Thrombocytopenia with multiple splenic lesions-histiocytic sarcoma of the spleen without splenomegaly: A case report  

作　　者：Kai Huang Alvaro Frometa Columbie Robert W Allan Subhasis Misra 

机构地区：[1]Department of General Surgery,Brandon Regional Hospital,HCA West Florida Division/USF Consortium,Brandon,FL 33511,United States [2]Department of Pathology and Laboratory Medicine,Brandon Regional Hospital,University of South Florida,HCA West Florida Division,Brandon,FL 33511,United States [3]Chief Pathology and Laboratory Medicine Service,North Florida and Southern Georgia VA System,Clinical Professor of Pathology,University of Florida,Gainesville,FL 32611,United States

出　　处：《World Journal of Clinical Oncology》2020年第3期162-168,共7页世界临床肿瘤学杂志（英文版）

基　　金：supported (in whole or part) by HCA Healthcare and/or an HCA Healthcare affiliated entity

摘　　要：BACKGROUND Histiocytic sarcoma(HS)of the spleen is reported to be a rare and lethal disease.The clinicopathological features of splenic HS have not been well described.The objective of this paper is to describe the diagnosis and treatment of a case of this rare disease and provide a review of the literature.CASE SUMMARY In this article,we discuss the case of a 40-year-old Hispanic female who presented with progressive thrombocytopenia and multiple hypoechoic lesions in the spleen without splenomegaly.Positron emission tomography-computed tomography showed increased activity in cervical lymph nodes,as well as multiple bone and splenic lesions with positive uptake.Two bone marrow biopsies and fine-needle aspiration of the cervical lymph node were inconclusive.Laparoscopic splenectomy was performed,and gross examination showed a 110.1 g spleen with multiple rubbery,nodular lesions within the subcapsular sinus and splenic parenchyma.The microscopic findings showed multinodular histiocyte proliferation with atypia and multilobulated nuclei,which were positive for CD163,CD4,and CD68 by immunohistochemical analysis.The final pathologic diagnosis was difficult and was found to be low-grade HS of the spleen,after consultations with two renowned hematopathology institutions.At the patient’s five-month follow-up visit,her bone marrow metastasis had progressed.She is waiting to be enrolled in a clinical trial.CONCLUSION Pathologic diagnosis of splenic HS can be challenging.Low-grade differentiation may be associated with a slow progressive disease.BACKGROUND Histiocytic sarcoma(HS) of the spleen is reported to be a rare and lethal disease.The clinicopathological features of splenic HS have not been well described. The objective of this paper is to describe the diagnosis and treatment of a case of this rare disease and provide a review of the literature.CASE SUMMARY In this article, we discuss the case of a 40-year-old Hispanic female who presented with progressive thrombocytopenia and multiple hypoechoic lesions in the spleen without splenomegaly. Positron emission tomography-computed tomography showed increased activity in cervical lymph nodes, as well as multiple bone and splenic lesions with positive uptake. Two bone marrow biopsies and fine-needle aspiration of the cervical lymph node were inconclusive.Laparoscopic splenectomy was performed, and gross examination showed a110.1 g spleen with multiple rubbery, nodular lesions within the subcapsular sinus and splenic parenchyma. The microscopic findings showed multinodular histiocyte proliferation with atypia and multilobulated nuclei, which were positive for CD163, CD4, and CD68 by immunohistochemical analysis. The final pathologic diagnosis was difficult and was found to be low-grade HS of the spleen, after consultations with two renowned hematopathology institutions. At the patient’s five-month follow-up visit, her bone marrow metastasis had progressed. She is waiting to be enrolled in a clinical trial.CONCLUSION Pathologic diagnosis of splenic HS can be challenging. Low-grade differentiation may be associated with a slow progressive disease.

关 键 词：Histiocytic sarcoma SPLEEN Proliferation THROMBOCYTOPENIA Bone marrow metastasis Case report 

分 类 号：R733.2[医药卫生—肿瘤]