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Multiplexed Fluorescent Immunohistochemical Staining, Imaging, and Analysis in Histological Samples of Lymphoma
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Histiocytic sarcoma arising from a lymph node: a diagnostic conundrum.

Anoshia Afzal1, Sepideh N Asadbeigi2, Umar Farooque3

  • 1Department of Pathology, The University of Oklahoma Health Science Center, Oklahoma City, OK USA.

International Cancer Conference Journal
|July 5, 2021
PubMed
Summary

Histiocytic Sarcoma (HS) is a rare cancer. This case highlights a solitary HS in a lymph node, initially misdiagnosed as high-grade sarcoma on fine-needle aspiration biopsy.

Keywords:
Histiocytic sarcomaLymph nodeSarcoma

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Area of Science:

  • Oncology
  • Pathology

Background:

  • Histiocytic Sarcoma (HS) is an exceptionally rare malignancy, with limited documented cases.
  • Typically, HS presents as unifocal or multifocal extranodal disease, with lymph node involvement being uncommon (<20%).

Observation:

  • A 53-year-old woman presented with a 2.7-cm right groin mass originating from an inguinal lymph node.
  • Initial fine-needle aspiration (FNA) cytology revealed high-grade spindle-shaped morphology and high mitotic activity, suggesting high-grade sarcoma.
  • Histological examination showed epithelioid to spindle cells with large nuclei, prominent nucleoli, and high mitotic index, along with focal lymphoid tissue rimming and central necrosis.

Findings:

  • Immunohistochemistry confirmed HS with strong positivity for CD68, CD163, and Vimentin.
  • The diagnosis of HS was established based on integrated clinicopathologic findings.
  • The isolated lymph node presentation mimicked high-grade sarcoma on FNA biopsy.

Implications:

  • The rarity and varied presentation of HS pose diagnostic challenges for pathologists.
  • No established FNA criteria exist for diagnosing HS, emphasizing the need for comprehensive evaluation.
  • This case underscores the importance of considering HS in the differential diagnosis of lymph node masses, particularly when initial cytology is atypical.