Abstract
Follicular dendritic cell sarcoma is a rare malignant neoplasm originating from follicular dendritic cells, and most of them develop in lymph nodes of the head and neck. One third of follicular dendritic cell sarcomas occur in the extranodal sites such as the tonsils, mesentery, and retroperitoneal organs, but those of mediastinal origin are rare. Here, we present the case of a 16-year-old female with a large follicular dendritic cell sarcoma of posterior mediastinal origin. The tumor was found by a chest X-ray mass examination at her high school, and she had no subjective symptoms or significant past medical history. The tumor was diagnosed as a follicular dendritic cell sarcoma by computed tomography-guided needle biopsy. Although the tumor compressed the mediastinal organs and showed moderate uptake in 18-fluorodeoxyglucose positron emission tomography imaging, it was completely resected through posterolateral incision. Histological examination revealed that spindle-shaped tumor cells formed fascicular or storiform pattern with cellular pleomorphism. By immunohistochemical examination, the tumor cells were found to be positive for CD21 and follicular dendritic cell antigen. Two years after surgery, the patient remains alive with no signs of tumor recurrence.
Highlights
Follicular dendritic cell sarcoma (FDCS) is a rare malignant neoplasm originating from follicular dendritic cells, and most FDCSs develop in lymph nodes of the head and neck [1,2,3,4]
Several lymph nodes reside in the subcarinal region, and these can be a site for development of FDCS
The prognosis of mediastinal FDCS is unknown because long-term outcome beyond 2 years has not been described in reported cases
Summary
Follicular dendritic cell sarcoma (FDCS) is a rare malignant neoplasm originating from follicular dendritic cells, and most FDCSs develop in lymph nodes of the head and neck [1,2,3,4]. Case presentation A 16-year-old otherwise healthy female visited a local hospital because of detection of a mediastinal tumor at a school screening Her vital signs were normal, and physical examination was completely unremarkable. Immunohistochemical analyses revealed that the tumor cells were positive for CD21 (Fig. 2c) and follicular dendritic cell antigen (Fig. 2d), but were negative for CD68, S-100, anaplastic lymphoma kinase, and Epstein-Barr virus-encoded small RNA (data not shown). There was no evidence of the neoplasm in the dissected para-esophageal lymph nodes She had a benign postoperative course and was discharged 8 days after surgery. There has been no evidence of recurrence 2 years after surgery as observed during biannual followup with CT
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