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Background
This term and disease was relatively common prior to age of immunohistochemistry and sophisticated molecular biology techniques which pathologists helped to pioneer. Cases which have previiously been reported as histiocytic lymphoma almost all represent lymphomas of T or B lineage, especially anaplastic large cell lymphoma. The commonest sites of involvement by true histiocytic lymphomas are lymph node, gastrointestinal tract, skin, and soft tissue. Regardless of site, this tumor has an aggressive behavior and most often presents with a high stage of disease. The pathologist must rely upon a combination of the morphologic features of histiocytes an appropriate immunohistochemical markers. Although not specific, CD68 and lysozyme have been used. This positivity is combined with lack of markers for T and B cell malignancies, myeloid markers, CD30, and Langherhans cells.
The International Lymphoma Study Group has identified the following classification scheme:
CATEGORY DISEASES Macrophage/Histiocytic neoplasms Histiocytic sarcoma Dendritic Cell Neoplasms Langerhans Cell Tumor
Langerhans Cell Sarcoma
Interdigitating Cell Tumor/Sarcoma
Follicular Dendritic Cell Tumor/SarcomaUnclassifiable
DISEASE Histiocytic sarcoma Langerhans cell tumor/sarcoma Interdigitating cell tumor/sarcoma Follicular dendritic cell tumor/sarcoma
Adapted from Pileri SA, Grogan TM, Harris NL, etal. Histopathology 2002;31:1-29.OUTLINE
EPIDEMIOLOGY CHARACTERIZATION SYNONYMS Malignant histiocytosis
Histiocytic sarcomaAGE Mean 44 years, wide age range INCIDENCE Histiocytic sarcomas and monoblastic leukemias. A clinical, histologic, and immunophenotypical study.
Lauritzen AF, Delsol G, Hansen NE, Horn T, Ersboll J, Hou-Jensen K, Ralfkiaer E.
Department of Pathology, Herlev Hospital, University of Copenhagen, Denmark.
Am J Clin Pathol 1994 Jul;102(1):45-54 Abstract quote
Eight histiocytic sarcomas, identified by examination of more than 2000 malignant lymphomas, are described.
For comparison, tumor infiltrates from five monoblastic leukemias were also analyzed. The histiocytic sarcomas were all high-grade malignancies consisting of markedly pleomorphic large cells with many mitotic figures. At presentation, six of the patients had systemic symptoms (fever, fatigue, loss of weight), skin infiltrates, and lymphadenopathy. Despite aggressive chemotherapy, clinical remissions were short, and six patients died of disease .5-48 months (mean, 6.5 months) after diagnosis. The remaining two patients are alive and in partial or complete remission 7 and 12 months after diagnosis. Immunotypic examination showed that all the histiocytic sarcomas were positive for macrophage-related antigens and negative for antigens on B cells, T cells, myeloid cells, epithelial cells, and melanocytes. T-cell receptor and immunoglobulin genes were studied in three cases and were present in a germline configuration. One of the histiocytic sarcomas resembled Langerhans' cells in phenotype and morphology; it was classified as a Langerhans' cell sarcoma. The remaining histiocytic sarcomas did not express accessory cell-associated antigens, but more closely resembled "ordinary" tissue macrophages; they were positive for lysozyme and/or CD68, followed in frequency by CD11c, CD4, CD11b, CDw32, peanut agglutinin receptor, and CD13. Similar features were seen in the monoblastic leukemias. These conditions could only be distinguished from histiocytic sarcoma by clinical and morphologic, rather than immunophenotypic, criteria. Expression of oncoprotein p53 was studied in nine cases and was positive in six of six histiocytic sarcomas and one of three monoblastic leukemias. Rare malignancies show features consistent with the derivation from macrophages. Two entities may be distinguished: those that resemble antigen-presenting accessory cells and those that more closely resemble ordinary tissue macrophages.
Recognition of these tumors is important clinically and requires assessment of clinical, morphologic, and immunophenotypic features, supplemented by analysis of T-cell receptor and immunoglobulin genes. Whether (or how) p53 gene mutations are implicated in their pathogenesis will be an important topic for future investigation.
DISEASE ASSOCIATIONS CHARACTERIZATION True histiocytic lymphoma following B-acute lymphoblastic leukaemia: case report with evidence for a common clonal origin in both neoplasms.
Bouabdallah R, Abena P, Chetaille B, Aurran-Schleinitz T, Sainty D, Dubus P, Arnoulet C, Coso D, Xerri L, Gastaut JA.
Department of Haematology, Cancer Centre Institut Paoli-Calmettes, Universite de la Mediterranee, Marseille, France.
Br J Haematol 2001 Jun;113(4):1047-50 Abstract quote
True histiocytic lymphoma (THL) is a very rare type of non-Hodgkin's lymphoma (NHL) in which neoplastic cells exhibit markers of histiocytic differentiation. Some cases of THL have been reported in patients with previous acute lymphoblastic leukaemia (ALL), especially in children and young adults, in whom the acute leukaemia was of T-cell origin. The relationship between the initial lymphoid tumour and the secondary THL remains unclear, as a common monoclonal origin shared by both neoplasms has never been definitively demonstrated.
We report a patient with B-ALL who developed a nodal and extranodal tumour with histological and immunohistochemical features of THL 4 years after the initial diagnosis. Genotypic study showed that both neoplasms contained the same immunoglobulin heavy gene rearrangement, which has not been reported previously.
GROSS APPEARANCE/
CLINICAL VARIANTSCHARACTERIZATION GENERAL VARIANTS CNS
Histiocytic sarcoma is a rare, malignant neoplasm of the lymphohematopoietic system that usually occurs in the skin, lymph node, and intestinal tract. Here we describe a unique case of primary central nervous system histiocytic sarcoma that initially showed an indolent clinical course following local resection and radiotherapy. However, relapse of disease within the mediastinum was noted 3 1/2 years later.
Biopsies of the initial brain lesion and subsequent mediastinal recurrence each revealed an identical, diffuse proliferation of histiocytes with expression of CD45, CD68, and CD163 but not pan-cytokeratin, epithelial membrane antigen, CD3, CD15, CD20, CD30, CD43, CD79a, CD138, myeloperoxidase, ALK-1, PAX-5, CAM 5.2, S100, CD1a, or glial fibrillary acidic protein.
In the literature, central nervous system histiocytic sarcoma portends a poor prognosis with median survival of 4.5 months.
To our knowledge, this case represents the first case of "low-grade" primary central nervous system histiocytic sarcoma with relatively indolent clinical course.
A thorough discussion of the differential diagnosis of histiocytic sarcoma and a review of primary central nervous system histiocytic sarcoma are also presented.
Histiocytic sarcoma involving the central nervous system: clinical, immunohistochemical, and molecular genetic studies of a case with review of the literature.Sun W, Nordberg ML, Fowler MR.
Am J Surg Pathol 2003 Feb;27(2):258-65 Abstract quote Histiocytic sarcoma (HS) is a rare disease, and there has been much confusion concerning the diagnostic criteria for this entity. Since immunohistochemical and cytogenetic techniques have become more universally available, many cases initially diagnosed as histiocytic sarcoma have been reclassified as other diseases.
We describe a case of HS that presented as a single mass lesion in left occipital lobe. At autopsy the tumor also involved the meninges as a thick exudate. Histologic examination showed numerous large pleomorphic malignant cells with areas of necrosis, numerous neutrophils, and phagocytosis by tumor cells. Immunohistochemically, the tumor cells stained positively with antibodies directed against most histiocytic markers and did not stain with antibodies directed against myeloid markers, dendritic markers, CD30, ALK1, or other lymphoid markers. Molecular cytogenetic analysis showed no rearrangement [i.e. t(2;5) translocation or other variant] by fluorescence in situ hybridization. The T-cell receptor-gamma chain by multiplex polymerase chain reaction showed a polyclonal pattern. No heavy or light chain gene rearrangements were found.
To our knowledge, this is the first reported autopsy case of this rare entity primarily involving the brain and meninges.
Primary Histiocytic Lymphoma of the Central Nervous System A Neoplasm Frequently Overshadowed by a Prominent Inflammatory Component
Wah Cheuk, M.B.B.S. ; Norman Walford, M.B. , F.R.C.Path. ; June Lou, M.B.B.S. ; Arthur K. C. Lee, M.B.B.S. ; C. F. Fung, M.B.B.S. ; K. H. Au, M.B.B.S. ; L. S. Mak, B.Sc. ; John K. C. Chan, M.B.B.S.
From the Department of Pathology (W.C., L.S.M., J.K.C.C.) and the Department of Oncology and Radiotherapy (K.H.A.), Queen Elizabeth Hospital; and the Departments of Pathology (N.W.) and Pediatric Oncology (J.L.), Kadang Kerbau Women's and Children's Hospital, Singapore; and St. Paul's Hospital, Hong Kong (A.K.C.L., C.F.F.).
Am J Surg Pathol 2001;25:1372-1379 Abstract quote
True histiocytic lymphoma, as defined by strict criteria, is a very rare neoplasm.
We describe three cases occurring as primary tumors in the central nervous system. The patients, two females and one male, ranged in age from 11 to 69 years. The tumors involved the brain in two cases and spinal cord in one, with a size ranging from 7 to 17 mm. Two patients died at 4 months and 8 months, respectively, and one was alive with disease at 5 months. Pathologically, the tumors comprised groups and sheets of noncohesive large cells with pleomorphic vesicular nuclei, distinct nucleoli, and abundant eosinophilic cytoplasm. A dense inflammatory infiltrate consisting of neutrophils, lymphocytes, plasma cells, and histiocytes was present, with multiple foci of necrosis and abscess formation.
All three cases demonstrated an identical immunophenotype: positive for CD68 and lysozyme; focally positive for S-100 protein, CD45RB, and CD4; and negative for CD3, CD20, CD21/CD35, CD1a, CD30, ALK1, myeloperoxidase, glial fibrillary acidic protein, and cytokeratin. The proliferative index ranged from 20% to 35%.
Ultrastructural examination further confirmed the histiocytic nature of the tumor cells, characterized by irregularly folded or multisegmented nuclei and abundant cytoplasm containing lysosomes; Birbeck granules, interdigitating cell processes, and cell junctions were not found.
Although the presence of abundant inflammatory cells could obscure the neoplastic histiocytes, making the distinction from inflammatory conditions difficult, awareness of this unusual histologic feature and the invariable finding of pleomorphic cells in some areas of the lesion permit the correct diagnosis to be made.
GASTROINTESTINAL TRACT True histiocytic lymphoma of small intestine. Analysis of two S-100 protein-positive cases with features of interdigitating reticulum cell sarcoma.
Miettinen M, Fletcher CD, Lasota J.
Department of Pathology and Cell Biology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
Am J Clin Pathol 1993 Sep;100(3):285-92 Abstract quote
Two cases of true histiocytic lymphoma of the small intestine occurred in middle-aged patients, manifesting as tumors causing intestinal obstruction.
One of the patients died of uncontrollable local and metastatic disease, 16 months after surgery and polychemotherapy, and the other patient is alive 12 months after surgery and chemotherapy.
The histologic characteristics of the tumor cells, namely complex nuclear outlines and abundant variably eosinophilic cytoplasm, suggested histiocytic differentiation. Both cases had negative results for B-cell and T-cell markers but stained for the histiocytic markers lysozyme, CD68, and HLA-DR and had positive results for S-100 protein and vimentin. Acetone-fixed frozen sections of one case showed positive results for several histiocytic markers, including CD11c, CD14, CD33, CD68, and BerMac3 (unclustered monoclonal antibody). CD4, a T-cell antigen present in a subset of histiomonocytic cells, had positive results in the cytoplasm. The tumor cells had negative results for CD1a, CD15, and CD30. Immunoglobulin and T-cell receptor gene probes showed germline configuration in one case studied.
These results indicate the tumors are true histiocytic lymphomas, which have immunophenotypic features of both ordinary histiocytes and interdigitating reticulum cells.
SKIN True histiocytic lymphoma (monocytic sarcoma)
Soria C, Orradre JL, Garcia-Almagro D, Martinez B, Algara P, Piris MA.
Department of Dermatology, Virgen de la Salud Hospital, Toledo, Spain.
Am J Dermatopathol 1992 Dec;14(6):511-7 Abstract quote
The clinical, histological, immunophenotypic, and genotypic characteristics of two cases of cutaneous genuine histiocytic lymphoma are described.
Both cases presented as cutaneous lesions. Both patients remain alive and free of disease at 26 and 10 months after the diagnosis and after having been treated with polychemotherapy. Neither peripheral blood nor bone marrow infiltration was detected in either case. Histological and immunophenotypic examination showed dense, diffuse dermic infiltrates of mononuclear cells with positive macrophage-associated markers (CD11c, CD68), and negative T- or B-cell-associated antigens. A germline configuration of both T-cell receptor and immunoglobulin genes was observed in gene rearrangement studies. Although most of the cases that have been diagnosed as histiocytic lymphoma or malignant histiocytosis in the past turned out to be B- or T-large-cell lymphomas, a small number of cases (two in our consecutive series of 350 cases) show characteristics of monocyte-macrophage tumors.
We stress the importance of the CD68 marker in the diagnosis of true histiocytic lymphoma, suggest a therapeutic approach based on similarities with monocytic leukemia, and propose the use of the term monocytic sarcoma for this clinicopathological presentation.
SPLEEN Histiocytic sarcoma of the spleen associated with hypoalbuminemia, hypo gamma-globulinemia and thrombocytopenia as a possibly unique clinical entity--report of three cases.
Kimura H, Nasu K, Sakai C, Shiga Y, Miyamoto E, Shintaku M, Wakatsuki S, Tominaga K, Abe M, Maruyama Y. I
nternal Medicine, Hobara Central Hospital, Fukushima, Japan.
Leuk Lymphoma 1998 Sep;31(1-2):217-24 Abstract quote
We report three patients with histiocytic sarcoma of the spleen associated with severe hypoalbuminemia, hypo gamma-globulinemia and thrombocytopenia.
After the clinical diagnosis of splenic tumor of unknown origin was made, all three patients underwent splenectomy. The histiocytic origin of the tumor was confirmed histopathologically and immunohistochemically using a panel of antibodies. In contrast to malignant histiocytosis (MH), which typically reveals severe generalized clinical manifestations and a rapidly fatal course caused by the disseminated proliferation of neoplastic histiocytes, these patients were asymptomatic or showed only mild clinical symptoms for a long period of time until the recurrence was detected by which time the tumor cells had already spread to other organs. All three cases were characteristically associated with hypoalbuminemia, hypo gamma-globulinemia and thrombocytopenia, which returned to normal after splenectomy.
Splenic histiocytic sarcoma with the features described here may represent a unique clinical entity, distinct from MH.
HISTOLOGICAL TYPES CHARACTERIZATION GENERAL Key is a pink staining cytoplasm-lymphomas usually have an amphophilic cytoplasm
- Histiocytic sarcoma with secondary involvement of the skin and expression of CD1a: evidence of indeterminate cell differentiation?
Frater JL, Kling CW, Obadiah JM, Gardner LJ, Grosso LE, Resh B, Hurley MY.
Department of Pathology, Saint Louis University School of Medicine, St Louis, MO, USA.
J Cutan Pathol. 2006 Jun;33(6):437-42. Abstract quote
Background: Histiocytic sarcoma is an exceedingly rare malignant neoplasm composed of cells with a monocyte/macrophage phenotype.
In the current nosology of histiocytic neoplasms, histiocytic sarcoma is separate from indeterminate cell histiocytosis, a generally benign disorder characterized by proliferation of a CD1a(+) and S-100(+) population of cells lacking Birbeck granules usually limited to the skin.
Methods: We present a case of histiocytic sarcoma in a 64-year-old man presenting as a peritonsillar mass and secondarily involving the skin.
Results: The malignant cells in the extracutaneous foci of disease expressed macrophage-associated antigens including S-100 but were CD1a(-). The malignant cells in the skin coexpressed CD1a and S-100 but lacked ultrastructural features of Langerhans cells, findings indicative of indeterminate cells.
Conclusions: We discuss the clinical and histopathologic differential diagnosis in association with prior reported cases of histiocytic sarcoma, particularly in cases involving the skin and cases expressing the Langerhans cell-associated antigen CD1a.
- Extranodal Histiocytic Sarcoma: Clinicopathologic Analysis of 14 Cases of a Rare Epithelioid Malignancy.
Hornick JL, Jaffe ES, Fletcher CD.
*Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and daggerLaboratory of Pathology, National Cancer Institute, Bethesda, MD.
Am J Surg Pathol. 2004 Sep;28(9):1133-1144. Abstract quote
Histiocytic sarcoma is a rare malignant neoplasm that occurs in lymph nodes, skin, and the gastrointestinal tract. Many previously published cases were likely misdiagnosed examples of non-Hodgkin lymphoma. Only small numbers of bona fide examples exist in the world literature; cases arising primarily at extranodal sites are not well described and often seem to go unrecognized.
To characterize these tumors further, 14 extranodal histiocytic sarcomas were analyzed. Hematoxylin and eosin sections were reexamined, immunohistochemistry was performed, and clinical details were obtained from referring hospitals. Eight patients were female and 6 male (median age, 55 years; range, 15-89 years). All patients presented with a solitary mass, ranging in size from 1.8 to 12 cm (median 6.8 cm). Seven tumors arose in soft tissue (6 lower limb; 1 upper limb), 5 in the gastrointestinal tract (1 involving both stomach and colon, 1 ileum, 2 rectum, 1 anus), 1 in the nasal cavity, and 1 in the lung. Three gastrointestinal tract tumors also involved regional lymph nodes, and 1 involved the liver. Most cases had infiltrative margins. The tumors were generally composed of sheets of large epithelioid cells with abundant eosinophilic cytoplasm, oval to irregular nuclei, vesicular chromatin, and large nucleoli. Binucleated cells were common, and 6 cases contained tumor giant cells. Mitoses ranged from 1 to 64 per 10 HPF (median 11 per 10 HPF). Necrosis was present in 8 cases. Nearly all tumors showed a striking inflammatory infiltrate, most often of neutrophils or lymphocytes.
All cases were reactive for LCA, CD45RO, and CD68 (KP1 and PG-M1); 13 of 14 (93%) expressed CD4, 12 of 14 (86%) lysozyme, 8 of 10 (80%) CD31, 7 of 14 (50%) S-100 protein, and 5 of 14 (36%) focal CD1a. Two tumors showed weak, focal cytoplasmic positivity for CD30, and 1 for epithelial membrane antigen. The tumors were negative for ALK-1, CD21, CD35, CD3, CD20, CD34, myeloperoxidase, HMB-45, and keratins. Gastrointestinal tract cases were negative for c-kit and desmin. Six patients were treated with postoperative radiation and 7 with chemotherapy (CHOP or ProMACE-MOPP).
Follow-up was available for 10 patients (median, 24 months; range, 4 months to 11 years). Two tumors recurred locally, and 5 patients developed distant spread: 3 to lymph nodes, 1 to lung, and 1 to bone. At the last follow-up, 2 patients have died of disseminated disease, 4 and 5 months following initial diagnosis. The patients who died thus far had the largest primary tumors. Histiocytic sarcoma may arise primarily in soft tissue and shows reproducible histologic features, including abundant eosinophilic cytoplasm and a prominent inflammatory infiltrate. Metastatic carcinoma, metastatic melanoma, and large cell non-Hodgkin lymphomas should be excluded by immunohistochemistry.
Histiocytic sarcoma has the potential for an aggressive clinical course, most often with lymph node involvement. However, a subset of cases presenting with clinically localized disease have a favorable long-term outcome. Tumor size may be a prognostic factor.Malignant lymphoma of true histiocytic origin: histiocytic sarcoma. A morphological, ultrastructural, immunological, cytochemical and clinical study of 10 cases.
van der Valk P, te Velde J, Jansen J, Ruiter DJ, Spaander PJ, Cornelisse CJ, Meijer CJ
Virchows Arch A Pathol Anat Histol 1981;391(3):249-65 Abstract quote
Ten tumors of true histiocytic origin (Histiocytic Sarcoma) are presented.
The tumor cells were identified as histiocytes by immunological, cytochemical and ultrastructural criteria (cytoplasmic lysozyme activity, presence of C3 and Fc gamma receptor, strong acid phosphatase and alpha-naphthyl acetate esterase activity, presence of lysosomes, absence of cell junctions and evidence of phagocytosis). The tumors identified in this way showed the following histological characteristics: diffuse proliferation of large tumor cells with ample cytoplasm, containing granular or occasionally diffuse diastase resistant PAS positive material, erythrophagocytosis, and haemosiderin pigment. The large or enormous nuclei were irregular, with occasional deep indentations, sharply defined nuclear membrane, coarse chromatin and conspicuous nucleoli. Despite the uniformity of these criteria differences in presence of alpha 1-antitrypsin, alpha 1-antichymotrypsin and 5 Nucleotidase activity and the number of lysosomes in the cytoplasm were found. The findings are suggestive of a spectrum of cytological in these Histiocytic Sarcomas. The clinical picture ranged from monolocalization in a lymphoid organ to that of a diffuse Malignant Histiocytosis.
The relationship between good response to therapy and complete remission and the absence of alpha 1-antitrypsin and a high number of lysosomes is discussed.
Malignant histiocytosis and related tumors. A clinicopathologic study of 42 cases using cytological, histochemical and ultrastructural parameters.
van Heerde P, Feltkamp CA, Hart AA, Somers R, van Unnik JA, Vroom TM.
Hematol Oncol 1984 Jan-Mar;2(1):13-32 Abstract quote
Light and electron microscopical, immunohistochemical and clinical characteristics in 42 cases of malignant neoplasms, arising from true histiocytes, are described.
These were separated in a lymphoma-like subtype, called true histiocytic lymphoma (29 patients) and a disseminated variant, called malignant histiocytosis (9 patients). In addition 4 related histiocytic tumors are discussed, including 2 tumors arising from interdigitating cells. Sinus pattern and cytologic features, especially 'window' nuclei, are emphasized as diagnostic criteria. Erythrophagocytosis was not a constant finding. Electron microscopic features, presence of acid phosphatase, acid alpha-naphthylacetate esterase, lysozyme, alpha 1-antitrypsin, alpha 1-antichymotrypsin, Ia-antigen and absence of B- and T-cell markers, were important in establishing the histiocytic nature or excluding a non-histiocytic tumor. A distinct male predominance existed (male:female = 2.5:1) with a higher relapse free period in females (p = 0.032). A high number of mitotic figures appeared to be a favourable sign, p = 0.020 and 0.019, for remission rate and relapse free period respectively. The degree of cell differentiation and the immunohistochemical pattern did not show a correlation with remission and relapse free period.
Extranodal involvement and the presence of short profiles of endoplasmic reticulum were prognostically unfavourable signs. True histiocytic lymphomas showed a higher remission rate (p = 0.041) and relapse-free period (p = 0.017) than malignant histiocytosis.
Malignant lymphomas of true histiocytic origin. A clinical, histological, immunophenotypic and genotypic study.
Ralfkiaer E, Delsol G, O'Connor NT, Brandtzaeg P, Brousset P, Vejlsgaard GL, Mason DY.
Department of Pathology, Rigshospitalet, University of Copenhagen, Denmark.
J Pathol 1990 Jan;160(1):9-17 Abstract quote
The clinical, histological, immunophenotypic and genotypic properties of four cases of lymphoma of true histiocytic origin are described.
The cases were identified by typing 925 non-Hodgkin's lymphomas by immunophenotypic and/or genotypic techniques, and they all presented with skin lesions. The histological and immunophenotypic examination showed dense, diffuse infiltrates of markedly pleomorphic mononuclear cells that were positive for macrophage-associated markers, and negative for B-cell, T-cell and myeloid cell-associated antigens. Staining for Ki-1 and epithelial membrane antigen was also negative. Gene rearrangements studies were performed in three cases, and all of these showed germline configuration of both T-cell receptor and immunoglobulin genes. In all cases, the clinical course was aggressive with rapid and widespread dissemination to internal organs, poor response to conventional chemotherapy, and short survival times (0.5 to 14 months).
This suggests that although true histiocytic tumours are very rare, their recognition may be important for clinical and/or prognostic reasons.
SPECIAL STAINS/
IMMUNOPEROXIDASE/
OTHERCHARACTERIZATION SPECIAL STAINS IMMUNOPEROXIDASE CD68 is not specific
Must confirm histiocytic nature of neoplasm by excluding other lymphomas with markers such as CD45, CD4, CD43
NOTE: Some histiocytic lymphomas may express S-100True histiocytic lymphoma: histopathologic, immunophenotypic and genotypic analysis.
Hanson CA, Jaszcz W, Kersey JH, Astorga MG, Peterson BA, Gajl-Peczalska KJ, Frizzera G.
Department of Laboratory Medicine and Pathology, University of Minnesota Hospital and Clinic, Minneapolis 55455
Br J Haematol 1989 Oct;73(2):187-98 Abstract quote
Five cases of true histiocytic lymphoma (THL) were analysed by immunophenotyping and immunoglobulin/T-cell receptor genotyping.
These cases showed striking morphologic diversity but a strong degree of immunophenotypic homogeneity. The malignant cells reacted with multiple histiocytic markers including CD11c (Ki-M1, LeuM5), CD14, CD68 (Ki-M6) and Ki-M8; anti-HLA-DR and non-specific esterase staining was also found in all cases. The malignant cells did not express monoclonal immunoglobulin and did not react with the B- or T-cell monoclonal antibodies used except for those known to be cytoplasmically expressed in monocytes/histiocytes, such as CD4 and CD19; B- and T-cell staining was otherwise limited to background small lymphocytes. By genotypic analysis, three cases showed rearrangements: one with T beta, one with T beta and immunoglobulin heavy chain (JH) and one with both JH and light chain; the remaining two cases retained their immunoglobulin and T-cell receptor genes in germline configuration.
The results not only suggest that certain subsets of the histiocyte/reticulum cell system may be capable of rearranging immunoglobulin or T beta genes while simultaneously expressing multiple histiocytic surface antigens but also demonstrate the necessity of using multiple histiocytic-specific monoclonal antibodies and cytochemical staining in diagnosing THL. Gene rearrangement studies must be interpreted in conjunction with immunophenotyping and morphology in the determination of cell lineage.
Lymphomas of true histiocytic origin. Expression of different phenotypes in so-called true histiocytic lymphoma and malignant histiocytosis.
Hsu SM, Ho YS, Hsu PL.
Department of Pathology, University of Arkansas for Medical Science, Little Rock.
Am J Pathol 1991 Jun;138(6):1389-404 Abstract quote
The authors determined the phenotypes of neoplastic cells in true histiocytic lymphoma and malignant histiocytosis by using a large panel of monoclonal antibodies and enzyme histochemistry procedures.
Although the phenotypes overlapped slightly, the authors noted a distinct pattern in these tumors. The tumor cells of malignant histiocytosis generally expressed the monocyte markers CD11b, CD11c, CD14, and CD45, especially after induction with phorbol ester. In contrast, the tumor cells of true histiocytic lymphoma exhibited a marker expression very similar to that of Reed-Sternberg cells in Hodgkin's disease. These cells expressed markers CD30, 2H9, and 1A2, but rarely expressed CD11b, CD11c, CD14, or CD45. Regardless of their cytologic features, the tumor cells from both types of histiocytic lymphoma exhibited diffuse nonspecific esterase and acid phosphatase activities, and they expressed histiocyte markers CD15, CD68, LN5, 1E9, and M387 to varying degrees. The tumor cells from both lymphomas did not exhibit T- or B-cell markers, T-cell receptor or immunoglobulin gene rearrangements, or gene translation products, even when they were induced with phorbol ester. The phenotypic expression in these two histiocytic malignancies suggests that they are derived from different types of histiocytes, or from histiocytes in different stages of maturation or differentiation, or from histiocytes that have distinct mechanisms of tumorigenic transformation.
The expression of circulating monocyte markers in malignant histiocytosis suggests that this tumor originates in monocytes or free histiocytes, whereas the phenotype of true histiocytic lymphoma is compatible with an origin in fixed histiocytes, which generally are devoid of the monocyte markers CD11b and CD14.
KP1 (CD68)-positive large cell lymphomas: a histopathologic and immunophenotypic characterization of 12 cases.
Carbone A, Gloghini A, Volpe R, Pinto A.
Division of Pathology, Istituto Nazionale di Ricovero e Cura a Carattere Scientifico, Aviano, Italy.
Hum Pathol 1993 Aug;24(8):886-96 Abstract quote
CD68/KP1 antigen expression in a series of 298 non-Hodgkin's lymphoma (NHL) cases, including 41 cases of CD30/Ki-1-positive anaplastic large cell (Ki-1+ ALC) lymphomas, was examined.
Among the cases in this series, 12 large cell NHLs, including five centroblastic (G group according to the Working Formulation) NHLs, three immunoblastic (H group) NHLs, and four Ki-1+ ALC lymphomas, were found to express KP1. By extensive immunophenotypic analysis and in situ hybridization, KP1-positive large cell lymphomas of the G and H groups were assigned a B-cell phenotype. The pattern of KP1 staining usually consisted of localized small to medium-sized cytoplasmic dots; only two cases showed diffuse fine granular reactivity. In two of the four Ki-1+ ALC lymphomas tumor cells failed to express a B- or T-cell phenotype and stained positively for lysozyme, whereas in the other two cases they showed a hybrid T/histiocytic, phenotypic profile. KP1 staining of Ki-1+ ALC lymphoma cells was usually intense and showed a diffuse granular cytoplasmic pattern; tumor cells also expressed the CD13 antigen and showed strong reactivity with the anti-CD68 EBM11 antibody.
Our results suggest that certain subsets of large "blastic" B-cell lymphomas may simultaneously express the CD68/KP1 histiocyte-specific marker and other myeloid-associated antigens, indicating the necessity of using a multiparameter approach in the determination of cell lineage. Moreover, this study, which demonstrates that the expression of CD68/KP1 and CD30 antigens is not mutually exclusive, supports the view that a fraction of cases diagnosed as Ki-1+ ALC lymphomas (at least those with KP1 expression along with the lack of B- or T-antigen expression) represent true histiocytic lymphomas despite the Ki-1+ phenotype.
CD163
- Histiocytic sarcoma: a study of five cases including the histiocyte marker CD163.
Vos JA, Abbondanzo SL, Barekman CL, Andriko JW, Miettinen M, Aguilera NS.
1Department of Hematopathology, Armed Forces Institute of Pathology, Washington, DC, USA.
Mod Pathol. 2005;18:693-704 Abstract quote
Histiocytic sarcoma (HS) is a rare but controversial hematopoietic neoplasm. In the past, malignancies have been misclassified as histiocytic tumors due to overlapping histologic features and inadequate phenotypic data. CD163, a recently characterized hemoglobin scavenger receptor, appears to be a 'specific' marker of histiocytic lineage and a promising diagnostic tool for evaluating histiocytic neoplasms.
Five cases of HS were studied to further elucidate the clinicopathologic features of these rare tumors and to demonstrate the diagnostic utility of CD163. Criteria for diagnosis included histologic and immunohistochemical evidence of histiocytic differentiation, CD45 positivity, and exclusion of lymphoid, epithelial, melanocytic and dendritic cell phenotype. Sites of disease included the colon (two cases), palate, inguinal lymph node, and testis. The clinical course was aggressive in 4/5 patients (survival=2-15 months). One patient with localized disease of the palate, survived 17 years after diagnosis. All patients with poor survival had tumors >/=3.5 cm. Histologically, all cases showed diffuse architecture with large, discohesive polygonal cells. Spindling of cells was focally noted. Hemophagocytosis was identified in 3/5 cases. A prominent inflammatory background was present in 4/5 tumors. All cases were immunoreactive for CD45, CD163, CD68, and lysozyme. S-100 was focally positive in 4/5 cases. Antibodies for melanocytic, epithelial, lymphoid, and dendritic cell markers were negative. Molecular studies showed monoclonal IgH gene rearrangements in three cases.
Our findings suggest that HS is an uncommon neoplasm frequently extranodal in presentation and aggressive in behavior, with rare exceptions. Stage of disease and possibly tumor size are significant prognostic indicators. Molecular studies remain controversial in the diagnosis. The morphologic and phenotypic features are relatively uniform; however, the diagnosis requires exclusion of more common neoplasms by extensive immunophenotypic studies. CD163 appears to be a specific histiocytic marker and is important in establishing the diagnosis of HS.ELECTRON MICROSCOPY True histiocytic lymphoma with multiple skin nodules.
Osborne BM, Mackay B.
Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston 77030.
Ultrastruct Pathol 1994 Jan-Apr;18(1-2):241-6 Abstract quote
A 73-year-old white woman developed multiple cutaneous nodules that fluctuated in size and occasionally regressed. The tumor cells infiltrating the dermis were histiocytic by light microscopy, marker studies, and electron microscopy. Similar cells were present in a bone marrow biopsy specimen. A diagnosis of true histiocytic lymphoma was made.
The case illustrates some of the problems that may arise in evaluation of clinical and pathologic findings in a patient with a proliferative disorder of histiocytes and demonstrates the contribution that electron microscopy can provide in establishing the diagnosis.
DIFFERENTIAL DIAGNOSIS KEY DIFFERENTIATING FEATURES Anaplastic Large cell lymphoma-CD30 Graulocytic sarcoma Langerhan's cell histiocytosis Peripheral T cell lymphoma Large B-cell lymphoma
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Robbins Pathologic Basis of Disease. Seventh Edition. WB Saunders 2005.
DeMay RM. The Art and Science of Cytopathology. Volume 1 and 2. ASCP Press. 1996.
Weedon D. Weedon's Skin Pathology Second Edition. Churchill Livingstone. 2002
Fitzpatrick's Dermatology in General Medicine. 6th Edition. McGraw-Hill. 2003.
Weiss SW and Goldblum JR. Enzinger and Weiss's Soft Tissue Tumors. Fourth Edition. Mosby 2001.
Basic Principles of Disease
Learn the basic disease classifications of cancers, infections, and inflammation
Commonly Used Terms
This is a glossary of terms often found in a pathology report.Diagnostic Process
Learn how a pathologist makes a diagnosis using a microscopeSurgical Pathology Report
Examine an actual biopsy report to understand what each section meansSpecial Stains
Understand the tools the pathologist utilizes to aid in the diagnosisHow Accurate is My Report?
Pathologists actively oversee every area of the laboratory to ensure your report is accurateGot Path?
Recent teaching cases and lectures presented in conferences
Last Updated February 19, 2007
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