Radiation Oncology, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India.
Pathology, Amrita Institute of Medical Sciences, Cochin, Kerala, India.
BMJ Case Rep. 2022 Apr 26;15(4):e244812. doi: 10.1136/bcr-2021-244812.
Follicular dendritic cells are antigen-presenting immune accessory cells of mesenchymal origin. Follicular dendritic cell sarcomas (FDCS) typically occur in nodal and extranodal sites. However, presentation in the extremity has rarely been reported. A woman in her 60s had a painless, slow-growing right posterior thigh swelling, which had been present for 9 months. Imaging revealed a subcutaneous lesion in the posterior aspect of the right mid-thigh. Fine-needle aspiration cytology from the lesion was suggestive of a malignant spindle cell neoplasm, and she underwent its wide local excision. Immunohistochemistry showed expression of epithelial membrane antigen and CD35, but an absence of cytokeratin, desmin, CD23 and S100. The Ki-67 index was low and a diagnosis of FDCS was made. The lack of clinical guidelines was a challenge in the treatment of this rare case. A multidisciplinary board discussion played a critical role in the planning of the patient's adjuvant treatment.
滤泡树突状细胞是起源于间充质的抗原呈递免疫辅助细胞。滤泡树突状细胞瘤（FDCS）通常发生在淋巴结和结外部位。然而，在四肢的表现很少有报道。一位 60 多岁的女性右大腿后侧出现无痛、缓慢生长的肿胀，已经存在 9 个月。影像学显示右大腿中后侧皮下有一个病变。病变的细针穿刺细胞学检查提示为恶性梭形细胞肿瘤，随后进行了广泛局部切除术。免疫组化显示上皮膜抗原和 CD35 表达阳性，但细胞角蛋白、结蛋白、CD23 和 S100 阴性。Ki-67 指数较低，诊断为 FDCS。由于缺乏临床指南，给这种罕见病例的治疗带来了挑战。多学科委员会的讨论在规划患者的辅助治疗中发挥了关键作用。
