Extranodal follicular dendritic cell sarcoma of the soft palate: a case report

Follicular dentritic cell sarcoma (FDCS) is an extremely rare malignant neoplasm arising from the accessory cells of the lymph nodes, the follicular dendritic cells. They commonly occur in the lymph nodes, but have also been reported at extranodal sites. Because of its rarity, FDCS is not easily to make a diagnosis by clinicians or pathologists. Herein, we report a soft palate tumor in a 59-year-old female, with a history of tonsillectomy. Pharynx MRI scan revealed a 4.7×3.0×3.5 cm mass at the right side of the parapharyngeal space. The pathology results returned as Follicular dentritic cell sarcoma. The patient underwent a tumorectomy and adjuvant postoperative radiotherapy. The patient was free of disease 1 year after the end of the treatment. The FDCS is an infrequent nonlymphoid malignant tumor accounting for less than 1% of all head and neck tumors. The immunohistochemical technique is essential for accurately identifying this class of tumour.     

Composite mantle cell and follicular lymphoma. A case report

We describe the association of 2 types of small B-cell lymphomas with different morphologic and immunophenotype patterns inside the same lymph node. Morphologically distinct zones were detected and studied with immunohistochemistry analyses. Most of the areas examined were characteristic of classic mantle cell lymphoma (CD20+, CD5+, cyclin D1+) with nodular and mantle zone areas. However, other areas had the morphologic and immunohistochemistry pattern of follicular lymphoma (CD20+, CD10+, Bcl2+). The diagnosis of both lymphomas was confirmed by polymerase chain reaction detection of both Bcl-1 MTC and Bcl-2 MBR rearrangements. DNA degradation in fixed tissue prevented a complete polymerase chain reaction analysis of immunoglobulin heavy chain rearrangements, but a single immunoglobulin H rearrangement was detected at the FR3 locus. These findings confirm the presence of a monoclonal cell population but do not demonstrate the same clonal origin for both lymphoma populations.     

Nodal follicular helper T-cell lymphoma may present with different patterns. A case report

We report the case of a 62-year-old patient presenting with 3 different patterns of follicular helper T-cell lymphoma. The patient initially presented with angioimmunoblastic T-cell lymphoma. A nodal relapse in the form of follicular T-cell lymphoma with a progressively transformed germinal center pattern occurred 8 years later. Two years later, this was followed by another relapse presenting as a predominantly large-cell peripheral T-cell lymphoma, unspecified. All neoplastic cells expressed CD3, CD5, and CD2, with some neoplastic cells also expressing CD7. These cells also expressed CD4, with some expressing CD10, bcl-6, CXCL13, and programmed death-1, all of which are characteristic of the normal subset of follicular T-helper cells. The immunophenotype showed a progressive increase in the proportion of cells expressing CD10, bcl-6, CXCL13, and programmed death-1 from the first to the last lymphoma. In addition, neoplastic T cells from the last biopsy sample expressed CD20.     

Mediastinal follicular dendritic cell sarcoma involving bone marrow: a case report and review of the literature

We report a rare case of mediastinal follicular dendritic cell (FDC) sarcoma involving the bone marrow. The patient, a 46-year-old woman, had a clinically aggressive tumor in the anterior mediastinum that was initially diagnosed as a diffuse B-cell lymphoma. She received chemotherapy but showed no significant improvement. One year later, the patient presented at our institution with pelvic bone metastases. Biopsy specimens of the sacrum lesion and bone marrow were obtained. The diagnosis of FDC sarcoma was made based on histological examination and immunohistochemical findings, including strong positive staining of tumor cells for CD21, CD23, clusterin, and epidermal growth factor receptor (EGFR) and negative staining for CD20, CD30, CD45, CD1a, S-100, vimentin, and keratin cocktail. Histological examination and immunohistochemical studies of a previous biopsy of the mediastinal mass confirmed the diagnosis of mediastinal FDC sarcoma. The patient was treated with an appropriate chemotherapy regimen; 1 month later, follow-up bone marrow biopsy revealed no tumor cells. Although FDC sarcoma is considered a low-grade tumor, the tumor in the present case not only developed at an unusual location with bone metastasis but also involved bone marrow. To our knowledge, this is the first such case ever reported. This case also highlights the utility of EGFR as an immunohistochemical marker of dendritic cell tumors that could be used as a diagnostic tool and guide for choosing appropriate chemotherapy regimens.     

Primary follicular lymphoma of the extrahepatic bile duct mimicking a hilar cholangiocarcinoma: case report and review of the literature

We report a case of a 53-year-old Asian woman who presented with abdominal pain, bloating, dysphagia, and signs of incomplete biliary obstruction, having elevated liver function tests but without increased bilirubin. Imaging studies revealed a mass measuring 6.0 × 8.0 cm at the porta hepatis extending to the right lobe of the liver and obstructing the common hepatic duct, causing mild to moderate intrahepatic biliary dilation and variable occlusion of the right portal vein. At laparotomy, an infiltrative neoplasm was noted at the hilum that involved the common bile duct, right and left hepatic ducts, and the right lobe of the liver. Extended right hepatectomy and resection of the extrahepatic bile duct and right portal vein was performed. Histologic examination revealed a high grade follicular lymphoma (grade 3A) with a predominantly follicular pattern of growth. Portal lymph nodes and a staging bone marrow biopsy showed no evidence of lymphoma. The patient subsequently received chemotherapy. Postoperative follow-up of more than 4 years has been uneventful, without disease recurrence. To the best of our knowledge, this is the third report of a primary extranodal follicular lymphoma of the extrahepatic biliary system.     

Evaluation of respiratory mechanics and lung histology in a model of atelectasis

To develop a reproducible model of atelectasis, 15 mechanically ventilated Wistar rats were wrapped around the thorax/abdomen with a sphygmomanometer. The cuff was inflated to transpulmonary pressures (PL) of -4 cmH2O (group A) and -8 cmH2O (group B) for 5 sec. Group C was not compressed. Airflow, volume, tracheal and oesophageal pressures were registered. Respiratory system (rs), lung (L), and chest wall resistive (DeltaP1), viscoelastic/inhomogeneous pressures (DeltaP2), DeltaPtot (=DeltaP1 + DeltaP2), static (Est) and dynamic (Edyn) elastances, and DeltaE (=Edyn - Est) were determined before and after compression. In A, respiratory mechanics remained unaltered. In B, Est,rs (+99%), Est,L (+111%), DeltaE,rs (+41%), DeltaE,L (+73%), DeltaP1,rs (+45%), DeltaP1,L (+44%), DeltaP2,rs (+41%), DeltaP2,L (+69%), DeltaPtot,rs (+40%), and DeltaPtot,L (+58%) increased after compression. Mean alveolar diameter and bronchiolar lumen decreased in A, and were even smaller in B. In conclusion, chest wall compression with PL of -8 cmH2O yielded a reproducible alveolar collapse, which resulted in increased elastic, resistive and viscoelastic/inhomogeneous pressures.     

Risk factors for the development of bronchiolitis obliterans in children with severe adenovirus pneumonia: A retrospective study with dose-response analysis

To investigate and analyze the relevant risk factors for bronchiolitis obliterans (BO) in children with severe adenovirus pneumonia, a retrospective study of children with severe adenovirus pneumonia was performed in 34 cases that developing BO and 105 cases not developing BO in Children's hospital of Chongqing Medical University from January 2015 to February 2019. The multivariate logistic regression analysis was used to identify factors which were significantly associated with development of BO after the univariate analysis, and receiver operating characteristic (ROC) curve analysis was performed to find out the cut-off value for the significant relevant factors. A nonlinear dose-response relationship between risk factors and the risk of BO was assessed by restricted cubic spline model. Three factors were independently associated with development of BO, which were length of fever (OR 1.129, 95% CI 1.033-1.234), dyspnea (OR 3.922, 95% CI 1.060-14.514) and invasive mechanical ventilation (OR 6.861, 95% CI 1.854-25.387). The cut-off value of length of fever were 10.5 days. A linear dose-response relationship between length of fever and occurrence of BO was observed (P = .57 for nonlinearity). Children with severe adenovirus pneumonia who have a longer duration of fever (especially more than 10.5 days), have dyspnea or require invasive mechanical ventilation in the acute phase are more likely to develop BO.     

Extranodal follicular dendritic cell sarcoma of the tonsil - case report of an epithelioid cell variant with osteoclastic giant cells

Follicular dendritic cell sarcomas are rare neoplasms arising from the accessory cells of the lymph nodes, the follicular dendritic cells. They commonly occur in the lymph nodes, but have also been reported at extranodal sites (especially the tonsil). At both sites, there is usually a proliferation of spindled to ovoid cells, mimicking a mesenchymal tumor. Herein, we report a tonsillar tumor in a 50-year-old man, which was composed exclusively of large polygonal cells and numerous osteoclastic giant cells that resembled a giant cell carcinoma. The true nature of the tumor was revealed after an array of immunohistochemical stains. The patient is well 4 years after tonsillectomy.     

Follicular lymphoma mimicking marginal zone lymphoma in lymph node: a case report

Nodal follicular lymphoma (FL) is typically composed of follicular or nodular proliferation of small cleaved lymphoid cells, presumably derived from germinal center (GC) B cells. The hallmark of FL is t(14;18)(q32;q21) chromosomal translocation, which juxtaposes anti-apoptotic gene BCL2 to immunoglobulin heavy chain (IGH) promoter. Reflecting this background, FL cells are immunohistochemically positive for BCL2 as well as GC B cell markers CD10 and BCL6. It is known that low grade B-cell lymphomas, including FL, chronic lymphocytic leukemia/small lymphocytic lymphoma, and marginal zone lymphoma, are sometimes associated with marginal zone differentiation or plasmacytic differentiation. The marginal zone differentiation obscures the morphological differences among these, providing diagnostic challenges for histopathologists. In this paper, we present a case of FL, originally mimicking marginal zone lymphoma in the axillary lymph node. Subsequent bone marrow biopsy showed paratrabecular infiltration of small to medium-sized lymphoid cells. Immunohistochemical analysis of the bone marrow biopsy together with histopathology and flow cytometry of the axillary lymph node led to a final diagnosis of FL with marginal zone differentiation in the axillary lymph node and its bone marrow infiltration. Our case illustrates and reconfirms the importance of clinicopathological correlation which leads to a correct diagnosis.     

Parotid gland follicular lymphoma lacking both cytoplasmic and surface light chains: a rare case

Immunoglobulin light chain (LC) restriction is detected in the majority of B-cell non-Hodgkin lymphoma (B-NHL) by flow cytometric immunophenotyping (FCI) and serves as a surrogate marker of monoclonality. Even though it is known a small percentage of mature B-NHLs lacking surface LC, deficiency of both cytoplasmic and surface LCs has been reported in only three B-NHL cases. We report a primary parotid gland follicular lymphoma in a 63-year-old man and the lymphoma cells were deficient of cytoplasmic/surface LCs. Compared to previous reports, we used a more sensitive FCI method by combining both monoclonal and polyclonal anti-LC antibodies. Lacking LCs poses as a pitfall for the initial diagnosis of B-NHL, as well as for detecting minimal residual disease. It is important to be aware of this rare immunophenotypic aberrancy.     

Cytomorphologic appearance of follicular dendritic-cell tumor: a case report

Follicular dendritic-cell (FDC) tumors are extremely rare, recently described neoplasms. Only one report currently exists in the cytology literature. We present a case of FDC tumor with emphasis on its cytomorphology and its correlation with histology, immunohistochemistry, and ultrastructure.     

Significance of C4d deposition in the follicular lymphoma and MALT lymphoma and their relationship with follicular dendritic cells

We evaluated the deposition of C4d in follicular lymphomas (FL) and extranodal marginal zone B-cell lymphomas of mucosa-associated lymphoid tissue (MALT lymphoma). Deposition of C4d was detected in 118 lymphoma tissues from patients with lymphoma and in 20 reactive hyperplasia lymphadens (RHL) using immunohistochemistical methods. FL, MALT lymphoma, and RHL were studied using double staining for CD35/C4d and Bcl-2/C4d. We studied 26 FL tissues, 19 of which showed C4d deposition. C4d deposition was detected around the follicular dendritic cells (FDCs) in the neoplastic follicles. There was no significant difference between the positive ratio of C4d and the grades of FL. We studied 12 MALT lymphoma tissues, six of which displayed C4d deposition. In these tissues, C4d deposition was detected in the peripheral region of partially colonized follicles in the form of an irregular ring, but was not found in the central region. C4d deposition was negative in completely colonized follicles. There was no C4d deposition in diffuse large B-cell lymphomas, mantle cell lymphomas, B-small lymphocytic lymphomas, T-lymphoblastic lymphomas, peripheral T-cell lymphomas, and anaplastic large cell lymphomas. C4d around the FDCs in the neoplastic follicles was a specific indicator for FL. C4d deposition in partially colonized follicles of MALT lymphoma was completely different from that in neoplastic follicles of FL, forming a key point for differential diagnosis.     

Cryptogenic organizing pneumonia associated with invasive pulmonary aspergillosis: a case report and review of the literature

Background: Concomitant occurrence of invasive pulmonary aspergillosis (IPA) with cryptogenic organizing pneumonia (COP) is scarce. Here, we report a case where COP was a presenting feature in a patient with diagnosed IPA, and review additional 58 COP patients reported in the literature from 1988 through 2013. Case outline: The study was reviewed and approved by the Institutional Ethics Committee of Shanghai Tenth People’s Hospital of Tongji University and was conducted in compliance with the Helsinki Declaration. Written informed consent was obtained from patient. A 56-year-old man presenting with productive cough for several weeks and unremitting high fever for a week was hospitalized with an initial clinical diagnosis of pneumonia, for which antibiotics were prescribed but did not work. Seeing that the condition progressed both clinically and radiographically, bronchoscopy, bronchoalveolar lavage and lung biopsy were performed, and the diagnosis of cryptogenic organizing pneumonia (COP) and invasive pulmonary aspergillosis (IPA) co-existence was made. Initially, the patient responded to steroid pulse therapy and voriconazole treatment, and his condition was partially improved. However, the patient’s condition deteriorated progressively 5 months after the disease onset and the patient died during the third admission due to respiratory failure and the adverse reactions of coriaceous hormone therapy. Conclusion: The diagnosis of cryptogenic organizing pneumonia (COP) and invasive pulmonary aspergillosis (IPA) co-occurrence depends on clinical, radiological and histological presentations. Similarities with other disease processes could lead to a delayed diagnosis or misdiagnosis. The present case suggests that clinicians should be alert to this disease in their clinical practices.     

甲状腺滤泡癌合并鳞状细胞癌1例

甲状腺滤泡癌合并鳞状细胞癌非常罕见,本例肿瘤具有滤泡癌和鳞状细胞癌的组织学特点,两种成分存在移行和过渡,诊断依靠形态学结合免疫组织化学染色和详尽的全身检查。该病进展较快,预后不一,规范治疗后需长期随访。     

甲状腺滤泡癌合并鳞状细胞癌1例

甲状腺滤泡癌合并鳞状细胞癌非常罕见,本例肿瘤具有滤泡癌和鳞状细胞癌的组织学特点,两种成分存在移行和过渡,诊断依靠形态学结合免疫组织化学染色和详尽的全身检查。该病进展较快,预后不一,规范治疗后需长期随访。     

The fine-needle aspiration appearance of the follicular variant of thyroid papillary carcinoma: A report of three cases

The follicular variant of thyroid papillary carcinoma (FVTPC) is an uncommon neoplasm with the architectural features of a follicular lesion and the nuclear characteristics of a papillary carcinoma. The fine-needle aspiration (FNA) appearance is underreported in the literature. Three cases of histologically confirmed FVTPC that were aspirated prior to surgery are presented. Although the cytological features were suspicious or confirmatory of a low-grade thyroid carcinoma, they did not convey a specific diagnosis of the FVTPC. We suggest that this variant is recognizable as a neoplasm requiring surgical excision on FNA, but that the cytological appearance does not allow its specific diagnosis.