Korean J Gastroenterol.  2010 Feb;55(2):127-132. 10.4166/kjg.2010.55.2.127.

A Case of Extranodal Histiocytic Sarcoma of Stomach Mimicking Gastric Adenocarcinoma

• Yoo KD
• Han DS
• Chung SM
• Kim SM
• Bae JH
• Eun CS
• Paik SS
• Oh YH

• KMID: 1718296
• DOI: http://doi.org/10.4166/kjg.2010.55.2.127

Abstract

Histiocytic sarcoma is a rare malignant neoplasm that originates from a histiocytic hematopoietic lineage characterized by histiocytic differentiation and its corresponding immunophenotypic features. Patients with histiocytic sarcoma usually have a poor prognosis due to its aggressive clinical behavior. Here we report a rare case of extranodal histiocytic sarcoma of the stomach which was confirmed through immunohistochemical staining. A 71-yearold man was presented with epigastric pain. Gastroscopy, abdominal CT, and EUS revealed a mass located on the posterior wall of upper body and fundus of the stomach. Grossly, grayish white solid masses were seen extending down to the submucosal layer. Microscopically, the tumor cells had eosinophilic cytoplasm, abundant vacuole, and mitosis. Immunohistochemical staining revealed that the tumor cells were positive for LCA, CD68, and lysozyme. Early detection and accurate diagnosis of this rare neoplasm is important because it can make a great difference in prognostic outcomes. To make an accurate and definitive diagnosis, immunohistochemical staining is essential in the confimation of histiocytic orign.

Keyword

Histiocytic sarcoma; Stomach; Immunohistochemistry

MeSH Terms

Adenocarcinoma/diagnosis/pathology/ultrasonography
Aged
Antigens, CD/metabolism
Antigens, CD45/metabolism
Antigens, Differentiation, Myelomonocytic/metabolism
Diagnosis, Differential
Gastroscopy
Histiocytic Sarcoma/*diagnosis/pathology/ultrasonography
Humans
Male
Muramidase/metabolism
Stomach Neoplasms/*diagnosis/pathology/ultrasonography
Tomography, X-Ray Computed

Figure

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  Fig. 1. Gastroscopic findings. A flat elevated mass was located on the posterior wall of upper body and fundus, measuring about 2 cm in size. It had an irregular surface with suspected area of vessel exposure.

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  Fig. 2. Abdominal CT and EUS findings. (A) Abdominal CT showed focal irregular thickening of posterior wall of body and fundal area with small regional lymphadenopa-thies. (B) A 2 cm sized heteroge-nous, hypoechoic mass was seen on the posterior wall of upper body, involving proper muscle layer. Regional lymphadenopathy was suspicious.

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  Fig. 3. The gross specimen. (A) Two discrete nodular masses were located on the posterior wall of the gastric body and fundus, measuring 3×3 cm and 1×1 cm (arrow). (B) Cut surface showed grayish white solid masses involving up to muscular and submucosal layers for larger and smaller one, respectively.

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  Fig. 4. Microscopic findings. (A) The tumor was composed of large epithelioid cells without any organoid structure (H&E stain, ×40). (B) The tumor cells had abundant eosinophilic cytoplasm, well defined cell borders, and oval to irregular nuclei with vesicular chromatin and large eosinophilic nucleoli. Some tumor cells showed prominent clear or foamy cytoplasm. Mitotic figures were also seen (H&E stain, ×400).

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  Fig. 5. Immunohistochemical stain. Tumor cells were positive for (A) CD68 (×200), and (B) lysozyme (×200).

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