Abstract
This is the first case report of Histiocytic Sarcoma (HS) with predominant spindle cell component occurring in the head and neck region of a 41-year-old man. The tumor was composed of sheets of large round to oval cells with pleomorphic vesicular nuclei, prominent nucleoli and abundant eosinophilic cytoplasm. Multinucleated forms, numerous mitoses, and tumor necrosis were also noted. Sheets, fascicles, and whorls of spindle cells with spindled to ovoid vesicular nuclei, small to medium-sized distinct nucleoli, and eosinophilic cytoplasm were frequently observed. Immunohistochemical staining in the tumor cells was positive for CD163, CD68, lysozyme, CD45, and NSE. Focal expression of CD4 and S-100 was also noted. Electron microscopy demonstrated an abundance of lysosomes in the cytoplasm of tumor cells. Chromosome study revealed a 57–80 hyperdiploid [7]/46, XY [13] karyotype, including 3 to 4 copies of various chromosomes. The immunohistochemical and ultrastructural findings confirmed the diagnosis of HS.
Highlights
Histiocytic sarcoma (HS) is rare neoplasm characterized by malignant proliferation of cells showing morphologic and immunophenotypic features similar to those of mature tissue histiocytes [1]
We present a case of HS of the head and neck which was initially identified only as malignant spindle cell tumor not further classifiable
Immunohistochemical, and ultrastructural features, as well as the cytogenetics of a HS with unusual differentiation
Summary
Histiocytic sarcoma (HS) is rare neoplasm characterized by malignant proliferation of cells showing morphologic and immunophenotypic features similar to those of mature tissue histiocytes [1]. About one-third of cases present in lymph nodes, about one-third in skin, and about one-third in a variety of other extranodal sites, most commonly the intestinal tract [1]. Awareness of HS is important, as the tumor closely mimics other lymphoid tissue malignancies in their clinical presentation and morphologic appearance. We present a case of HS of the head and neck which was initially identified only as malignant spindle cell tumor not further classifiable. A case of HS with predominant spindle cell component has never been reported before. Immunohistochemical, and ultrastructural features, as well as the cytogenetics of a HS with unusual differentiation
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