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Yamada T, Ishido K, Kimura N, Wakiya T, Nagase H, Goto S, Yoshizawa T, Kijima H, Kato S, Hakamada K. Follicular dendritic cell sarcoma arising from the lymph node of the pancreatic head: a case report with literature review. Clin J Gastroenterol 2024; 17:788-794. [PMID: 38532076 DOI: 10.1007/s12328-024-01956-5] [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: 07/26/2023] [Accepted: 03/13/2024] [Indexed: 03/28/2024]
Abstract
A 72-year-old man was referred to our hospital for the examination of a pancreatic head mass. Abdominal computed tomography revealed a contrasted 8-cm-diameter tumor extending from the dorsal pancreatic head to the porta hepatis. The preoperative diagnosis was challenging due to the absence of specific imaging findings and the inability to perform a biopsy. Positron emission tomography/computed tomography and diffusion-weighted imaging suggested a malignant tumor originating from the organs surrounding the pancreatic head. Subtotal stomach-preserving pancreaticoduodenectomy with regional lymph node dissection was performed, as dissection from the pancreatic head proved unfeasible. Pathological examination identified the tumor as an enlarged lymph node consisting of pleomorphic large cells forming clusters, positive for follicular dendritic cell markers cluster of differentiation (CD) 21 and CD23. No evidence of tumor capsule infiltration, other organ infiltration, or metastasis to other lymph nodes was observed. The final diagnosis was nodal follicular dendritic cell sarcoma (FDCS) originating from the pancreatic head lymph nodes. No recurrence occurred at 3 years postoperatively with no postoperative treatment. Intraperitoneal nodal FDCS is extremely rare, and occasionally, it can lead to postoperative recurrence and progression. It is crucial to differentiate neoplastic lymph node enlargement around the pancreatic head from nodal FDCS.
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Affiliation(s)
- Takahiro Yamada
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8563, Japan.
| | - Keinosuke Ishido
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8563, Japan
| | - Norihisa Kimura
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8563, Japan
| | - Taiichi Wakiya
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8563, Japan
| | - Hayato Nagase
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8563, Japan
| | - Shintaro Goto
- Department of Pathology and Bioscience, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8563, Japan
| | - Tadashi Yoshizawa
- Department of Pathology and Bioscience, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8563, Japan
| | - Hiroshi Kijima
- Department of Pathology and Bioscience, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8563, Japan
| | - Seiichi Kato
- Center for Clinical Pathology, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan
| | - Kenichi Hakamada
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8563, Japan
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Feng Z, Du Z, Liang Y, Zhou J. Apatinib manifests an unexpectedly favorable outcome in the management of axillary lymph node follicular dendritic cell sarcoma: a case report. Front Oncol 2024; 14:1388982. [PMID: 38962273 PMCID: PMC11219944 DOI: 10.3389/fonc.2024.1388982] [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] [Received: 02/21/2024] [Accepted: 06/05/2024] [Indexed: 07/05/2024] Open
Abstract
We present a case of follicular dendritic cell sarcoma in the axillary lymph node, which unexpectedly showed favorable outcomes after the application of apatinib. Follicular Dendritic Cell Sarcoma (FDCS) exhibits a rare incidence and an unclear pathogenic mechanism, contributing to the limited breakthroughs in its treatment to date within the medical field. The current mainstream therapeutic approaches include surgery, CHOP(cyclophosphamide, doxorubicin, vincristine, prednisone), ICE(ifosfamide, carboplatin, etoposide), ABVD(doxorubicin, bleomycin, vinblastine, dacarbazine), and immune checkpoint inhibitors. A 38-year-old male patient was admitted to the hospital due to a lump in the right axilla and underwent surgical treatment. Postoperative pathology confirmed the diagnosis of follicular dendritic cell sarcoma. Two months post-surgery, he faced a recurrence, prompting a subsequent surgical intervention complemented by tumor radiofrequency ablation. Despite these interventions, the treatment response was suboptimal. Subsequently, the patient was treated with the CHOP regimen, but after two cycles, he developed bone metastasis. Due to the patient's limited financial resources and refusal of immunotherapy, we switched to a regimen of gemcitabine and docetaxel, but the disease progressed again after two cycles. A one-cycle trial of albumin-bound paclitaxel yielded unsatisfactory results. Ultimately, the patient was treated with Apatinib, achieving a 10-month progression-free survival. Due to the patient's limited financial circumstances, we, in the absence of guideline recommendations and evidence from evidence-based medicine, achieved a 10-month progression-free survival (PFS) solely based on experiential use of the anti-angiogenic drug, Apatinib. The purpose of this case report is to provide additional therapeutic options for FDCS treatment and to pave the way for exploring the mechanism of action of Apatinib in FDCS.
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Affiliation(s)
- Zhiying Feng
- Graduate Institute, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Department of Oncology, Weifang Hospital of Traditional Chinese Medicine, Weifang, Shandong, China
| | - Zhonghai Du
- Department of Oncology, Weifang Hospital of Traditional Chinese Medicine, Weifang, Shandong, China
| | - Yan Liang
- Department of Oncology, Weifang Hospital of Traditional Chinese Medicine, Weifang, Shandong, China
| | - Juyue Zhou
- Graduate Institute, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Department of Oncology, Weifang Hospital of Traditional Chinese Medicine, Weifang, Shandong, China
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Assi T, Cesne AL. Immune checkpoint inhibitors in follicular dendritic cell sarcoma. Immunotherapy 2024; 16:341-344. [PMID: 38362643 DOI: 10.2217/imt-2023-0230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Affiliation(s)
- Tarek Assi
- International Department, Gustave Roussy, 114, Rue Edouard Vaillant, Villejuif, France
| | - Axel Le Cesne
- International Department, Gustave Roussy, 114, Rue Edouard Vaillant, Villejuif, France
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Zhang Y, Jin X, Lian L. Rare co-occurrence of tonsillar follicular dendritic cell sarcoma and schizophrenia: A comprehensive study. Clin Case Rep 2024; 12:e8700. [PMID: 38585586 PMCID: PMC10995268 DOI: 10.1002/ccr3.8700] [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: 12/08/2023] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 04/09/2024] Open
Abstract
This study investigated the infrequent occurrence of tonsillar follicular dendritic cell sarcoma (FDCS) co-existing with schizophrenia, presenting a comprehensive examination of clinical, pathological, and literature aspects. A systematic literature review was conducted, focusing on articles related to "schizophrenia" and "sarcoma," with in-depth analysis of included case reports. Clinical data, pathological findings, and patient follow-up information were collected and synthesized. The study detailed a rare case of FDCS in the tonsil concurrent with schizophrenia, providing insights into diagnosis, treatment, and follow-up. A literature review of combined FDCS in the tonsil and schizophrenia cases highlighted their clinical and pathological characteristics. Eight case reports encompassing 11 patients diagnosed with sarcoma and schizophrenia were included. Surgical resection was the preferred primary treatment, while chemotherapy was suggested for recurrences. Instances of co-occurring FDCS and schizophrenia were exceptionally limited, with tonsillar FDCS being particularly uncommon. The coexistence of tonsillar FDCS and schizophrenia was an exceptionally rare condition, posing diagnostic and therapeutic challenges. This study contributed valuable insights into clinical and pathological practice through a systematic review, underscoring the significance of early diagnosis and comprehensive management.
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Affiliation(s)
- Yu Zhang
- Department of Pathology, Hangzhou Hospital of Traditional Chinese MedicineZhejiang Chinese Medicine UniversityHangzhouP. R. China
| | - Xiaoxi Jin
- Department of PathologyWenzhou People's HospitalWenzhouP. R. China
| | - Liyan Lian
- Department of Pathologythe First Affiliated Hospital of Zhejiang UniversityHangzhouP. R. China
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Hu A, Chen T, Dong J. Promising clinical outcome after body gamma knife radiotherapy for mediastinal follicular dendritic cell sarcoma with thoracic spine invasion and iliac metastasis: A case report and literature review. Front Oncol 2022; 12:919644. [PMID: 36185314 PMCID: PMC9524614 DOI: 10.3389/fonc.2022.919644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/23/2022] [Indexed: 12/03/2022] Open
Abstract
Background Follicular dendritic cell sarcoma (FDCS) is a rare type of intermediate grade tumor. Mediastinal FDCS with spinal invasion has not been well described. The treatment options include surgical resection and radiation therapy. The body gamma knife is a stereotactic body radiotherapy (SBRT) technology that is widely used in China. The pathological evaluation of a bone lesion after a body gamma knife procedure has not been reported. Here, we report a case of a patient with FDCS with thoracic spine invasion and iliac metastasis treated with surgery and body gamma knife. Case summary A 36-year-old male patient was hospitalized at Zhongshan Hospital, Fudan University, due to a gradually aggravated pain on the lateral side of the left scapula for 6 months. Imaging examination showed neoplastic lesions on the left side of C7-T2 invading the vertebral body of T1, T2, and caput costae of the second rib and suspected metastasis in the left ilium. FDCS was diagnosed after performing a computed tomography (CT)-guided core needle biopsy, and the thoracic lesion was surgically resected. The body gamma knife was used as an adjuvant radiotherapy for the thoracic lesion and a primary therapy for the left ilium lesion. Iliac bone lesion resection was performed at Zhongshan Hospital, Fudan University, 10 weeks after RT. Compared with the biopsy report, the body gamma knife treatment resulted in a pathological complete response (PCR). The magnetic resonance imaging (MRI) examinations showed stable disease of the thoracic lesion after body gamma knife radiosurgery. Conclusion This case report describes the treatment of mediastinal FDCS with thoracic spinal invasion and iliac metastasis. The promising outcome suggests that separation surgery is an effective treatment option for mediastinal FDCS with spinal column invasion. It also demonstrates the application prospects of the body gamma knife treatment in malignant lesions of the axial bones.
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Affiliation(s)
- Annan Hu
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ting Chen
- Department of Radiotherapy, People’s Liberation Army of China (PLA) Naval Medical Center, Naval Medical University, Shanghai, China
- *Correspondence: Jian Dong, ; Ting Chen,
| | - Jian Dong
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Jian Dong, ; Ting Chen,
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Facchetti F, Simbeni M, Lorenzi L. Follicular dendritic cell sarcoma. Pathologica 2021; 113:316-329. [PMID: 34837090 PMCID: PMC8720404 DOI: 10.32074/1591-951x-331] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 06/21/2021] [Indexed: 12/17/2022] Open
Abstract
Follicular dendritic cells (FDC) are mesenchymal-derived dendritic cells located in B-follicles where they play a pivotal role in triggering and maintaining B-cell adaptive immune response. In 1986 Dr. Juan Rosai first reported a series of neoplasms showing features of FDC and defined it as Follicular Dendritic Cell Tumor, subsequently renamed as "sarcoma" (FDCS). In its seminal and subsequent articles Rosai and colleagues highlighted the heterogeneous microscopic appearance of FDCS and its immunohistochemical and ultrastructural features. FDCS mostly occurs in extranodal sites (79.4% of cases) and lymph nodes (15.1%); in about 7%-10% of cases it is associated with hyaline-vascular Castleman disease. Given its significant growth pattern and cytological variability, FDCS can be confused with various neoplasms and even inflammatory processes. The diagnosis requires the use of a broad spectrum of FDC markers (e.g. CD21, CD23, CD35, clusterin, CXCL13, podoplanin), particularly considering that tumor antigen-loss is frequent. The inflammatory-pseudotumor-like (IPT-like) variant of FDCS, in addition to its peculiar histopathological and clinical features, is characterized by positivity of tumor cells for Epstein-Barr virus, representing a diagnostic requisite. No distinctive genetic and molecular anomalies have been identified in FDCS. It often carries an aberrant clonal karyotype and chromosomal structural alterations, frequently involving onco-suppressor genes. Direct or next generation sequencing showed alterations on genes belonging to the NF-κB regulatory pathway and cell-cycle regulators. In contrast to hematopoietic-derived histiocytic and dendritic cells tumors, FDCS typically lacks mutations in genes related to the MAPK pathway. FDCS recurs locally in 28% and metastasizes in 27% of cases. Extent of the disease, surgical resectability and histopathological features are significantly associated with the outcome. IPT-like FDCS behaves as an indolent tumor, even if it often recurs locally over years. Complete surgical excision is the gold standard of treatment. Data on targeted therapies (e.g.: tyrosine kinase inhibitors) or immune checkpoint inhibitors are very limited and responses are variable. A better understanding of the molecular drivers of this tumor may lead to potential new therapeutic strategies.
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Affiliation(s)
- Fabio Facchetti
- Department of Molecular and Translational Medicine, Section of Pathology, University of Brescia, Spedali Civili, Brescia (Italy)
| | - Matteo Simbeni
- Department of Molecular and Translational Medicine, Section of Pathology, University of Brescia, Spedali Civili, Brescia (Italy)
| | - Luisa Lorenzi
- Department of Molecular and Translational Medicine, Section of Pathology, University of Brescia, Spedali Civili, Brescia (Italy)
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Umakanth S, Lakshminarayana B, Kudva R. Concomitant malignancies in the neck: follicular dendritic cell sarcoma; a rare tumour presenting as a right-sided neck nodal mass and papillary carcinoma thyroid. BMJ Case Rep 2021; 14:e244175. [PMID: 34789524 PMCID: PMC8601071 DOI: 10.1136/bcr-2021-244175] [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] [Accepted: 09/28/2021] [Indexed: 11/03/2022] Open
Abstract
Follicular dendritic cell sarcoma is a rare low-grade sarcoma of mesenchymal origin. It involves the lymph nodes more commonly and rarely extranodal sites. The most common lymph node is cervical and usually presents as a painless asymptomatic mass. More often, it is a misdiagnosis, and there is a delay in treatment. It is rarely associated with Castleman disease, myasthenia gravis. Diagnosis of this condition is by histopathology and immunochemistry. Surgery is the primary modality of treatment, and adjuvant therapy has been tried with no definite trials due to the rarity of the disease. Here, we report a case of concomitant follicular dendritic sarcoma of the right cervical lymph node and papillary carcinoma of the thyroid managed in our institute. There was a line of investigations approaching towards a diagnosis, and she underwent total thyroidectomy and right modified radical neck dissection.
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Affiliation(s)
- Suhas Umakanth
- General Surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Badareesh Lakshminarayana
- General Surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ranjini Kudva
- Department of Pathology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Lei Y, Zhao S, Jiang M. Unexpected Favorable Outcome to PD-1 Antibody Plus Lenvatinib in a Patient With Recurrent Intestinal Follicular Dendritic Cell Sarcoma: A Case Report and Literature Review. Front Immunol 2021; 12:653319. [PMID: 34566950 PMCID: PMC8456086 DOI: 10.3389/fimmu.2021.653319] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 08/23/2021] [Indexed: 02/05/2023] Open
Abstract
Background Follicular dendritic cell sarcoma (FDCS) is an uncommon malignant cancer, and there is no standard treatment to date. Resection followed by adjuvant chemotherapy or radiation is considered the most commonly used strategy for treatment. However, the treatment for patients who have progressed after systemic treatment is more controversial. Case summary In this case report, we describe a 57-year-old man with primary small intestine FDCS where surgery and second-line systemic chemotherapy failed. After disease progression (PD), the patient received sintilimab plus lenvatinib as third-line treatment and achieved a progression-free survival (PFS) with 7 months. Conclusion This is the first report of a FDCS patient treated with immune checkpoint inhibitors (ICIs) and antiangiogenic agents, sintilimab and lenvatinib, as third-line therapy. Our case provides a potential therapeutic option for patients with FDCS who progressed after multiline therapy.
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Affiliation(s)
- Yanna Lei
- Center of Medical Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Sha Zhao
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Jiang
- Center of Medical Oncology, West China Hospital, Sichuan University, Chengdu, China
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