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Jin J, Zhu X, Wan Y, Shi Y. Epstein-barr virus (EBV)-positive inflammatory pseudotumor-like follicular dendritic cell sarcoma (IPT-like FDCS) presenting as thrombocytopenia: A case report and literature review. Heliyon 2024; 10:e32997. [PMID: 38994118 PMCID: PMC11238001 DOI: 10.1016/j.heliyon.2024.e32997] [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: 02/02/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 07/13/2024] Open
Abstract
Background Follicular dendritic cell sarcoma (FDCS) represents an exceedingly rare malignant neoplasm. Inflammatory pseudotumor-like follicular dendritic cell sarcoma (IPT-like FDCS) is recognized as a variant manifestation of FDCS. The clinical incidence of this particular disease is remarkably low, resulting in the absence of established standardized clinical protocols for its management and treatment. Methods Presented here is a case of primary Epstein-Barr virus (EBV)-positive splenic IPT-like FDCS, noteworthy for manifesting thrombocytopenia as its initial symptom. Our study analyzed the clinicopathologic characteristics of this case and 29 previously reported cases identified in the literature. Also, we conducted a comprehensive review of pertinent literature. Results We administered splenectomy to this patient and verified the diagnosis of EBV-positive IPT-like FDCS through immunohistochemical examination. Postoperatively, the patient underwent a one-year follow-up period, demonstrating no signs of recurrence. Analyzing a total of 30 cases revealed that this disease is more prevalent in female patients (F:M = 1.14:1), with a median age of 62 years. Fifteen patients were asymptomatic, and nine patients presented with abdominal discomfort or pain. All patients underwent surgical treatment. Among the cases, histopathological and immunohistochemical information was unavailable for five; however, in the remaining 25 cases, histopathology revealed a distinct inflammatory cell infiltration and spindle tumor cells arranged in sheets or fascicles. These tumor cells had vesicular chromatin and distinct nucleoli and they expressed conventional FDC markers. In situ hybridization analysis of Epstein-Barr virus-encoded small RNA (EBER) showed that all 30 cases were EBV-positive. Follow-up information showed that no patients relapsed and one (3.8 %) patient died. Conclusion The clinical diagnosis of EBV-positive IPT-like FDCS poses considerable challenges, necessitating a conclusive diagnosis through pathological immunohistochemical examination. EBER in situ hybridization holds significance for the definitive diagnosis of the disease. We advocate for splenectomy as the treatment of choice for limited splenic IPT-like FDCS.
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Affiliation(s)
| | | | - Yi Wan
- Hospital of Soochow University, China
| | - Yang Shi
- Hospital of Soochow University, China
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2
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Zhang Q, Gao J. EBER-negative inflammatory pseudotumor-like follicular dendritic cell sarcoma of liver: A case report. Medicine (Baltimore) 2024; 103:e37651. [PMID: 38579046 PMCID: PMC10994431 DOI: 10.1097/md.0000000000037651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/28/2024] [Indexed: 04/07/2024] Open
Abstract
RATIONALE Inflammatory pseudotumor-like follicular dendritic cell sarcoma (IPT-like FDCS) of the liver is rare. It was previously believed that Epstein-Barr virus (EBV) positivity was a necessary criterion for pathological diagnosis. However, we found that there were also cases of EBV negativity. Therefore, clinicians and pathologists are reminded that EBV positivity is not a necessary condition for diagnosis. PATIENT CONCERNS A 70-year-old female underwent computed tomography (CT) examination for upper abdominal discomfort, which revealed the presence of a liver tumor. Follow-up revealed that the tumor had progressively increased in size. DIAGNOSIS The final diagnosis was an IPT-like follicular cell sarcoma, based on CT, MRI, HE staining, and immunohistochemical staining. INTERVENTIONS The patient underwent a laparoscopic left hemihepatectomy. OUTCOMES The patient has not undergone any special treatment, such as radiotherapy and chemotherapy, and has been followed up for over 3 years without experiencing any recurrence. LESSONS IPT-like FDCS is a rare tumor that lacks definitive criteria, and its diagnosis mainly relies on pathological findings. Previously, it was believed that being EBV-positive was an important condition for diagnosis. Primary IPT-like FDCS in the liver is even rarer, and the patient in this case tested negative for EBV. It may be necessary for pathologists to consider the role of EBV in the diagnosis of IPT-like FDCS.
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Affiliation(s)
- Qiang Zhang
- Department of Hepatobiliary Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Jialin Gao
- Department of Pathology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
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3
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Nie C, Xie X, Li H, Li Y, Chen Z, Li Y, Li Z. Epstein-Barr virus-positive inflammatory follicular dendritic cell sarcoma with significant granuloma: case report and literature review. Diagn Pathol 2024; 19:34. [PMID: 38365739 PMCID: PMC10870656 DOI: 10.1186/s13000-024-01457-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/31/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Epstein-Barr virus-positive inflammatory follicular dendritic cell sarcoma (EBV+IFDCS) is a rare disease characterized by mild clinical symptoms and non-specific imaging findings. The diagnosis of the disease depends on pathological diagnosis. However, EBV+IFDCS has a very broad spectrum of histological morphology and immune phenotypes, and its histopathological features have not been fully described by pathologists. CASE PRESENTATION A 59-year-old female, with no significant discomfort, was found to have a splenic mass during a routine physical examination. Microscopic examination at low magnification revealed numerous epithelioid granulomas, amidst which a substantial inflammatory response was observed. Interspersed among the dense inflammatory cells were spindle or oval-shaped cells, distributed sporadically with indistinct boundaries. Under high magnification, these spindle cells had subtle features: smooth and clear nuclear membranes, inconspicuous small nucleoli, and infrequent mitotic figures. Immunophenotypically, the spindle cells expressed CD21 and CD23, and Epstein-Barr encoding region (EBER) in situ hybridization yielded positive results. The inflammatory milieu predominantly consisted of T cells, with a minority of plasma cells expressing IgG4. The confluence of morphological and immunohistochemical findings led to the final pathological diagnosis of EBV+IFDCS in this case. CONCLUSIONS The presentation of EBV+IFDCS with pronounced granulomatous changes is rare. This morphological variant poses a high risk of misdiagnosis, frequently leading to confusion with other granulomatous diseases. Accurate diagnosis necessitates a comprehensive analysis, integrating immunohistochemistry and in situ hybridization. The case presented here is instrumental in raising awareness and understanding of EBV+IFDCS, with the goal of reducing misdiagnoses and unrecognized cases.
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Affiliation(s)
- Chenchen Nie
- Department of pathology, the First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Jiefang West Road, Changsha, 410000, Hunan Province, China
| | - Xun Xie
- Department of pathology, the First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Jiefang West Road, Changsha, 410000, Hunan Province, China
| | - Hangyan Li
- Department of pathology, the First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Jiefang West Road, Changsha, 410000, Hunan Province, China
| | - Yangcan Li
- Department of pathology, the First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Jiefang West Road, Changsha, 410000, Hunan Province, China
| | - Zhihong Chen
- Department of pathology, the First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Jiefang West Road, Changsha, 410000, Hunan Province, China.
| | - Yanchun Li
- Department of pathology, the First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Jiefang West Road, Changsha, 410000, Hunan Province, China
| | - Zhenfeng Li
- Department of pathology, the First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Jiefang West Road, Changsha, 410000, Hunan Province, China
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4
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Hu J, Huang D, Xu C, Chen Y, Ma H, Shen Z. Epstein-Barr Virus-Positive Inflammatory Follicular Dendritic Cell Sarcoma Presenting as a Colonic Polyp: Report of a Case with a Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1341. [PMID: 37512154 PMCID: PMC10385426 DOI: 10.3390/medicina59071341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/09/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
Background: Follicular dendritic cell (FDC) sarcoma is an uncommon mesenchymal origin neoplasm derived from the abnormal proliferation and differentiation of FDCs. Epstein‒Barr virus-positive inflammatory follicular dendritic cell sarcoma (EBV+ iFDCS), which used to be known as the inflammatory pseudotumour (IPT)-like variant, occurs exclusively in the liver and spleen and has rarely been reported in the gastrointestinal tract. Case study: Here, we report a case of a 52-year-old woman with a special family history undergoing a routine physical examination. The colonoscope revealed an approximately 18 mm transverse colonic polyp, and the endoscopic polypectomy was performed. Microscopically, the excised polypoid mass was composed predominantly of inflammatory cells scattered with atypical ovoid to spindle tumor cells. Interestingly, there was a remarkable infiltration of IgG4+ cells. Immunohistochemistry showed that the tumor cells were positive for CD21, CD23 and CD35. EBV-encoded mRNA (EBER) in situ hybridization also gave positive signals. These histopathology features supported the diagnosis of EBV+ iFDCS. The patient was free of disease over 1-year follow-up. Conclusion: Identification of the potential pathogenesis sites of EBV+ iFDCS in extra-hepatosplenic regions is necessary for correct and timely diagnosis, and we consider it very meaningful to share our experience of diagnosing this tumor type. Furthermore, we summarize the clinicopathological features of EBV+ iFDCS presenting as a colon polyp after a thorough review of the literature.
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Affiliation(s)
- Jiahui Hu
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Dongdong Huang
- Department of Pathology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Chengfu Xu
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Yi Chen
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Han Ma
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Zhe Shen
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
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Fu LY, Jiang JL, Liu M, Li JJ, Liu KP, Zhu HT. Surgical treatment of liver inflammatory pseudotumor-like follicular dendritic cell sarcoma: A case report. World J Gastrointest Oncol 2022; 14:2288-2294. [PMID: 36438696 PMCID: PMC9694274 DOI: 10.4251/wjgo.v14.i11.2288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/28/2022] [Accepted: 10/18/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Inflammatory pseudotumor-like follicular dendritic cell sarcoma (IPT-like FDCS) is rare with a low malignant potential. Hepatic IPT-like FDCS has similar clinical features to hepatocellular carcinoma (HCC), making it extremely difficult to distinguish between them in clinical practice. We describe the case of a young female patient diagnosed with HCC before surgery, which was pathologically diagnosed as IPT-like FDCS after the left half of the liver was resected. During 6 mo of follow-up, the patient recovered well with no signs of recurrence or metastasis.
CASE SUMMARY A 23-year-old female patient with a 2-year history of hepatitis B presented to the Affiliated Hospital of Guizhou Medical University. She was asymptomatic at presentation, and the findings from routine laboratory examinations were normal except for slightly elevated alpha-fetoprotein levels. However, ultrasonography revealed a 3-cm diameter mass in the left hepatic lobe, and abdominal contrast-enhanced computed tomography revealed that the tumor had asymmetrical enhancement during the arterial phase, which declined during the portal venous phase, and had a pseudo-capsule appearance. Based on the findings from clinical assessments and imaging, the patient was diagnosed with HCC, for which she was hospitalized and had undergone laparoscopic left hepatectomy. However, the tumor specimens submitted for pathological analyses revealed IPT-like FDCS. After surgical removal of the tumor, the patient recovered. In addition, the patient continued to recover well during 6 mo of follow-up.
CONCLUSION Hepatic IPT-like FDCS is difficult to distinguish from HCC. Hepatectomy may provide beneficial outcomes in non-metastatic hepatic IPT-like FDCS.
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Affiliation(s)
- Li-Yue Fu
- Clinical School, Guizhou Medical University, Guiyang 550001, Guizhou Province, China
| | - Jiu-Liang Jiang
- Clinical School, Guizhou Medical University, Guiyang 550001, Guizhou Province, China
| | - Meng Liu
- Clinical School, Guizhou Medical University, Guiyang 550001, Guizhou Province, China
| | - Jun-Jun Li
- Department of Hepatobiliary Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang 550001, Guizhou Province, China
| | - Kai-Ping Liu
- Clinical School, Guizhou Medical University, Guiyang 550001, Guizhou Province, China
| | - Hai-Tao Zhu
- Department of Hepatobiliary Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang 550001, Guizhou Province, China
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6
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Ding F, Wang C, Xu C, Tang H. Case report: Hepatic inflammatory pseudotumor-like follicular dendritic cell sarcoma: A rare case and minireview of the literature. Front Med (Lausanne) 2022; 9:1002324. [PMID: 36425103 PMCID: PMC9679012 DOI: 10.3389/fmed.2022.1002324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022] Open
Abstract
Inflammatory pseudotumor (IPT)-like follicular dendritic cell sarcoma (FDCS) is a rare neoplasm referred to as the FDCS variant. Here we report a 66-year-old female patient suffering from hepatic IPT-like FDCS and summarize IPT-like FDCS reported in the literature. The patient presented with obvious abdominal pain without significant laboratory abnormalities and subsequently underwent surgical resection of a hepatic lesion. Postoperative pathological results demonstrated a vascular tissue-rich neoplasm (7.0-cm maximum diameter). The tumor cells expressed CD21 and CD35, and in situ hybridization detected Epstein–Barr virus-encoded RNA (EBER). Metastasis or recurrence was not detected during the 7-year follow-up.
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Affiliation(s)
- Fan Ding
- Center of Gallbladder Disease, East Hospital of Tongji University, Shanghai, China
- Institute of Gallstone Disease, Tongji University School of Medicine, Shanghai, China
| | - Chao Wang
- Department of Radiology, Nanxiang Hospital of Jiading District, Shanghai, China
| | - Chi Xu
- Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Organ Transplantation Institute, Sun Yat-sen University, Guangzhou, China
- Chi Xu,
| | - Hui Tang
- Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Organ Transplantation Institute, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Hui Tang,
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7
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Gui H, Chaudhari J, Mannan R. Follicular dendritic cell sarcoma of gastrointestinal tract with two emerging distinct subtypes: a case report and systemic review. Diagn Pathol 2022; 17:64. [PMID: 35941667 PMCID: PMC9358870 DOI: 10.1186/s13000-022-01246-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 07/22/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Follicular dendritic cell sarcoma (FDCS) is a rare neoplasm of mesenchymal origin. FDCS of gastrointestinal tract (GI) are exceedingly uncommon. CASE PRESENTATION We report the first case of classic type FDCS in a 34-year-old male with Birt-Hogg-Dubé syndrome, which presented as a mass at the ileo-cecal junction. He received no further treatment after resection and remained disease free for 3.5 years. We further analyze and review the clinical and pathologic findings of 33 cases of GI tract FDCS reported in the literature. CONCLUSIONS There are two distinct subtypes of FDCS in the GI tract: the classic type occurs in relatively younger patients (mean = 45.3 years) without Epstein-Barr virus (EBV) association, and behaves more aggressively; the inflammatory subtype presents as colonic polypoid tumor in older patients (mean = 60.7 years) and is EBV positive. The clinical outcome in the latter group appears favorable although mortality rate is not necessarily low.
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Affiliation(s)
- Hongxing Gui
- Department of Pathology and Laboratory Medicine, Pennsylvania Hospital of the University of Pennsylvania Health System, 801 Spruce Street, 10th Floor Spruce building, Philadelphia, PA, 19107, USA.
| | - Jigisha Chaudhari
- Department of Pathology and Laboratory Medicine, Pennsylvania Hospital of the University of Pennsylvania Health System, 801 Spruce Street, 10th Floor Spruce building, Philadelphia, PA, 19107, USA
| | - Rifat Mannan
- Department of Pathology and Laboratory Medicine, Pennsylvania Hospital of the University of Pennsylvania Health System, 801 Spruce Street, 10th Floor Spruce building, Philadelphia, PA, 19107, USA
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8
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New Clinicopathologic Scenarios of EBV+ Inflammatory Follicular Dendritic Cell Sarcoma: Report of 9 Extrahepatosplenic Cases. Am J Surg Pathol 2021; 45:765-772. [PMID: 33264138 DOI: 10.1097/pas.0000000000001632] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
EBV+ inflammatory follicular dendritic cell (FDC) sarcoma is an indolent malignant neoplasm of spindled FDCs with a rich lymphoplasmacytic infiltrate and a consistent association with Epstein-Barr virus (EBV). It occurs exclusively in the liver and spleen, with the exception of a few colonic examples. In this study, we report 9 extrahepatosplenic cases, including 4 occurring in previously undescribed sites, but all apparently anatomically related to the aerodigestive tract. The cases included 5 gastrointestinal tumors all presenting as colonic pedunculated polyps, 2 presenting as mesocolon mass, and 2 involving the palatine or nasopharyngeal tonsils. One patient with a colonic tumor was complicated by paraneoplastic pemphigus. The patients had a median age of 58 years, with female predominance (female:male=7:2). A favorable outcome was observed in 7 patients. Histologically, EBV+ inflammatory FDC sarcomas arising from these anatomic sites were similar to their hepatosplenic counterparts. Spindled to oval neoplastic cells with ill-defined cell borders were dispersed or formed loose whorled fascicles in a dense lymphoplasmacytic background. They had vesicular nuclei with distinct nucleoli and typically exhibited a range of nuclear atypia in the same case. The neoplastic cells showed variable expression of FDC markers and were labeled for Epstein-Barr virus-encoded RNA on in situ hybridization. These 9 cases thus broaden the clinicopathologic scenarios of EBV+ inflammatory FDC sarcoma. Recognition of the potential existence of this tumor type in extrahepatosplenic sites permits a correct diagnosis to be made.
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Gonzalez RS, Raza A, Propst R, Adeyi O, Bateman J, Sopha SC, Shaw J, Auerbach A. Recent Advances in Digestive Tract Tumors: Updates From the 5th Edition of the World Health Organization "Blue Book". Arch Pathol Lab Med 2021; 145:607-626. [PMID: 32886739 DOI: 10.5858/arpa.2020-0047-ra] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The World Health Organization Classification of Tumours: Digestive System Tumors, 5th edition, was published in 2019 and shows several impactful changes as compared with the 4th edition published in 2010. Changes include a revised nomenclature of serrated lesions and revamping the classification of neuroendocrine neoplasms. Appendiceal goblet cell adenocarcinoma is heavily revised, and intrahepatic cholangiocarcinoma is split into 2 subtypes. New subtypes of colorectal carcinoma and hepatocellular carcinoma are described. Precursor lesions are emphasized with their own entries, and both dysplastic and invasive lesions are generally recommended to be graded using a 2-tier system. Hematolymphoid tumors, mesenchymal tumors, and genetic tumor syndromes each have their own sections in the 5th edition. New hematolymphoid lesions include monomorphic epitheliotropic intestinal T-cell lymphoma; duodenal-type follicular lymphoma; intestinal T-cell lymphoma, not otherwise specified; and indolent T-cell lymphoproliferative disorder of the gastrointestinal tract. This paper will provide an in-depth look at the changes in the 5th edition as compared with the 4th edition. OBJECTIVE.— To provide a comprehensive, in-depth update on the World Health Organization classification of digestive tumors, including changes to nomenclature, updated diagnostic criteria, and newly described entities. DATA SOURCES.— The 5th edition of the World Health Organization Classification of Tumours: Digestive System Tumours, as well as the 4th edition. CONCLUSIONS.— The World Health Organization has made many key changes in its newest update on tumors of the digestive system. Pathologists should be aware of these changes and incorporate them into their practice as able or necessary.
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Affiliation(s)
- Raul S Gonzalez
- The Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Gonzalez)
| | - Anwar Raza
- The Department of Pathology and Human Anatomy, Loma Linda University, Loma Linda, California (Raza, Propst)
| | - Robert Propst
- The Department of Pathology and Human Anatomy, Loma Linda University, Loma Linda, California (Raza, Propst)
| | - Oyedele Adeyi
- The Department of Pathology, University of Minnesota, Minneapolis (Adeyi, Bateman)
| | - Justin Bateman
- The Department of Pathology, University of Minnesota, Minneapolis (Adeyi, Bateman)
| | - Sabrina C Sopha
- The Department of Pathology, University of Maryland Baltimore Washington Medical Center, Glen Burnie (Sopha)
| | - Janet Shaw
- The Joint Pathology Center, Silver Spring, Maryland (Shaw, Auerbach)
| | - Aaron Auerbach
- The Joint Pathology Center, Silver Spring, Maryland (Shaw, Auerbach)
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Auerbach A, Aguilera NS. Overview of Gastrointestinal Lymphoproliferative disorders ✰. Semin Diagn Pathol 2021; 38:1-5. [PMID: 33714627 DOI: 10.1053/j.semdp.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/21/2021] [Accepted: 02/25/2021] [Indexed: 11/11/2022]
Abstract
Lymphoproliferative processes which occur in the gastrointestinal tract range from benign reactive processes such as follicular hyperplasia (rectal tonsil) to high grade malignant lymphomas and histiocytic sarcoma. The WHO Classification of Tumors: Digestive System Tumors, 5th Edition was published in 2019 and shows several impactful changes as compared to the 4th Edition published in 2010. WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues 2017 also included detailed changes in hematopoietic neoplasms within the gastrointestinal tract. New entities or renamed hematolymphoid lesions include monomorphic epitheliotropic intestinal T-cell lymphoma, duodenal-type follicular lymphoma, intestinal T-cell lymphoma, NOS and indolent T-cell lymphoproliferative disorder of the gastrointestinal tract. A brief overview of WHO classification of digestive tumors and WHO classification of tumors of hematopoietic and lymphoid tissue is discussed focusing on the changes in the most recent WHO texts. In depth discussions will be presented in other papers in this series.
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Affiliation(s)
- Aaron Auerbach
- Joint Pathology Center, Silver Spring, MD, United States.
| | - Nadine S Aguilera
- University of Virginia Health System, Charlottesville, VA, United States
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Follicular Dendritic Cell Sarcomas: CT and MRI Findings in 20 Patients. AJR Am J Roentgenol 2021; 216:835-843. [PMID: 33405946 DOI: 10.2214/ajr.19.22759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The objective of this study was to assess the imaging features of follicular dendritic cell sarcoma (FDCS) on CT and MRI. MATERIALS AND METHODS. The clinical data and pretreatment findings of 20 patients with pathologically proven FDCS on CT (n = 15), MRI (n = 7), or both (n = 2) were analyzed retrospectively. Tumor location, number, size, morphology, attenuation or signal intensity, margin, presence of metastases, and contrast enhancement were evaluated. RESULTS. FDCS originated from lymph nodes (n = 6) or a variety of extranodal sites (n = 14). The tumors were typically solitary and well-circumscribed. Extranodal lesions (mostly in the abdomen or mediastinum with mean diameter, 11.8 cm) were larger than nodal lesions (mean diameter, 6.5 cm). Nodal-type cases presented with homogeneous masses on CT and MRI. However, on CT, all extranodal tumors (n = 12) showed heterogeneous attenuation, of which 91.7% (11/12) contained areas of lower attenuation because of internal necrosis and 50.0% (6/12) showed calcifications. On MRI, primary hepatic or splenic tumors (n = 3) also appeared as large heterogeneous masses. Seven patients (35.0%) had advanced-stage disease, and intraabdominal extranodal cases were more likely to have regional lymphadenopathy (n = 4) and distant metastases (n = 5). Hypervascularity was seen in 90.0% (18/20) of patients and progressive enhancement was seen in 11 (78.6%) of 14 tumors with multiphase imaging. CONCLUSION. FDCS is a rare, mostly solitary, well-delineated malignancy. A nodal-type FDCS typically presents as a small homogeneous mass, whereas an extranodal FDCS in the mediastinum or abdomen manifests as a large heterogeneous mass with internal necrosis and calcifications accompanied by regional lymphadenopathy. Hypervascularity and progressive enhancement can be seen in the majority of tumors.
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12
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Liu X, Cao L, Chin W, Yu J, Liu Y, Zheng S. Epstein-Barr virus-negative inflammatory pseudotumor-like variant of follicular dendritic cell sarcoma of the liver: A case report and literature review. Clin Res Hepatol Gastroenterol 2021; 45:101457. [PMID: 32540141 DOI: 10.1016/j.clinre.2020.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/10/2020] [Accepted: 05/04/2020] [Indexed: 02/07/2023]
Abstract
Follicular dendritic cell sarcoma (FDCS) can be divided into the conventional type, and the inflammatory pseudotumor (IPT)-like variant type. Epstein-Barr virus (EBV) infection is considered to be closely associated with the pathogenesis of IPT-like variant of FDCS. Hepatic FDCS has an exceedingly low incidence of only 29 cases reported, with most of these tumors being classified as the IPT-like type. We report a case of an IPT-like variant of FDCS of the liver in a 61-year old man who presented with no marked symptoms. The patient underwent laparoscopic surgery for the mass and was well during a 13-month follow-up periods. The postoperative pathological examination found a proliferation of spindle cells and a diffuse infiltration of inflammatory cells within the tumor. Immunohistochemistry revealed that neoplastic cells were positive for CD23, clusterin, fascin, and PD-L1, and weakly positive for CD35, SMA, and D2-40. The infiltrating lymphocytes were strongly positive for PD1, and IgG4-positive plasma cells were less than 10 cells/high-power field. In situ hybridization for Epstein-Barr virus encoded RNA (EBER) was negative. To our knowledge, the present case is the second case of hepatic IPT-like variant of FDCS without EBV involvement, indicating that EBV infection is not an absolute prerequisite for a diagnosis of the IPT-like variant of FDCS.
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Affiliation(s)
- Xi Liu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, 310003 Hangzhou, China
| | - Linping Cao
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, 310003 Hangzhou, China
| | - Wenjie Chin
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, 310003 Hangzhou, China
| | - Jun Yu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, 310003 Hangzhou, China
| | - Yuanxing Liu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, 310003 Hangzhou, China.
| | - Shusen Zheng
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, 310003 Hangzhou, China; Key Laboratory of Combined Multi-organ Transplantation, 310003 Hangzhou, China.
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Ke X, He H, Zhang Q, Yuan J, Ao Q. Epstein-Barr virus-positive inflammatory follicular dendritic cell sarcoma presenting as a solitary colonic mass: two rare cases and a literature review. Histopathology 2020; 77:832-840. [PMID: 32506505 DOI: 10.1111/his.14169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/02/2020] [Indexed: 11/29/2022]
Abstract
AIMS Follicular dendritic cell (FDC) sarcoma is a rare neoplasm originating from follicular dendritic cells in germinal centres. It is classified as conventional and Epstein-Barr virus (EBV)-positive inflammatory FDC sarcoma according to the 2019 World Health Organization classification of digestive system tumours; the latter is rarer. So in view of the rarity and difficulty in diagnosis, the aim of the manuscript is to share our experience of diagnosing EBV-positive inflammatory FDC sarcoma. METHODS AND RESULTS Here, we describe the clinicopathological features, gross description, histomorphology, immunophenotype, EBV-encoded mRNA (EBER) in-situ hybridisation, gene rearrangement and clinical follow-up of two patients with EBV-positive inflammatory FDC sarcoma in the colon, and review the relevant literature. The tumours were found in two males, aged 53 and 48 years, respectively, with a tumour diameter between 10 and 45 mm. Both cases occurred in the colon and presented as pedunculated colonic masses. Microscopically, scanty atypical ovoid to spindle neoplastic cells were mixed in a background of florid lymphoplasmacytic infiltration. The nuclei of these atypical cells showed vesicular chromatin and small, distinct nucleoli. Immunohistochemistry demonstrated that the atypical stromal cells were positive for CD21, CD23, CD35, and D2-40. EBER in-situ hybridisation also gave positive results in two cases. There was a mean follow-up of 9 months (range, 7-11 months). CONCLUSION EBV-positive inflammatory FDC sarcoma is an extremely rare tumour with a distinct morphology and phenotype. Therefore, it is very important to recognise it particularly for correct diagnosis and prevention of misdiagnosis and mistreatment.
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Affiliation(s)
- Xiaokang Ke
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Huihua He
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qingping Zhang
- Department of Pathophysiology, School of Basic Medicine, Huazhong University of Science and Technology, Wuhan, China
| | - Jingping Yuan
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qilin Ao
- Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Chen YR, Lee CL, Lee YC, Chang KC. Inflammatory pseudotumour-like follicular dendritic cell tumour of the colon with plasmacytosis mimicking EBV-positive lymphoproliferative disorder. Pathology 2020; 52:484-488. [PMID: 32327214 DOI: 10.1016/j.pathol.2020.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 02/17/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Ying-Ren Chen
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Lin Lee
- Department of Pathology, Taichung Tzu-Chi Hospital, Taichung, Taiwan
| | - Yen-Chien Lee
- Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kung-Chao Chang
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Bedri S, Sultan AA, Alkhalaf M, Al Moustafa AE, Vranic S. Epstein-Barr virus (EBV) status in colorectal cancer: a mini review. Hum Vaccin Immunother 2018; 15:603-610. [PMID: 30380978 DOI: 10.1080/21645515.2018.1543525] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Epstein-Barr virus (EBV) is a well-characterized oncovirus, associated with several malignancies. The complex and heterogeneous nature of colorectal cancer (CRC) has led to many epidemiological causal associations with CRC. However, a direct causal link between microbial infections and CRC has not been established yet. Our review indicates that the current evidence for the presence and role in EBV in CRC is insufficient and contradictory. The design of the analyzed studies, sample size as well as methodology used for EBV detection varied markedly and consequently may not lead to meaningful conclusions. The presence of EBV in other colorectal tumors (lymphomas, smooth muscle tumors) is in line with their status at other anatomic locations and may have therapeutic implications with EBV-specific vaccines. On the other hand, studies exploring EBV in colorectal adenoma-carcinoma sequence and its molecular genetic characteristics are largely missing and may significantly contribute to a better understanding of the role of EBV in CRC.
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Affiliation(s)
| | - Ali A Sultan
- b Weill Cornell Medicine - Qatar , Cornell University, Qatar Foundation - Education City , Doha , Qatar
| | | | - Ala-Eddin Al Moustafa
- d College of Medicine , Qatar University , Doha , Qatar.,e Syrian Research Cancer Centre of the Syrian Society against Cancer , Aleppo , Syria.,f Oncology Department , McGill University , Quebec , Montreal , Canada
| | - Semir Vranic
- d College of Medicine , Qatar University , Doha , Qatar
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