Histiocytic Sarcoma Arising From a Long Bone: Report of Two Cases

Histiocytic sarcoma is a rare, but aggressive malignant neoplasm of monocyte/macrophage lineage with a wide age distribution. Bone involvement is exceedingly rarer compared to the lymph node, skin, and soft tissue, and no long bone involvement has been reported in the English literature. We here rep...

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Bibliographic Details
Published in:International journal of surgical pathology 2021-10, Vol.29 (7), p.752-758
Main Authors: Ajabnoor, Rana, Bell, Phoenix D., Schiffman, Scott, Carmody, Emily, Monu, Johnny, Wang, Xi
Format: Article
Language:English
Subjects:
Aged
Amputation
Bone Neoplasms - diagnosis
Bone Neoplasms - pathology
Bone Neoplasms - therapy
Chemoradiotherapy, Adjuvant
Child, Preschool
Fatal Outcome
Female
Femur - diagnostic imaging
Femur - pathology
Femur - surgery
Histiocytic Sarcoma - diagnosis
Histiocytic Sarcoma - pathology
Histiocytic Sarcoma - therapy
Humans
Positron Emission Tomography Computed Tomography
Radius - diagnostic imaging
Radius - pathology
Radius - surgery
Sarcoma
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Summary:Histiocytic sarcoma is a rare, but aggressive malignant neoplasm of monocyte/macrophage lineage with a wide age distribution. Bone involvement is exceedingly rarer compared to the lymph node, skin, and soft tissue, and no long bone involvement has been reported in the English literature. We here report 2 cases of histiocytic sarcoma involving the long bone: one from the femur of a 77-year-old female, status post the placement of an intramedullary nail for subtrochanteric hip fracture; the other from the radius of a 3-year-old female with no significant medical history. Radiologic imaging showed highly destructive lesions in both cases with soft-tissue extension. Microscopy in both cases showed sheets of polygonal mononuclear cells with abundant eosinophilic cytoplasm, prominent nucleoli, and frequent mitosis. Hemophagocytosis were also identified. Immunohistochemistry showed that the lesional cells were strongly diffusely positive for CD68 and CD163. The first patient deteriorated rapidly, despite the aggressive treatment of amputation and chemotherapy. However, the second patient is disease free 36 months post the treatment of amputation only. We conclude that the long bone could be the primary site of histiocytic sarcoma. Its prognosis could be very variable and it is difficult to predict its behavior based on morphological evaluation only.
ISSN:1066-8969
1940-2465
DOI:10.1177/1066896921996464