Tracht Jessica, Ahmed Ali M, Rosenblum Donath Frida
University of Alabama at Birmingham, Department of Pathology, 619 19th Street South, HSB136, Birmingham, Alabama, 34249.
University of Alabama at Birmingham, Division of Gastroenterology and Hepatology.
Diagn Cytopathol. 2017 Dec;45(12):1142-1147. doi: 10.1002/dc.23788. Epub 2017 Jul 27.
A 51-year-old female who presented with obstructive jaundice was found to have masses in the pancreatic head and tail as well as suspicious liver and periaortic masses on imaging. Aspiration cytology of the pancreatic tail mass showed abundant large single cells with vacuolated eosinophilic cytoplasm, marked nuclear pleomorphism, large bizarre irregular nuclei, binucleation, and prominent nucleoli. Numerous cells also showed intracytoplasmic black to brown pigmentation. A cell block was obtained and extensive immunohistochemical staining was performed. S-100, HMB-45, Sox10, pancytokeratin, CK7, RCC antigen, synaptophysin, HepPar 1, inhibin, CD45, CD21, and CD123 were negative, making melanoma, epithelial malignancies, lymphoma, follicular dendritic and plasmacytoid dendritic cell neoplasms less likely. CD4 and CD56 showed partial positivity, and CD68, CD163, and CD14 were positive, supporting the diagnosis of histiocytic sarcoma. Surgical specimens and immunohistochemistry confirmed the cytologic findings. Histiocytic sarcoma is a rare aggressive malignancy of histiocytic origin with most cases presenting in adults in extranodal sites, most commonly the intestinal tract. Few cases are reported in the literature, presenting diagnostic challenges for cytopathologists when seen on fine-needle aspiration. We present the first reported case of histiocytic sarcoma presenting as a pancreatic mass, diagnosed by endoscopic ultrasound guided fine-needle aspiration (EUS-FNA). This entity is rarely described on cytology and arose in a location in which EUS-FNA is the diagnostic modality of choice. This case study highlights that cytopathologists should be aware of histiocytic sarcoma occurring in extranodal locations accessible by EUS-FNA and be familiar with the cytomorphologic appearance.
一名51岁女性因出现梗阻性黄疸就诊，影像学检查发现胰头和胰尾有肿块，肝脏及腹主动脉旁也有可疑肿块。胰尾肿块的细针穿刺细胞学检查显示有大量单个大细胞，胞质呈空泡状嗜酸性，核多形性明显，有大的奇异不规则核、双核及显著核仁。许多细胞还显示胞质内有黑色至棕色色素沉着。制作了细胞块并进行了广泛的免疫组化染色。S-100、HMB-45、Sox10、全细胞角蛋白、CK7、肾细胞癌抗原、突触素、HepPar 1、抑制素、CD45、CD21和CD123均为阴性，可排除黑色素瘤、上皮性恶性肿瘤、淋巴瘤、滤泡树突状细胞和浆细胞样树突状细胞瘤。CD4和CD56呈部分阳性，CD68、CD163和CD14呈阳性，支持组织细胞肉瘤的诊断。手术标本及免疫组化结果证实了细胞学检查结果。组织细胞肉瘤是一种罕见的起源于组织细胞的侵袭性恶性肿瘤，大多数病例发生于成人的结外部位，最常见于肠道。文献报道的病例较少，细针穿刺时给细胞病理学家带来诊断挑战。我们报告首例经内镜超声引导细针穿刺活检（EUS-FNA）诊断为胰腺肿块的组织细胞肉瘤病例。该实体在细胞学上很少被描述，且发生在EUS-FNA为首选诊断方式的部位。本病例研究强调，细胞病理学家应意识到EUS-FNA可及的结外部位可能发生组织细胞肉瘤，并熟悉其细胞形态学表现。
