Togashi Ken-ichi, Shinohara Hirohiko, Isoda Manabu
Division of Thoracic Surgery, Nagaoka Red Cross Hospital, Nagaoka, Niigata, Japan.
Jpn J Thorac Cardiovasc Surg. 2005 Jul;53(7):377-81. doi: 10.1007/s11748-005-0054-2.
A 56-year-old man underwent preoperative chest computed tomography to further evaluate a well defined mass in the middle lobe with subcarinal lymph node swelling. There was no pathological diagnosis established by either bronchoscopic biopsy specimens or computed tomography-guided percutaneous needle biopsy. The middle lobe and mediastinal lymph nodes were excised, then postoperative radiotherapy (60 Gy) was administered to the mediastinum. Results of histological and immunohistochemical study showed that the lung mass consisted of completely necrotic tissue and that the subcarinal lymph node was involved by malignant cells suggestive of dendritic cell sarcoma. Primary dendritic cell sarcoma of the mediastinal lymph node is extremely rare. Dendritic cell sarcoma is a neoplasm of reticular dendritic origin and includes both follicular dendritic cell sarcoma and interdigitating reticulum (or dendritic) cell sarcoma. These rare neoplasms may pose difficulty in pathologic diagnosis and treatment. Although our patient died of hepatic rupture due to dendritic cell sarcoma or gastric cancer metastases one year after surgery, complete surgical resection with or without postoperative radiotherapy may be an acceptable therapeutic option for localized dendritic cell sarcoma.
一名56岁男性接受了术前胸部计算机断层扫描，以进一步评估中叶边界清晰的肿块及隆突下淋巴结肿大情况。支气管镜活检标本和计算机断层扫描引导下经皮穿刺活检均未确立病理诊断。切除中叶及纵隔淋巴结，随后对纵隔进行术后放疗（60 Gy）。组织学和免疫组化研究结果显示，肺部肿块由完全坏死组织构成，隆突下淋巴结有恶性细胞浸润，提示为树突状细胞肉瘤。纵隔淋巴结原发性树突状细胞肉瘤极为罕见。树突状细胞肉瘤是一种源于网状树突的肿瘤，包括滤泡性树突状细胞肉瘤和交错突网状（或树突状）细胞肉瘤。这些罕见肿瘤在病理诊断和治疗上可能存在困难。尽管我们的患者在术后一年因树突状细胞肉瘤或胃癌转移导致肝破裂死亡，但对于局限性树突状细胞肉瘤，完整手术切除加或不加术后放疗可能是一种可接受的治疗选择。
