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Zuo P, Zhang M, Wu W, Wang Y, Li T, Sun T, Wang Y, Wu Z, Zhang J, Zhang L. Primary intracranial histiocytic sarcomas: a report of six cases and a pooled analysis of individual patient data. J Cancer Res Clin Oncol 2023; 149:12071-12079. [PMID: 37421454 DOI: 10.1007/s00432-023-05112-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/04/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE Primary intracranial histiocytic sarcomas (PIHSs) are extremely rare with limited reported cases, making their prognostic factors and management uncertain. This study aims to describe the clinical characteristics of PIHSs and propose a treatment protocol for this entity. METHODS Clinical data were collected from six patients diagnosed with PIHSs at Beijing Tiantan Hospital between March 2011 and October 2022. Additionally, a comprehensive search of the PubMed database was conducted using the keywords "primary intracranial" or "primary central nervous system" combined with "histiocytic sarcoma" or "histiocytic sarcomas" between 1996 and 2022, identifying 24 cases. A pooled analysis of individual patient data was performed to assess risk factors for overall survival (OS). RESULTS The six cases included four males and two females, with a mean age of 42.2 ± 13.3 years. In total, 24 cases of PIHSs were identified from previous studies. Multivariate Cox regression analysis revealed that gross total resection (GTR) was the only factor predicting a longer OS (p = 0.027). Kaplan-Meier analysis demonstrated that GTR (p = 0.0013), solitary lesions (p = 0.0048), and radiotherapy (p = 0.0492) were associated with a longer OS. CONCLUSION PIHSs are rare brain tumors with poor clinical prognosis. Patients with solitary lesions have a longer OS than those with multifocal lesions. Gross total resection must be the first choice. Radiotherapy may bring benefits for these patients, but chemotherapy may not be useful. Further studies involving larger cohorts are necessary to validate these findings.
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Affiliation(s)
- Pengcheng Zuo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mingxin Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenhao Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tian Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tao Sun
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - YuJin Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhen Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Junting Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liwei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
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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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Bellalah A, korbi I, Ben Hammouda S, Achour A, Ben Abdeljelil N, Njima M, Daldoul A, Hadhri R, Njim L, Zakhama A. Small bowel and lung histiocytic sarcoma revealed by acute peritonitis: A case report with review of literature. Ann Med Surg (Lond) 2021; 68:102638. [PMID: 34381610 PMCID: PMC8339142 DOI: 10.1016/j.amsu.2021.102638] [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] [Received: 07/09/2021] [Revised: 07/26/2021] [Accepted: 07/26/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Histiocytic sarcoma (HS) is a rare malignant neoplasm showing morphologic and immunohistochemical features of histiocytes. It is characterized typically by extranodal presentation and a poor clinical course, particularly in cases with disseminated disease. CASE PRESENTATION This report documents a case of bifocal and aggressive HS in small bowel and lung revealed by acute peritonitis in a 63-year-old man. CLINICAL DISCUSSION Despite its rarity, we believe that the correct diagnosis of HS is crucial for clinical treatment and prognostic prediction. CONCLUSION The collection of additional cases of HS are important to obtain further progress in prognosis and guide treatment decisions.
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Affiliation(s)
- Ahlem Bellalah
- Department of Pathology, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
- Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
| | - Ibtissem korbi
- Department of Digestive Surgery, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
- Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
| | - Seifeddine Ben Hammouda
- Department of Pathology, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
- Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
| | - Asma Achour
- Department of Radiology, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
- Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
| | - Nouha Ben Abdeljelil
- Department of Pathology, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
- Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
| | - Manel Njima
- Department of Pathology, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
- Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
| | - Amira Daldoul
- Department of Carcinology, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
- Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
| | - Rim Hadhri
- Department of Pathology, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
- Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
| | - Leila Njim
- Department of Pathology, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
- Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
| | - Abdelfatteh Zakhama
- Department of Pathology, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
- Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
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Afzal A, Asadbeigi SN, Farooque U, Mather C, Khan S. Histiocytic sarcoma arising from a lymph node: a diagnostic conundrum. Int Cancer Conf J 2021; 10:244-247. [PMID: 34221840 DOI: 10.1007/s13691-021-00489-9] [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: 12/15/2020] [Accepted: 05/05/2021] [Indexed: 11/30/2022] Open
Abstract
Histiocytic Sarcoma (HS) is extremely rare, with only a few hundred cases reported in the literature. The majority of patients present with symptoms due to unifocal or multifocal extra-nodal disease. Less than 20% of these cases show solitary involvement of a lymph node. We report a case of a solitary HS in a 53-year-old woman presenting with a 2.7-cm right groin mass arising from an inguinal lymph node. The initial cytologic examination of the tissue showed a high-grade spindle-shaped morphology with high-grade mitotic activity. A high-grade sarcoma was initially considered considering the absence of normal lymphoid aggregate and the presence of high-grade cytologic features in the cells. To evaluate the tumor in its entirety, the mass was surgically excised. A histological examination of the tumor showed focal rimming of the lymphoid tissue at the periphery and a centrally located stellate necrotic focus. The tumor cells had an epithelioid to spindle cell morphology along with large uniform nuclei and prominent nucleoli. A high mitotic index was present. Immunohistochemistry (IHC) stains showed strong positivity for CD68, CD163, and Vimentin, and were weakly positive for SMA and CD45. Based on the histologic and clinical examination, a diagnosis of HS was made. Multiple malignancies can mimic HS histopathology and the rarity of this tumor makes the diagnosis more challenging. No fine-needle aspiration (FNA) criteria for its diagnosis have been recognized. Herein, we report a rare case of an isolated HS involving a lymph node which resembled high-grade sarcoma on the FNA biopsy to raise awareness among our surgical pathologist colleagues.
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Affiliation(s)
- Anoshia Afzal
- Department of Pathology, The University of Oklahoma Health Science Center, Oklahoma City, OK USA
| | - Sepideh N Asadbeigi
- Department of Dermatopathology, McGaw Medical Center of Northwestern University, Suite 1600, 676 North Saint Clair Street, Chicago, IL 60611 USA
| | - Umar Farooque
- Department of Neurology, Dow University of Health Sciences, Karachi, Pakistan
| | - Christy Mather
- Department of Psychology, University of Tulsa, Tulsa, OK USA
| | - Shahbaz Khan
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN USA
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Toyoda I, Vernau W, Sturges BK, Vernau KM, Rossmeisl J, Zimmerman K, Crowe CM, Woolard K, Giuffrida M, Higgins RJ, Dickinson PJ. Clinicopathological characteristics of histiocytic sarcoma affecting the central nervous system in dogs. J Vet Intern Med 2020; 34:828-837. [PMID: 31919895 PMCID: PMC7096655 DOI: 10.1111/jvim.15673] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/14/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Histiocytic sarcoma affecting the central nervous system (CNS HS) in dogs may present as primary or disseminated disease, often characterized by inflammation. Prognosis is poor, and imaging differentiation from other CNS tumors can be problematic. OBJECTIVE To characterize the clinicopathological inflammatory features, breed predisposition, and survival in dogs with CNS HS. ANIMALS One hundred two dogs with HS, 62 dogs with meningioma. METHODS Retrospective case series. Records were reviewed for results of cerebrospinal fluid (CSF) analysis, CBC, treatment, and outcome data. RESULTS Predisposition for CNS HS was seen in Bernese Mountain Dogs, Golden Retrievers, Rottweilers, Corgis, and Shetland Sheepdogs (P ≤ .001). Corgis and Shetland Sheepdogs had predominantly primary tumors; Rottweilers had exclusively disseminated tumors. Marked CSF inflammation was characteristic of primary rather than disseminated HS, and neoplastic cells were detected in CSF of 52% of affected dogs. Increased neutrophil to lymphocyte ratios were seen in all groups relative to controls (P <.008) but not among tumor subtypes. Definitive versus palliative treatment resulted in improved survival times (P < .001), but overall prognosis was poor. CONCLUSIONS AND CLINICAL IMPORTANCE Clinicopathological differences between primary and disseminated HS suggest that tumor biological behavior and origin may be different. Corgis and Shetland Sheepdogs are predisposed to primary CNS HS, characterized by inflammatory CSF. High total nucleated cell count and the presence of neoplastic cells support the use of CSF analysis as a valuable diagnostic test. Prognosis for CNS HS is poor, but further evaluation of inflammatory mechanisms may provide novel therapeutic opportunities.
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Affiliation(s)
- Izumi Toyoda
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - William Vernau
- Department of Pathology, Microbiology and Immunology, University of California Davis, School of Veterinary Medicine, Davis, California
| | - Beverly K Sturges
- Department of Surgical and Radiological Sciences, University of California Davis, School of Veterinary Medicine, Davis, California
| | - Karen M Vernau
- Department of Surgical and Radiological Sciences, University of California Davis, School of Veterinary Medicine, Davis, California
| | - John Rossmeisl
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia
| | - Kurt Zimmerman
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia
| | - Chelsea M Crowe
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Kevin Woolard
- Department of Pathology, Microbiology and Immunology, University of California Davis, School of Veterinary Medicine, Davis, California
| | - Michelle Giuffrida
- Department of Surgical and Radiological Sciences, University of California Davis, School of Veterinary Medicine, Davis, California
| | - Robert J Higgins
- Department of Pathology, Microbiology and Immunology, University of California Davis, School of Veterinary Medicine, Davis, California
| | - Peter J Dickinson
- Department of Surgical and Radiological Sciences, University of California Davis, School of Veterinary Medicine, Davis, California
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6
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Abstract
Histiocytic sarcoma, a rare malignant neoplasm showing morphologic and immunophenotypic features of histiocytes, is characterized typically by extranodal presentation and a dismal clinical course, particularly in patients with disseminated disease. A history of hematolymphoid disorder can be identified in a subset of patients, suggesting transdifferentiation of a preexisting hematolymphoid neoplasm in its pathogenesis. The differential diagnosis of histiocytic sarcoma includes various lymphomas, other histiocytic and dendritic cell neoplasms, carcinomas, melanomas, and pleomorphic sarcomas. Given its rarity and histologic overlap with diverse mimics, the diagnosis of histiocytic sarcoma can be extremely challenging. Recognition of morphologic clues, as well as judicious application of immunohistochemical markers to confirm its histiocytic lineage and to exclude mimics, is crucial for the diagnosis. Recent molecular studies by targeted next-generation sequencing identified recurrent alterations in the mitogen-activated protein (MAP) kinase pathway and chromatin regulators in the pathogenesis of histiocytic sarcoma and may suggest possible therapeutic targets.
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Affiliation(s)
- Yin P. Hung
- From the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (Dr Hung); and Fine Needle Aspiration Service, Brigham and Women's Hospital, Boston, Massachusetts, the Department of Pathology, Harvard Medical School, Boston, Massacusetts, and Bone and Soft Tissue Pathology Service, Dana Farber Cancer Institute, Boston, Massachusetts (Dr Qian)
| | - Xiaohua Qian
- From the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (Dr Hung); and Fine Needle Aspiration Service, Brigham and Women's Hospital, Boston, Massachusetts, the Department of Pathology, Harvard Medical School, Boston, Massacusetts, and Bone and Soft Tissue Pathology Service, Dana Farber Cancer Institute, Boston, Massachusetts (Dr Qian)
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7
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May JM, Waddle MR, Miller DH, Stross WC, Kaleem TA, May BC, Miller RC, Jiang L, Strong GW, Trifiletti DM, Chaichana KL, Reimer R, Tun HW, Peterson JL. Primary histiocytic sarcoma of the central nervous system: a case report with platelet derived growth factor receptor mutation and PD-L1/PD-L2 expression and literature review. Radiat Oncol 2018; 13:167. [PMID: 30185195 PMCID: PMC6126020 DOI: 10.1186/s13014-018-1115-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/27/2018] [Indexed: 12/22/2022] Open
Abstract
Background Histiocytic sarcoma (HS) is an aggressive malignant neoplasm. HS in the central nervous system is exceptionally rare and associated with a poor prognosis. This report documents a case of primary HS of the central nervous system with treatment including surgery, radiotherapy, and chemotherapy. Case presentation Our patient was a 47 year old female presenting with progressive ataxia, headaches, imbalance, nausea, vomiting, and diplopia. MRI showed a heterogeneously enhancing lesion approximately 2.9 × 3.0 × 2.3 cm centered upon the cerebellar vermis with mild surrounding vasogenic edema and abnormal enhancement of multiple cranial nerves. The patient underwent surgical debulking, which revealed histiocytic sarcoma with grossly purulent drainage. Staging revealed diffuse leptomeningeal involvement, primarily involving the brain and lower thoracic and lumbar spine. She underwent adjuvant radiotherapy to the brain and lower spine and was started on high dose methotrexate. However, she experienced progressive disease in the cervical and thoracic spine as well as pulmonary involvement. Genomic sequencing of her tumor showed a mutation in the platelet-derived growth factor receptor A (p.V0681) which could be targeted with Dasatinib. However, she did not tolerate Dasatinib and she succumbed to progressive disseminated disease eight months from original diagnosis. Our pathologic evaluation also revealed expression of PD-L1 and PD-L2 by tumor cells raising the potential therapeutic role for immune checkpoint inhibition. Conclusions This case provides an example of effective CNS control with resection and moderate doses of radiation therapy. A review of the literature confirms aggressive multidisciplinary treatment is the most effective treatment against this disease. In addition, genomic sequencing may play an important role in determining new therapeutic options. However, CNS histiocytic sarcoma remains an aggressive disease with a propensity for early widespread dissemination and few long term survivors.
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Affiliation(s)
- Jackson M May
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA
| | - Mark R Waddle
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA
| | - Daniel H Miller
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA
| | - William C Stross
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA
| | - Tasneem A Kaleem
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA
| | - Byron C May
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA
| | - Robert C Miller
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA
| | - Liuyan Jiang
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Gerald W Strong
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA
| | - Daniel M Trifiletti
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA
| | | | - Ronald Reimer
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Han W Tun
- Department of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jennifer L Peterson
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA. .,Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA.
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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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Ma S, Schild M, Tran D, Zhang X, Zhang WL, Shen S, Xu HT, Yang LH, Wang E. Primary central nervous system histiocytic sarcoma: A case report and review of literature. Medicine (Baltimore) 2018; 97:e11271. [PMID: 29953002 PMCID: PMC6039672 DOI: 10.1097/md.0000000000011271] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RATIONALE Primary central nervous system histiocytic sarcoma (PCNSHS) is a rare lymphohematopoietic tumor with a histiocytic cell origin. To our knowledge, only 28 cases have been published in English and 2 cases in Chinese. PATIENT CONCERNS A 49-year-old Asian female presented to the hospital with a 2 month history of hypomnesia, odynophagia, and gait disorder. Physical examination demonstrated decreased lower extremity muscle strength. The patient denied a history of malignancy. DIAGNOSES Radiology demonstrated a lesion in parietal lobe with uniformenhancement. Histologic analysis showed pleomorphic tumor cells with a loose arrangement, effacing the normal brain tissue. The tumor cells exhibited abundant eosinophilic cytoplasm, highly atypical nuclei and predominant nucleoli. Immunohistochemistry revealed positive immunoreactivity for CD45, lysozyme, CD68, and CD163, and negative for pan-cytokeratin (CK), epithelial membrane antigen (EMA), glial fibrillary acidic protein (GFAP), CD3, CD20, CD1a, CD79a, CD138, oligodendrocyte transcription factor (olig2), CD15, melan-A, CD30, CD21, CD35, Human Melanoma Black-45 (HMB45), and anaplastic lymphoma kinase-1 (ALK-1). The diagnosis of PCNSHS was rendered. INTERVENTIONS The patient underwent complete surgical resection and adjuvant radiotherapy. OUTCOMES Follow-up information shows the patient died 8 months following the initial diagnosis. LESSONS PCNSHS is extremely rare with an aggressive clinical course. Immunohistiochemistry is necessary to make this diagnosis and to exclude other primary intracranial and lymphohematopoietic tumors. Further research is required to improve the outcome of patients with PCNSHS.
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Affiliation(s)
- Shuang Ma
- Department of Neurology, Sheng Jing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Michael Schild
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Diana Tran
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Xuefeng Zhang
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Wan-Lin Zhang
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, Liaoning, China
| | - Shuai Shen
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, Liaoning, China
| | - Hong-Tao Xu
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, Liaoning, China
| | - Lian-He Yang
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, Liaoning, China
| | - Endi Wang
- Department of Pathology, Duke University Medical Center, Durham, NC
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10
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Kim YH, Yie GT, Kim NR, Jeon IS, Cho HY, Seok JY, Kim EY, Lee KC. Pediatric intracerebral histiocytic sarcoma with rhabdoid features: Case report and literature review. Neuropathology 2017; 37:560-568. [PMID: 28748542 DOI: 10.1111/neup.12396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/09/2017] [Accepted: 06/09/2017] [Indexed: 12/30/2022]
Abstract
A 16-year-old boy presented with marked weight loss, weakness of the left extremities and dizziness of 2 months duration and vomiting for 2 days. Brain MRI showed an approximately 6.5 × 5.3 cm-sized huge heterogeneous enhancing mass located in the corpus callosum, extending into the lateral ventricle. Open biopsy showed that the lesion consisted of lymphoplasmacytes and plump histiocytes with rhabdoid morphology, which were stained with S-100 protein, CD68 (KP1) and negative for CD1a. Histiocytic tumor was initially diagnosed. Chemotherapy using methotrexate, 6-mercaptopurine, vinblastine, interferon-alpha and dexamethasone was performed. After 5 months, partial removal was done. Microscopically, plump and bizarre tumor cells as well as rhabdoid features were found. Occasional spindle cells and necrosis were also found. These cells were positive for CD163, CD68, lysozyme, CD4, INI-1 and BRG1. BRAF V600E mutation was detected. The lesion was finally diagnosed as histiocytic sarcoma. Radiotherapy (6000 cGy in 30 fractions) was done. Both cerebral and extracerebral histiocytic sarcomas have long been diagnosed by unclarified criteria; its rarity as well as previously unclarified criteria can easily lead to a misinterpretation. Histiocytic sarcoma of the CNS is exceptionally rare in children, associated with an exceptionally poor prognosis. To date, only seven cases of pediatric cerebral histiocytic sarcomas have been reported. The present case is the first pediatric case showing BRAF V600E-mutated intracerebral histiocytic sarcoma.
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Affiliation(s)
- Young Hye Kim
- Department of Pathology, Gachon University Gil Hospital, Incheon, South Korea
| | - Gie-Taek Yie
- Department of Neurosurgery, Gachon University Gil Hospital, Incheon, South Korea
| | - Na Rae Kim
- Department of Pathology, Gachon University Gil Hospital, Incheon, South Korea
| | - In-Sang Jeon
- Department of Pediatrics, Gachon University Gil Hospital, Incheon, South Korea
| | - Hyun Yee Cho
- Department of Pathology, Gachon University Gil Hospital, Incheon, South Korea
| | - Jae Yeon Seok
- Department of Pathology, Gachon University Gil Hospital, Incheon, South Korea
| | - Eung Yeop Kim
- Department of Radiology, Gachon University Gil Hospital, Incheon, South Korea
| | - Kyu Chan Lee
- Department of Radiation Oncology, Gachon University Gil Hospital, Incheon, South Korea
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Zanelli M, Ragazzi M, Marchetti G, Bisagni A, Principi M, Fanni D, Froio E, Serra S, Zanetti E, De Marco L, Giangaspero F, Ascani S. Primary histiocytic sarcoma presenting as diffuse leptomeningeal disease: Case description and review of the literature. Neuropathology 2017; 37:517-525. [PMID: 28548244 DOI: 10.1111/neup.12390] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 04/07/2017] [Accepted: 04/08/2017] [Indexed: 01/24/2023]
Abstract
Histiocytic sarcoma is a rare malignant neoplasm arising most commonly in lymph nodes, intestinal tract, skin and soft tissue. The incidence of primary CNS histiocytic sarcoma is even rarer with a total of just 27 cases reported in the literature so far. Herein we describe the first autopsy case of histiocytic sarcoma presenting as a diffuse leptomeningeal disease in absence of a CNS tumor-forming parenchymal lesion. The clinical, pathological and immunophenotypic features are described and an updated literature review on primary CNS histiocytic sarcoma is included.
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Affiliation(s)
- Magda Zanelli
- Pathology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Moira Ragazzi
- Pathology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | | | - Alessandra Bisagni
- Pathology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Massimo Principi
- Radiology Department, Ospedale di Terni, University of Perugia, Italy
| | - Daniela Fanni
- Pathology Unit, Ospedale S. Giovanni di Dio, University of Cagliari, Italy
| | - Elisabetta Froio
- Pathology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Silvia Serra
- Pathology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Eleonora Zanetti
- Pathology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Loredana De Marco
- Pathology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Felice Giangaspero
- Department of Radiological, Oncological and Anatomo-pathological Sciences University Sapienza of Rome, Rome, Italy.,IRCC Neuromed, Porzilli, Italy
| | - Stefano Ascani
- Institute of Pathology, Ospedale di Terni, University of Perugia, Italy
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12
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Abstract
Follicular dendritic cell sarcoma is a rare tumor that typically arises within lymph nodes but can also occur extranodally. It is important to have a high index of suspicion, so follicular dendritic cell sarcoma is included in the differential diagnosis of a spindle cell neoplasm in the appropriate clinical and morphologic settings. When included in the differential diagnosis, immunohistochemistry is generally sufficient to substantiate the diagnosis of follicular dendritic cell sarcoma. In this review, we discuss the clinicopathologic features of follicular dendritic cell sarcoma, recent molecular and cytogenetic findings, prognosis, and current approaches to treatment.
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Affiliation(s)
| | - Purva Gopal
- From the University of Texas, Southwestern Medical School, Dallas (Ms Chen); and the Department of Pathology, University of Texas, Southwestern Medical Center, Dallas (Dr Gopal)
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13
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Curry RC, Faivre G, Akkari L, Joyce JA, Lin O, Rosenblum M, Diamond EL, Fisher R, Omuro A. High-dose methotrexate-based chemotherapy as treatment for histiocytic sarcoma of the central nervous system. Leuk Lymphoma 2016; 57:1961-4. [PMID: 26727454 DOI: 10.3109/10428194.2015.1120867] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Richard C Curry
- a Department of Neurology , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Geraldine Faivre
- a Department of Neurology , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Leila Akkari
- b Cancer Biology and Genetics Program, Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Johanna A Joyce
- b Cancer Biology and Genetics Program, Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Oscar Lin
- c Department of Pathology , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Marc Rosenblum
- c Department of Pathology , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Eli L Diamond
- a Department of Neurology , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Rebecca Fisher
- d Department of Neurology , Mount Sinai Hospital , New York , NY , USA
| | - Antonio Omuro
- a Department of Neurology , Memorial Sloan Kettering Cancer Center , New York , NY , USA
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14
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Brown AF, Fan H, Floyd JR, Henry JM, Higgins RA. Primary Central Nervous System Histiocytic Sarcoma Arising After Precursor B-Cell Acute Lymphoblastic Leukemia. J Neuropathol Exp Neurol 2015. [DOI: 10.1093/jnen/74.12.1120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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15
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Primary Central Nervous System Histiocytic Sarcoma Arising After Precursor B-Cell Acute Lymphoblastic Leukemia. J Neuropathol Exp Neurol 2015; 74:1120-6. [DOI: 10.1097/nen.0000000000000258] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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16
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Foster M, Kamaly-Asl I, Stivaros S, Kelsey A, Gattamenini R, Kilday JP. Primary cerebral histiocytic sarcoma in childhood: a case report of protracted survival and review of the literature. Childs Nerv Syst 2015; 31:2363-8. [PMID: 26174618 DOI: 10.1007/s00381-015-2815-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/03/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Histiocytic sarcoma (HS) of the central nervous system (CNS) is exceptionally rare in pediatric patients, historically associated with an exceptionally poor prognosis. Here, the authors present a novel case of protracted progression-free survival following surgical excision, radiotherapy and temozolomide. CASE REPORT A 15-year-old Caucasian girl presented with a two-month history of headache, diplopia, vomiting, lethargy, weight loss and neurocognitive deterioration without gross neurological deficit on physical examination. Magnetic resonance imaging (MRI) of the brain identified a 5.8 × 4.7 × 4.0 cm lesion in the right frontal lobe with associated mass effect and no dissemination. Following two surgical procedures, gross total resection was achieved. Histology and immunohistochemistry confirmed HS, with strong CD163 staining. After focal radiotherapy with concomitant temozolomide, and a further seven cycles of temozolomide, the patient made an excellent recovery and is recurrence free without neurological deficit, 23 months following presentation. CONCLUSION To the authors' knowledge, this is the first incidence of a prolonged, functionally preserved and recurrence-free outcome following a diagnosis of HS within the CNS of a pediatric patient. We suggest early diagnosis prior to dissemination and complete surgical resection as an essential treatment goal in this rare disease.
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Affiliation(s)
- Mitchell Foster
- Salford Royal Hospital, Stott Lane, M6 8HD, Salford, England, UK
| | - Ian Kamaly-Asl
- Children's Brain Tumour Research Network, Royal Manchester Children's Hospital, Oxford Road, M13 9WL, Manchester, England, UK.,The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, University of Manchester, Wilmslow Road, M20 4QL, Manchester, England, UK
| | - Stavros Stivaros
- Children's Brain Tumour Research Network, Royal Manchester Children's Hospital, Oxford Road, M13 9WL, Manchester, England, UK.,Academic Unit of Paediatric Radiology, Manchester Academic Health Science Centre, University of Manchester, M13 9WL, Manchester, England, UK
| | - Anna Kelsey
- Department of Histopathology Children's Brain Tumour Research Network, Royal Manchester Children's Hospital, Oxford Road, M13 9WL, Manchester, England, UK
| | - Rao Gattamenini
- Department of Clinical Oncology, Christie Hospital, Wilmslow Rd, Withington, England, UK
| | - John-Paul Kilday
- Children's Brain Tumour Research Network, Royal Manchester Children's Hospital, Oxford Road, M13 9WL, Manchester, England, UK. .,The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, University of Manchester, Wilmslow Road, M20 4QL, Manchester, England, UK.
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17
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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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18
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So H, Kim SA, Yoon DH, Khang SK, Hwang J, Suh CH, Suh C. Primary histiocytic sarcoma of the central nervous system. Cancer Res Treat 2015; 47:322-8. [PMID: 25345462 PMCID: PMC4398107 DOI: 10.4143/crt.2013.163] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 10/15/2013] [Indexed: 01/18/2023] Open
Abstract
Histiocytic sarcoma is a type of lymphoma that rarely involves the central nervous system (CNS). Its rarity can easily lead to a misdiagnosis. We describe a patient with primary CNS histocytic sarcoma involving the cerebral hemisphere and spinal cord, who had been initially misdiagnosed as demyelinating disease. Two biopsies were necessary before a correct diagnosis was made. A histologic examination showed bizarre shaped histiocytes with larger nuclei and nuclear atypia. The cells were positive for CD68, CD163, and S-100 protein. As a resection was not feasible due to multifocality, he was treated with highdose methotrexate, but showed no response. As a result, he was switched to high dose cytarabine; but again, showed no response. The patient died 2 months from the start of chemotherapy and 8 months from the onset of symptoms. Since few patients with this condition have been described and histopathology is difficult to diagnose, suspicion of the disease is essential.
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Affiliation(s)
- Hoonsub So
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun A Kim
- Department of Pathology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Kwang Khang
- Department of Pathology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jihye Hwang
- Departmens of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheolwon Suh
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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19
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Moulignier A, Mikol J, Heran F, Galicier L. Isolated III cranial nerve palsies may point to primary histiocytic sarcoma. BMJ Case Rep 2014; 2014:bcr-2014-204663. [PMID: 25123571 DOI: 10.1136/bcr-2014-204663] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Primary histiocytic sarcoma (HS) of the central nervous system (CNS) is a rare haematopoietic neoplasm. The inconsistent terminology and diagnostic criteria currently used for CNS HS have complicated the appreciation of the clinical aspects of the disease. The main differential diagnoses are non-Hodgkin's lymphoma, reactive histiocytic proliferation, dendritic cell neoplasm, undifferentiated carcinoma, inflammatory pseudotumour, Rosai-Dorfman disease and abscess. The true diagnosis of CNS HS requires an extensive immunophenotypic workup using specific histiocytic markers, such as CD163, with the exclusion of markers of other cell lineages. This clinicopathological case report describes an improved approach towards the differential diagnosis of CNS HS.
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Affiliation(s)
| | - Jacqueline Mikol
- Service d'anatomie et cytologie pathologiques, Hôpital Lariboisière, APHP, Paris, France
| | - Françoise Heran
- Service d'Imagerie Médicale, Fondation Adolphe de Rothschild, Paris, France
| | - Lionel Galicier
- Service d'immunologie, Hôpital Saint Louis, APHP, Paris, France
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20
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Histiocytic sarcoma of the cavernous sinus: case report and literature review. Brain Tumor Pathol 2014; 32:66-71. [DOI: 10.1007/s10014-014-0191-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 04/18/2014] [Indexed: 02/06/2023]
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21
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Almefty RO, Tyree TL, Fusco DJ, Coons SW, Nakaji P. Primary histiocytic sarcoma of the brain mimicking cerebral abscess. J Neurosurg Pediatr 2013; 12:251-7. [PMID: 23889356 DOI: 10.3171/2013.6.peds12533] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Histiocytic sarcoma is a rare malignancy with only 10 reports confirmed primarily involving the CNS. The diagnosis is dependent on the finding of malignant cells with histiocytic morphology and immunophenotype. The authors report a case of pathologically proven HS of the CNS. A 16-year-old boy presented with headaches, emesis, and altered sensorium. Noncontrast head CT scanning demonstrated a left parietal mass consistent with a tumor. Surgery was undertaken. Intraoperative findings revealed green-yellow exudates consistent with an abscess. Cultures were obtained and broad-spectrum antibiotics were started. The patient subsequently underwent multiple surgical procedures, including drainage and debulking of abscesses and hemicraniectomy. Two months after initial presentation, the patient's diagnosis of histiocytic sarcoma was confirmed. Pathological examination demonstrated necrotizing inflammation with preponderant neutrophil infiltration, variably atypical mononuclear and multinucleate histiocytes, and numerous mitoses. Additional immunohistochemistry studies confirmed immunoreactivity for CD68, CD45, CD45RO, and CD15 and were negative for CD3, CD20, melanoma cocktail, CD30, CD1a, CD34, HMB-45, and melan-A. Once the diagnosis of histiocytic sarcoma was confirmed, antibiotics were stopped and radiation therapy was undertaken. Despite treatment, the patient's neurological status continued to decline and the patient died 126 days after initial presentation. This case represents a rare confirmed example of CNS histiocytic sarcoma. A profound inflammatory infiltrate seen on pathology and green exudates seen intraoperatively make the condition difficult to distinguish from an abscess. Immunohistochemistry showing a histiocytic origin and negative for myeloid, dendritic, or other lymphoid markers is essential for the diagnosis. Further research is needed to establish consensus on treatment.
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Affiliation(s)
- Rami O Almefty
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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22
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Wu W, Tanrivermis Sayit A, Vinters HV, Pope W, Mirsadraei L, Said J. Primary central nervous system histiocytic sarcoma presenting as a postradiation sarcoma: case report and literature review. Hum Pathol 2013; 44:1177-83. [DOI: 10.1016/j.humpath.2012.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 11/01/2012] [Indexed: 11/16/2022]
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23
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Pérez-Ruiz E, Delgado M, Sanz A, Gil AMS, Domínguez AR. Primary leptomeningeal histiocytic sarcoma in a patient with a good outcome: a case report and review of the literature. J Med Case Rep 2013; 7:127. [PMID: 23668836 PMCID: PMC3663802 DOI: 10.1186/1752-1947-7-127] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 04/11/2013] [Indexed: 12/05/2022] Open
Abstract
Introduction Histiocytic sarcoma is a rare neoplasm with few cases reported in the literature of which some were diagnosed in animals. This neoplasm arises from abnormal reticuloendothelial system cell proliferation of histiocytes and has an aggressive behavior especially if located in the central nervous system. We present the first case of a patient with histiocytic sarcoma that involved the meninges and had a good course after multidisciplinary treatment. Case presentation Our patient was a 41-year-old Caucasian woman with no previous history of disease who started with systemic symptoms such as headache and chills. Magnetic resonance imaging with gadolinium contrast of the brain suggested a mass 1.5×2cm in diameter in the temporal lobe with a non-uniform vasogenic edema. This lesion was implanted in the meninges and surgery was the first treatment. The histological findings revealed a histiocytic sarcoma. The patient received concomitant chemoradiotherapy after surgery with good tolerance and currently lives without disease. Conclusion Although histiocytic sarcomas in the brain present an unusual location and have a poorer prognosis, we have identified the first primary leptomeningeal histiocytic sarcoma with a disease-free survival greater than 3 years following multidisciplinary treatment with surgery and chemotherapy and radiotherapy.
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Affiliation(s)
- Elisabeth Pérez-Ruiz
- Division of Medical Oncology, REDISSEC, Hospital Costa del Sol, Autovía A-7, Km 187, Marbella, C,P, 29603, Spain.
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24
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Chalasani S, Hennick MR, Hocking WG, Shaw GR, Lawler B. Unusual presentation of a rare cancer: histiocytic sarcoma in the brain 16 years after treatment for acute lymphoblastic leukemia. Clin Med Res 2013; 11:31-5. [PMID: 22997353 PMCID: PMC3573091 DOI: 10.3121/cmr.2012.1092] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Histiocytic sarcoma (HS) is a very rare hematopoietic neoplasm that has been reported in association with other hematological malignancies. Presentation of HS in the central nervous system is even less common. Diagnosis of HS requires the presence of histiocytic markers and the systematic exclusion of markers of other cell lineages. Primary HS central nervous system tumors are aggressive and generally have poor outcomes. There are no standard treatment guidelines due to lack of clinical trials and a limited number of case reports. Here we present a unique case with two primary histiocytic lesions in the brain, refractory to systemic and radiation therapies, that developed after being treated for T-cell acute lymphoblastic leukemia 16 years prior.
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Affiliation(s)
- Sreelatha Chalasani
- Department of Internal/Hospital Medicine, Marshfield Clinic, Marshfield, Wisconsin 54449, USA.
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25
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Laviv Y, Zagzag D, Fichman-Horn S, Michowitz S. Primary central nervous system histiocytic sarcoma. Brain Tumor Pathol 2012; 30:192-5. [PMID: 23135612 DOI: 10.1007/s10014-012-0123-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 10/21/2012] [Indexed: 11/25/2022]
Abstract
Histiocytic sarcoma is a rare, lymphohematopoietic malignant neoplasm composed of tumor cells showing morphologic and immunophenotypic features of mature tissue histiocytes. Involvement of the central nervous system (CNS) as either a part of a systemic disease or as a primary lesion has rarely been described so far. We present a case of primary CNS histiocytic sarcoma in an adult patient and review the literature on this rare entity.
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Affiliation(s)
- Yosef Laviv
- Department of Neurosurgery, Beilinson Hospital, Rabin Medical Center, 49100 Petah Tiqva, Israel.
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26
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A case of primary central nervous system histiocytic sarcoma. Clin Neurol Neurosurg 2012; 114:1074-6. [DOI: 10.1016/j.clineuro.2012.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 02/04/2012] [Accepted: 02/07/2012] [Indexed: 11/23/2022]
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27
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Gomi K, Tanaka M, Yoshida M, Ito S, Sonoda M, Iwasaki F, Niwa T, Aida N, Kigasawa H, Tanaka Y. Primary cerebellar histiocytic sarcoma in a 17-month-old girl. J Neurosurg Pediatr 2012; 10:126-9. [PMID: 22747089 DOI: 10.3171/2012.5.peds11270] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report on a case of histiocytic sarcoma (HS) in a pediatric patient presenting with a solitary tumor in the cerebellum, with the aim of providing insight into primary HS in the CNS, which is especially rare. A 17-month-old Japanese girl presented with a 2-week history of progressive gait disturbance. Brain MRI revealed a 4.7 × 4.3 × 4.3-cm well-demarcated solitary mass in the right hemisphere of the cerebellum, initially suggestive of medulloblastoma, ependymoma, or anaplastic astrocytoma. On intraoperative inspection the cerebellar tumor showed intensive dural attachment and was subtotally removed. Histological and immunohistochemical findings were consistent with HS. The patient subsequently received chemotherapy, and her preoperative neurological symptoms improved. Primary HS in the CNS usually demonstrates an aggressive clinical course and is currently considered to have a poor prognosis. The possibility of this rare tumor should be included in the differential diagnosis of localized cerebellar tumors in the pediatric age group.
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Affiliation(s)
- Kiyoshi Gomi
- Division of Pathology, Kanagawa Children's Medical Center, Yokohama, Japan.
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28
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Histiocytic sarcoma of the brain. J Clin Neurosci 2012; 19:1456-8. [PMID: 22831650 DOI: 10.1016/j.jocn.2011.10.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Revised: 10/02/2011] [Accepted: 10/09/2011] [Indexed: 11/22/2022]
Abstract
Histiocytic sarcoma is a rare malignant neoplasm of the lympho-hematopoietic system that usually occurs in the skin, lymph nodes and intestinal tract. We present a 36-year-old woman with a rare histiocytic sarcoma with isolated central nervous system (CNS) involvement of multifocal circumscribed lesions. Biopsy of the brain lesions showed diffuse proliferation of pleomorphic histiocytes that were immunopositive for CD45, CD68 and CD163. Various cytokeratins and markers of lymphoma, melanoma, germ cell tumours and primary CNS tumours were negative. Examination of bone marrow trephine and a whole-body positron emission tomography scan showed no evidence of involvement of any other organ systems, thus establishing the primary nature of the lesion. The neoplastic cells uniquely showed eosinophilic globules within the cytoplasm, which were positive for CD68. These globules were shown by electron microscopy to be collections of lysosomes. A thorough discussion of the differential diagnosis and literature review is included.
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29
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Bell SL, Hanzely Z, Alakandy LM, Jackson R, Stewart W. Primary meningeal histiocytic sarcoma: a report of two unusual cases. Neuropathol Appl Neurobiol 2012; 38:111-4. [PMID: 21711377 DOI: 10.1111/j.1365-2990.2011.01205.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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30
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Devic P, Androdias-Condemine G, Streichenberger N, Berger F, Honnorat J, Broussolle E, Thobois S. Histiocytic sarcoma of the central nervous system: a challenging diagnosis. QJM 2012; 105:77-9. [PMID: 21186180 DOI: 10.1093/qjmed/hcq244] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- P Devic
- Université Lyon I, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Neurologie C, CNRS, UMR 5229, U 401, 59 Boulevard Pinel, 69677 Bron, Lyon, France
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31
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Gergis U, Dax H, Ritchie E, Marcus R, Wissa U, Orazi A. Autologous Hematopoietic Stem-Cell Transplantation in Combination With Thalidomide As Treatment for Histiocytic Sarcoma: A Case Report and Review of the Literature. J Clin Oncol 2011; 29:e251-3. [DOI: 10.1200/jco.2010.32.6603] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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32
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Toshkezi G, Edalat F, O'Hara C, Delalle I, Chin LS. Primary intramedullary histiocytic sarcoma. World Neurosurg 2011; 74:523-7. [PMID: 21492606 DOI: 10.1016/j.wneu.2010.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Accepted: 06/30/2010] [Indexed: 10/18/2022]
Abstract
Intramedullary primary central nervous system lymphoma (PCNSL) is a rare central nervous system (CNS) malignancy affecting mostly the brain, but it may also involve the leptomeninges, eyes, and spinal cord. A 71-year-old woman presented with back pain and progressive unilateral lower extremity weakness owing to an intramedullary primary histiocytic sarcoma of the spine, a rare PCNSL subtype. To the authors' knowledge, this is the first case of an intramedullary PCNSL caused by histiocytic sarcoma.
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Affiliation(s)
- Gentian Toshkezi
- Department of Neurosurgery, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
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33
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Rubenstein J, Ferreri AJM, Pittaluga S. Primary lymphoma of the central nervous system: epidemiology, pathology and current approaches to diagnosis, prognosis and treatment. Leuk Lymphoma 2009; 49 Suppl 1:43-51. [PMID: 18821432 DOI: 10.1080/10428190802311441] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
An overview of the current approaches to the management of patients with primary central nervous system lymphoma (PCNSL) is provided. Although accumulating evidence demonstrates that PCNSL is a curable type of brain tumor, in many cases establishing the diagnosis and overcoming chemotherapeutic resistance remain significant obstacles. The issue of treatment-related neurotoxicity is also a central consideration in treatment planning. The introduction of highly active antiretroviral therapy has had a major impact on this disease in that the incidence of AIDS-related central nervous system lymphoma, once highly prevalent in the 1980s and 1990s, has now virtually disappeared. However, the problem of diagnostic delays secondary to steroid effects, radiation-induced neurotoxicity and methotrexate resistance represent unique and important problems in this disease. The use of anti-CD20 antibody in this disease represents the first application of biologically based targeted therapies for PCNSL; however, the overall impact of this modality in brain lymphoma awaits further evaluation in ongoing studies The application of proteomic as well as gene expression technologies is yielding insights into PCNSL pathogenesis, in particular specific oncogenic pathways, which may be exploited to develop new therapies.
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Zhang X, Kryston JJ, Michalak WA, Zhang K, Lin F, Schuerch C. Histiocytic sarcoma in the small intestine: A case report with flow cytometry study and review of the literature. Pathol Res Pract 2008; 204:763-70. [DOI: 10.1016/j.prp.2008.03.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2007] [Revised: 01/12/2008] [Accepted: 03/13/2008] [Indexed: 11/26/2022]
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Huang SC, Chang CL, Huang CH, Chang CCJ. Histiocytic sarcoma – A case with evenly distributed multinucleated giant cells. Pathol Res Pract 2007; 203:683-9. [PMID: 17673373 DOI: 10.1016/j.prp.2007.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Revised: 04/29/2007] [Accepted: 05/09/2007] [Indexed: 02/06/2023]
Abstract
Histiocytic sarcoma is an uncommon neoplasm of mature histiocytes with a poor clinical outcome. We report a case of a true histiocytic sarcoma with prominent and evenly distributed multinucleated giant cells that mimics a giant cell tumor of soft tissue. The tumor was located between the appendix, right ovary, and the terminal ileum with severe adhesion. The liver and spleen were not enlarged. Grossly, the tumor appeared grayish white, solid, and soft. Microscopically, polygonal mononuclear tumor cells aggregated to form somewhat epithelioid nests, which occasionally showed coagulative necrosis. Prominent and evenly scattered giant cells were present in all sections. In addition, tumor cell infiltration was noted in regional lymph nodes. The tumor cells were positive for lysozyme, CD68, CD163, and negative for T- and B-cell lineage markers, follicular dendritic cell, megakaryocytic, epithelial, muscular, and melanocytic markers, CD1a and CD30. This case posed great difficulty in clinical and pathological diagnoses. Gross pictures, microscopic findings, and extensive immunostains are important for the differential diagnosis.
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Affiliation(s)
- Shun-Chen Huang
- Department of Pathology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, 123 Ta-Pei Rd, Niao-Sung Hasiang, Kaohsiung Hsien 833, Taiwan.
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Cao M, Eshoa C, Schultz C, Black J, Zu Y, Chang CC. Primary central nervous system histiocytic sarcoma with relapse to mediastinum: a case report and review of the literature. Arch Pathol Lab Med 2007; 131:301-5. [PMID: 17284118 DOI: 10.5858/2007-131-301-pcnshs] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2006] [Indexed: 11/06/2022]
Abstract
Histiocytic sarcoma is a rare, malignant neoplasm of the lymphohematopoietic system that usually occurs in the skin, lymph node, and intestinal tract. Here we describe a unique case of primary central nervous system histiocytic sarcoma that initially showed an indolent clinical course following local resection and radiotherapy. However, relapse of disease within the mediastinum was noted 3 1/2 years later. Biopsies of the initial brain lesion and subsequent mediastinal recurrence each revealed an identical, diffuse proliferation of histiocytes with expression of CD45, CD68, and CD163 but not pan-cytokeratin, epithelial membrane antigen, CD3, CD15, CD20, CD30, CD43, CD79a, CD138, myeloperoxidase, ALK-1, PAX-5, CAM 5.2, S100, CD1a, or glial fibrillary acidic protein. In the literature, central nervous system histiocytic sarcoma portends a poor prognosis with median survival of 4.5 months. To our knowledge, this case represents the first case of "low-grade" primary central nervous system histiocytic sarcoma with relatively indolent clinical course. A thorough discussion of the differential diagnosis of histiocytic sarcoma and a review of primary central nervous system histiocytic sarcoma are also presented.
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Affiliation(s)
- Ming Cao
- Department of Pathology, The Methodist Hospital, Weill Medical College of Cornell University, Houston, TX 77030, USA
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Abstract
Primary central nervous system lymphoma (PCNSL) is a very rare brain tumor in children, and the optimal management and prognosis of such patients have yet to be defined. In this study, the incidence rate, clinical features, diagnosis, and treatment of childhood PCNSL are reviewed. Except for human immunodeficiency virus-related PCNSL, the prognosis for patients with this tumor type is significantly better in children than in adults. In the absence of prospective studies, it is very difficult to determine the true incidence and the best therapeutic strategy for this rare entity. The majority of children with PCNSL, however, can achieve long-term remissions with intensive chemotherapy alone (an estimated 70% 5-year event-free survival rate), and cranial irradiation can be reserved for relapse of the disease. Further progress in the management of childhood PCNSL will require prospective multinational studies.
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Affiliation(s)
- Oussama Abla
- Division of Hematology/Oncology, The Hospital for Sick Children and Department of Paediatrics, University of Toronto, Ontario, Canada
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Low SE, Stafford JS. Malignant histiocytosis: a case report of a rare tumour presenting with spontaneous splenic rupture. J Clin Pathol 2006; 59:770-2. [PMID: 16803951 PMCID: PMC1860417 DOI: 10.1136/jcp.2005.027870] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Malignant histiocytosis is a rare invasive proliferation of neoplastic histiocytes. Cases previously reported as malignant histiocytosis were shown to be lymphomas of T or B lineage, especially anaplastic large-cell lymphomas. A case of malignant histiocytosis is described, in which a patient presenting with symptoms suggestive of pneumonia suddenly deteriorated and died. At autopsy, a large quantity of fresh blood, originating from several ruptured nodules on the enlarged spleen, was seen in the peritoneal cavity. Extensive infiltration by pleomorphic tumour cells and erythrophagocytosis by tumour cells were seen on histological examination of the spleen. Immunohistochemical analysis and staining were carried out. This is the second reported case of malignant histiocytosis presenting with spontaneous splenic rupture.
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Affiliation(s)
- S E Low
- Department of Histopathology, Leighton Hospital, Crewe, UK.
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Alécio-Mattei T, Alécio-Mattei J, Aguiar PH, Ramina R. Primary central nervous system lymphomas in immunocompetent patients. Neurocirugia (Astur) 2006; 17:46-53. [PMID: 16565780 DOI: 10.1016/s1130-1473(06)70369-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Primary central nervous system lymphoma (PCNSL) is a rare pathology and is most often seen in immunodeficient patients. This article presents our casuistic of PCNSL in immunocompetent patients and make a literature review on this issue with focus on recent advances, investigations, and controversies in diagnosis and management of this pathology. MATERIAL AND METHODS Nine patients operated in the last years in our clinics are analysed in relation to sex, age, time of symptoms, procedures and adjuvant treatment. Posteriorly the results are compared with those in the preview literature. RESULTS The age ranged from 44-68 years (middle of 66 years); 62.5% of the patients were female. The mean time of symptoms, when the diagnostic was made, was 3.2 months (range 1-6 months). The most common symptoms were hemiparesis (present in 75% of the patients) headache (37.5%) seizures (25%) and ataxia (25%). The most common localization was the parietal, frontal and temporal lobe surface with 25% of the patients for each localization. Five patients (50%) were treated with stereotactic biopsy, three with surgery (37.5%) and one (12.5%) with both of them. Five patients (62.5%) were submitted to pos-operative radiotherapy as adjuvant treatment. In relation to the histology, the most common cell type was Diffuse B Cells. CONCLUSIONS This study demonstrated that complete surgical resection followed by radiotherapy have shown good results. In opposition to the literature, the authors regard chemotherapy as a secondary line treatment and recommend its use only in some selected cases.
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Abstract
Meningeal derived tumors of the first 2 decades of life are often diagnostically challenging due to the wide morphologic spectrum encountered and the rarity of most individual entities. The 2 most common patterns include the dural/leptomeningeal-based mass and neoplastic meningitis. Both primary and secondary meningeal presentations may occur, either early or late in the course of various meningothelial, mesenchymal, embryonal, glial, hematopoietic, histiocytic, melanocytic, and inflammatory tumors. As in other areas of pediatric pathology, there are significant differences between this patient cohort and adults, differences which will be emphasized in this review.
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Affiliation(s)
- Arie Perry
- Division of Neuropathology, Washington University School of Medicine, St. Louis, Mo 63110-1093, USA.
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Vos JA, Abbondanzo SL, Barekman CL, Andriko JW, Miettinen M, Aguilera NS. Histiocytic sarcoma: a study of five cases including the histiocyte marker CD163. Mod Pathol 2005; 18:693-704. [PMID: 15696128 DOI: 10.1038/modpathol.3800346] [Citation(s) in RCA: 156] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Histiocytic sarcoma (HS) is a rare but controversial hematopoietic neoplasm. In the past, malignancies have been misclassified as histiocytic tumors due to overlapping histologic features and inadequate phenotypic data. CD163, a recently characterized hemoglobin scavenger receptor, appears to be a 'specific' marker of histiocytic lineage and a promising diagnostic tool for evaluating histiocytic neoplasms. Five cases of HS were studied to further elucidate the clinicopathologic features of these rare tumors and to demonstrate the diagnostic utility of CD163. Criteria for diagnosis included histologic and immunohistochemical evidence of histiocytic differentiation, CD45 positivity, and exclusion of lymphoid, epithelial, melanocytic and dendritic cell phenotype. Sites of disease included the colon (two cases), palate, inguinal lymph node, and testis. The clinical course was aggressive in 4/5 patients (survival=2-15 months). One patient with localized disease of the palate, survived 17 years after diagnosis. All patients with poor survival had tumors > or =3.5 cm. Histologically, all cases showed diffuse architecture with large, discohesive polygonal cells. Spindling of cells was focally noted. Hemophagocytosis was identified in 3/5 cases. A prominent inflammatory background was present in 4/5 tumors. All cases were immunoreactive for CD45, CD163, CD68, and lysozyme. S-100 was focally positive in 4/5 cases. Antibodies for melanocytic, epithelial, lymphoid, and dendritic cell markers were negative. Molecular studies showed monoclonal IgH gene rearrangements in three cases. Our findings suggest that HS is an uncommon neoplasm frequently extranodal in presentation and aggressive in behavior, with rare exceptions. Stage of disease and possibly tumor size are significant prognostic indicators. Molecular studies remain controversial in the diagnosis. The morphologic and phenotypic features are relatively uniform; however, the diagnosis requires exclusion of more common neoplasms by extensive immunophenotypic studies. CD163 appears to be a specific histiocytic marker and is important in establishing the diagnosis of HS.
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MESH Headings
- Adult
- Aged
- Antigens, CD/analysis
- Antigens, Differentiation, Myelomonocytic/analysis
- Female
- Gene Rearrangement
- Histiocytes/chemistry
- Histiocytes/pathology
- Histiocytes/ultrastructure
- Histiocytic Disorders, Malignant/genetics
- Histiocytic Disorders, Malignant/metabolism
- Histiocytic Disorders, Malignant/pathology
- Humans
- Immunoglobulin Heavy Chains/genetics
- Immunohistochemistry
- Leukocyte Common Antigens/analysis
- Male
- Microscopy, Electron
- Middle Aged
- Receptors, Antigen, T-Cell/genetics
- Receptors, Cell Surface/analysis
- Sarcoma/genetics
- Sarcoma/metabolism
- Sarcoma/pathology
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Affiliation(s)
- Jeffrey A Vos
- Department of Hematopathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA
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Hornick JL, Jaffe ES, Fletcher CDM. Extranodal histiocytic sarcoma: clinicopathologic analysis of 14 cases of a rare epithelioid malignancy. Am J Surg Pathol 2004; 28:1133-44. [PMID: 15316312 DOI: 10.1097/01.pas.0000131541.95394.23] [Citation(s) in RCA: 202] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Histiocytic sarcoma is a rare malignant neoplasm that occurs in lymph nodes, skin, and the gastrointestinal tract. Many previously published cases were likely misdiagnosed examples of non-Hodgkin lymphoma. Only small numbers of bona fide examples exist in the world literature; cases arising primarily at extranodal sites are not well described and often seem to go unrecognized. To characterize these tumors further, 14 extranodal histiocytic sarcomas were analyzed. Hematoxylin and eosin sections were reexamined, immunohistochemistry was performed, and clinical details were obtained from referring hospitals. Eight patients were female and 6 male (median age, 55 years; range, 15-89 years). All patients presented with a solitary mass, ranging in size from 1.8 to 12 cm (median 6.8 cm). Seven tumors arose in soft tissue (6 lower limb; 1 upper limb), 5 in the gastrointestinal tract (1 involving both stomach and colon, 1 ileum, 2 rectum, 1 anus), 1 in the nasal cavity, and 1 in the lung. Three gastrointestinal tract tumors also involved regional lymph nodes, and 1 involved the liver. Most cases had infiltrative margins. The tumors were generally composed of sheets of large epithelioid cells with abundant eosinophilic cytoplasm, oval to irregular nuclei, vesicular chromatin, and large nucleoli. Binucleated cells were common, and 6 cases contained tumor giant cells. Mitoses ranged from 1 to 64 per 10 HPF (median 11 per 10 HPF). Necrosis was present in 8 cases. Nearly all tumors showed a striking inflammatory infiltrate, most often of neutrophils or lymphocytes. All cases were reactive for LCA, CD45RO, and CD68 (KP1 and PG-M1); 13 of 14 (93%) expressed CD4, 12 of 14 (86%) lysozyme, 8 of 10 (80%) CD31, 7 of 14 (50%) S-100 protein, and 5 of 14 (36%) focal CD1a. Two tumors showed weak, focal cytoplasmic positivity for CD30, and 1 for epithelial membrane antigen. The tumors were negative for ALK-1, CD21, CD35, CD3, CD20, CD34, myeloperoxidase, HMB-45, and keratins. Gastrointestinal tract cases were negative for c-kit and desmin. Six patients were treated with postoperative radiation and 7 with chemotherapy (CHOP or ProMACE-MOPP). Follow-up was available for 10 patients (median, 24 months; range, 4 months to 11 years). Two tumors recurred locally, and 5 patients developed distant spread: 3 to lymph nodes, 1 to lung, and 1 to bone. At the last follow-up, 2 patients have died of disseminated disease, 4 and 5 months following initial diagnosis. The patients who died thus far had the largest primary tumors. Histiocytic sarcoma may arise primarily in soft tissue and shows reproducible histologic features, including abundant eosinophilic cytoplasm and a prominent inflammatory infiltrate. Metastatic carcinoma, metastatic melanoma, and large cell non-Hodgkin lymphomas should be excluded by immunohistochemistry. Histiocytic sarcoma has the potential for an aggressive clinical course, most often with lymph node involvement. However, a subset of cases presenting with clinically localized disease have a favorable long-term outcome. Tumor size may be a prognostic factor.
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Affiliation(s)
- Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
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Miliauskas JR. Fine-needle aspiration cytology: True histiocytic lymphoma/histiocytic sarcoma. Diagn Cytopathol 2003; 29:233-5. [PMID: 14506679 DOI: 10.1002/dc.10362] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
True histiocytic lymphoma/histiocytic sarcoma is an extremely rare, malignant histiocytic tumor. This report is of such a case in a 52-yr-old woman. Fine-needle aspiration (FNA) smears showed large pleomorphic nuclei, prominent nucleoli, moderately dense abundant cytoplasm, and scattered cells with cytoplasmic vacuoles and some with reniform nuclei. Small numbers of background lymphocytes and benign histiocytes were present as well as many multinucleated tumor cells. The immunophenotype was CD45, Lysozyme, CD68 (PGMI), CD43, and S-100 positive. Genotypic analysis revealed a germline configuration. This type of tumor has a large cytological differential diagnosis and immunophenotyping is essential for diagnosis.
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Affiliation(s)
- John R Miliauskas
- Department of Cytopathology, Clinpath Laboratories, Adelaide, South Australia.
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Sun W, Nordberg ML, Fowler MR. Histiocytic sarcoma involving the central nervous system: clinical, immunohistochemical, and molecular genetic studies of a case with review of the literature. Am J Surg Pathol 2003; 27:258-65. [PMID: 12548175 DOI: 10.1097/00000478-200302000-00017] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Histiocytic sarcoma (HS) is a rare disease, and there has been much confusion concerning the diagnostic criteria for this entity. Since immunohistochemical and cytogenetic techniques have become more universally available, many cases initially diagnosed as histiocytic sarcoma have been reclassified as other diseases. We describe a case of HS that presented as a single mass lesion in left occipital lobe. At autopsy the tumor also involved the meninges as a thick exudate. Histologic examination showed numerous large pleomorphic malignant cells with areas of necrosis, numerous neutrophils, and phagocytosis by tumor cells. Immunohistochemically, the tumor cells stained positively with antibodies directed against most histiocytic markers and did not stain with antibodies directed against myeloid markers, dendritic markers, CD30, ALK1, or other lymphoid markers. Molecular cytogenetic analysis showed no rearrangement [i.e. t(2;5) translocation or other variant] by fluorescence in situ hybridization. The T-cell receptor-gamma chain by multiplex polymerase chain reaction showed a polyclonal pattern. No heavy or light chain gene rearrangements were found. To our knowledge, this is the first reported autopsy case of this rare entity primarily involving the brain and meninges.
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Affiliation(s)
- Wei Sun
- Department of Pathology, Louisiana State University Health Sciences Center, Shreveport 71130-3932, USA
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