Katano H, Kaneko K, Shimizu S, Saito T, Irié T, Mori S
Department of Pathology, Omiya Red Cross Hospital, Japan.
Pathol Int. 1997 Oct;47(10):703-6. doi: 10.1111/j.1440-1827.1997.tb04445.x.
Follicular dendritic cell (FDC) sarcoma is an exceedingly rare neoplasm of unknown pathogenesis. A case of FDC sarcoma complicated by the hyaline-vascular type Castleman's disease occurring in a schizophrenic male is presented. Swelling of the left cervical lymph node appeared in a 44-year-old male schizophrenic who had been medicated with major tranquilizers for 20 years. He had had a history of cervical lymphadenopathy 14 years before, for which a diagnosis of hyaline-vascular type Castleman's disease had been made. The present specimen, obtained from the same site, was an enlarged lymph node heavily infiltrated with oval to spindle-shaped atypical cells but was uninvolved at the periphery. The infiltrating cells showed nodular or sheet-like growth, occasionally taking fascicular or storiform patterns. Follicular involvement was also common. Peculiarly, various amounts of small lymphocytes were intermingled with the neoplastic cells. The atypical cells expressed two FDC-specific antigens, DRC-1 and Ki-M4 antigen, together with a few other markers that are shared by FDC, including CD21 and HLA-DR. These findings clearly show the tumor to be FDC sarcoma. In addition, a peculiar fibro-hyalinous change in the lymph follicle, which is compatible with hyaline-vascular type Castleman's disease, was noted at the periphery of the lymph node where neoplastic cells had not infiltrated. Surprisingly, similar hyaline-vascular changes were observed in the previous biopsy taken 14 years ago. Meanwhile, Kaposi's sarcoma-associated herpesvirus, which is often identified from generalized Castleman's disease, was not identified in the present case by polymerase chain reaction study. Thus, this case is unique in two aspects: (i) the overlap of FDC sarcoma with hyaline-vascular type follicular changes; and (ii) its occurrence in a schizophrenic patient.
滤泡性树突状细胞（FDC）肉瘤是一种发病机制不明的极其罕见的肿瘤。本文报告1例发生于1例男性精神分裂症患者的FDC肉瘤，该肉瘤合并透明血管型Castleman病。1例44岁男性精神分裂症患者，服用抗精神病药物20年，出现左颈部淋巴结肿大。14年前他曾有颈部淋巴结病病史，当时诊断为透明血管型Castleman病。本次标本取自同一部位，为一个肿大的淋巴结，大量椭圆形至梭形非典型细胞浸润，但周边未受累。浸润细胞呈结节状或片状生长，偶尔呈束状或车辐状排列。滤泡受累也很常见。特别的是，各种数量的小淋巴细胞与肿瘤细胞混合存在。非典型细胞表达两种FDC特异性抗原，DRC-1和Ki-M4抗原，以及一些FDC共有的其他标志物，包括CD21和HLA-DR。这些发现清楚地表明该肿瘤为FDC肉瘤。此外，在淋巴结周边肿瘤细胞未浸润处，发现了与透明血管型Castleman病相符的淋巴滤泡内特殊的纤维透明样改变。令人惊讶的是，在14年前的前一次活检中也观察到了类似的透明血管改变。同时，通过聚合酶链反应研究，在本病例中未发现通常在全身性Castleman病中鉴定出的卡波西肉瘤相关疱疹病毒。因此，该病例在两个方面具有独特性：（i）FDC肉瘤与透明血管型滤泡改变重叠；（ii）其发生在一名精神分裂症患者身上。
