He Huayu, Xue Qi, Tan Fengwei, Yang Lin, Wang Xin, Gao Yushun, Mao Yousheng, Mu Juwei, Wang Dali, Zhao Jun, Zhao Liang, Gao Shugeng
Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Ann Transl Med. 2021 Jan;9(1):77. doi: 10.21037/atm-20-4965.
Primary pulmonary inflammatory pseudotumor-like follicular dendritic cell sarcoma (IPT-like FDCS) is extremely rare. Here, we report a case of a 64-year-old female with primary pulmonary IPT-like FDCS. The patient was found to have a solid nodule in the right lower lobe (RLL) of the lung incidentally without any symptoms or signs of discomfort. The chest computed tomography (CT) showed that there was an irregular nodule in the basal segment of the RLL, approximately 2.0 cm × 1.1 cm × 1.0 cm in size, of 15 HU in CT value. While the result of the fiberoptic bronchoscope-guided biopsy of the mass showed that there was inflammatory cell infiltration, no evidence of malignancy was found. After a thorough discussion of the multidisciplinary team, lobectomy of the RLL and systematic lymph node dissection were performed for the patient. Histologic analysis of the resected mass revealed infiltration of a large number of lymphocytes and plasma cells with the expression of CD21, CD23, CD35 were positive. In addition, the Epstein-Barr virus (EBV) probe hybridization were positive. As a result, the diagnosis of EBV-positive IPT-like FDCS was strongly supported. No recurrence or any signs of metastasis were found during a 10-month follow-up time. As we have reported in this rare case, the diagnosis of primary pulmonary IPT-like FDCS should be considered even when there is only lymphoplasmacytic infiltration and no evidence of malignant tumor cells in the lung.
原发性肺炎症性假瘤样滤泡树突状细胞肉瘤（IPT样FDCS）极为罕见。在此，我们报告一例64岁女性原发性肺IPT样FDCS病例。该患者偶然发现右肺下叶有一个实性结节，无任何不适症状或体征。胸部计算机断层扫描（CT）显示右肺下叶基底段有一个不规则结节，大小约为2.0 cm×1.1 cm×1.0 cm，CT值为15 HU。而对该肿块进行纤维支气管镜引导下活检的结果显示有炎性细胞浸润，未发现恶性证据。经过多学科团队的充分讨论，为患者实施了右肺下叶切除术及系统性淋巴结清扫术。对切除肿块的组织学分析显示有大量淋巴细胞和浆细胞浸润，CD21、CD23、CD35表达阳性。此外，爱泼斯坦-巴尔病毒（EBV）探针杂交呈阳性。因此，强烈支持EBV阳性IPT样FDCS的诊断。在10个月的随访期内未发现复发或任何转移迹象。正如我们在这个罕见病例中所报告的，即使肺部仅有淋巴浆细胞浸润且无恶性肿瘤细胞证据，也应考虑原发性肺IPT样FDCS的诊断。
