Abstract
We present a 62-year-old Chinese woman with histiocytic sarcoma (HS) and diffuse large B cell lymphoma (DLBL) located in the stomach. HS showed abundant eosinophilic cytoplasm with large, pleomorphic nuclei. Tumor giant and multinucleated cells were also prominent. Hemophagocytosis was common in the neoplastic cells. These cells were positive for CD68, CD45RO, and leukocyte common antigen (LCA), partly positive for S-100 and lysozyme, and negative for CD3, CD5, CD20, Pax-5, CD79a, CD1a, CD21, CD35, CD34, myeloperoxidase, HMB45 and cytokeratin (CK). These cells invaded the submucosa, muscularis mucosa, and serosa. DLBL was located in the mucosa and engulfed the covering epithelium and gland. The nuclei of tumor cells were medium-to-large in size, being ≥twice the size of normal lymphocytes. They were diffusely positive for CD20, Pax-5, and LCA, partly positive for vimentin, CD79a, CD10, CD30, CD15, and epithelial membrane antigen, and negative for S-100, CD1a, CD21, CD5, cyclin D1, CD23, CD35, HMB45, and CD68. Both types of tumor cell were positive for Oct-2, Bcl-2, and Bcl-6. These results suggest that HS may have shared a common clonal origin with DLBL, or may have transdifferentiated from DLBL The patient refused further chemotherapy, and died 7 months after surgical resection.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Swerdlow SH, Campo E, Harris NL, et al. Histiocytic sarcoma. In: Grogan TM, Pileri SA, Chan JKC, et al., editors. WHO Classification of tumours of haematopoietic and lymphoid tissues. 4th ed. Lyon: IARC Press; 2008. p. 356–7.
Hornick JL, Jaffe ES, Fletcher CD. Extranodal histiocytic sarcoma clinicopathologic analysis of 14 cases of a rare epithelioid malignancy. Am J Surg Pathol. 2004;28:1133–44.
Copie-Bergman C, Wotherspoon AC, Norton AJ, et al. True histiocytic lymphoma: a morphologic, immunohistochemical, and molecular genetic study of 13 cases. Am J Surg Pathol. 1998;22:1386–92.
Alexiev BA, Sailey CJ, McClure SA, et al. Primary histiocytic sarcoma arising in the head and neck with predominant spindle cell component. Diagn Pathol. 2007;2:7.
Pileri1 SA, Grogan TM, Harris NL, et al. Tumours of histiocytes and accessory dendritic cells: an immunohistochemical approach to classification from the International Lymphoma Study Group based on 61 cases. Histopathology. 2002;41:1–29.
Sun W, Nordberg ML, Fowler MR. Histiocytic sarcoma involving the central nervous system: clinical, immunohistochemical, and molecular genetic studies of a case with review of the literature. Am J Surg Pathol. 2003;27:258–65.
Vos JA, Abbondanzo SL, Barekman CL, et al. Histiocytic sarcoma: a study of five cases including the histiocyte marker CD163. Modern Pathol. 2005;18:693–704.
Wotherspoon A, Chott A, Gascoyne RD, et al. Lymphoma of the stomach. In: Hamilton SR, Aartonen LA, editors. World Health Organization Classification of tumours, pathology and genetics of tumours of the digestive system. 3rd ed. Lyon: IARC Press; 2000. p. 57–61.
Zhang D, McGuirk J, Ganguly S, et al. Histiocytic/dendritic cell sarcoma arising from follicular lymphoma involving the bone: a case report and review of literature. Int J Hematol. 2009;89(4):529–32.
Bassarova A, Trøen G, Fosså A, et al. Transformation of B cell lymphoma to histiocytic sarcoma: somatic mutations of PAX-5 gene with loss of expression cannot explain transdifferentiation. J Hematop. 2009;2:135–41.
Wang E, Hutchinson CB, Huang Q, et al. Histiocytic sarcoma arising in indolent small B-cell lymphoma: report of two cases with molecular/genetic evidence suggestive of a ‘transdifferentiation’ during the clonal evolution. Leuk Lymphoma. 2010;51:802–12.
Kong YY, Kong JC, Shi DR, et al. Cutaneous Rosai-Dorfman disease: a clinical and histopathologic study of 25 cases in China. Am J Surg Pathol. 2007;31:341–50.
Maric I, Pittaluga S, Dale JK. Histologic features of sinus histiocytosis with massive lymphadenopathy in patients with autoimmune lymphoproliferative syndrome. Am J Surg Pathol. 2005;29:903–11.
Feldman AL, Arber DA, Pittaluga S, Camos M, Warnke R, Jaffe ES, et al. Clonally related follicular lymphomas and histiocytic/dendritic cell sarcomas: evidence for transdifferentiation of the follicular lymphoma clone. Blood 2008;111:5433–9.
Martin Rodilla C, Fernández Aceñero J, Peña Mayor L, et al. True histiocytic lymphoma as a second neoplasm in a follicular centroblastic-centrocytic lymphoma. Pathol Res Pract. 1997;193:319–22.
Gao LX, Liu G, Yang GZ, et al. Collision tumor of small lymphocytic lymphoma and histiocytic sarcoma: report of a case. Zhonghua Bing Li Xue Za Zhi. 2009;38:775–7.
Alvaro T, Bosch R, Salvadó MT, et al. True histiocytic lymphoma of the stomach associated with low-grade B-cell mucosa-associated lymphoid tissue (Malt)-type lymphoma. Am J Surg Pathol. 2010;34:589–94.
Xie H, Ye M, Feng R, et al. Stepwise reprogramming of B cells into macrophages. Cell. 2004;117:663–76.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Congyang, L., Xinggui, W., Hao, L. et al. Synchronous histiocytic sarcoma and diffuse large B cell lymphoma involving the stomach: a case report and review of the literature. Int J Hematol 93, 247–252 (2011). https://doi.org/10.1007/s12185-011-0773-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12185-011-0773-3