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Zhang M, Xiao F, Fang J, Liu Z, Shen Y, Zhu D, Zhang Y, Hou J, Huang H. Long-Term Remission with Novel Combined Immune-Targeted Treatment for Histiocytic Sarcoma Accompanied by Follicular Lymphoma: Case Report and Literature Review. Int J Mol Sci 2024; 25:7293. [PMID: 39000399 PMCID: PMC11242306 DOI: 10.3390/ijms25137293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/18/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024] Open
Abstract
Histiocytic sarcoma (HS) is an extremely rare but aggressive hematopoietic malignancy, and the prognosis has been reported to be rather unfavorable with a median overall survival of merely 6 months. We presented a 58-year-old female patient complaining of abdominal pain and fever, who was admitted to our institution in September 2021. Fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) scan showed enlargement of generalized multiple lymph nodes. Subsequently, laparoscopic retroperitoneal lesion biopsy and bone marrow aspiration were performed. The pathological findings indicated the diagnosis of HS concurrent with follicular lymphoma. The immunohistochemistry (IHC) staining of the tumor lesion revealed a high expression of CD38 and PD-L1 proteins. Furthermore, KRAS gene mutation was identified by means of next-generation sequencing. The patient exhibited poor treatment response to both first- and second-line cytotoxic chemotherapies. Therefore, she underwent six cycles of Daratumumab (anti-CD38 monoclonal antibody), Pazopanib (multi-target receptor tyrosine kinases inhibitor) combined with third-line chemotherapy, followed by involved-site radiotherapy and maintenance therapy with the PD-1 inhibitor Tislelizumab. Long-term partial remission was finally achieved after multi-modality treatment. Duration of remission and overall survival reached 22 and 32 months, respectively. Our case indicated that immuno-targeted treatment coupled with chemotherapy and radiotherapy might constitute a potential therapeutic option for HS.
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Affiliation(s)
- Minyue Zhang
- Department of Hematology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Fei Xiao
- Department of Hematology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Jianchen Fang
- Department of Pathology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Zebing Liu
- Department of Pathology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Yanying Shen
- Department of Pathology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Di Zhu
- Department of Hematology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Yiwei Zhang
- Department of Hematology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Jian Hou
- Department of Hematology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Honghui Huang
- Department of Hematology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
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2
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Muacevic A, Adler JR, Sukaina M, Shaik Masthan S, Bint I Munir A, Iqbal Y, Qureshi MH, Husnain A, Ghafoor S, Ghafoor B, Nagarajan JS, Pervaiz F, Haseeb ul Rasool M. Histiocytic Sarcoma Secondary to Gastrointestinal Stromal Tumors: A Literature Review. Cureus 2022; 14:e33055. [PMID: 36721560 PMCID: PMC9882698 DOI: 10.7759/cureus.33055] [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] [Accepted: 12/28/2022] [Indexed: 12/29/2022] Open
Abstract
Histiocytic sarcoma (HS) is a rare tumor that may result from the transdifferentiation of preexisting hematolymphoid neoplasms in a subset of patients. There are instances of correlation or concurrence between HS and a number of cancers, particularly B-cell-associated hematopoietic tumors. Only three cases of HS occurring subsequent to or concurrently with gastrointestinal stromal tumors (GIST) have been recorded. Our main objective was to give an overview of demographics, clinical signs and symptoms, histopathological findings, and immunohistochemical and molecular analysis when HS develops secondary to or concurrently with GIST. A search of PubMed, Google Scholar, and ScienceDirect was undertaken using Medical Subject Headings (MeSH) keywords. According to the findings of our review, there were two males (66.6%) and one female (33.3%). The average age of patients at presentation was 59.6 years. On the immunohistochemistry, three patients were positive for cluster of differentiation (CD) 68 (100%), two patients were positive for CD 163 (67%), one patient was positive for leukocyte common antigen (LCA) (33%), and only one patient was positive for CD 4, CD 10, CD 31, CD 45, human leukocyte antigen (HLA)-DR, lysozyme, and vimentin (33%). On molecular investigation, the gastric mass of only one patient (33.33%) contained a KIT mutation on exon 11. Emperipolesis was observed in one patient (33.33%) on histological examination. Our study provides an important overview of the available literature and gives insight into important diagnostic markers of HS when it occurs secondary to or concurrently with GIST.
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3
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Larocca C, Shanmugam V, Zemmour D, Antin JH, Lane AA. Shared Clonal Origin of Multiple Histiocytic and Dendritic Neoplasms and Polycythemia Vera, Follicular Lymphoma in 1 Patient. Am J Dermatopathol 2022; 44:929-932. [PMID: 35642960 DOI: 10.1097/dad.0000000000002231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Cecilia Larocca
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Vignesh Shanmugam
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and
| | - David Zemmour
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and
| | - Joseph H Antin
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and
| | - Andrew A Lane
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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4
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A Rare Case of Histiocytic Sarcoma Secondary to Gastrointestinal Stromal Tumor in the Stomach: Transdifferentiation or Synchronicity? Case Rep Hematol 2021; 2021:8856649. [PMID: 33747577 PMCID: PMC7960056 DOI: 10.1155/2021/8856649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 03/01/2021] [Indexed: 11/18/2022] Open
Abstract
Histiocytic sarcoma is a rare malignant histiocytic neoplasm composed of cells with morphologic and immunophenotypic features of mature tissue histiocytes. It occurs anywhere in the body and behaves aggressively. However, its etiology is unknown. Here, we report a 68-year-old female who developed histiocytic sarcoma following chemotherapy with imatinib (Gleevec) for gastrointestinal stromal tumor. Possible mechanisms of transdifferentiation from gastrointestinal stromal tumor to histiocytic sarcoma are discussed based on the features of our case and other two similar cases in the literature.
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5
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Tashakori M, Thakral B, Tang G, Khoury JD, Medeiros LJ. From the archives of MD Anderson Cancer Center: A case of concurrent follicular lymphoma and Langerhans cell sarcoma with a review of the literature. Ann Diagn Pathol 2021; 52:151720. [PMID: 33676171 DOI: 10.1016/j.anndiagpath.2021.151720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 01/26/2021] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Abstract
Transdifferentiation of follicular lymphoma to a Langerhans cell neoplasm is rarely reported and not well understood. Here we present a case, review the literature and discuss some of the biological underpinnings of lineage switch of B cells to histiocytes/Langerhans cells. A 31-year-old woman had follicular lymphoma (FL) and Langerhans cell sarcoma (LCS) co-localized above and below diaphragm. The FL was low-grade, had typical morphologic features, and was positive for CD10, BCL-2, and BCL-6. The LCS was cytologically atypical with necrosis and a high mitotic rate, and the immunophenotype supported Langerhans cell lineage positive for CD1a, CD207/langerin, and S-100 protein. Both tumors carried IGH-BCL2 and the LCS cells had immunophenotypic evidence of a residual B cell program, supporting the notion that these neoplasms are clonally related. The case reported is unusual because the patient was young and both diseases presented simultaneously, before any therapy. In addition, immunohistochemical analysis showed that the LCS was negative for BRAF V600E and phospho-ERK, suggesting that the LCS belongs to the known subset of Langerhans cell tumors lacking BRAF V600E and MAP2K1 mutations. Concurrent occurrence of FL and Langerhans cell neoplasm is an unusual phenomenon, with 10 cases reported previously: 4 Langerhans cell histiocytosis and 6 Langerhans cell sarcoma, including this case.
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Affiliation(s)
- Mehrnoosh Tashakori
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Beenu Thakral
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Guilin Tang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Joseph D Khoury
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.
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6
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Li JJ, Talam S, Star P, Getta B. Atypical cutaneous histiocytic eruption in a patient with chronic myelomonocytic leukemia: A case report. J Cutan Pathol 2021; 48:680-688. [PMID: 33416192 DOI: 10.1111/cup.13957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 11/27/2022]
Abstract
Chronic myelomonocytic leukemia (CMML) is a clonal hematopoietic stem cell malignancy with features of both a myeloproliferative neoplasm and a myelodysplastic syndrome. We present a case of 72-year-old man with CMML who presented with generalized hemorrhagic papules and plaques which on histopathology showed a peculiar infiltrate of atypical mature histiocytes. The immunohistochemical markers for Langerhans cells, indeterminate dendritic cells, and plasmacytoid dendritic cells were negative. Next generation sequencing performed on the paraffin block of the leg biopsy specimen revealed identical ASXL1, SRSF2, and KRAS mutations as seen in the CMML clone of the peripheral blood. Along with recent literature, this case illustrates the spectrum of histiocytic and dendritic cell proliferations in CMML, many of which may be clonally related to the hematopoietic malignancy.
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Affiliation(s)
- Jing Jing Li
- Department of Anatomical Pathology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Stephanie Talam
- Department of Hematology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Phoebe Star
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Bartlomiej Getta
- Department of Hematology, Liverpool Hospital, Liverpool, New South Wales, Australia
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7
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Péricart S, Waysse C, Siegfried A, Struski S, Delabesse E, Laurent C, Evrard S. Subsequent development of histiocytic sarcoma and follicular lymphoma: cytogenetics and next-generation sequencing analyses provide evidence for transdifferentiation of early common lymphoid precursor-a case report and review of literature. Virchows Arch 2019; 476:609-614. [PMID: 31807922 DOI: 10.1007/s00428-019-02691-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/07/2019] [Accepted: 10/14/2019] [Indexed: 02/07/2023]
Abstract
Histiocytic sarcoma (HS) is a rare aggressive hematologic neoplasm that can be associated with low-grade B cell lymphoma. The development of both neoplasms is currently being considered a transdifferentiation mechanism but remains elusive. We report the case of a 65-year-old patient with synchronous development of peritoneal/abdominal HS and grade 1-2 follicular lymphoma (FL). Cytogenetic analysis and targeted next-generation sequencing of both FL and HS tumors identified common genomic alterations such as IGH-BCL2 rearrangement, CREBBP and KMT2D, and aberrations of chromosomes 9q and 19q. However, only the HS tumor had a KRAS mutation while the lymph node involved by FL harbored a TNFAIP3 mutation and both tumors also showed distinct chromosomal alterations. This report strengthens the hypothesis of a common lymphoid progenitor which accumulates genetic alterations leading to two different hematologic malignant diseases with significantly distinct prognoses.
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Affiliation(s)
- Sarah Péricart
- Departement de Pathologie, Institut Universitaire du Cancer Oncopole, CHU Toulouse, 1 avenue Irène Joliot-Curie, 31059, Toulouse cedex 09, France. .,Université Paul Sabatier, 118 route de Narbonne 31062, Toulouse cedex 09, France.
| | - Charlotte Waysse
- Département de Chirurgie oncologique, Centre Hospitalier Universitaire - Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, 1 avenue Irène Joliot-Curie, 31059, Toulouse Cedex 9, France
| | - Aurore Siegfried
- Departement de Pathologie, Institut Universitaire du Cancer Oncopole, CHU Toulouse, 1 avenue Irène Joliot-Curie, 31059, Toulouse cedex 09, France.,Université Paul Sabatier, 118 route de Narbonne 31062, Toulouse cedex 09, France
| | - Stephanie Struski
- Laboratoire de Cytogénétique, Institut Universitaire du Cancer Oncopole de Toulouse, 1 avenue Irène Joliot-Curie, 31059, Toulouse cedex 09, France
| | - Eric Delabesse
- Laboratoire Hematologie, Institut Universitaire du Cancer Oncopole de Toulouse, 1 avenue Irène Joliot-Curie, 31059, Toulouse cedex 09, France
| | - Camille Laurent
- Departement de Pathologie, Institut Universitaire du Cancer Oncopole, CHU Toulouse, 1 avenue Irène Joliot-Curie, 31059, Toulouse cedex 09, France.,Université Paul Sabatier, 118 route de Narbonne 31062, Toulouse cedex 09, France.,Institut National de la Sante et de la Recherche Médicale, U1037, Centre de Recherches en Cancérologie de Toulouse U1037 and Laboratoire d'Excellence (Labex Toucan), 2 avenue Hubert Curien, 31037, Toulouse cedex 01, France
| | - Solène Evrard
- Departement de Pathologie, Institut Universitaire du Cancer Oncopole, CHU Toulouse, 1 avenue Irène Joliot-Curie, 31059, Toulouse cedex 09, France.,Université Paul Sabatier, 118 route de Narbonne 31062, Toulouse cedex 09, France.,Institut National de la Sante et de la Recherche Médicale, U1037, Centre de Recherches en Cancérologie de Toulouse U1037 and Laboratoire d'Excellence (Labex Toucan), 2 avenue Hubert Curien, 31037, Toulouse cedex 01, France
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8
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Papoudou‐Bai A, Vassou A, Marinos L, Papathanasiou K, Kapsali E, Kanavaros P. Concurrent cutaneous localization of Langerhans cell sarcoma and chronic lymphocytic leukemia/small lymphocytic lymphoma in a patient with a history of chronic lymphocytic leukemia/small lymphocytic lymphoma. J Cutan Pathol 2019; 47:161-165. [DOI: 10.1111/cup.13571] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 08/11/2019] [Accepted: 08/19/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Alexandra Papoudou‐Bai
- Department of Pathology, Faculty of Medicine, School of Health SciencesUniversity of Ioannina Ioannina Greece
| | - Amalia Vassou
- Department of Hematology, Faculty of Medicine, School of Health SciencesUniversity of Ioannina Ioannina Greece
| | - Leonidas Marinos
- Department of HematopathologyEvangelismos General Hospital Athens Greece
| | - Konstantina Papathanasiou
- Department of Hematology, Faculty of Medicine, School of Health SciencesUniversity of Ioannina Ioannina Greece
| | - Eleni Kapsali
- Department of Hematology, Faculty of Medicine, School of Health SciencesUniversity of Ioannina Ioannina Greece
| | - Panagiotis Kanavaros
- Department of Anatomy‐Histology‐Embryology, Faculty of Medicine, School of Health SciencesUniversity of Ioannina Ioannina Greece
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9
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Broadwater DR, Conant JL, Czuchlewski DR, Hall JM, Wei S, Siegal GP, Peker D. Clinicopathologic Features and Clinical Outcome Differences in De Novo Versus Secondary Histiocytic Sarcomas: A Multi-institutional Experience and Review of the Literature. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:e427-e435. [DOI: 10.1016/j.clml.2018.07.286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/26/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
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10
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Takahashi E, Sakakibara A, Tsuzuki T, Nakamura S. Case of primary central nervous system histiocytic sarcoma with prominent proliferation of histiocytic cells between the trabeculae of reactive glial cells. Neuropathology 2018; 38:609-618. [PMID: 30155921 DOI: 10.1111/neup.12510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/24/2018] [Accepted: 07/26/2018] [Indexed: 11/27/2022]
Abstract
Histiocytic sarcoma (HS) is an extremely rare malignant neoplasm that exhibits morphologic and immune-phenotype evidence of histiocytic differentiation. The disease most commonly involves the lymph nodes, gastrointestinal tract, skin, and soft tissue, as well as in the central nervous system (CNS) being relatively rare. Here we report a case of primary CNS HS with unusual histopathological characteristics. A 65-year-old woman presented with CNS HS in the left frontal lobe region, showing two distinct histological patterns. Approximately half of the lesion displayed histological characteristics typical of HS, including diffuse invasion of large round-to-ovoid pleomorphic cells, with mitotic figures (Ki-67 index: 30%) and coagulative necrotic foci. The other half exhibited prominent proliferation of histiocytic cells between the trabeculae of reactive glial cells, with rare mitotic figures (Ki-67 index: < 1%) and no necrotic foci. There were transitions between two morphologies. The HS tumor cells and the histiocytic cells between the trabeculae of reactive glial cells possessed nearly identical histomorphologic and immunophenotypic features, although the HS tumor cells showed a more pronounced degree of cytologic atypia and mitotic activity. To our knowledge, this is the first reported case of HS with prominent proliferation of the histiocytic cells between the trabeculae of reactive glial cells. Here we present the detailed histological, immunohistochemical, and molecular findings. Investigating cases of HS may provide insight into the pathogenesis of this disease.
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Affiliation(s)
- Emiko Takahashi
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Japan
| | - Ayako Sakakibara
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Japan
| | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
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11
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Sandler G, Franklin A, Hayes-Jordan A. Histiocytic sarcoma in a child-successful management and long-term survival with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Pediatr Blood Cancer 2018; 65:e27054. [PMID: 29630764 DOI: 10.1002/pbc.27054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/06/2018] [Accepted: 02/20/2018] [Indexed: 11/11/2022]
Abstract
Histiocytic sarcoma is an extremely rare tumor in children. It may occur sporadically or in association with other hematological malignancies. It arises most commonly in the lymph nodes but may occur anywhere in the body and clinical presentation is usually with advanced disease. Following tissue diagnosis and staging, management is with chemotherapy though there are no standard regimes. Surgery has been used successfully for local control. This is the first description of the use of peritonectomy and hyperthermic intraperitoneal chemotherapy to treat histiocytic sarcoma. The 4-year-old patient has been disease free for 6 years.
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Affiliation(s)
- Gideon Sandler
- Pediatric Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anna Franklin
- Pediatric Hematology & Oncology, Children's Hospital Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Andrea Hayes-Jordan
- Pediatric Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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12
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Magro CM, Kazi N, Sisinger AE. Primary cutaneous histiocytic sarcoma: A report of five cases with primary cutaneous involvement and review of the literature. Ann Diagn Pathol 2017; 32:56-62. [PMID: 29414400 DOI: 10.1016/j.anndiagpath.2017.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 10/23/2017] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Histiocytic sarcoma is an extremely rare hematologic malignancy of histiocytic origin. Five cases of primary cutaneous histiocytic sarcoma are presented. MATERIALS AND METHODS Cases of primary cutaneous histiocytic sarcoma were identified using a natural language search from the dermatopathology data base of Cornell University. RESULTS There was a male predominance (4 males and 1 female) ranging in age from 33years to 92years (mean age of 73years); all presented with a solitary nodule which involved the head and neck area in four and thigh in one. The 73-year-old male had chronic myeloproliferative disorder. Biopsies showed a nonepitheliotropic dermal-based atypical large cell histiocytoid appearing infiltrate dermis showing positivity for common leukocyte antigen, CD4, CD14, CD68, CD163, CD2, CD11c, and lysozyme. Markers of terminal histiocytic differentiation such as S100, langerin, MXA, and CD83 were not seen. In two of the cases there was evidence of extracutaneous dissemination. The treatment in three of the cases was wide excision; there was no evidence of recurrent or metastatic disease. One case was given palliative radiation; the patient died. The other patient with underlying myelodysplastic syndrome died within a few weeks of initial cutaneous presentation. CONCLUSION HS must be differentiated from other malignant histiocytoid lesions. Staining for common leukocyte antigen and CD163 are the most reliable markers allowing this distinction. Patients who present with primary involvement of the skin may have a favorable outcome but only if treated relatively early in the course of the disease with complete excision.
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Affiliation(s)
- Cynthia M Magro
- Weill Cornell Medical Center, 1300 York Avenue, New York, NY 10065, USA.
| | - Najiyah Kazi
- Columbia University Medical Center, 630 West 168th Street, New York, NY, USA
| | - Aimee E Sisinger
- The Ohio State University Wexner Medical Center, 452 West 10th Avenue, Columbus, OH 43210, USA.
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13
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Langerhans cell histiocytosis followed by folliculotropic mycosis fungoides. Postepy Dermatol Alergol 2017; 34:273-275. [PMID: 28670259 PMCID: PMC5471370 DOI: 10.5114/pdia.2017.67055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 06/14/2016] [Indexed: 12/28/2022] Open
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14
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Steussy B, Lekostaj J, Qian Q, Rosenthal N, Holman CJ, Syrbu S, Darbro B, Bossler A, Karandikar NJ. Leukemic Transdifferentiation of Follicular Lymphoma Into an Acute Histiocytic Leukemia in a 52-Year-Old Caucasian Woman. Lab Med 2016; 47:155-7. [PMID: 27069033 PMCID: PMC7243928 DOI: 10.1093/labmed/lmw011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We report an instructive case of acute myeloid leukemia with histiocytic differentiation (acute histiocytic leukemia) arising in a patient, a 52-year-old woman with a history of follicular lymphoma. The results of genetic studies proved a clonal relationship between the lymphoma and the leukemic cells. To our knowledge, this is the first report of leukemic transdifferentiation of follicular lymphoma into modified base 5-methylcytosine (M5c)–like acute histiocytic leukemia and the first reported karyotype on a transdifferentiated neoplasm.
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Affiliation(s)
- Bryan Steussy
- Department of Pathology, University of Iowa, Iowa City
| | | | - Qining Qian
- Department of Pathology, University of Iowa, Iowa City
| | | | | | - Sergei Syrbu
- Department of Pathology, University of Iowa, Iowa City
| | | | - Aaron Bossler
- Department of Pathology, University of Iowa, Iowa City
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15
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Ansari J, Naqash AR, Munker R, El-Osta H, Master S, Cotelingam JD, Griffiths E, Greer AH, Yin H, Peddi P, Shackelford RE. Histiocytic sarcoma as a secondary malignancy: pathobiology, diagnosis, and treatment. Eur J Haematol 2016; 97:9-16. [PMID: 26990812 DOI: 10.1111/ejh.12755] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2016] [Indexed: 12/13/2022]
Abstract
Histiocytic sarcoma (HS) is an extremely rare non-Langerhans cell disorder with an aggressive course and limited treatment options. Recent advances in molecular/genetic sequencing have suggested a common clonal origin between various hematolymphoid disorders and cases of secondary HS. Deriving conclusions from previously reported cases of HS arising secondarily to certain hematolymphoid disorders, here we have tried to provide insight into the mechanisms influencing this evolution. We also discuss a clinical case of a 72-year-old man with a diagnosis of chronic myeloid leukemia (CML), presenting subsequently with a heterogeneous liver mass positive with a diagnosis of HS. The liver mass showed a retained BCR-ABL1 translocation suggesting clonality between the CML and HS. As seen in our case and other reported cases of HS derived secondarily, the concurrent expression of immunoglobulin heavy (IGH)-/light-chain rearrangements or cytogenetic markers common to the primary malignancy suggests an evolutionary mechanism involving lineage switching that could potentially be influenced by genetic or epigenetic cues which may occur at the level of a progenitor or the malignant cell itself.
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Affiliation(s)
- Junaid Ansari
- Feist-Weiller Cancer Center, LSU Health, Shreveport, LA, USA
| | - Abdul Rafeh Naqash
- University of Buffalo, Buffalo, NY, USA.,Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Reinhold Munker
- Feist-Weiller Cancer Center, LSU Health, Shreveport, LA, USA
| | - Hazem El-Osta
- Feist-Weiller Cancer Center, LSU Health, Shreveport, LA, USA
| | - Samip Master
- Feist-Weiller Cancer Center, LSU Health, Shreveport, LA, USA
| | | | | | - Adam H Greer
- Feist-Weiller Cancer Center, LSU Health, Shreveport, LA, USA
| | - Hong Yin
- Feist-Weiller Cancer Center, LSU Health, Shreveport, LA, USA
| | - Prakash Peddi
- Feist-Weiller Cancer Center, LSU Health, Shreveport, LA, USA
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Spillane DR, Wang DY, Newbigging S, Wang Y, Shi CX, Cho HR, Shimizu H, Gramolini A, Liu M, Wen XY. Chromosome Condensation 1-Like (Chc1L) Is a Novel Tumor Suppressor Involved in Development of Histiocyte-Rich Neoplasms. PLoS One 2015; 10:e0135755. [PMID: 26291700 PMCID: PMC4546397 DOI: 10.1371/journal.pone.0135755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 07/25/2015] [Indexed: 11/30/2022] Open
Abstract
Human chromosomal region 13q14 is a deletion hotspot in prostate cancer, multiple myeloma, and chronic lymphocytic leukemia. This region is believed to host multiple tumor suppressors. Chromosome Condensation 1-like (CHC1L) is located at 13q14, and found within the smallest common region of loss of heterozygosity in prostate cancer. Decreased expression of CHC1L is linked to pathogenesis and progression of both prostate cancer and multiple myeloma. However, there is no direct evidence for CHC1L’s putative tumor suppressing role in current literature. Presently, we describe the generation and characterization of Chc1L knockout mice. Chc1L-/- mice do not develop cancer at a young age, but bone marrow and spleen cells from 8–12 week-old mice display an exaggerated proliferative response. By approximately two years of age, knockout and heterozygote mice have a markedly increased incidence of tumorigenesis compared to wild-type controls, with tumors occurring mainly in the spleen, mesenteric lymph nodes, liver and intestinal tract. Histopathological analysis found that most heterozygote and knockout mice succumb to either Histiocytic Sarcoma or Histiocyte-Associated Lymphoma. Our study suggests that Chc1L is involved in suppression of these two histiocyte-rich neoplasms in mice and supports clinical data suggesting that CHC1L loss of function is an important step in the pathogenesis of cancers containing 13q14 deletion.
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Affiliation(s)
- David R. Spillane
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine & Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Ding Yan Wang
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Susan Newbigging
- Centre for Modeling Human Disease, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, The Toronto Centre for Phenogenomics, University of Toronto, Toronto, Ontario, Canada
| | - Youdong Wang
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Chang-Xin Shi
- Department of Medicine & Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Hae-Ra Cho
- Latner Thoracic Surgery Research Laboratories, Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Hiroki Shimizu
- Latner Thoracic Surgery Research Laboratories, Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Anthony Gramolini
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Mingyao Liu
- Department of Medicine & Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
- Latner Thoracic Surgery Research Laboratories, Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Xiao-Yan Wen
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine & Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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Ambrosio MR, De Falco G, Rocca BJ, Barone A, Amato T, Bellan C, Lazzi S, Leoncini L. Langerhans cell sarcoma following marginal zone lymphoma: expanding the knowledge on mature B cell plasticity. Virchows Arch 2015; 467:471-80. [PMID: 26286813 DOI: 10.1007/s00428-015-1814-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/08/2015] [Accepted: 07/16/2015] [Indexed: 12/27/2022]
Abstract
The concept of unidirectional differentiation of the haematopoietic stem cell has been challenged after recent findings that human B cell progenitors and even mature B cells can be reprogrammed into histiocytic/dendritic cells by altering expression of lineage-associated transcription factors. The conversion of mature B cell lymphomas to Langerhans cell neoplasms is not well documented. Three previous reports have described clonally related follicular lymphoma and Langerhans cell tumours, whereas no case has been published of clonally related marginal zone lymphoma and Langerhans cell sarcoma. We describe the case of a 77-year-old patient who developed a Langerhans cell sarcoma and 6 years later a nodal marginal zone lymphoma. Mutation status examination showed 100 % gene identity to the germline sequence, suggesting direct trans-differentiation or dedifferentiation of the nodal marginal zone lymphoma to the Langerhans cell sarcoma rather than a common progenitor. We found inactivation of paired box 5 (PAX-5) in the lymphoma cells by methylation, along with duplication of part of the long arm of chromosomes 16 and 17 in the sarcoma cells. The absence of PAX-5 could have triggered B cells to differentiate into macrophages and dendritic cells. On the other hand, chromosomal imbalances might have activated genes involved in myeloid lineage maturation, transcription activation and oncogenesis. We hypothesize that this occurred because of previous therapies for nodal marginal zone lymphoma. Better understanding of this phenomenon may help in unravelling the molecular interplay between transcription factors during haematopoietic lineage commitment and may expand the spectrum of clonally related mature B cell neoplasms and Langerhans cell tumours.
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Affiliation(s)
| | - Giulia De Falco
- Department of Medical Biotechnologies, Section of Pathology, University of Siena, Siena, Italy.,School of Biological and Chemical Sciences, Queen Mary University of London, London, UK
| | - Bruno Jim Rocca
- Department of Medical Biotechnologies, Section of Pathology, University of Siena, Siena, Italy.,Pathology Unit, Ospedale di Circolo di Busto Arsizio, Busto Arsizio, Italy
| | - Aurora Barone
- Department of Medical Biotechnologies, Section of Pathology, University of Siena, Siena, Italy
| | - Teresa Amato
- Department of Medical Biotechnologies, Section of Pathology, University of Siena, Siena, Italy
| | - Cristiana Bellan
- Department of Medical Biotechnologies, Section of Pathology, University of Siena, Siena, Italy
| | - Stefano Lazzi
- Section of Pathology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Lorenzo Leoncini
- Department of Medical Biotechnologies, Section of Pathology, University of Siena, Siena, Italy
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18
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Zhao J, Niu X, Wang Z, Lu H, Lin X, Lu Q. Histiocytic sarcoma combined with acute monocytic leukemia: a case report. Diagn Pathol 2015; 10:110. [PMID: 26187047 PMCID: PMC4506588 DOI: 10.1186/s13000-015-0350-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 07/09/2015] [Indexed: 11/20/2022] Open
Abstract
Background Histiocytic sarcoma (HS) is a rare malignant tumor. Underlying or associated disorders have been reported in some patients with HS. We herein report a very rare case of HS combined with acute monocytic leukemia (AMoL). Case presentation A 62-year-old man presented with systemic lymph node enlargement and pancytopenia in August 2012. Bone marrow (BM) aspirate showed abnormal hematopoiesis with 3 % blast, but no obvious abnormalities on flow cytometric immunophenotyping. A BM cytogenetic study and fluorescence in situ hybridization revealed a 46, XY karyotype and no myelodysplastic syndrome-associated features, respectively. A right cervical node biopsy showed disrupted node structure with diffuse pleomorphic neoplastic cells that were positive for cluster of differentiation (CD) 68, MAC387 and lysozyme, but negative for CD1a, CD21, CD30, S100, and T-cell, B-cell, and myeloid lineage markers. The patient was diagnosed with HS and treated with 8 courses of CHOP chemotherapy. After 4 courses, total-body FDG-PET imaging showed partial remission and disappearance of abnormal hematopoiesis in the BM, but 2 % blasts remained. Lymphadenopathy and pancytopenia recurred 1 month after the his last chemotherapy dose. He became resistant to second-line chemotherapy, with gradually increasing leukocytes, up to 50 % blasts in BM in December 2013, and abnormal cells positive for CD117, CD13, CD33, HLA-DR, CD34, CD11c, CD38, and myeloperoxidase. He was diagnosed with acute monocytic leukemia (AMoL-M5), and treated by CAG regimen + decitabine, but died of severe pneumonia and hepatic failure. Conclusion To our knowledge, this is the first case of HS combined with AMoL. The coexistence of these two neoplasms was shown by the lymph node biopsy findings and BM myeloid markers. The patient had a transient response to chemotherapy and a poor prognosis. Whether these two neoplasms were related is unclear; however, if so, we suspect the combination might be caused by a malignant transformation of a promonocyte or stem cell, upstream of histiocytes and monocytes.
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Affiliation(s)
- Jiangning Zhao
- Department of Hematology, Zhongshan Hospital of Xiamen University, Xiamen, 361004, Fujian, China.
| | - Xiaoqing Niu
- Department of Hematology, Zhongshan Hospital of Xiamen University, Xiamen, 361004, Fujian, China.
| | - Zhao Wang
- Department of Hematology, Zhongshan Hospital of Xiamen University, Xiamen, 361004, Fujian, China.
| | - Huadong Lu
- Department of Pathology, Zhongshan Hospital of Xiamen University, Xiamen, 361004, Fujian, China.
| | - Xiaoyan Lin
- Clinical Laboratories, Zhongshan Hospital of Xiamen University, Xiamen, 361004, Fujian, China.
| | - Quanyi Lu
- Department of Hematology, Zhongshan Hospital of Xiamen University, Xiamen, 361004, Fujian, China.
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Successful Treatment of Multifocal Histiocytic Sarcoma Occurring after Renal Transplantation with Cladribine, High-Dose Cytarabine, G-CSF, and Mitoxantrone (CLAG-M) Followed by Allogeneic Hematopoietic Stem Cell Transplantation. Case Rep Hematol 2015; 2015:728260. [PMID: 26167311 PMCID: PMC4475737 DOI: 10.1155/2015/728260] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 05/31/2015] [Indexed: 01/14/2023] Open
Abstract
Histiocytic sarcoma (HS) is a rare, aggressive malignancy. Lesions previously called HS were typically non-Hodgkin lymphomas, not HS. As such, chemotherapy directed at lymphoid neoplasms was frequently successful, but it is unclear if these regimens are ideal for HS. We present a 33-year-old African gentleman who underwent sequential renal transplants for glomerulonephritis. He subsequently developed HS of the upper airway and multiple cutaneous sites. The patient received cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) followed by salvage ifosfamide, carboplatin, and etoposide (ICE) but had continuous progression of cutaneous involvement. Cladribine, high-dose cytarabine, G-CSF, and mitoxantrone (CLAG-M) yielded a partial response with near resolution of disease. Ultimately, the patient achieved a complete remission after myeloablative allogeneic hematopoietic stem cell transplant. HS occurring after solid organ transplant raises the possibility of HS as a potential posttransplant malignancy. The use of CLAG-M has not been reported in HS. In this case, histiocyte-directed chemotherapy with CLAG-M was superior to lymphoma-directed regimens.
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20
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Takahashi E, Nakamura S. Histiocytic sarcoma : an updated literature review based on the 2008 WHO classification. J Clin Exp Hematop 2014; 53:1-8. [PMID: 23801128 DOI: 10.3960/jslrt.53.1] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Histiocytic sarcoma (HS) is an extremely rare malignant neoplasm showing morphologic and immunophenotypic evidence of histiocytic differentiation. The vast majority of previously reported HSs are now generally recognized to be misdiagnosed examples of non-Hodgkin lymphomas, predominantly diffuse large B-cell lymphoma or anaplastic large cell lymphoma. The recognition of such tumors parallels the development and widespread use of immunohistochemical techniques, along with the development of molecular genetic methods to detect immunoglobulin (IG) or T-cell receptor (TCR) gene rearrangement. The 2001 World Health Organization (WHO) definition of HS requires the absence of clonal B/T-cell receptor gene rearrangements. However, the 2008 WHO classification no longer strictly requires the absence of clonal immunoglobulin heavy chain (IGH) or TCR gene rearrangement for the diagnosis of HS. Recent studies demonstrated that HSs that occur subsequent to or concurrent with B- or T-lymphoblastic lymphoma/leukemia or mature B-cell neoplasms generally show clonal IgH and/or TCR gene rearrangement. These findings suggest the possibility of transdifferentiation of the two otherwise morphologically and immunohistochemically distinctive neoplasms. In addition, a recent study suggested clonal IG gene rearrangements may be detected at a high frequency in sporadic HS, indicating that a large subset of sporadic HSs may inherit the B-lymphocyte genotype. These findings provide new insights into the pathogenesis of HS, although the etiology of HS is still unknown. HS is a diagnosis of exclusion. It is necessary to rule out other diseases that could be misdiagnosed as HS with extensive immunophenotypical analysis before diagnosing HS.
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21
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Feldman AL. Clonal Relationships Between Malignant Lymphomas and Histiocytic/Dendritic Cell Tumors. Surg Pathol Clin 2013; 6:619-629. [PMID: 26839189 DOI: 10.1016/j.path.2013.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Tumors of histiocytic or dendritic cell origin appear to occur with increased frequency in patients with lymphoma. Recent molecular data have demonstrated clonal relationships between the lymphoma and the histiocytic/dendritic cell tumor in some of these cases. Clinical, pathologic, and experimental data suggest that this phenomenon probably represents transdifferentiation of the lymphoma clone to a histiocytic/dendritic cell lineage in most cases. Awareness of this entity is necessary to prompt comparative molecular studies in appropriate cases.
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Affiliation(s)
- Andrew L Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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22
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Chen W, Jaffe R, Zhang L, Hill C, Block AM, Sait S, Song B, Liu Y, Cai D. Langerhans Cell Sarcoma Arising from Chronic Lymphocytic Lymphoma/Small Lymphocytic Leukemia: Lineage Analysis and BRAF V600E Mutation Study. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2013; 5:386-91. [PMID: 23923114 PMCID: PMC3731871 DOI: 10.4103/1947-2714.114172] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background: the phenomenon that histiocytic/dendritic cell sarcomas may be transformed from lymphoproliferative diseases is dubbed ‘transdifferentiation’. Langerhans cell sarcoma (LCS) transdifferentiated from chronic lymphocytic leukemia/small cell lymphoma (CLL/SLL) is extremely rare. The underlying mechanisms of LCS tumorogenesis and its transdifferentiation from CLL/SLL are largely unknown. Aims: the authors strive to further characterize LCS, to understand the potential molecular changes in LCS and the underlying mechanisms of CLL/SLL transformation to LCS. Materials and Methods: a progressively enlarging right inguinal lymph node from a 68-year-old female patient with a history of CLL was biopsied and submitted for flow cytometry analysis, routine hematoxylin, and eosin (H and E) stain and immunohistochemical study. Furthermore, clonality study (fluorescent in situ hybridization (FISH) analysis with a CLL panel probes) and BRAF V600E mutation study (pyrosequencing and immunostain) were performed. Results: two different neoplasms, LCS and CLL/SLL, were discovered to occur simultaneously in the same lymph node. These two entities were shown to be clonally related. More importantly, for the first time, BRAF V600E mutation was detected in LCS. Conclusions: LCS can be transdifferentiated from CLL/SLL and BRAF V600E mutation may provide the foundation for alternative therapy of LCS.
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Affiliation(s)
- Weiwei Chen
- Department of Pathology, Buffalo General Hospital, State University of New York at Buffalo, Buffalo, NY 14214, USA
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23
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Stoecker MM, Wang E. Histiocytic/Dendritic Cell Transformation of B-Cell Neoplasms: Pathologic Evidence of Lineage Conversion in Differentiated Hematolymphoid Malignancies. Arch Pathol Lab Med 2013; 137:865-70. [DOI: 10.5858/arpa.2012-0104-rs] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
B-cell lymphomas, such as low-grade follicular lymphoma and chronic lymphocytic leukemia/small lymphocytic lymphoma, can transform to histiocytic/dendritic cell sarcoma (H/DS) in rare cases. The diagnosis of this unconventional neoplastic evolution relies on a combination of immunophenotypic analysis and genotypic studies. A genotype identical to that of the primary B-cell neoplasm in a secondary neoplasm with H/DS immunophenotype supports the lineage conversion to H/DS. Putative mechanisms for this unusual phenomenon include dedifferentiation, common immature progenitor, and transdifferentiation models, the latter of which is suggested by clinical laboratory data at the present time. Elucidation of the molecular mechanisms governing this lineage conversion may facilitate the understanding of carcinogenesis of not only hematopoietic but also nonhematolymphoid neoplasms. The clinical outcome of secondary H/DS is dismal, as observed in sporadic cases, and the optimal treatment remains to be determined.
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Affiliation(s)
- Maggie M. Stoecker
- From the Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Endi Wang
- From the Department of Pathology, Duke University Medical Center, Durham, North Carolina
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24
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Llamas-Velasco M, Cannata J, Dominguez I, García-Noblejas A, Aragües M, Fraga J, Arranz R. Coexistence of Langerhans cell histiocytosis, Rosai-Dorfman disease and splenic lymphoma with fatal outcome after rapid development of histiocytic sarcoma of the liver. J Cutan Pathol 2012; 39:1125-30. [DOI: 10.1111/cup.12013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Revised: 05/20/2012] [Accepted: 06/29/2012] [Indexed: 12/25/2022]
Affiliation(s)
- Mar Llamas-Velasco
- Department of Dermatology; Hospital Universitario de La Princesa; Madrid; Spain
| | - Jimena Cannata
- Department of Haematology; Hospital Universitario de La Princesa; Madrid; Spain
| | | | - Ana García-Noblejas
- Department of Haematology; Hospital Universitario de La Princesa; Madrid; Spain
| | - Maximiliano Aragües
- Department of Dermatology; Hospital Universitario de La Princesa; Madrid; Spain
| | - Javier Fraga
- Department of Pathology; Hospital Universitario de La Princesa; Madrid; Spain
| | - Reyes Arranz
- Department of Haematology; Hospital Universitario de La Princesa; Madrid; Spain
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25
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Muslimani A, Chisti MM, Blenc AM, Boxwala I, Micale MA, Jaiyesimi I. Langerhans/dendritic cell sarcoma arising from hairy cell leukemia: a rare phenomenon. Ann Hematol 2012; 91:1485-7. [DOI: 10.1007/s00277-011-1399-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 12/28/2011] [Indexed: 11/28/2022]
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26
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Clonally related histiocytic/dendritic cell sarcoma and chronic lymphocytic leukemia/small lymphocytic lymphoma: a study of seven cases. Mod Pathol 2011; 24:1421-32. [PMID: 21666687 PMCID: PMC3175277 DOI: 10.1038/modpathol.2011.102] [Citation(s) in RCA: 137] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Histiocytic and interdigitating dendritic cell sarcomas are rare tumors originating from bone marrow-derived myeloid stem cells. Recent studies have shown evidence of cross-lineage transdifferentiation of B cells in follicular lymphoma to histiocytic and dendritic cell sarcomas. In this study, we report the morphologic, molecular and cytogenetic analysis of seven cases of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) associated with histiocytic and dendritic cell sarcomas. All seven patients were elderly males (median age 71 years). The B-cell neoplasms preceded the development of the histiocytic and dendritic cell sarcomas in six of seven patients, and one patient had both tumors diagnosed at the same time. The tumors included four interdigitating dendritic cell sarcomas: one Langerhans cell sarcoma, one histiocytic sarcoma and one immature neoplasm with evidence of histiocytic origin. Laser-capture microdissection and PCR analysis showed identical clonal immunoglobulin gene rearrangements in the two phenotypically distinct components in all cases. There was a preferential usage of IGHV4-39 by the V-D-J gene rearrangement. By fluorescence in situ hybridization (FISH) analysis, two cases showed deletion 17p in both components, whereas four cases had normal cytogenetic findings by FISH in the CLL/SLL cells, but acquired cytogenetic abnormalities in the corresponding histiocytic and dendritic tumors. Chromosome 17p abnormalities were the most common cytogenetic abnormality detected in the sarcomas, seen in five of six cases studied. Compared with the CLL/SLL cells, the histiocytic/dendritic cells were largely negative for PAX5, but showed strong expression of PU.1 and variable and weak expression of CEBPβ. Our study provides evidence for transdifferentiation of CLL/SLL B cells to tumors of dendritic and less often histiocytic lineage, and suggests that secondary genetic events may play a role in this phenomenon.
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27
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Zeng W, Meck J, Cheson BD, Ozdemirli M. Histiocytic sarcoma transdifferentiated from follicular lymphoma presenting as a cutaneous tumor. J Cutan Pathol 2011; 38:999-1003. [DOI: 10.1111/j.1600-0560.2011.01769.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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28
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Congyang L, Xinggui W, Hao L, Weihua H. Synchronous histiocytic sarcoma and diffuse large B cell lymphoma involving the stomach: a case report and review of the literature. Int J Hematol 2011; 93:247-252. [PMID: 21286876 DOI: 10.1007/s12185-011-0773-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 01/12/2011] [Accepted: 01/12/2011] [Indexed: 02/06/2023]
Abstract
We present a 62-year-old Chinese woman with histiocytic sarcoma (HS) and diffuse large B cell lymphoma (DLBL) located in the stomach. HS showed abundant eosinophilic cytoplasm with large, pleomorphic nuclei. Tumor giant and multinucleated cells were also prominent. Hemophagocytosis was common in the neoplastic cells. These cells were positive for CD68, CD45RO, and leukocyte common antigen (LCA), partly positive for S-100 and lysozyme, and negative for CD3, CD5, CD20, Pax-5, CD79a, CD1a, CD21, CD35, CD34, myeloperoxidase, HMB45 and cytokeratin (CK). These cells invaded the submucosa, muscularis mucosa, and serosa. DLBL was located in the mucosa and engulfed the covering epithelium and gland. The nuclei of tumor cells were medium-to-large in size, being ≥twice the size of normal lymphocytes. They were diffusely positive for CD20, Pax-5, and LCA, partly positive for vimentin, CD79a, CD10, CD30, CD15, and epithelial membrane antigen, and negative for S-100, CD1a, CD21, CD5, cyclin D1, CD23, CD35, HMB45, and CD68. Both types of tumor cell were positive for Oct-2, Bcl-2, and Bcl-6. These results suggest that HS may have shared a common clonal origin with DLBL, or may have transdifferentiated from DLBL The patient refused further chemotherapy, and died 7 months after surgical resection.
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Affiliation(s)
- Li Congyang
- Department of Pathology, People's Liberation Army 152 Hospital, Room 42, Jianshe Road, Pingdingshan, 467000, Henan, China.
| | - Wu Xinggui
- Department of General Surgery, People's Liberation Army 152 Hospital, Room 42, Jianshe Road, Pingdingshan, 467000, Henan, China
| | - Li Hao
- Department of Clinical Laboratories, People's Liberation Army 152 Hospital, Room 42, Jianshe Road, Pingdingshan, 467000, Henan, China
| | - Hou Weihua
- Department of Pathology, People's Liberation Army 152 Hospital, Room 42, Jianshe Road, Pingdingshan, 467000, Henan, China
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29
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Aggressive sporadic histiocytic sarcoma with immunoglobulin heavy chain gene rearrangement and t(14;18). Int J Hematol 2010; 92:659-63. [PMID: 20976632 DOI: 10.1007/s12185-010-0704-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 09/22/2010] [Accepted: 09/30/2010] [Indexed: 01/31/2023]
Abstract
Histiocytic sarcoma (HS) is a rare but aggressive malignant neoplasm of histiocytic lineage with a poor prognosis. Immunohistochemically, the neoplastic cells are positive for CD163, CD68, and lysozyme, and negative for B and T cell markers. However, molecular studies on the origin of the neoplastic cells remain inconclusive. A 54-year-old woman was admitted to our hospital because of painful swelling of the left knee. Examination revealed generalized lymphadenopathy and splenomegaly. HS was diagnosed according to morphologic and immunohistochemical features observed on biopsy of the left inguinal lymph node. The tumor demonstrated a clonal immunoglobulin heavy chain gene rearrangement and a clonal cytogenetic abnormality including t(14;18) which was confirmed by fluorescence in situ hybridization analysis showing the IgH/BCL2 fusion gene. The neoplastic cells were negative for PAX5, a B cell associated transcription factor, and positive for CEBPβ, a transcription factor mediating macrophage and myeloid differentiation. Positron emission tomography showed disseminated areas of increased 18F-fluorodeoxyglucose uptake in multiple lymph nodes, the liver, spleen, both lungs, both kidneys, and many bony sites. The patient received localized irradiation therapy followed by chemotherapy, she failed to respond and died of the disease progression. The case findings suggest lineage promiscuity or plasticity related to the pathogenesis of HS.
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30
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Histiocytic sarcoma with two immunohistopathologically distinct populations. Int J Hematol 2010; 92:642-6. [PMID: 20924729 DOI: 10.1007/s12185-010-0699-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 09/15/2010] [Accepted: 09/16/2010] [Indexed: 12/30/2022]
Abstract
This report is a case of histiocytic sarcoma (HS), in which tumor cells consist of two immunohistopathologically distinct populations (A) oval CD68+lysozyme+CD163- cells and (B) abundant cytoplasm or spindle-shaped CD68+lysozyme-CD163+ cells. Cervical lymph node was infiltrated mainly by population (A), where chemotherapy was quite effective. On the other hand, vast majority of infiltrated tumor cells in the hilar lymph node belonged to population (B), in which the cells were resistant to chemo-radiotherapy. Considering the poor prognosis of HS, the expression of CD163 could be a marker for resistance to chemo-radiotherapy. It is also notable that CD163-negative stage of HS may exist and still be reactive for the treatment.
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31
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Wang E, Hutchinson CB, Huang Q, Sebastian S, Rehder C, Kanaly A, Moore J, Datto M. Histiocytic sarcoma arising in indolent small B-cell lymphoma: report of two cases with molecular/genetic evidence suggestive of a 'transdifferentiation' during the clonal evolution. Leuk Lymphoma 2010; 51:802-12. [PMID: 20331331 DOI: 10.3109/10428191003699845] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The biologic relationship between small B-cell lymphoma and histiocytic sarcoma (HS) when occurring in the same patient remains unclear, though recent data suggest a possible 'transdifferentiation' from follicular lymphoma (FL) to HS. We investigated the clonal relationship in two cases of small B-cell lymphoma with subsequent HS. Case 1: A 62-year-old female with splenic marginal zone lymphoma (SMZL) developed HS in a groin lymph node 1 year after the primary diagnosis. PCR/sequence analysis of the IGH gene showed a monoclonal rearrangement carrying an identical nucleotide sequence of PCR products from the spleen with SMZL and the lymph node with HS. Case 2: A 61-year-old female with a remote history of FL developed supraclavicular lymphadenopathy, which was confirmed to be HS. PCR analysis of the HS detected a monoclonal rearrangement of the IGH gene and FISH analysis revealed IGH/BCL2 fusion, a genetic hallmark for FL. The transformed HSs showed partial retention of their prior B-cell lymphomas' signatures, including expression of OCT2 in both cases and expression of BCL6 and enhanced expression of BCL2 in case 2. Both HSs demonstrated hypermutated IGH variable regions, arguing against a common progenitor mechanism of the transformation process. The data suggest a common clonal origin of B-cell lymphoma and subsequent HS occurring in the same patient, indicating that 'transdifferentiation' occurs in other small B-cell lymphomas, in addition to the previously reported FL or B-cell lymphoma with IGH/BCL2.
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Affiliation(s)
- Endi Wang
- Department of Pathology, DUMC Box 3712, Duke University Medical Center, Durham, NC 27710, USA.
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Histiocytic sarcoma and underlying chronic myelomonocytic leukemia: a proposal for the developmental classification of histiocytic sarcoma. Int J Hematol 2010; 92:168-73. [PMID: 20535595 DOI: 10.1007/s12185-010-0603-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Revised: 05/09/2010] [Accepted: 05/13/2010] [Indexed: 10/19/2022]
Abstract
A 70-year-old male was admitted because of back pain due to peri-vertebral tumors. The histologic picture of a needle-biopsied tumor specimen showed pleomorphic large cell infiltration into the collagen fibers. On immunohistochemistry, these abnormal cells were positive for CD68, CD163 and lysozyme but negative for CD1a, 21, 30, and S100. Flow cytometric analysis also demonstrated that these cells were positive for CD13, 14, 38, 45, 56, and HLA-DR. A bone marrow aspirate showed the marked infiltration of abnormal large cells with the same surface antigens as described above. A diagnosis of HS was made. He showed monocytosis in the peripheral blood of more than 1.0 x 10(9)/L from presentation. The karyotype of bone marrow cells was 46,XY,+8. Fluorescent in situ hybridization (FISH) analysis with a probe for chromosome no. 8 showed that all these monocytes carried +8, indicating that he had another disorder of chronic myelomonocytic leukemia (CMML). FISH analysis with a probe for chromosome no. 12 demonstrated that the abnormal large cells in the bone marrow were all tetraploid, while analysis with the chromosome no. 8 probe showed more than 8 signals per cell, indicating that HS cells carried octasomy to decasomy of chromosome no. 8. These findings strongly suggest that HS in the present patient originated from underlying CMML.
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Zhang D. Histiocytic sarcoma arising from lymphomas via transdifferentiation pathway during clonal evolution. Leuk Lymphoma 2010; 51:739-40. [PMID: 20388055 DOI: 10.3109/10428191003774978] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Da Zhang
- Department of Pathology, MS3045, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66219, USA.
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Fraser CR, Wang W, Gomez M, Zhang T, Mathew S, Furman RR, Knowles DM, Orazi A, Tam W. Transformation of chronic lymphocytic leukemia/small lymphocytic lymphoma to interdigitating dendritic cell sarcoma: evidence for transdifferentiation of the lymphoma clone. Am J Clin Pathol 2009; 132:928-39. [PMID: 19926586 DOI: 10.1309/ajcpwq0i0dgxbmho] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Interdigitating dendritic cell sarcoma (IDCS) is a rare tumor derived from interdigitating dendritic cells. Three cases of IDCS associated with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) have been described, but no clonal relationship between the 2 neoplasms was demonstrated. We present a detailed case analysis of a CLL/SLL with metachronous IDCS and demonstrate that these 2 neoplasms are clonally related. The IDCS and CLL cells had trisomy 12 and identical monoclonal immunoglobulin heavy chain gene rearrangements. Analysis of transcription factors with a role in myeloid differentiation demonstrated PU.1 up-regulation and C/EBPalpha down-regulation in IDCS compared with CLL. High-density array comparative genomic hybridization also identified gains in part of chromosome 16q in IDCS. Our study demonstrates for the first time clonal transformation of CLL/SLL into IDCS. This phenomenon may be triggered by alterations in lineage-determining transcription programs, which result in transdifferentiation, coupled with additional oncogenic stimuli caused by chromosomal imbalances.
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