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Panigrahi C, Nayak HK, Patra S, Mitra S. Hepatic Follicular Dendritic Cell Sarcoma with Epithelioid Morphology: Histopathologist's Perspective. J Clin Exp Hepatol 2022; 12:677-685. [PMID: 35535111 PMCID: PMC9077179 DOI: 10.1016/j.jceh.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/12/2021] [Indexed: 12/12/2022] Open
Abstract
Follicular dendritic cell (FDC) sarcoma is an uncommon tumor of the liver with only 30 previous cases reported in the English literature. Histopathological examination is the gold standard for the diagnosis of FDC sarcoma although the diagnosis is often missed because of its rarity. It usually presents with spindle-cell morphology although epithelioid/biphasic morphology is also well-known. This morphological variation can also pose a diagnostic challenge. We discuss a case of unresectable hepatic FDC sarcoma in an adult male who was diagnosed in core biopsy. We highlight the relevant histomorphological differentials and diagnostic approaches to FDC sarcoma in this anecdote.
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Key Words
- AFP, alpha-fetoprotein
- CT, computed tomography
- E-GIST, epithelioid gastrointestinal stromal tumor
- E-LMS, epithelioid leiomyosarcoma
- E-MPNST, epithelioid malignant peripheral nerve sheath tumor
- EBV, Epstein–Barr virus
- EHE, epithelioid hemangioendothelioma
- FDC, follicular dendritic cell
- HAML, hepatic angiomyolipoma
- HCC, hepatocellular carcinoma
- IPT, inflammatory pseudotumor
- LMP, latent membrane protein
- USG, ultrasonography
- epithelioid
- extranodal
- follicular dendritic cell sarcoma
- histopathology
- liver
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Affiliation(s)
- Chinmayee Panigrahi
- Department of Pathology and Laboratory Medicine, AIIMS, Bhubaneswar, 751019, India
| | - Hemanta K. Nayak
- Department of Gastroenterology, AIIMS, Bhubaneswar, 751019, India
| | - Susama Patra
- Department of Pathology and Laboratory Medicine, AIIMS, Bhubaneswar, 751019, India
| | - Suvradeep Mitra
- Department of Pathology and Laboratory Medicine, AIIMS, Bhubaneswar, 751019, India
- Address for correspondence: Dr Suvradeep Mitra MD, DM (Histopathology), Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Academic Block, 2nd Floor, Bhubaneswar, 751019, India. Tel.: +91 9855663999 (mobile), Fax: +91 6742472215.
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Pflüger MJ, Maurer MM, Hillebrandt KH, Andreou A, Geisel D, Schmelzle M, Pratschke J, Eurich D. Intrahepatic De Novo Tumors in Liver Recipients are Highly Associated With Recurrent Viral Hepatitis. J Clin Exp Hepatol 2021; 11:435-442. [PMID: 34276150 PMCID: PMC8267361 DOI: 10.1016/j.jceh.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/16/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIMS Long-term survival of liver transplant recipients is endangered by tumorigenesis at different sites. Little is known about primary de novo tumors developing in the graft. METHODS We analyzed the follow-up data of 2731 liver recipients that were transplanted between 1988 and 2019 at our institution (Charité - Universitätsmedizin Berlin, Department of Surgery). All cases with new intrahepatic tumors during follow-up were identified. RESULTS A total of nine patients were diagnosed at a median of 16 years (range, 2-24 years) after surgery. Eight patients presented with hepatocellular carcinoma (HCC), and one patient presented with epithelioid hemangioendothelioma (EHE). All eight HCC patients had a recurrence of the initial disease that had caused liver failure before transplantation. This was associated with viral reinfection with either HCV or HBV in seven cases. Of the nine patients, three underwent surgical resection and only one patient was alive at data abstraction. CONCLUSION Intrahepatic de novo neoplasms in the liver graft need to be considered in the long-term follow-up of liver recipients and were strongly associated with recurrent viral hepatitis in our study. Although prognosis of this rare complication is generally poor, patients may benefit from surgical resection of localized disease.
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Key Words
- AFP, alpha-fetoprotein
- ALF, acute liver failure
- CA 19-9, carbohydrate antigen 19-9
- CCA, cholangiocarcinoma
- CEA, carcinoembryonic antigen
- DCV, daclatasvir
- EHE, epithelioid hemangioendothelioma
- ESLD, end-stage liver disease
- HBIG, hepatitis B immune globulin
- HBsAg, hepatitis B surface antigen
- HCC, hepatocellular carcinoma
- IS, immunosuppressive therapy
- LT, liver transplantation
- NUCs, nucleos(t)ide analogues
- PSC, primary sclerosing cholangitis
- PTLD, post-transplantation lymphoproliferative disorder
- PegIFN, pegylated interferon
- RBV, ribavirin
- SOF, sofosbuvir
- SVR, sustained viral response
- epithelioid hemangioendothelioma
- hepatocellular carcinoma
- liver transplant
- long-term survival
- surgical resection
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Affiliation(s)
- Michael J. Pflüger
- Department of Surgery, Campus Charité Mitte
- Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany,Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Max M. Maurer
- Department of Surgery, Campus Charité Mitte
- Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Karl H. Hillebrandt
- Department of Surgery, Campus Charité Mitte
- Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Andreas Andreou
- Department of Surgery, Campus Charité Mitte
- Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany,Liver and Kidney Transplant Center, Inselspital – Bern University Hospital, Switzerland
| | - Dominik Geisel
- Department of Radiology (including Pediatric Radiology), Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Moritz Schmelzle
- Department of Surgery, Campus Charité Mitte
- Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte
- Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Dennis Eurich
- Department of Surgery, Campus Charité Mitte
- Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany,Address for correspondence. Dr. Dennis Eurich, PD, Charité – Universitätsmedizin Berlin, Department of Surgery, Campus Virchow-Klinikum (CVK), Augustenburger Platz 1, 13353, Berlin, Germany.
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Abstract
The lymphatic vascular system has been minimally explored in the liver despite its essential functions including maintenance of tissue fluid homeostasis. The discovery of specific markers for lymphatic endothelial cells has advanced the study of lymphatics by methods including imaging, cell isolation, and transgenic animal models and has resulted in rapid progress in lymphatic vascular research during the last decade. These studies have yielded concrete evidence that lymphatic vessel dysfunction plays an important role in the pathogenesis of many diseases. This article reviews the current knowledge of the structure, function, and markers of the hepatic lymphatic vascular system as well as factors associated with hepatic lymphangiogenesis and compares liver lymphatics with those in other tissues.
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Key Words
- CCl4, carbon tetrachloride
- Cirrhosis
- EHE, epithelioid hemangioendothelioma
- HA, hyaluronan
- HBx Ag, hepatitis B x antigen
- HCC, hepatocellular carcinoma
- IFN, interferon
- IL, interleukin
- Inflammation
- LSEC, liver sinusoidal endothelial cell
- LYVE-1, lymphatic vessel endothelial hyaluronan receptor 1
- LyEC, lymphatic endothelial cell
- NO, nitric oxide
- Portal Hypertension
- Prox1, prospero homeobox protein 1
- VEGF
- VEGF, vascular endothelial growth factor
- VEGFR, vascular endothelial growth factor receptor
- mTOR, mammalian target of rapamycin
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Affiliation(s)
| | - Yasuko Iwakiri
- Reprint requests Address requests for reprints to: Yasuko Iwakiri, PhD, Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, TAC S223B, 333 Cedar Street, New Haven, Connecticut 06520. fax: (203) 785-7273.Section of Digestive DiseasesDepartment of Internal MedicineYale University School of MedicineTAC S223B, 333 Cedar StreetNew HavenConnecticut 06520
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