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Primary mediastinal histiocytic sarcoma presenting as pleural effusion
Jie-Yang Jhuang1, Wei-Yu Chen2, Shih-Sung Chuang3,4,5
1Department of Pathology, Mackay Memorial Hospital, Taipei, Taiwan.
Diagnostic Cytopathology
|May 15, 2018
Summary
This study details a rare case of histiocytic sarcoma (HS) presenting as malignant pleural effusion. Cytological analysis of effusion fluid revealed atypical histiocytoid cells, aiding in the diagnosis of this uncommon lymphoma mimic.
Area of Science:
- Oncology
- Cytopathology
- Hematopathology
Background:
- Histiocytic sarcoma (HS) is a rare malignancy of histiocytes, often challenging to diagnose due to its mimicry of non-Hodgkin lymphoma (NHL).
- Diagnostic criteria for HS in effusion cytology are not well-established, with limited prior reports focusing on fine-needle aspiration or bronchoalveolar lavage specimens.
Observation:
- A 61-year-old male presented with a mediastinal tumor and malignant pleural effusion.
- Effusion cytology demonstrated atypical epithelioid (histiocytoid) cells with significant nuclear pleomorphism, irregular contours, and mitotic activity, distinct from benign histiocytes.
- Liu stain revealed abundant cytoplasm with vacuoles and pseudopods in tumor cells.
Findings:
- Immunohistochemistry on subsequent biopsies confirmed HS by identifying neoplastic cells expressing CD4, CD45, CD68, and lysozyme.
- This case highlights the initial presentation of HS as malignant pleural effusion, a rare initial manifestation.
Implications:
- Accurate cytological identification of HS in effusion fluid is crucial for timely diagnosis and treatment, especially when the primary tumor is not yet confirmed.
- Immunophenotyping via cell blocks or excisional specimens is essential for definitive diagnosis of histiocytic sarcoma.
- This report expands the understanding of HS cytological features in effusions, aiding future diagnostic efforts.
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