Hemophagocytosis in an adrenal aspirate: Histiocytic sarcoma

Singh, Charanjeet; Schmechel, Stephen C.; Cioc, Adina; Jessurun, José; Pambuccian, Stefan E.

doi:10.1002/dc.22974

Cited by 5 publications

(11 citation statements)

References 14 publications

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“…In 2003, Miliauskas described the first case of HS sampled cytologically: large pleomorphic cells with occasional reniform nuclei, prominent nucleoli, and moderately dense and abundant vacuolar cytoplasm in a lymphohistiocytic background. Similar findings were described in the 3 subsequent reports; notably, Singh et al noted the presence of hemophagocytosis in a case of HS sampled from the adrenal gland. Yang et al and Mehrotra and Pan each described the cytomorphologic and immunophenotypic profile of an HS with interdigitating dendritic cell differentiation based on additional spindle cell cytomorphology with long, thin cytoplasmic processes and diffuse, strong expression of S100 protein.…”

Section: Discussionsupporting

confidence: 88%

“… Singh et al noted the presence of binucleated or multinucleated tumor cells with mirror‐imaged nuclei; however, their illustrations did not show any tumor cells with the partially overlapping nuclei characteristic of the Pac‐Man–like cells in our cohort.…”

Section: Resultscontrasting

confidence: 76%

“…Of the large case series of extranodal HS by Hornick et al, half were from an extremity or buttock, with the remainder from the gastrointestinal tract, head and neck, and lungs. In our cohort and the prior FNA case reports, the presentation was predominantly in the head and neck region (5 cases and 5 patients), which was followed by the retroperitoneum (5 cases and 4 patients) and lungs (2 cases and 2 patients). These sites, especially the head and neck, are superficial and amenable to sampling by FNA.…”

Section: Discussionmentioning

confidence: 55%

“…Cytomorphologic features of the 8 cases of HS sampled by FNA in this study along with the 6 previous case reports are summarized in Table . In our series, cytologic smears were variably cellular: moderately cellular in 5 cases, hypocellular in 2 cases, and hypercellular in 1 case.…”

Section: Resultsmentioning

confidence: 99%

“…Patients with extranodal disease often undergo diagnostic fine‐needle aspiration (FNA). Although the histologic features of HS are established, its FNA cytology has been limited to a few case reports . This study evaluates the FNA cytomorphology of 8 cases of HS in 6 patients along with clinical, histopathologic, immunophenotypic, and (in 4 cases) molecular characterization.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Histiocytic sarcoma: New insights into FNA cytomorphology and molecular characteristics

Hung

Lovitch

Qian

2017

Cancer Cytopathology

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Although diagnosing HS with FNA alone is extremely challenging, the presence of pleomorphic and epithelioid large cells with binucleation and/or multinucleation in an inflammatory background should prompt the diagnosis of HS with judicious use of confirmatory histiocytic lineage markers. The detection of recurrent KMT2D/MLL2 alterations implicates epigenetic regulation in the pathogenesis of HS and supports the notion of transdifferentiation from a genetically similar but phenotypically distinct tumor of a different lineage. Cancer Cytopathol 2017;125:604-14. © 2017 American Cancer Society.

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Section: Discussionsupporting

confidence: 88%

Section: Resultscontrasting

confidence: 76%

Section: Discussionmentioning

confidence: 55%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Histiocytic sarcoma: New insights into FNA cytomorphology and molecular characteristics

Hung

Lovitch

Qian

2017

Cancer Cytopathology

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Adrenal Gland

Bertazzolo¹

2020

Veterinary Cytology

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Fine‐needle aspiration findings of a rare hematopoietic neoplasm presenting as obstructive jaundice

Tracht

Ahmed

Donath

2017

Diagnostic Cytopathology

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A 51-year-old female who presented with obstructive jaundice was found to have masses in the pancreatic head and tail as well as suspicious liver and periaortic masses on imaging. Aspiration cytology of the pancreatic tail mass showed abundant large single cells with vacuolated eosinophilic cytoplasm, marked nuclear pleomorphism, large bizarre irregular nuclei, binucleation, and prominent nucleoli. Numerous cells also showed intracytoplasmic black to brown pigmentation. A cell block was obtained and extensive immunohistochemical staining was performed. S-100, HMB-45, Sox10, pancytokeratin, CK7, RCC antigen, synaptophysin, HepPar 1, inhibin, CD45, CD21, and CD123 were negative, making melanoma, epithelial malignancies, lymphoma, follicular dendritic and plasmacytoid dendritic cell neoplasms less likely. CD4 and CD56 showed partial positivity, and CD68, CD163, and CD14 were positive, supporting the diagnosis of histiocytic sarcoma. Surgical specimens and immunohistochemistry confirmed the cytologic findings. Histiocytic sarcoma is a rare aggressive malignancy of histiocytic origin with most cases presenting in adults in extranodal sites, most commonly the intestinal tract. Few cases are reported in the literature, presenting diagnostic challenges for cytopathologists when seen on fine-needle aspiration. We present the first reported case of histiocytic sarcoma presenting as a pancreatic mass, diagnosed by endoscopic ultrasound guided fine-needle aspiration (EUS-FNA). This entity is rarely described on cytology and arose in a location in which EUS-FNA is the diagnostic modality of choice. This case study highlights that cytopathologists should be aware of histiocytic sarcoma occurring in extranodal locations accessible by EUS-FNA and be familiar with the cytomorphologic appearance.

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Hemophagocytosis in an adrenal aspirate: Histiocytic sarcoma

Cited by 5 publications

References 14 publications

Histiocytic sarcoma: New insights into FNA cytomorphology and molecular characteristics

Histiocytic sarcoma: New insights into FNA cytomorphology and molecular characteristics

Adrenal Gland

Fine‐needle aspiration findings of a rare hematopoietic neoplasm presenting as obstructive jaundice

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