1
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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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2
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Menghani SV, Diaz-Hanson JP, Heimbigner A, Wakefield C, Fuchs D, Reveles CY, Spier C, Amaraneni A, Kumar A. Peripheral T-Cell Lymphoma in a Patient Previously Diagnosed With Sarcoidosis. J Hematol 2023; 12:272-276. [PMID: 38188478 PMCID: PMC10769647 DOI: 10.14740/jh1173] [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: 07/28/2023] [Accepted: 09/19/2023] [Indexed: 01/09/2024] Open
Abstract
Sarcoidosis is a multisystem disorder characterized by granulomatous inflammation on histopathological evaluation. Diagnosis of sarcoidosis requires thorough elimination of malignancy and alternative causes of noncaseating granulomatous inflammation. Sarcoidosis and several subtypes of lymphoma have similar clinical presentations and can potentially have similar histopathological findings. Patients with a histopathology-confirmed diagnosis of sarcoidosis are at higher risk of developing malignancies. In this report, we present a case of a 64-year-old male diagnosed with sarcoidosis 2 years before presenting to the emergency department with a 4-month history of generalized weakness, cough, and very high fever. After a thorough workup involving cervical lymph node biopsy and bone marrow biopsy, he was diagnosed with peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS). Due to the patient's current lymphoma diagnosis and features noted on pathology, a retrospective review of the prior biopsy specimen was performed, finding similar hematopathological features on both initial lymph node biopsy diagnosing sarcoidosis and current biopsies diagnosing lymphoma. Given these findings, our patient likely had early manifestation of PTCL misdiagnosed as sarcoidosis. In summary, lymphoma should be considered in all patients with suspected sarcoidosis, especially those who do not respond to treatment or who present with persistent hematological abnormalities.
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Affiliation(s)
- Sanjay V. Menghani
- University of Arizona College of Medicine - Tucson, Tucson, AZ, USA
- Medical Scientist Training MD-PhD Program, University of Arizona College of Medicine - Tucson, Tucson, AZ, USA
- These authors contributed equally to this work
| | - Jessica P. Diaz-Hanson
- University of Arizona College of Medicine - Tucson, Tucson, AZ, USA
- These authors contributed equally to this work
| | - Alex Heimbigner
- Department of Pathology, University of Arizona College of Medicine - Tucson, Tucson, AZ, USA
- Banner Health, Tucson, AZ, USA
| | - Chelby Wakefield
- Banner Health, Tucson, AZ, USA
- Division of Hematology and Oncology, Department of Medicine, University of Arizona College of Medicine - Tucson, Tucson, AZ, USA
| | - Deborah Fuchs
- Department of Pathology, University of Arizona College of Medicine - Tucson, Tucson, AZ, USA
- Banner Health, Tucson, AZ, USA
| | - Candace Y. Reveles
- Department of Pathology, University of Arizona College of Medicine - Tucson, Tucson, AZ, USA
- Banner Health, Tucson, AZ, USA
| | - Catherine Spier
- Department of Pathology, University of Arizona College of Medicine - Tucson, Tucson, AZ, USA
- Banner Health, Tucson, AZ, USA
| | - Akshay Amaraneni
- Banner Health, Tucson, AZ, USA
- Division of Hematology and Oncology, Department of Medicine, University of Arizona College of Medicine - Tucson, Tucson, AZ, USA
- University of Arizona Cancer Center, University of Arizona College of Medicine - Tucson, Tucson, AZ, USA
| | - Abhijeet Kumar
- Banner Health, Tucson, AZ, USA
- Division of Hematology and Oncology, Department of Medicine, University of Arizona College of Medicine - Tucson, Tucson, AZ, USA
- University of Arizona Cancer Center, University of Arizona College of Medicine - Tucson, Tucson, AZ, USA
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3
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Ji B, Khatun N, Mostafidi E, Gupta R, McFarlane SI. Sarcoidosis Versus Lymphoma: A Clinical Diagnostic Dilemma in a Patient With Extensive Lymphadenopathy. Cureus 2023; 15:e43281. [PMID: 37692669 PMCID: PMC10492610 DOI: 10.7759/cureus.43281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Sarcoidosis is a granulomatous disease involving multiple organ systems. In its classic form, sarcoidosis is associated with non-caseating granuloma. Several differential diagnostic entities exist for sarcoidosis, including tuberculosis (TB), as well as lymphomas. In this report, we present a case of sarcoidosis in a 55-year-old male with diffuse lymphadenopathy and hepatosplenic involvement, highlighting the differential diagnostic point for this disease.
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Affiliation(s)
- Beisi Ji
- Internal Medicine, Downstate-Health Sciences University of New York, Downstate Medical Center, Brooklyn, USA
| | - Nazima Khatun
- Internal Medicine, Downstate-Health Sciences University of New York, Downstate Medical Center, Brooklyn, USA
| | - Elmira Mostafidi
- Pathology, Downstate-Health Sciences University of New York, Downstate Medical Center, Brooklyn, USA
| | - Raavi Gupta
- Pathology, Downstate-Health Sciences University of New York, Downstate Medical Center, Brooklyn, USA
| | - Samy I McFarlane
- Internal Medicine, Downstate-Health Sciences University of New York, Brooklyn, USA
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4
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Yan S, Yue Z, Zhang P, Yuan L, Wang H, Yin F, Ju L, Chen L, Cai W, Ni Y, Wu J. Case report: Hepatic inflammatory pseudotumor-like follicular dendritic cell sarcoma: a rare case and review of the literature. Front Med (Lausanne) 2023; 10:1192998. [PMID: 37476617 PMCID: PMC10354642 DOI: 10.3389/fmed.2023.1192998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/06/2023] [Indexed: 07/22/2023] Open
Abstract
Inflammatory pseudotumor-like follicular dendritic cell sarcoma (IPT-like FDCS) is a rare subtype of follicular dendritic cell sarcoma (FDCS) that primarily occurs in the liver and spleen. The etiology of IPT-like FDCS is unknown, and it has nonspecific clinical manifestations, imaging performance and laboratory test results. Recently, a patient with IPT-like FDCS was admitted to our hospital because of abdominal distension and anemia. Over the past 3 years, the patient has been followed up after a liver mass was found in a physical examination. The lesion gradually enlarged and caused compression symptoms. In November 2022, a tumor with a diameter of approximately 20 cm was found in the right posterior lobe of the liver after abdominal enhanced Magnetic resonance imaging (MRI) in our hospital. Liver tumor biopsy before the operation revealed a large number of hyperplastic plasma cells and a small number of spindle cells, and the spindle cells were atypical. After a complete examination, the patient underwent liver resection. Pathology after surgery confirmed liver IPT-like FDCS.
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Affiliation(s)
- Shuai Yan
- School of Medicine, Nantong University, Nantong, Jiangsu, China
| | - Zhiqiang Yue
- School of Medicine, Nantong University, Nantong, Jiangsu, China
| | - Peng Zhang
- Institute of Liver Diseases, Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, China
| | - Liuxia Yuan
- Institute of Liver Diseases, Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, China
| | - Huixuan Wang
- Institute of Liver Diseases, Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, China
| | - Fei Yin
- Department of Nail and Breast Surgery, Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, China
| | - Linglin Ju
- Institute of Liver Diseases, Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, China
| | - Lin Chen
- Institute of Liver Diseases, Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, China
| | - Weihua Cai
- Department of Hepatobiliary Surgery, Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, China
| | - Yi Ni
- Department of Nail and Breast Surgery, Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, China
| | - Jinzhu Wu
- Department of Hepatobiliary Surgery, Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, China
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5
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Xu J, Li S, Yin CC, Patel KP, Tang G, Wang W, Miranda RN, Garces S, Tang Z, Lin P, Medeiros LJ. Classic Hodgkin lymphoma with marked granulomatous reaction: A clinicopathologic study of 20 cases. Hum Pathol 2023; 134:114-123. [PMID: 36584716 DOI: 10.1016/j.humpath.2022.12.014] [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: 09/12/2022] [Revised: 12/12/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
Granulomatous reactions can be associated with various types of lymphoma, most commonly classic Hodgkin lymphoma (CHL). In some cases, the granulomatous reaction is extensive, obscuring the presence of neoplastic cells and potentially leading to delayed diagnosis and treatment. It is unknown if this subgroup of CHL has any unique clinicopathologic features. Here, we assessed the clinical and pathological features of 20 cases of CHL with a marked granulomatous reaction, defined in this study as granulomas representing ≥50% of the total cellularity/space of the specimen. This cohort of patients showed a male predominance (M:F ratio = 1.9:1) and 75% of patients were older than 40 years. Nineteen (95%) patients presented with lymphadenopathy with the neck/supraclavicular areas being most commonly involved (11/19; 58%). Advanced stage (III-IV) disease and B symptoms were present in 69% and 64% of patients, respectively. The morphologic features of these neoplasms fit best with mixed cellularity type. The Hodgkin and Reed-Sternberg (HRS) cells were positive for CD30, PAX5 (weak), pSTAT3 (80%), CD15 (70%), PD-L1 (67%), EBV-encoded small RNA (EBER)/LMP1 (50%) and CD20 (42%), and were negative for CD3, CD5, CD45, ALK and pERK. The histiocytes of the granulomas were positive for PD-L1 (67%), pSTAT3 (50%), and were negative for pERK and cyclin D1. Next generation sequencing using a 162-gene panel was negative for mutations in 4 cases. With a median follow-up of 58.9 months (range, 3.4-199.2 months), the median overall survival was 111 months and the 5-year overall survival was 78%. In summary, patients with CHL and a marked granulomatous reaction can present a diagnostic challenge and the pathologist must be alert to the possible presence of CHL to avert potential misdiagnosis. The histiocytes in the granulomas frequently express PD-L1, likely through the activation of the JAK/STAT pathway, suggesting a potential role for PD-1 blockade therapy in these patients.
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Affiliation(s)
- Jie Xu
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Shaoying Li
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - C Cameron Yin
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Keyur P Patel
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Guilin Tang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Wei Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Sofia Garces
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Zhenya Tang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Pei Lin
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
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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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Tariq H. Classic Hodgkin lymphoma cloaked in an intense sarcoid-like reaction. Leuk Lymphoma 2022; 63:2719-2722. [DOI: 10.1080/10428194.2022.2081848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Hamza Tariq
- Northwestern University Feinberg School of Medicine, Chicago, United States
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8
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Li HN, Wang RC, Chen CH, Chen JP, Yang SF, Chen SW, Chuang SS. Distinctive patterns of marrow involvement by classic Hodgkin lymphoma are clues for diagnosis and subtyping. Virchows Arch 2022; 480:899-907. [PMID: 35122497 DOI: 10.1007/s00428-022-03273-z] [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: 09/09/2021] [Revised: 12/23/2021] [Accepted: 12/30/2021] [Indexed: 11/24/2022]
Abstract
Classic Hodgkin lymphoma (CHL) is a lymphoid neoplasm deriving from B cells in a rich inflammatory background. There are four histological subtypes with different epidemiological features. Bone marrow involvement by CHL is infrequent, and subtyping CHL from the bone marrow is not suggested as there might be discordant histopathology between the primary tumors and bone marrow specimens. In this study, we aimed to identify the histopathological features of bone marrow involved by CHL and tried to correlate these features with their subtypes. Among the 23 recruited cases, the frequencies of mixed cellularity (MC; 48%, 11/23) and nodular sclerosis (NS; 44%, 10/23) were similar. There were two patterns of marrow involvement: pattern A (fibrous), space-occupying lesions with alternating hypo- and hypercellular areas against a fibrotic background with dilated sinusoids and pattern B (histiocyte-rich), ill-defined granuloma-like lesions in which histiocytes merged with normal hematopoietic and inflammatory cells. Pattern A was more frequent in patients with CHL-NS than CHL-MC (100% vs. 18.2%; p < 0.001). Diagnostic Hodgkin cells and Reed-Sternberg (HRS) cells were identified in all cases, while HRS variant lacunar cells were occasionally discovered, particularly in the CHL-NS subtype (NS 100% vs. MC 9%; p < 0.001). The frequency of EBV association was higher in MC (64%) than that in NS (36%) subtype, but not statistically significant. Of the two patterns of marrow involvement, pattern A was more commonly associated with the NS subtype and less frequently associated with EBV. Recognizing the patterns of marrow involvement is important for diagnosis and may contribute to the subtyping of CHL.
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Affiliation(s)
- Hsin-Ni Li
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Nursing, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Ren Ching Wang
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Nursing, Hung Kuang University, Taichung, Taiwan
| | - Chuan-Han Chen
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jun-Peng Chen
- Biostatistics Task Force, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Sheau-Fang Yang
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Pathology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shang-Wen Chen
- Division of Hemato-Oncology, Department of Internal Medicine, Lioying Chi-Mei Hospital, Tainan, Taiwan
| | - Shih-Sung Chuang
- Department of Pathology, Chi-Mei Medical Center, 901 Chung-Hwa Road, Yong-Kang District, Tainan, 71004, Taiwan.
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9
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Lal JM, Rashid A. Lymphoma with tuberculous granulomas. Clin Case Rep 2022; 10:e05431. [PMID: 35154734 PMCID: PMC8826124 DOI: 10.1002/ccr3.5431] [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: 09/29/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 11/17/2022] Open
Abstract
Chronic granulomatous inflammation is a common finding in lymphoproliferative disorders (LPDs), but it is important to exclude coexisting mycobacterium tuberculosis (MTB) especially in patients from areas of high endemicity. This case emphasizes the relevance of performing MTB culture on bone marrow exhibiting LPD and concomitant granulomas.
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Affiliation(s)
- Jyoti Mohan Lal
- Section of Hematology & Transfusion Medicine Department of Pathology and Laboratory Medicine Aga Khan University Hospital Karachi Pakistan
| | - Anila Rashid
- Section of Hematology & Transfusion Medicine Department of Pathology and Laboratory Medicine/Oncology Aga Khan University Hospital Karachi Pakistan
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10
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Chiang I, Wang RC, Lai YC, Chang CC, Chen CH, Hsu CY, Chen CH. Clinicopathologic Features of Lymphoproliferative Neoplasms Involving the Liver. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58010072. [PMID: 35056380 PMCID: PMC8780190 DOI: 10.3390/medicina58010072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/25/2021] [Accepted: 12/29/2021] [Indexed: 11/30/2022]
Abstract
Background and Objectives: Primary hepatic lymphoproliferative neoplasms (PHL) are uncommon. This retrospective study is aimed to present the clinicopathological characteristics of PHL and compare to secondary hepatic lymphoproliferative neoplasms (SHL). Materials and Methods: Patients who were diagnosed with lymphoproliferative neoplasms involving the liver between January 2004 and December 2018 at a tertiary medical center in central Taiwan were included. The demographic and clinical data, radiological results and histopathological findings were reviewed and summarized. Results: We analyzed 36 patients comprising 6 PHL patients and 30 SHL patients. The median age at diagnosis tended to be younger in PHL than in SHL (59 vs. 63 years old, p = 0.349). Both entities had a small male predominance. The PHL patients tended to have higher levels of aspartate aminotransferase, alanine transaminase and serum albumin and lower levels of alkaline phosphatase, total bilirubin, γ-glutamyl transferase and lactate dehydrogenase compared with SHL, but there was no significant difference. Multiple mass lesions were the most common radiological finding in both groups. Diffuse large B-cell lymphoma was the predominant subtype in both groups (67% in PHL and 40% in SHL). The PHL patients had a longer median survival than the SHL patients (not reached vs. 3 months, p = 0.003). Conclusions: Although there was no significant difference between PHL and SHL in clinical, laboratory and radiological features, the SHL patients had very poor outcomes with a median survival time of 3 months. Effective therapies are urgently required for these patients.
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Affiliation(s)
- I Chiang
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (I.C.); (R.-C.W.); (Y.-C.L.)
| | - Ren-Ching Wang
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (I.C.); (R.-C.W.); (Y.-C.L.)
- Department of Nursing, College of Nursing, Hungkuang University, Taichung 40705, Taiwan
| | - Ying-Ching Lai
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (I.C.); (R.-C.W.); (Y.-C.L.)
| | - Chung-Che Chang
- Department of Pathology and Laboratory Medicine, Florida Hospital, Orlando, FL 32803, USA;
| | - Chuan-Han Chen
- Department of Radiology, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
| | - Chiann-Yi Hsu
- Biostatistics Task Force, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
| | - Chi-Hung Chen
- Division of Gastroenterology, Department of Internal Medicine, Cheng Ching General Hospital, Taichung 40705, Taiwan
- Correspondence: ; Tel.: +886-4-24632000
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11
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Kandemir Alibakan Ö, Keskin G, Yılmaz U, Arman Y, Doğan EE, Apaydın Arıkan E. Granulomatous Inflammation in a Patient With Alk-Negative Anaplastic Large Cell Lymphoma. Turk J Haematol 2021; 39:82-83. [PMID: 34753277 PMCID: PMC8886270 DOI: 10.4274/tjh.galenos.2021.2021.0367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Özlem Kandemir Alibakan
- University of Health Sciences Turkey Prof. Dr. Cemil Taşçıoğlu City Hospital, Clinic of Internal Medicine, İstanbul,Turkey
| | - Gülşah Keskin
- University of Health Sciences Turkey Prof. Dr. Cemil Taşçıoğlu City Hospital, Clinic of Internal Medicine, İstanbul,Turkey
| | - Uğur Yılmaz
- University of Health Sciences Turkey Prof. Dr. Cemil Taşçıoğlu City Hospital, Clinic of Internal Medicine, İstanbul,Turkey
| | - Yücel Arman
- University of Health Sciences Turkey Prof. Dr. Cemil Taşçıoğlu City Hospital, Clinic of Internal Medicine, İstanbul,Turkey
| | - Esma Evrim Doğan
- University of Health Sciences Turkey Prof. Dr. Cemil Taşçıoğlu City Hospital, Clinic of Hematology, İstanbul,Turkey
| | - Evşen Apaydın Arıkan
- İstanbul University İstanbul Faculty of Medicine, Department of Pathology, İstanbul, Turkey
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12
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Aróstegui Aguilar J, Diago A, Carrillo Gijón R, Fernández Figueras M, Fraga J, García Herrera A, Garrido M, Idoate Gastearena M, Christian Laga A, Llamas-Velasco M, Martínez Campayo N, Monteagudo C, Onrubia J, Pérez Muñoz N, Ríos-Martín J, Ríos-Viñuela E, Rodríguez Peralto J, Rozas Muñoz E, Sanmartín O, Santonja C, Santos-Briz A, Saus C, Suárez Peñaranda J, Velasco Benito V, Beato Merino M, Fernandez-Flores A. Granulomas in Dermatopathology: Principal Diagnoses - Part 1. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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13
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Judson MA. Granulomatous Sarcoidosis Mimics. Front Med (Lausanne) 2021; 8:680989. [PMID: 34307411 PMCID: PMC8295651 DOI: 10.3389/fmed.2021.680989] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/10/2021] [Indexed: 12/19/2022] Open
Abstract
Many granulomatous diseases can mimic sarcoidosis histologically and in terms of their clinical features. These mimics include infectious granulomatous diseases, granulomatous reactions to occupational and environmental exposures, granulomatous drug reactions, vasculitides and idiopathic granulomatous conditions. It is important to distinguish sarcoidosis from these mimics, as a misdiagnosis of these diseases may have serious consequences. This manuscript reviews numerous sarcoidosis mimics and describes features of these diseases that may allow them to be differentiated from sarcoidosis. Distinguishing features between sarcoidosis and its mimics requires a careful review of the medical history, symptoms, demographics, radiographic findings, histologic features, and additional laboratory data. Understanding the clinical characteristics of sarcoidosis and its mimics should lead to more accurate diagnoses and treatment of granulomatous disorders that should improve the care of these patients. As the diagnostic criteria of sarcoidosis are not standardized, it is possible that some of these sarcoidosis mimics may represent varied clinical presentations of sarcoidosis itself.
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Affiliation(s)
- Marc A Judson
- Division of Pulmonary and Critical Care Medicine MC-91, Department of Medicine, Albany, NY, United States
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14
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Julien LA, Michel RP. Imprint cytology: Invaluable technique to evaluate fresh specimens received in the pathology department for Lymphoma workup. Cancer Cytopathol 2021; 129:759-771. [PMID: 34015191 DOI: 10.1002/cncy.22442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/02/2021] [Accepted: 03/08/2021] [Indexed: 11/10/2022]
Abstract
At the time of intraoperative consultation, cytologic preparations including smears and imprints can be used in combination with frozen sections to increase diagnostic yield; however, these simple and rapid techniques are not adopted by all pathologists and their use varies considerably between institutions. In patients under investigation for suspected lymphoma, optimal triaging of tissue received fresh in pathology for lymphoma workup is paramount to maximize the odds of obtaining an accurate and clinically meaningful diagnosis and to avoid the need for additional procedures and delays in management, particularly in the current context in which core biopsies have become common practice as a first attempt to attain this goal. Imprint cytology is invaluable in this regard, also as these patients may not have a lymphoma but rather one of its clinical mimics. Herein, imprint cytology is used to approach fresh specimens received intraoperatively for lymphoma workup. More specifically, how these specimens are triaged for ancillary studies, such as flow cytometry, florescence in situ hybridization, or molecular analyses based on an interpretation of the touch imprints, is described. Detailed imprint cytological findings of typical benign and malignant lymphoid and nonlymphoid lesions are discussed and illustrated.
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Affiliation(s)
- Louis-André Julien
- Department of Pathology, Charles-Le Moyne Hospital, CISSS Montérégie-Centre, University of Sherbrooke, Longueuil, Canada.,Department of Pathology, McGill University, Montreal, Canada
| | - René P Michel
- Department of Pathology, McGill University, Montreal, Canada
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15
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Aróstegui Aguilar J, Diago A, Carrillo Gijón R, Fernández Figueras M, Fraga J, García Herrera A, Garrido M, Idoate Gastearena MÁ, Christian Laga Á, Llamas-Velasco M, Martínez Campayo N, Monteagudo C, Onrubia J, Pérez Muñoz N, Ríos-Martín JJ, Ríos-Viñuela E, Rodríguez Peralto JL, Rozas Muñoz E, Sanmartín O, Santonja C, Santos-Briz Á, Saus C, Suárez Peñaranda JM, Velasco Benito V, Beato Merino MJ, Fernandez-Flores A. Granulomas in Dermatopathology: Principal Diagnoses - Part 1. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:S0001-7310(21)00139-3. [PMID: 33887235 DOI: 10.1016/j.ad.2021.04.002] [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: 03/20/2021] [Accepted: 04/05/2021] [Indexed: 11/23/2022] Open
Abstract
This series of 2 articles on dermatopathologic diagnoses reviews conditions in which granulomas form. Part 1 clarifies concepts, discusses the presentation of different types of granulomas and giant cells, and considers a large variety of noninfectious diseases. Some granulomatous diseases have a metabolic origin, as in necrobiosis lipoidica. Others, such as granulomatous mycosis fungoides, are related to lymphomas. Still others, such as rosacea, are so common that dermatologists see them nearly daily in clinical practice.
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Affiliation(s)
- J Aróstegui Aguilar
- Servicio de Dermatología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - A Diago
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - R Carrillo Gijón
- Servicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - M Fernández Figueras
- Servicio de Anatomía Patológica, Hospital Universitari General de Catalunya, Barcelona, España
| | - J Fraga
- Servicio de Anatomía Patológica, Hospital Universitario de La Princesa, Madrid, España
| | - A García Herrera
- Servicio de Anatomía Patológica, Hospital Clinic, Barcelona, España
| | - M Garrido
- Departamento de Anatomía Patológica, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación I+12, Madrid, España
| | - M Á Idoate Gastearena
- Servicio de Anatomía Patológica, Hospital Universitario Virgen Macarena, Departamento de Citología, Histología y Anatomía Patológica, Facultad de Medicina, Universidad de Sevilla, Sevilla, España
| | - Á Christian Laga
- Departamento de Patología, Brigham and Women's Hospital, Boston, EE. UU
| | - M Llamas-Velasco
- Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, España
| | - N Martínez Campayo
- Servicio de Dermatología, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - C Monteagudo
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Valencia, Facultad de Medicina, Universidad de Valencia, Valencia, España
| | - J Onrubia
- Servicio de Anatomía Patológica, Hospital Universitario San Juan de Alicante, Alicante, España
| | - N Pérez Muñoz
- Servicio de Anatomía Patológica, Hospital Universitari General de Catalunya, Quirón salud, Barcelona, España
| | - J J Ríos-Martín
- Servicio de Anatomía Patológica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - E Ríos-Viñuela
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - J L Rodríguez Peralto
- Departamento de Anatomía Patológica, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación I+12, Madrid, España
| | - E Rozas Muñoz
- Departamento de Dermatología, Hospital de San Pablo, Coquimbo, Chile
| | - O Sanmartín
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - C Santonja
- Servicio de Anatomía Patológica, Fundación Jiménez Díaz, Madrid, España
| | - Á Santos-Briz
- Servicio de Anatomía Patológica, Hospital Universitario de Salamanca, Salamanca, España
| | - C Saus
- Servicio de Anatomía Patológica, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España
| | - J M Suárez Peñaranda
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, España
| | - V Velasco Benito
- Servicio de Anatomía Patológica, Hospital Universitario de Cruces, Barakaldo, Vizcaya, España
| | - M J Beato Merino
- Servicio de Anatomía Patológica, Hospital Universitario La Paz, Madrid, España
| | - A Fernandez-Flores
- Servicio de Anatomía Patológica, Hospital Universitario El Bierzo, Ponferrada, León, España; Servicio de Anatomía Patológica, Hospital de La Reina, Ponferrada, León, España; Unidad de Investigación, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidad de A Coruña, A Coruña, España.
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16
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Kobata K, Kimura S, Mihashi Y, Iwasaki H, Nonaka S, Matsumoto S, Takamatsu Y, Choi I, Kawauchi S, Ishitsuka K, Takeshita M. Clinical and cytopathological characteristics of HTLV-1 + hodgkin lymphoma. Cancer Med 2020; 9:5788-5797. [PMID: 32597011 PMCID: PMC7433818 DOI: 10.1002/cam4.3139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/23/2020] [Accepted: 04/23/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Human T-lymphotropic virus-1 (HTLV-1)+ Hodgkin lymphoma (HL) is difficult to differentiate from adult T-cell leukemia/lymphoma (ATLL) with HL-like histology (HL-like ATLL). METHODS Cytological and immunohistological features, HTLV-1 proviral DNA integration, and rearrangements of the T-cell receptor (TCR) Cβ1 gene were examined in 11 HTLV-1+ patients with HL-like disease. RESULTS Six patients were classified as HTLV-1+ HL and five as HL-like ATLL in accordance with genetic findings of HTLV-1 proviral DNA integration and rearrangements of the TCR Cβ1 gene. Small ordinary looking lymphocytes with round nuclei were detected in the background of six patients with HTLV-1+ HL, which were immunohistochemically negative for CD25 and CC chemokine receptor (CCR)4 and had a low MIB1 labeling index (mean: 28.3%). In the HL-like ATLL specimens, small- and medium-sized atypical lymphocytes with indented and irregular-shaped nuclei were found, and were diffusely positive for CD25 and CCR4, with high MIB1 labeling (mean: 76%). Both groups had scattered CD30+ and CD15+ Hodgkin and Reed Sternberg (RS) giant cells, with or without CD20 expression and Epstein-Barr virus infection. The 50% overall survival period was significantly longer for the HTLV-1+ HL group (180 months) than for the HL-like ATLL group (7.8 months; P = .004). CONCLUSIONS HTLV-1+ HL showed typical small lymphoid cells with a low MIB1 labeling index in a background of Hodgkin and RS cells, with some scattered CD25+ and CCR4+ lymphocytes. In HTLV-1 endemic areas, distinguishing HTLV-1+ HL from HL-like ATLL is important because of their differing treatment strategies and prognoses.
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Affiliation(s)
- Katsumi Kobata
- Division of Diagnostic Pathology, Faculty of Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Shoichi Kimura
- Departments of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yasuhito Mihashi
- Departments of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.,Departments of Otolaryngology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hiromi Iwasaki
- Departments of Hematology, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Shuichi Nonaka
- Departments of Pathology, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Shinji Matsumoto
- Division of Diagnostic Pathology, Faculty of Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Yasushi Takamatsu
- Division of Medical Oncology, Hematology and Infectious Diseases, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Ilseung Choi
- Department of Hematology, National Hospital Organization, Kyushu Cancer Center, Fukuoka, Japan
| | - Shigeto Kawauchi
- Departments of Pathology, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Kenji Ishitsuka
- Department of Internal Medicine, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Morishige Takeshita
- Division of Diagnostic Pathology, Faculty of Medicine, Fukuoka University Hospital, Fukuoka, Japan.,Departments of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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17
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El Jammal T, Jamilloux Y, Gerfaud-Valentin M, Valeyre D, Sève P. Refractory Sarcoidosis: A Review. Ther Clin Risk Manag 2020; 16:323-345. [PMID: 32368072 PMCID: PMC7173950 DOI: 10.2147/tcrm.s192922] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/22/2020] [Indexed: 12/18/2022] Open
Abstract
Sarcoidosis is a multi-system disease of unknown etiology characterized by granuloma formation in various organs (especially lung and mediastinohilar lymph nodes). In more than half of patients, the disease resolves spontaneously. When indicated, it usually responds to corticosteroids, the first-line treatment, but some patients may not respond or tolerate them. An absence of treatment response is rare and urges for verifying the absence of a diagnosis error, the good adherence of the treatment, the presence of active lesions susceptible to respond since fibrotic lesions are irreversible. That is when second-line treatments, immunosuppressants (methotrexate, leflunomide, azathioprine, mycophenolate mofetil, hydroxychloroquine), should be considered. Methotrexate is the only first-line immunosuppressant validated by a randomized controlled trial. Refractory sarcoidosis is not yet a well-defined condition, but it remains a real challenge for the physicians. Herein, we considered refractory sarcoidosis as a disease in which second-line treatments are not sufficient to achieve satisfying disease control or satisfying corticosteroids tapering. Tumor necrosis alpha inhibitors, third-line treatments, have been validated through randomized controlled trials. There are currently no guidelines or recommendations regarding refractory sarcoidosis. Moreover, criteria defining non-response to treatment need to be clearly specified. The delay to achieve response to organ involvement and drugs also should be defined. In the past ten years, the efficacy of several immunosuppressants beforehand used in other autoimmune or inflammatory diseases was reported in refractory cases series. Among them, anti-CD20 antibodies (rituximab), repository corticotrophin injection, and anti-JAK therapy anti-interleukin-6 receptor monoclonal antibody (tocilizumab) were the main reported. Unfortunately, no clinical trial is available to validate their use in the case of sarcoidosis. Currently, other immunosuppressants such as JAK inhibitors are on trial to assess their efficacy in sarcoidosis. In this review, we propose to summarize the state of the art regarding the use of immunosuppressants and their management in the case of refractory or multidrug-resistant sarcoidosis.
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Affiliation(s)
- Thomas El Jammal
- Department of Internal Medicine, Lyon University Hospital, Lyon, France
| | - Yvan Jamilloux
- Department of Internal Medicine, Lyon University Hospital, Lyon, France
| | | | - Dominique Valeyre
- Department of Pneumology, Assistance Publique - Hôpitaux de Paris, Hôpital Avicenne et Université Paris 13, Sorbonne Paris Cité, Bobigny, France
| | - Pascal Sève
- Department of Internal Medicine, Lyon University Hospital, Lyon, France
- Hospices Civils de Lyon, Pôle IMER, Lyon, F-69003, France, University Claude Bernard Lyon 1, HESPER EA 7425, LyonF-69008, France
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