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Cutaneous Histiocytic Sarcoma With Cellular Cannibalism.

Aya Nanri1, Eri Katayama1, Taichi Imamura1

  • 1Department of Dermatology, Kurume University School of Medicine, Kurume, Japan.

The American Journal of Dermatopathology
|October 1, 2019
PubMed
Summary

Cutaneous histiocytic sarcoma (HS) is a rare skin cancer. Diagnosis requires immunohistochemistry, but specific cellular features in H&E stains can suggest HS, aiding early detection.

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Area of Science:

  • Dermatopathology
  • Oncology
  • Histopathology

Background:

  • Cutaneous histiocytic sarcoma (HS) is an uncommon and aggressive malignant neoplasm.
  • Accurate diagnosis is crucial for appropriate patient management and treatment planning.

Observation:

  • An 82-year-old female presented with a rapidly growing scalp nodule.
  • Biopsy revealed pleomorphic atypical cells in the dermis and subcutis.
  • Immunohistochemical stains confirmed HS, showing positivity for CD4, CD163, and HLA-DR.

Findings:

  • The resected tumor exhibited diverse cell morphologies including round, oval, plasmacytoid, spindled, and signet-ring cells.
  • Histiocytic features such as cellular cannibalism, emperipolesis, and various giant cell types were observed.
  • Storiform and fascicular patterns were noted in some areas, alongside hemosiderin deposition.

Implications:

  • Diagnosis of HS can be challenging, often necessitating immunohistochemical analysis.
  • Recognizing specific histiocytic features in routine H&E staining may aid in presumptive diagnosis.
  • The tumor demonstrated rapid growth and resistance to radiation therapy, highlighting its aggressive nature.