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Primary Histiocytic Sarcoma of the Spleen Associated with Erythrophagocytic Histiocytosis

We report an exceptional case of a histiocytic sarcoma presenting as a primary isolated spleen tumor in a 71-year-old woman. The neoplastic cells in the cords and sinuses of the red pulp formed multiple lobulated tumors, which were detected in vivo by ultrasound scan. The medium cells, large cells a...

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Published in:Pathology, research and practice research and practice, 2003, Vol.199 (2), p.107-112
Main Authors: Audouin, Josée, Vercelli-Retta, J., Le Tourneau, A., Adida, C., Camilleri-Broët, S., Molina, T., Diebold, J.
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description We report an exceptional case of a histiocytic sarcoma presenting as a primary isolated spleen tumor in a 71-year-old woman. The neoplastic cells in the cords and sinuses of the red pulp formed multiple lobulated tumors, which were detected in vivo by ultrasound scan. The medium cells, large cells and the giant cells expressed CD68, a histiocyte-associated marker, lysozyme and S100 protein. All these cells were negative for B- and T-cell markers, cytokeratins, melanosome markers (HMB45) and CD1a (Langerhans' cells). Many tumor cells displayed strong erythrophagocytosis and sometimes lymphocytophagocytosis. In addition, numerous histiocytes with morphology indistinguishable from reactive macrophages also exhibited a strong erythro-phagocytosis, and were found in the tumor as well as in the normal splenic parenchyma. Despite multi-agent chemotherapy, the patient suffered from a relapse in the liver, with a rapid fatal outcome. A literature review showed that such a primary splenic presentation with multiple tumors is rare. In contrast, in systemic malignant histiocytosis, secondary spleen involvement occurs more frequently but with diffuse infiltration. The association with a reactive histiocytosis with erythrophagocytosis corresponds to “histiocytic medullary reticulosis”, as previously described by Scott and Robb-Smith.
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subjects Aged
Biomarkers, Tumor
Diagnosis, Differential
Erythrophagocytic histiocytosis
Female
Histiocytic sarcoma
Histiocytic Sarcoma - complications
Histiocytic Sarcoma - metabolism
Histiocytic Sarcoma - pathology
Humans
Immunohistochemistry
Inflammation - metabolism
Inflammation - pathology
Liver Neoplasms - secondary
Lymph Nodes - pathology
Malignant histiocytosis
Primary splenic sarcoma
Sarcoma - complications
Sarcoma - metabolism
Sarcoma - pathology
Sarcoma - secondary
Splenic Neoplasms - complications
Splenic Neoplasms - metabolism
Splenic Neoplasms - pathology
title Primary Histiocytic Sarcoma of the Spleen Associated with Erythrophagocytic Histiocytosis
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