Histiocytic Sarcoma in a Kidney Transplant Patient: A Case Report and Review of the Literature

Abstract

Objective. Histiocytic sarcoma (HS) is an aggressive neoplasm with only limited number of reported series of cases and rare case reports of occurrence as a posttransplant neoplastic disorder. The etiology and pathogenesis of the disease is unknown and the optimal treatment is still under investigation. We describe an unusual case of HS in a patient with a remote history of kidney transplant. Method and Results. A 54-year-old male with a remote history of renal transplantation under maintenance immunosuppression presented with features of sepsis. CT abdomen revealed multiple heterogeneous masses in bilateral native kidneys and liver and enlarged abdominal and retroperitoneal lymph nodes. Viral serology work-up was negative. Needle core biopsy revealed a highly undifferentiated neoplasm comprised of highly atypical large cells with eosinophilic to vacuolated cytoplasm and hemophagocytosis. Extended panel of immunohistochemistry proved histiocytic lineage for the tumor cells. The patient expired 2 weeks following the diagnosis. Conclusion. Our case along with three previously published case reports raised the possibility of HS as a treatment-related neoplasm or a posttransplantation neoplastic disorder in solid organ transplant recipients.

Histiocytic sarcoma in renal transplant patients: a literature review

“…4 H&E and IHC panel of a histiocytic sarcoma of a transplanted kidney. Focal emperipolesis are marked by (arrowhead) and (arrows) point out frequent mitosis [ 6 ] …”

“…It has been reported in 1–2% of renal transplant patients [ 11 ]. PTLD is a chronic complication of transplantation and consists of hyperplastic-appearing lesions to frank non-Hodgkin’s lymphoma, multiple myeloma histology, and T-cell lymphomas [ 6 ].…”

“…WHO does not classify histiocytic sarcoma as a type of PTLD [ 2 , 5 ]. Only 4 cases of Histiocytic Sarcoma developed after renal transplantation are available in English Literature [ 6 – 9 ].…”

Histiocytic sarcoma of the neck: A case report

“…Due to its rapid invasiveness and high mortality rate, HS remains a medical challenge for which there is yet no effective treatment (7,8), which calls for more efforts and further research.…”

“…Histiocytic sarcoma (HS) is a rare malignant neoplasm originating from the hematopoietic system, composed of cells exhibiting morphological and immunophenotypical characteristics of mature tissue histiocytes, first described in 1939 as histiocytic medullary reticulosis, and as malignant histiocytosis by Rappaport in 1966 (1). Current epidemiological data estimate that <1% of tumors presenting in lymph nodes or soft tissue can be defined as HS (2). Approximately 1/3 of the cases have been reported to occur in lymph nodes, while the incidence of extranodular HS, such as in the gastrointestinal tract, spleen and soft tissue, is relatively low (3).…”