node enlargement around the pancreatic head from nodal FDCS.
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Affiliation(s)
- Takahiro Yamada
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8563, Japan.
| | - Keinosuke Ishido
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8563, Japan
| | - Norihisa Kimura
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8563, Japan
| | - Taiichi Wakiya
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8563, Japan
| | - Hayato Nagase
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8563, Japan
| | - Shintaro Goto
- Department of Pathology and Bioscience, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8563, Japan
| | - Tadashi Yoshizawa
- Department of Pathology and Bioscience, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8563, Japan
| | - Hiroshi Kijima
- Department of Pathology and Bioscience, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8563, Japan
| | - Seiichi Kato
- Center for Clinical Pathology, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan
| | - Kenichi Hakamada
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8563, Japan
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Gui H, Chaudhari J, Mannan R. Follicular dendritic cell sarcoma of gastrointestinal tract with two emerging distinct subtypes: a case report and systemic review. Diagn Pathol 2022; 17:64. [PMID: 35941667 PMCID: PMC9358870 DOI: 10.1186/s13000-022-01246-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 07/22/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Follicular dendritic cell sarcoma (FDCS) is a rare neoplasm of mesenchymal origin. FDCS of gastrointestinal tract (GI) are exceedingly uncommon. CASE PRESENTATION We report the first case of classic type FDCS in a 34-year-old male with Birt-Hogg-Dubé syndrome, which presented as a mass at the ileo-cecal junction. He received no further treatment after resection and remained disease free for 3.5 years. We further analyze and review the clinical and pathologic findings of 33 cases of GI tract FDCS reported in the literature. CONCLUSIONS There are two distinct subtypes of FDCS in the GI tract: the classic type occurs in relatively younger patients (mean = 45.3 years) without Epstein-Barr virus (EBV) association, and behaves more aggressively; the inflammatory subtype presents as colonic polypoid tumor in older patients (mean = 60.7 years) and is EBV positive. The clinical outcome in the latter group appears favorable although mortality rate is not necessarily low.
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Affiliation(s)
- Hongxing Gui
- Department of Pathology and Laboratory Medicine, Pennsylvania Hospital of the University of Pennsylvania Health System, 801 Spruce Street, 10th Floor Spruce building, Philadelphia, PA, 19107, USA.
| | - Jigisha Chaudhari
- Department of Pathology and Laboratory Medicine, Pennsylvania Hospital of the University of Pennsylvania Health System, 801 Spruce Street, 10th Floor Spruce building, Philadelphia, PA, 19107, USA
| | - Rifat Mannan
- Department of Pathology and Laboratory Medicine, Pennsylvania Hospital of the University of Pennsylvania Health System, 801 Spruce Street, 10th Floor Spruce building, Philadelphia, PA, 19107, USA
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Liberale G, Keriakos K, Azerad M, De Saint Aubain N, El Nakadi I. Intraperitoneal follicular dendritic cell sarcoma: role of chemotherapy and bone marrow allotransplantation in locally advanced disease? CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2015; 9:9-13. [PMID: 25698886 PMCID: PMC4324466 DOI: 10.4137/cmo.s12601] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 03/23/2014] [Accepted: 03/24/2014] [Indexed: 12/27/2022]
Abstract
We describe a case of a 44 year-old woman diagnosed with follicular dendritic cell sarcoma (FDCS). FDCS is a very rare disease affecting the dendritic antigen presenting cells and is often misdiagnosed. Surgery is considered the best treatment modality, followed by chemotherapy. In our case, surgical excision was not possible, therefore the patient received two lines of chemotherapy followed by bone marrow allotransplantation, then a third line of chemotherapy with a complete metabolic response seen on PET/computed tomography (CT) follow-up 29 months later. A review of the literature has been performed.
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Affiliation(s)
- G Liberale
- Department of Digestive Surgery, Medical School, Université Libre de Bruxelles, Jules Bordet Institute, Brussels, Belgium
| | - K Keriakos
- Department of Digestive Surgery, Medical School, Université Libre de Bruxelles, Jules Bordet Institute, Brussels, Belgium
| | - Ma Azerad
- Department of Medical Hematology, Medical School, Université Libre de Bruxelles, Jules Bordet Institute and CHU Brugmann, Brussels, Belgium
| | - N De Saint Aubain
- Department of Pathology, Medical School, Université Libre de Bruxelles, Jules Bordet Institute, Brussels, Belgium
| | - I El Nakadi
- Department of Digestive Surgery, Medical School, Université Libre de Bruxelles, Jules Bordet Institute, Brussels, Belgium
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4
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An unusual case of follicular dendritic cell sarcoma of the omentum with pleomorphous morphology and aberrant cytokeratin expression. J Hematop 2014. [DOI: 10.1007/s12308-014-0216-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Wang RF, Han W, Qi L, Shan LH, Wang ZC, Wang LF. Extranodal follicular dendritic cell sarcoma: A clinicopathological report of four cases and a literature review. Oncol Lett 2014; 9:391-398. [PMID: 25435998 PMCID: PMC4247019 DOI: 10.3892/ol.2014.2681] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 10/20/2014] [Indexed: 12/15/2022] Open
Abstract
The aim of the present study was to characterize the clinicopathological features of follicular dendritic cell sarcoma (FDCS), and to report the experience of the Xin Hua Hospital Affiliated to Shanghai Jiaotong University School of Medicine (Shanghai, China) with this entity. The clinicopathological findings of four cases that had recently been encountered and 142 previously reported cases in the English literature were evaluated. The current tumors were found in two male and two female patients, aged 49–76 years old, who exhibited a mean tumor size of 8.7 cm. Three of the four cases were misdiagnosed during the initial diagnosis and one experienced intra-abdominal recurrence six months after the first diagnosis. Assessment of all 142 cases in the literature revealed a mild female predominance. The tumors exhibited a mean tumor size of ~7.0 cm. Histologically, the tumors were composed of plump spindle- or oval-shaped cells that exhibited eosinophilic cytoplasm and were arranged in sheets, storiform patterns or whorls. Immunohistochemically, the neoplastic cells expressed at least one of the FDC markers. Among the 130 cases with follow-up data, the overall recurrence, metastasis and mortality rates were 49.2% (64 cases), 21.5% (28 cases), and 13.8% (18 cases), respectively. FDCS can appear deceptively similar to other soft-tissue tumors, even poorly-differentiated carcinomas. A correct diagnosis requires a high degree of suspicion and immunohistochemical evaluation.
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Affiliation(s)
- Rui-Fen Wang
- Department of Pathology, Xin Hua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, P.R. China
| | - Wei Han
- Department of Pathology, The First Hospital of Harbin Medical University, Harbin 150001, P.R. China
| | - Lei Qi
- Department of Pathology, The First Hospital of Harbin Medical University, Harbin 150001, P.R. China
| | - Li-Hui Shan
- Department of Pathology, The First Hospital of Harbin Medical University, Harbin 150001, P.R. China
| | - Zheng-Cai Wang
- Department of Pathology, The Fourth Hospital of Harbin Medical University, Harbin 150001, P.R. China
| | - Li-Feng Wang
- Department of Pathology, Xin Hua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, P.R. China
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Ohtake H, Yamakawa M. Interdigitating dendritic cell sarcoma and follicular dendritic cell sarcoma: histopathological findings for differential diagnosis. J Clin Exp Hematop 2014; 53:179-84. [PMID: 24369219 DOI: 10.3960/jslrt.53.179] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Both interdigitating cell sarcoma (IDCS) and follicular dendritic cell sarcoma (FDCS) are rare neoplasms derived from dendritic cells in lymphoid organs. IDCS is defined as a neoplastic proliferation of spindle-shaped to ovoid cells with phenotypic features similar to those of IDCs. FDCS is a malignant neoplasm derived from FDCs that possess and present antigens to B cells in the follicular (germinal) centers of lymphoid organs. They often occur in lymph nodes, although they can also arise at extranodal sites. In this review, we have highlighted the morphological and immunohistochemical properties of these neoplasms, which could help in unequivocal and accurate diagnosis.
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Affiliation(s)
- Hiroya Ohtake
- Department of Pathological Diagnostics, Yamagata University Faculty of Medicine
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Saygin C, Uzunaslan D, Ozguroglu M, Senocak M, Tuzuner N. Dendritic cell sarcoma: a pooled analysis including 462 cases with presentation of our case series. Crit Rev Oncol Hematol 2013; 88:253-71. [PMID: 23755890 DOI: 10.1016/j.critrevonc.2013.05.006] [Citation(s) in RCA: 154] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 03/16/2013] [Accepted: 05/08/2013] [Indexed: 02/06/2023] Open
Abstract
Dendritic cell tumors are extremely rare and current knowledge on these tumors is limited. The characteristics of three dendritic cell sarcoma subtypes and their optimal treatment approaches are not fully clarified. We aimed to make a systematic review of the literature and enrich the current data with five new cases. Pooled analysis of 462 reported cases revealed that the tumor had no age, gender or racial predilection. Our analysis suggests that the young age, advanced stage, intraabdominal involvement and unfavorable histological features (i.e. large tumor size, absence of lymphoplasmacytic infiltration, coagulative necrosis, high mitotic count) may predict poor prognosis. Subtypes of this tumor have different clinical behaviors with interdigitating dendritic cell sarcoma being the most aggressive form. In general, surgery is the most effective treatment modality and adjuvant radiotherapy has no significant effect on overall survival of patients. The role of chemotherapy for the management of advanced disease is controversial.
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Affiliation(s)
- Caner Saygin
- Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey.
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Chien JCW, Lao WT, Chen CL, Chan WP. Follicular dendritic cell sarcoma of the omentum: multidetector computed tomography findings. Korean J Radiol 2013; 14:213-7. [PMID: 23483068 PMCID: PMC3590332 DOI: 10.3348/kjr.2013.14.2.213] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 03/19/2012] [Indexed: 02/06/2023] Open
Abstract
We report computed tomography (CT) findings for a rare case of follicular dendritic cell sarcoma of the greater omentum from a 47-year-old female patient. The tumor presented ash a palpable mass lesion in the umbilical region for the last two months. Multidetector CT scan of the abdomen showed a 14-cm soft-tissue mass with calcification and necrosis within the greater omentum. As a result, a follicular dendritic cell sarcoma should be considered in the differential diagnosis of a solitary omentum mass, especially one with coarse and chunk-like calcifications.
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Affiliation(s)
- Jerry Chin-Wei Chien
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
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De Pas T, Spitaleri G, Pruneri G, Curigliano G, Noberasco C, Luini A, Andreoni B, Testori A, de Braud F. Dendritic cell sarcoma: an analytic overview of the literature and presentation of original five cases. Crit Rev Oncol Hematol 2007; 65:1-7. [PMID: 17658269 DOI: 10.1016/j.critrevonc.2007.06.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2006] [Accepted: 06/07/2007] [Indexed: 10/23/2022] Open
Abstract
Interdigitating and follicular dendritic cell sarcoma (DCS) are very rare diseases, with approximately 184 cases being reported thus far, and their best treatment modality is still on debate. This is a review of all the cases of dendritic cell sarcoma reported from 1981 until April 2006. This review is enriched with the original contribution of five cases occurred at our Institution from 1994 to 2006. The review of the literature pointed out that radical surgery alone was curative in approximately two thirds of these cases, the relapsing rate in patients who received adjuvant treatments being higher than 30%. We pinpoint new five cases of dendritic cell sarcoma (three FDCS and two IDCS). Both the analytic revision of the literature and our data suggest that localized DCS may be effectively treated by radical surgery and do not support the use of adjuvant treatments after radical excision.
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Affiliation(s)
- Tommaso De Pas
- New Drugs Development and Clinical Pharmacology Unit, Department of Medicine, European Institute of Oncology, Milan, Italy.
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Agaimy A, Wünsch PH. Follicular dendritic cell tumor of the gastrointestinal tract: Report of a rare neoplasm and literature review. Pathol Res Pract 2006; 202:541-8. [PMID: 16564140 DOI: 10.1016/j.prp.2006.01.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2005] [Accepted: 01/30/2006] [Indexed: 01/09/2023]
Abstract
Follicular dendritic cell (FDC) tumor is a rare neoplasm of the accessory immune system showing FDC differentiation. Histologically, a conventional type and an inflammatory pseudotumor (IPT-like) type are recognized. The etiology of FDC tumor is unknown. While rare FDC tumors were associated with hyaline-vascular Castleman's disease (HVCD), hepatosplenic IPT-like FDC tumors consistently harbor EBV infection. FDC tumors of the gastrointestinal (GI) tract and mesentery/omentum are exceedingly rare, with only 17 cases reported so far. We report an additional case of an IPT-like FDC tumor of the ileum and mesentery in a 52-year-old schizophrenic man. The tumor consisted of highly atypical multinucleated giant cells in a background of intense lymphoid infiltrate with prominent eosinophilia reminiscent of Hodgkin's lymphoma. Tumor cells were immunoreactive for vimentin, CD21, CD35, fascin, smooth muscle actin and CD68, but were negative for all lineage-specific lymphoreticular, myeloid, mesenchymal and epithelial markers. Immunostaining for HHV-8 and in situ hybridization for EBV-encoded RNA (EBER) were negative. Some mesenteric lymph nodes showed HVCD-like changes. The differential diagnostic considerations of this unusual and rare neoplasm, mainly lymphocyte-rich GI stromal tumor (GIST), malignant lymphoma and inflammatory neoplasia of diverse histogenetic types, will be discussed together with a literature review on gastrointestinal FDC tumors.
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Affiliation(s)
- Abbas Agaimy
- Institut für Pathologie, Klinikum Nürnberg, Prof.-Ernst-Nathan-Strasse 1, 90419 Nürnberg, Germany.
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