Role of Adjuvant Chemotherapy in Extranodal Follicular Dendritic Cell Sarcoma

Gupta, Amit; Goel, Mahesh; Sahay, Ayushi; Janjal, Sneha P.; Patkar, Shraddha

doi:10.14309/crj.0000000000000008

Cited by 6 publications

(5 citation statements)

References 18 publications

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“…FDCS mimicking ALCL morphologically is much rarer. Wu et al (2) recently reported an unusual case of FDCS in the left supraclavicular node with mixed morphologic patterns resembling desmoplastic infiltrative carcinoma, hemangiopericytoma, classical Hodgkin's lymphoma, and ALCL, along with a component of FDCS with classical morphology. Although the atypical round or polygonal large tumor cells arranged in a nested or patchy pattern closely resembling ALCL, these cells did not express CD30 but CD21, CD23, and CD35, guiding the pathologists to the diagnosis of FDCS.…”

Section: Discussionmentioning

confidence: 99%

Follicular Dendritic Cell Sarcoma With Co-Expression of CD4 and CD30 Mimics Anaplastic Large Cell Lymphoma

Liu

Xiang

et al. 2020

Front. Oncol.

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Follicular dendritic cell sarcoma (FDCS) is a low-grade malignant neoplasm that tends to be under-recognized owing to its rarity and wide pathologic spectrum. Knowledge of the atypical morphology and immunophenotype of FDCS is critical to avoid misdiagnosis. Here we presented a case of extranodal FDCS with an unusual morphology and a previously unreported immunophenotype leading to misdiagnosis. A 32-years-old man presented with a tonsilar mass that showed epithelioid cells in nested and alveolar patterns. Immunohistochemistry study revealed that the tumor cells were positive for CD4 and CD30, and were negative for cytokeratin, CD3, CD20, CD68, CD163, lysozyme, ALK, S-100, and desmin. Multiple outside expert consultations rendered a consensus diagnosis of ALK-negative anaplastic large cell lymphoma (ALCL). The patient received multiple lines of chemotherapy and radiotherapy. However, the residual tumor progressively enlarged eight months later and a more complex morphology was presented in the re-excised tumor: including spindle cells with vesicular nuclei and nuclear pseudoinclusions in fascicles or a whorled pattern, and plump ovoid cells arranged in meningioma-like whorls as well as epithelioid tumor cells similar to the initial biopsy. All these three components were positive for CD4, CD21, CD23, and CD35. The diagnosis was revised to FDCS after a positive immunostaining for CD21, CD23, and CD35 on the initial specimen was confirmed retrospectively. A literature review identified 57 cases of FDCS published from 2009 through 2019, and 13 (22.8%) of them were misdiagnosed at initial presentation. Among these misdiagnosed cases, all except one case were extranodal, and the incorrect initial diagnosis was mostly locationrelated. These cases expand the pathologic spectrum of FDCS, and further emphasize the necessity for pathologists to stay alert for this rare entity, bringing FDCS into the differentials for any spindle cell tumors, undifferentiated epithelioid cell tumors, and ALCL to avoid misdiagnosis.

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Section: Discussionmentioning

confidence: 99%

Follicular Dendritic Cell Sarcoma With Co-Expression of CD4 and CD30 Mimics Anaplastic Large Cell Lymphoma

Liu

Xiang

et al. 2020

Front. Oncol.

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“…Langerhans cells are specialized dendritic cells in mucosal sites and skin that upon activation become specialized for antigen presentation to T cells, and then migrate to the lymph node through lymphatics (14,15). In contrast to other types of myeloid-derived DCs (such as Langerhans cells, interdigitating DCs and dermal/interstitial DCs), FDCs seem to stem from bone marrow stromal cells, with myofibroblasts as a characteristic (35,42). FDCs are located in primary and secondary follicles, trapping and presenting antigens to B cells, and storing immune complexes for long periods of time on the cell surface (58,59).…”

Section: Discussionmentioning

confidence: 99%

“…These different results may be due to the limitation of the tumor sites. FDCS in the parapharyngeal space exhibited poorer outcomes, while intra-abdominal tumors are more likely to recur ( 40 , 42 ). However, in the present study, the follow-up data available for analysis were scarce, the follow-up time was short and the survival curves were founded on a small number of cases, affecting the availability and effectiveness of the present study.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological characteristics of extranodal follicular dendritic cell sarcoma: A report of two cases

2021

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Follicular dendritic cell sarcoma (FDCS) is an extremely rare tumor, which mainly originates from FDCs in the lymph nodes. Sometimes FDCS can arise from outside the lymph nodes due to the existence of acquired lymphoid tissue, which becomes the histological basis of the tumor. The diagnosis of FDCS, particularly extranodal FDCS, presents a challenge for pathologists and hematopathologists. The present study presents two cases of extranodal FDCS based on clinical features and histomorphology. Soft tissue of the chest wall was involved in case 1 and right tonsil tissue in case 2. Case 1 underwent surgery, and was in good health post-operatively. During the 5-month post-operative follow-up period, the patient was healthy in all respects. Case 2 received surgery combined with radiotherapy, and the follow-up data reported that the patient remained alive, without signs of recurrence or metastasis during the 4-month post-operative follow-up period. Additionally, a total of 102 cases of extranodal FDCS were retrieved from the literature, which were extracted and reviewed carefully. The rates of recurrence, metastasis and mortality were 14.63 (12/82), 17.07 (14/82) and 8.29% (15/82), respectively. The overall survival rates of the 102 cases, showing 2-year total survival rates, were 70%, the same with that of 5-year total survival rates. The 2-year tumor-free total survival rates were 68%, and the 5-year equivalents were 32%. Female patients had a poorer prognosis than male patients (P<0.05). Kaplan-Meier estimation presented no statistically significant differences between disease-free survival rates or overall survival rates and age, tumor size or treatment (P>0.05).

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“…These regimens have been used successfully to treat lymph node malignancies; however, due to the mesenchymal and vascular stromal nature of FDCS rather than its F I G U R E 1 Axial CT scan views showing pulmonary metastasis before(33 × 28 mm) and 6 mo after (13 × 9 mm) chemotherapy with gemcitabine + docetaxel | 475 ESMATI And KOLAHdOUZAn being hematopoietic, 11 others have used regimens most effective on soft tissue sarcomas like gemcitabine and docetaxel combination with comparable success in the management of local and metastatic FDCS. 12,13 Considering the patient's preferences regarding the higher nonhematologic toxicities of doxorubicin-containing regimens compared with gemcitabine and docetaxel combination, the latter chemotherapy regimen was prescribed for her.…”

Section: Discussionmentioning

confidence: 99%

“…Due to the rarity of FDCS, there is no common consensus on chemotherapy regimens but different regimens have been used 10 such as CHOP (cyclophosphamide, vincristine, doxorubicin, prednisolone), and ICE (ifosfamide, carboplatin, etoposide). These regimens have been used successfully to treat lymph node malignancies; however, due to the mesenchymal and vascular stromal nature of FDCS rather than its being hematopoietic, 11 others have used regimens most effective on soft tissue sarcomas like gemcitabine and docetaxel combination with comparable success in the management of local and metastatic FDCS 12,13 . Considering the patient's preferences regarding the higher nonhematologic toxicities of doxorubicin‐containing regimens compared with gemcitabine and docetaxel combination, the latter chemotherapy regimen was prescribed for her.…”

Section: Discussionmentioning

confidence: 99%

Metastatic follicular dendritic cell sarcoma treated with gemcitabine plus docetaxel with an outstanding survival: A case report and review of literature

Esmati

Kolahdouzan

2020

Clinical Case Reports

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Role of Adjuvant Chemotherapy in Extranodal Follicular Dendritic Cell Sarcoma

Cited by 6 publications

References 18 publications

Follicular Dendritic Cell Sarcoma With Co-Expression of CD4 and CD30 Mimics Anaplastic Large Cell Lymphoma

Follicular Dendritic Cell Sarcoma With Co-Expression of CD4 and CD30 Mimics Anaplastic Large Cell Lymphoma

Clinicopathological characteristics of extranodal follicular dendritic cell sarcoma: A report of two cases

Metastatic follicular dendritic cell sarcoma treated with gemcitabine plus docetaxel with an outstanding survival: A case report and review of literature

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