Soltani Amirhossein, Salimi Mohsen, Saeedi-Moghadam Mahdi
Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran.
Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Radiol Case Rep. 2024 Jun 21;19(9):3814-3819. doi: 10.1016/j.radcr.2024.05.069. eCollection 2024 Sep.
Histiocytic sarcoma is an extremely rare disease that's hard to diagnose and treat, often leading to a poor prognosis. Here, we present a case report detailing a rare occurrence of HS in a 37-year-old pregnant woman who first presented with left shoulder pain, palpitations, and a productive cough at 20 weeks of gestation. Her diagnostic evaluations were performed, including different imaging modalities such as chest X-rays, CT scans, and MRI. Imaging revealed a large mediastinal mass with extensive involvement of the adrenal glands, lungs, and lymph nodes. The definitive diagnosis of HS is based on pathological and morphological features, and the immunohistochemistry report plays a key role. In our case, the diagnosis of HS was confirmed through pathological evaluation and immunohistochemistry, with a positive CD68 result obtained from a supraclavicular lymph node biopsy. A hospital committee comprising medical specialists like hematologists-oncologists, pathologists, pulmonologists, and obstetricians was brought together to assess the case collectively. The patient received chemotherapy, which alleviated her symptoms and maintained her condition. Based on the committee's recommendations, despite a healthy fetus and normal obstetric sonograms, the decision was made to terminate the pregnancy with the consent of the patient and her family. Despite initial improvement postchemotherapy, the patient's condition worsened, necessitating intubation. Tragically, two months after the initial admission, the patient passed away due to severe complications. In this case report, we provide a literature review and review of the patient's imaging reports. Since the patient is pregnant and HS is uncommon, it's important to highlight that this case is unique and worth sharing.
组织细胞肉瘤是一种极其罕见的疾病，难以诊断和治疗，往往预后不良。在此，我们报告一例病例，详细介绍了一名37岁孕妇罕见地发生组织细胞肉瘤的情况。该孕妇在妊娠20周时首次出现左肩疼痛、心悸和咳痰性咳嗽。对她进行了诊断评估，包括不同的影像学检查，如胸部X光、CT扫描和MRI。影像学检查显示一个巨大的纵隔肿块，肾上腺、肺和淋巴结广泛受累。组织细胞肉瘤的确诊基于病理和形态学特征，免疫组化报告起着关键作用。在我们的病例中，通过病理评估和免疫组化确诊为组织细胞肉瘤，锁骨上淋巴结活检的CD68结果呈阳性。一个由血液肿瘤学家、病理学家、肺科医生和产科医生等医学专家组成的医院委员会共同对该病例进行了评估。患者接受了化疗，症状得到缓解，病情得以维持。根据委员会的建议，尽管胎儿健康且产科超声检查正常，但在患者及其家人同意下决定终止妊娠。尽管化疗后最初有所改善，但患者病情恶化，需要插管。不幸的是，首次入院两个月后，患者因严重并发症去世。在本病例报告中，我们提供了文献综述以及对患者影像学报告的回顾。由于患者怀孕且组织细胞肉瘤罕见，强调该病例独特且值得分享很重要。
