Interdigitating dendritic cell sarcoma. A report of four cases and review of the literature

To better define the clinical and pathologic features of interdigitating dendritic cell sarcoma (IDCS), we report 4 cases, including the first reported in the tonsil. There were 2 male and 2 female patients (mean age, 70 years). Sites of tumor included 1 case each in the right cervical lymph node, left axillary lymph node, right tonsil, and right inguinal lymph node. Histologically, all showed diffuse effacement of the lymphoid tissue by pleomorphic round to spindled cells with convoluted nuclei and abundant eosinophilic cytoplasm. All were immunoreactive for S-100, CD68, lysozyme, and vimentin. CD45 was positive in 3 cases and CD1a in 1 case. Fascin was positive in 3 cases. Other immunostains, including CD3, CD20, CD21, CD30, actin, cytokeratin, and HMB-45, were negative. Ultrastructurally, the tumor cells were elongated and showed indented nuclei, variable numbers of lysosomes, and interdigitating cytoplasmic processes. Follow-up was available for all cases. One patient died of widespread disease 2 months after diagnosis. One was alive with metastatic lung disease at 12 months. Two patients were disease free at 5 and 9 months.     

Reticulum cell sarcoma of lymph node with mixed dendritic and fibroblastic features.

We report a case of clinically aggressive reticulum cell sarcoma with mixed follicular dendritic cell (FDC) and fibroblastic reticular cell (FRC) features. Histologically, the tumor was confined to lymph nodes occurring as a multifocal epithelioid and spindle cell proliferation with appreciable mitotic rate and numerous admixed non-neoplastic B-cells. Ultrastructural examination revealed elongated cells with prominent nucleoli, interdigitating cell processes and frequent desmosomes. These features are typical of FDC sarcoma. However, immunohistochemical stains showed no expression of antigens characteristic of FDCs, including CD21, CD23 and CD35. Cytogenetic characterization of this tumor, by conventional G-banding and multicolor spectral karyotyping, revealed multiple clonal chromosomal aberrations, including del(X)(p11.4) and add (21)(p11.2). Gene expression analysis by cDNA microarray of RNA obtained from short-term tumor cultures revealed high-level expression of a set of genes (including PDGF receptor-alpha and -beta, certain metalloproteinases, and CD105) that were also highly expressed in cultures of nodal FRC cultured from non-neoplastic lymph nodes. We propose that this tumor represents a nodal sarcoma with intermediate differentiation between FDCs and FRCs. This case adds to the diversity of tumors that may arise from lymph node stroma and supports a possible relationship between the FDC and FRC lineages.     

Interdigitating dendritic reticulum cell tumor of lymph nodes: case report with differential diagnostic considerations

A 66-yr-old man with a history of interdigitating reticulum cell tumor (IDRCT) presented with an enlarging right cervical lymph node suspicious of recurrent disease. He reported no fevers or night sweats and was otherwise asymptomatic at the time of the fine-needle aspiration (FNA). FNA of the lymph node showed a spindle cell lesion with plump, at times deeply convoluted, large nuclei, coarsely granular chromatin, with one or two distinct nucleoli, intimately associated with mature-appearing lymphocytes. A cell block was made and immunohistochemistry was carried out. Immunopositivity for vimentin, S-100, and CD68 and immunonegativity for CD21 and AE1/AE3 were noted. This case report is the first to illustrate the FNA cytomorphology of IDRCT and to discuss the cytologic differential diagnosis of this rare tumor type in lymph nodes.     

Histiocytic lymphoma: a report of a case with an unusual phenotype

A 41-year-old female underwent a supraclavicular lymph node biopsy. Light microscopy showed a tumour with morphology suggestive of a malignant lymphoma arising from interdigitating reticulum cells (IDRC). Immunohistochemistry and enzyme histochemistry revealed the tumour cells not only to possess differentiation markers found on IDRCs but also markers characteristic of monocyte derived histiocytes. The implications of a neoplasm expressing this unusual phenotype are discussed in relation to the origin of histiocytes and their subsets.     

Lymph node interdigitating reticulum cell sarcoma

A 67-year-old man presented with a malignant tumor involving abdominal lymph nodes, spleen, liver, and lungs, with associated protracted fever and night sweats. The tumor consisted of large pleomorphic cells, often surrounding microabscesses. Intracytoplasmic S100 protein, surface T6, Leu-3a (T4), and HLA-DR antigens were demonstrated. The malignant cells also possessed ATPase activity. Ultrastructurally, the cells exhibited numerous interdigitating cell processes but no Birbeck granules. The anatomic distribution of the tumor, its ultrastructural features, immunologic phenotype, and enzymatic profile are all consistent with a derivation from lymph node interdigitating reticulum cell. The tumor was unresponsive to the chemotherapeutic agents administered, and the patient soon died.     

A malignant tumor arising from interdigitating cells; Light microscopical,ultrastructural, immuno- and enzyme-histochemical characteristics

Summary A tumor in a 37 years old male is described in which the tumor cells appeared to be derived from interdigitating cells normally found in the T-cell area of lymph nodes.The patient presented with superior vena caval obstruction due to a mediastinal mass, followed by lymph node enlargement and skin lesions leading to death within 4 months.The tumor cells lacked immune markers for lymphocytic cells. They showed Ia-like antigens and high adenosine triphosphatase activity, while acid phosphatase and -naphthyl acetate esterase activity was absent. Their fine morphology was strikingly similar to that of interdigitating cells.A combination of these data led us to the conclusion that this tumor represents a specific subtype of the tumors derived from the mononuclear phagocyte system, namely a sarcoma of interdigitating cells.     

Afferent lymph veiled cells prime CD4+ T cell responses in vivo.

The interdigitating cell (IDC) population of the lymph node paracortex is believed to be responsible for the induction of CD4+ T cell responses to soluble antigens. We have examined the role of afferent lymph veiled cells (ALVC), the putative precursors of IDC, in the induction of primary bovine CD4+ T cell responses in vivo. ALVC prepared from lymph draining an antigen inoculation site stimulated maximal responses in antigen-specific T cell clones as soon as 30 min after inoculation. In addition, antigen-pulsed ALVC were shown to induce primary antigen-specific T cell responses when administered in vivo. Observed influences of fixation and the addition of chloroquine or class II major histocompatibility complex-specific monoclonal antibodies on presenting function confirmed that ALVC process and present antigens using the endosomal pathway. We conclude that ALVC rapidly internalize antigens deposited in the periphery, and process them for presentation to naive T cells in the draining lymph node. Their function is, therefore, likely to be an important factor in the induction of primary T cell responses to soluble antigens in vivo.     

Immuno- and enzymehistochemical characterization of 'plasmacytoid T-cells' in formalin-fixed paraffin-embedded tissue of reactive lymph nodes.

In eight (10.4%) of 77 randomly selected cases of lymphadenitis, foci of 'plasmacytoid T-cells' (PTCs) were found. We characterized the PTCs in formalin-fixed paraffin-embedded tissue by immuno- and enzymehistochemical techniques. In each case the PTCs formed nodular and patchy infiltration patterns around the high endothelial venules in the paracortex of the lymph nodes. The PTCs in half of the cases were present near the intermediary peritrabecular sinuses. The PTCs were found to be positive for CD 45 (LCA), CD 45 R (4 KB 5) and CD 43 (MT 1), but not for CD 45 RO (UCHL 1), L 26 (CD 20), myeloperoxidase, naphthol AS-D chloroacetate esterase, Mac 387, alpha-1-antichymotrypsin or S 100 protein and anti-dendritic reticulum cell antibody. Some lysozyme+ PTCs were mingled in and around the foci in each case. In five cases the PTCs showed weaker positive reactions for CD 68 (EBM 11) and HLA-DR than for T-zone macrophages and sinus histiocytes. Related to the degree of desintegration of the nodular PTC-foci increasing numbers of T- and B-lymphocytes, T-zone macrophages and interdigitating reticulum cells with HLA-DR were detected in the foci. In two cases, where there was no HLA-DR expression by PTCs, small amounts of HLA-DR in secondary lymph follicles and a decrease of HLA-DR+ T-zone macrophages and interdigitating reticulum cells were observed. Our results suggest that there is a high degree of interaction between PTCs and other cellular components in the lymph node. The PTC may represent a special type of resident macrophage with secretory capacities.     

Synchronous interdigitating dendritic cell sarcoma and B-cell small lymphocytic lymphoma in a lymph node

A gradually enlarging axillary mass in a 79-year-old man was excised. The specimen was processed for light microscopy, immunohistochemical studies, and electron microscopy; gene rearrangement studies were also performed. A diagnosis of an interdigitating dendritic cell tumor of the lymph node and a B-cell small lymphocytic lymphoma occurring in the same anatomic location was made. We found that although rare cases of interdigitating dendritic cell tumor with an associated secondary malignancy have been described in the literature, to our knowledge, this is the first report of interdigitating dendritic cell tumor and synchronous neoplasm diagnosed at the same site. A possible relationship between the 2 disorders is also discussed.     

滤泡性树突状细胞肉瘤临床病理观察

目的探讨滤泡性树突状细胞肉瘤的临床病理特点及免疫表型,提高对该肿瘤的认识和诊断水平。方法通过光镜、电镜和免疫组织化学染色[EnVision法,所选用抗体为：CK（AE1／AE3）、S-100蛋白、CD1a、CD21、CD23、CD35、CD34、CD68、波形蛋白、结蛋白、HMB45、p53]观察并结合临床资料对5例滤泡性树突状细胞肉瘤进行临床病理分析。5例均获随访。结果5例患者中男3例,女2例,平均年龄37岁。肿瘤均位于头颈部淋巴结。镜下观察：肿瘤组织呈片巢状、束状或旋涡状排列,瘤细胞卵圆形或梭形,胞质丰富淡嗜酸性;核卵圆形或胖梭形,趋向不规则成簇分布,散见多核巨细胞;核染色质稀疏,核仁小而清楚;核分裂象数目不等,有时显示明显的核异型。瘤细胞CD21、CD23、CD35阳性,少数瘤细胞CD68、S-100蛋白阳性,CD1a、CD34、HMB45、CK均阴性。电镜下瘤细胞有长而明显的绒毛状胞质突起及特征性的桥粒样连接,未见Birbeek颗粒。随访5～52个月（平均26个月）,无复发或再复发及转移。结论滤泡性树突状细胞肉瘤是一种少见的恶性肿瘤,预后不确定。正确诊断需要病理组织形态、电镜及免疫组织化学相结合,并应与朗格汉斯细胞肉瘤、指突状树突状细胞肉瘤、恶性纤维组织细胞瘤、黑色素瘤、梭形细胞癌等相鉴别。     

Interdigitating dendritic cell sarcoma of the ileum recurred in multiple lymph nodes and duodenum three years after operation without chemotherapy

Neoplasms derived from interdigitating dendritic cell are extremely rare. Here we describe a case of a 47-year-old man with interdigitating dendritic cell sarcoma (IDCS) in the ileum. He was admitted to a hospital due to ileus. The ileal tumor, measuring 2 cm, was detected and resected with regional lymphadenectomy. At that time, a pathologic diagnosis of malignant peripheral nerve sheath tumor was made. The patient, who was not treated with chemotherapy, showed no signs of recurrence. After three years, we detected cervical lymphadenopathy and multiple duodenal masses in the patient in our hospital. Oval to spindle-shaped atypical cells, which resembled ileal tumor cells, infiltrated into the lymph node and duodenum. Immunohistochemical staining of these three lesions revealed positivity of S100 protein and several macrophage-related antigens. Based on the histologic and immunohistochemical analysis, the histopathologic diagnosis of IDCS was confirmed. To our knowledge, five cases of IDCS arising in the intestinal tract have been reported to date, and only one case, treated with both surgery and chemotherapy, led to remission. This is the first case that has a comparatively favorable prognosis without chemotherapy after surgery.     

Interdigitating cell sarcoma: A morphologic and immunologic study of lymph node lesions in four cases

lnterdigitating cell sarcoma is an extremely rare tumor. Its presentation and histologic appearance has varied among the reported cases. In this study, the authors investigated four cases of the hematolymphoid malignancy arising within lymph nodes, which were considered to be of interdigitating cell origin. All patients presented in the 6th to 8th decade of life with peripheral lymphadenopathy, and had a relatively indolent clinical course, without bone marrow or skin involvement. Carcinomas were observed as a second neoplasm in two of four patients. Distinctive morphologic features are proliferation of histiocyte-like cells with nuclear pleomorphism and occasionally multinucleated, paracortical distribution sparing of B-cell regions, fibrosis, sinus infiltration, and a prominent eosinophi/plasma cell infiltrates. The combination of light microscopic, fine structural, and immu-nohistochemical features suggested that these tumors derive from interdigitating cells: these tumor cells expressed CD68 (KP1), S-100 protein and HLA-DR, but lack CD21 (1F8), desmosomes and Birbeck granules. The diagnosis of interdigitating cell sarcoma should be considered on any pleo-morphic tumor with the features described in this report.     

指状树突细胞肉瘤/肿瘤的临床病理观察

目的 探讨指状树突细胞肉瘤/肿瘤(IDCS)的病理特征、诊断及鉴别诊断.方法 分析3例IDCS的临床表现,对标本进行病理形态和免疫组织化学(EnVision法)染色观察.结果 大体检查肿瘤呈灰白、灰黄色,质实.1例发生于左肺,1例原发于脾脏伴全身淋巴结累及,1例发生于淋巴结.光镜下肿瘤组织呈边界不甚清楚的巢片状,部分呈束状、旋涡状排列,周边较多淋巴细胞、浆细胞浸润.肿瘤细胞呈卵圆形或梭形,胞质透亮或轻度嗜酸性,核卵圆形,呈空泡状,可见不明显的小核仁,部分见有核沟.免疫组织化学肿瘤细胞表达S-100蛋白.结论 IDCS是一种罕见的组织细胞和树突细胞恶性肿瘤,有一定的病理学特征.应与滤泡树突细胞肉瘤、炎性假瘤、朗格汉斯细胞组织细胞增生症、恶性黑色素瘤、未分化癌及间变性大细胞淋巴瘤等鉴别.免疫组织化学S-100蛋白等标记对鉴别诊断有帮助.     

Interdigitating dendritic cell sarcoma of the duodenum with rapidly fatal course: a case report and review of the literature

Interdigitating dendritic cell sarcoma is an extremely rare malignancy derived from antigen-presenting cells. Dendritic cells constitute a heterogeneous group of cells, which includes Langerhans cells, dermal dendrocytes, follicular dendritic cells, and interdigitating dendritic cells present in lymphoid and nonlymphoid organs. We report the case of a 36-year-old woman who presented with epigastric pain, projectile vomiting, and significant weight loss. Upper gastrointestinal endoscopy showed a duodenal lesion; a biopsy of the lesion was taken and was diagnosed as sarcoma. She underwent a Whipple procedure. A final diagnosis of interdigitating dendritic cell sarcoma was made, with liver and peripancreatic lymph node involvement. The patient deteriorated rapidly and died 4 months later. Although interdigitating dendritic cell sarcoma of the duodenum is extremely rare, we think it should be included in the differential diagnosis of unusual spindle cell tumors with a rich lymphocytic infiltrate.     

T-cell variant of classical Hodgkin's lymphoma with nodal and cutaneous manifestations demonstrated by single-cell polymerase chain reaction

The atypical cells of CD30(+) cutaneous lymphoproliferative disorders (CD30CLD) are commonly of T-cell origin and frequently have a similar morphology as Hodgkin or Reed-Sternberg cells of Hodgkin's lymphoma (HL). HL is one of the tumors associated with CD30CLD. Although most studies support a B-cell derivation of the tumor cells in HL, recently a few cases of classical HL with T-cell genotype have been reported. We report a patient who presented with CD30CLD whose lymph nodes showed classical HL of mixed cellularity subtype at presentation. By single-cell PCR, the same clonal gene rearrangements of the T cell receptor-beta gene locus could be assigned to the CD30(+) and CD15(+) cells of both skin and lymph node. In a lymph node biopsy specimen taken in relapse after several courses of chemotherapy, the CD30(+) tumor cells were abundant. The T cell-derived tumor cells displayed aberrant expression of the Pax-5 gene in all specimens. A common clonal origin of both CD30CLD and HL of the lymph node in the patient presented here suggests that HL with T-cell genotype exists in association with CD30CLD as well as in sporadic cases and may share clonal origin with the skin tumor.     

Size, CD4 and CD8 marker profiles and functions of lymphocyte subpopulations in mucosal-associated lymph nodes.

We analyzed phenotypic and functional characteristics of T cell populations in mucosal-associated supramammary and mesenteric lymph nodes in goats. Here we demonstrate, by flow cytometry, quantitative differences in CD4 and CD8 T cell subsets among large and small mucosal-associated lymphocyte populations and their differential regulatory activities on resident lymph node B cells stimulated with Staphylococcus aureus Cowan I or pokeweed mitogen. The CD4/CD8 T cell ratio was lower in mesenteric lymph nodes (1.46) when compared to that of supramammary lymph nodes (2.18). Analysis of large and small lymphocyte subpopulations from lymph nodes showed nearly 62% of the lymphocytes from mesenteric lymph nodes being of large cell phenotype with CD4/CD8 ratios of 1.34. In contrast, large cell subpopulations in supramammary lymph nodes showed a significantly lower number (50%) with a higher CD4/CD8 ratio of 2.05. Functionally, mesenteric lymph node T cells, isolated by nylon wool, showed heightened suppressive activity in mitogen-driven B cell proliferation responses, whereas T cells from supramammary lymph nodes were stimulatory. These findings clearly demonstrate distinctive functional properties between resident T cell populations of supramammary and mesenteric lymph nodes, suggesting that different proportions of T cell subsets in these nodes are activated and thus regulate regional immune responses via different pathways.     

Variation in the histological pattern of nodal involvement by gamma/delta T-cell lymphoma

AIMS: Gamma-delta (gammadelta) T-cell non-Hodgkin's lymphomas (NHLs) usually present with liver, spleen and marrow infiltration. Lymph node involvement by gammadelta T-cell NHL has been rarely documented so far; its histological pattern needs to be further defined. METHODS AND RESULTS: Two cases of nodal gammadelta T-cell NHL are reported: case 1, a 44-year-old man, presented with cytomegalovirus retinitis and superficial lymphadenopathies. Histological analysis of an inguinal lymph node showed complete destruction by a diffuse pleomorphic lymphoid proliferation, which was positive for CD2, CD3, CD43, CD45, TIA-1 and granzyme B, and displayed a gammadelta phenotype (deltaTCR1+, Vdelta1+, Vdelta2-, Vdelta3-, betaF1-). Bone marrow was normal. Case 2, a male 24-year-old patient with a history of renal transplantation, presented with hepatosplenomegaly and supraclavicular lymph node enlargement. Lymph node architecture was globally preserved. Peripheral sinuses contained scattered nests of medium-sized irregular lymphoid cells. Bone-marrow was infiltrated. Phenotype showed positivity for CD2, CD3, CD45 and TIA1 and expression of gammadelta TCR (deltaTCR1+, deltaV1+, deltaV2-, deltaV3-, betaF1-). Both patients died a short time after diagnosis. CONCLUSIONS: These observations suggest that at least two forms of nodal gammadelta T-cell NHL may be encountered: one mimicking classical alphabeta T-cell NHL, with diffuse pleomorphic cell proliferation, and one displaying sinusoidal neoplastic infiltration suggesting a close relationship with hepatosplenic gammadelta T-cell NHL.     

Giant lymph node hyperplasia of the hyaline vascular type with plasmacytoid T-cells and presentation in infancy

Giant lymph node hyperplasia is uncommon in children and is exceptionally rare in infancy. The authors report a case of giant lymph node hyperplasia that presented as a right supraclavicular mass in an asymptomatic two-month-old female infant. Clinically, the mass was thought to be either a lipoma or a cystic hygroma, and it was followed for more than two years before excision. Histologically, the tumor showed classic features of giant lymph node hyperplasia of the hyaline vascular type but also showed many clusters of plasmacytoid T-cells.     

Interdigitating dendritic cell sarcoma of lymph node mimicking granuloma: a case report and review of the literature

Interdigitating dendritic cell sarcoma (IDCS), is an extremely rare neoplasm. We report a case of a 77-year-old man presented with gradual lymph nodes enlargement in inguina, neck and axilla for 6 months. Biopsy revealed that part of the lymph node was replaced by several large granuloma-like nodules composed of mild atypical tumor cells, resembling epithelioid cells. Mitotic figures were hardly found. Immunohistochemistry showed that tumor cells were positive for S-100, CD68 and CD45. Ki-67 labeling index was 5%. To the best of our knowledge, this is the first case of IDCS showing granuloma-like growth pattern with mild atypical tumor cells.     

Phenotypic and Functional Analysis of Mucosal Lymph Node T Cell Subpopulations Proximal and Distal to Chronic Staphylococcal Antigen Challenge

We investigated the functional and subset surface marker characteristics of supramammary lymph node T cell populations at sites proximal and distal to the mammary region of goats repeatedly injected with heat-treated Staphylococcus aureus antigen (HK-SAC). Flow cytometric studies showed quantitative differences in CD4⁺ and CD8⁺ T cell subsets among large and small lymphocyte populations in ipsilateral and contralateral supramammary lymph nodes of these animals. Although ipsilateral (draining) lymph nodes were enriched with CD4⁺ and CD8⁺ T cells, CD4/CD8 ratios were comparatively lower than those of contralateral (non-draining) lymph nodes (2.30 vs 2.60, respectively). Cell size analysis by flow cytometry showed that nearly 70% of the lymphocytes in ipsilateral nodes were of large cell phenotype with CD4/CD8 ratios of 2.52. In contrast, there were only 56.1% large lymphocytes in contralateral lymph nodes but with similar CD4/CD8 ratios of 2.55. The number of large lymphocytes in corresponding nodes of uninoculated control animals was significantly lower (50%) with much lower CD4/CD8 ratios (2.08). Alloantigenic responses of both ipsilateral and contralateral lymph node T cells were greater than those of uninoculated controls. Antigen-specific proliferation studies showed that ipsilateral lymph node T cells greatly enhanced both primed and non-primed lymph node B cell responses to HK-SAC, whereas those from contralateral lymph nodes were less stimulatory. In contrast, contralateral lymph node T cells had greater enhancing effects on PWM-induced polyclonal B cell responses. These studies indicate that repeated local infection with bacterial antigen induce changes in the numbers, ratios and antigen-specific and non-specific responses among ipsilateral (draining) and distal contralateral (non-draining) lymph node T cell populations in mucosal-associated immune systems such as the mammary gland.