Updates in histiocytic and dendritic cell proliferations and neoplasms

Imprint cytology of histiocytic sarcoma manifesting as a retroperitoneal mass: A valuable aid for frozen section diagnosis

Histiocytic sarcoma (HS) is a comparatively rare hematolymphoid neoplasm. Differential diagnosis of this entity has generally been proven to be so difficult that extensive immunohistochemical staining is required to confirm its presence. We herein present a case of HS manifesting as a retroperitoneal mass in which imprint cytology (IC) contributed to the diagnosis. A 77-year-old man was referred for the evaluation of a colonic tubulovillous polypoid lesion. Preoperative imaging revealed a 3 cm-sized polypoid lesion in the transverse colon. Incidentally, a retroperitoneal mass of 8 cm in the left para-aortic region was also detected. Diff-Quik stained IC slides were prepared as an adjunct to intraoperative pathology consultation. The smear exhibited moderate cellularity involving loosely cohesive cell clusters with intervening delicate vasculature. Most of the tumor cells consisted of large single cells with abundant eosinophilic cytoplasm that was vacuolated and foamy. The nuclei were predominantly large and eccentrically located. Mitotic figures were minimal in number and finely granular brown pigments were occasionally observed. A frozen section diagnosis was reported as a malignant neoplasm, and a histologic diagnosis of HS was confirmed by conducting a battery of immunohistochemical stains: negative for pan-cytokeratin, EMA, CD117, HMB45, Melan A, CD30, PAX5, CD20, S-100, and CD23 but strong positive for vimentin and CD68. This entity is rarely described in terms of cytopathologic features. This case study highlights how cytopathologists should be aware of HS as a retroperitoneal lesion and should become familiar with cytomorphologic features.