Ito Toshinari, Iwata Yuya, Akiba Yoshimasa, Ishiya Saki, Okasaka Toshiki
Department of Thoracic Surgery, Aichi Koseiren Toyota Kosei Hospital, Toyota, Aichi, Japan.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.25-0133. Epub 2025 May 29.
Histiocytic sarcoma (HS) is a rare malignant disease with a poor prognosis and unknown pathogenesis. In addition, this disease is difficult to diagnose due to the wide variety of diseases to be differentiated from it.
A 37-year-old woman with right-sided chest pain was referred to our hospital. Computed tomography (CT) revealed a 30-mm mass with osteolytic changes in the right eighth rib. Further examination revealed a rib mass, right renal mass, anterior mediastinal nodule, bilateral pulmonary nodules, and suprasellar nodule. A needle biopsy of the rib mass revealed granuloma with histiocytes. A subsequent needle biopsy of the right renal mass revealed similar findings without evidence of malignancy. The imaging findings suggested malignant disease; therefore, wedge resection of the upper lobe of the right lung and biopsy of the mediastinal mass were performed under general anesthesia. HS was diagnosed based on the immunostaining results.
For the treatment of HS, early intervention is said to contribute to a prolonged prognosis. In order to provide appropriate therapy, HS should be included in the differential diagnosis for multifocal extranodal tumors.
组织细胞肉瘤（HS）是一种罕见的恶性疾病，预后较差，发病机制不明。此外，由于需要与之鉴别的疾病种类繁多，这种疾病难以诊断。
一名37岁右侧胸痛的女性被转诊至我院。计算机断层扫描（CT）显示右第八肋骨有一个30毫米的肿块，伴有骨质溶解改变。进一步检查发现肋骨肿块、右肾肿块、前纵隔结节、双侧肺结节和鞍上结节。肋骨肿块的针吸活检显示为含有组织细胞的肉芽肿。随后对右肾肿块进行针吸活检，结果相似，无恶性证据。影像学检查结果提示为恶性疾病；因此，在全身麻醉下对右肺上叶进行楔形切除并对纵隔肿块进行活检。根据免疫染色结果诊断为HS。
对于HS的治疗，早期干预据说有助于延长预后。为了提供适当的治疗，HS应纳入多灶性结外肿瘤的鉴别诊断中。
