EXTRAORDINARY CASE REPORT
Primary Cutaneous Interdigitating Dendritic Cell Sarcoma: A Case Report and Review of the Literature Shi-Jun Shan, MD,*† Ling-He Meng, MD,‡ Rebecca Lu, MD,§ and Ying Guo, MD*
Abstract: Interdigitating dendritic cell sarcoma (IDCS) is defined as a neoplastic proliferation of spindle to ovoid cells with phenotypic features similar to those of interdigitating dendritic cells, which are present in the T cell–rich areas of lymphoid organs and participate as antigen-presenting cells responsible for initiating primary T lymphocyte immune response. IDCS usually presents with lymphadenopathy. Solitary lymph node involvement is often seen. Extra nodal presentation has been described as well. Cutaneous lesions are extremely rare, and less than 10 cases have been previously documented in medical literature. Here, the authors describe another primary cutaneous IDCS in a 42-year-old patient and review the literature. Key Words: primary, cutaneous, interdigitating dendritic cell sarcoma (Am J Dermatopathol 2015;37:639–642)
INTRODUCTION Interdigitating dendritic cell sarcoma (IDCS) is very rare and has been classified as a lesion under dendritic cell neoplasms according to the WHO classification in 2008. Histopathologically, IDCS is a neoplastic proliferation of spindle to oval cells with phenotypic features resembling those of interdigitating dendritic cells (IDCs). IDCs are located in the T cell–rich areas of lymphoid tissue and participate as antigen-presenting cells responsible for initiating primary lymphocyte immune response. On immunohistochemical staining, IDCs are positive for S100 protein, CD68, and vimentin. Clinically, IDCS mostly occurs in lymph nodes and is presented as solitary lymphadenopathy.1,2 Extra nodal diseases involving multiple organs have been reported. Among those, cutaneous IDCS is exceedingly rare.2–5 Here, we describe and added to the medical literature another case of primary cutaneous IDCS in a 41-year-old patient. From the *Ackerman Academy of Dermatopathology, New York, NY; †Department of Dermatology, Tianjin Medical University General Hospital, Tianjin, China; ‡Graduate School, Tianjin Medical University, Tianjin, China; and §Dermatology Associates of Central New Jersey, Old Bridge, NJ. The authors declare no conflicts of interest. Y. Guo had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: S.-J. Shan. Acquisition of data: R. Lu and L.-H. Meng. Reprints: Ying Guo, MD, Ackerman Academy of Dermatopathology, 145 East 32nd Street, 10th Floor, New York, NY 10016 (e-mail: yguo@ dermpathdiagnostics.com). Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.
Am J Dermatopathol Volume 37, Number 8, August 2015
CASE REPORT A 41-year-old woman presented to her dermatologist with a nodular lesion on the right posterior shoulder without subjective symptoms for several months. On physical examination, a domeshaped 2-cm erythematous firm nodule was noted. No history of trauma, insect bite, or other cutaneous and systemic disease could be elicited from the patient. Initial clinical differential diagnosis included basal cell carcinoma and persistent arthropod reaction. A biopsy was performed, and the sections revealed a nodular proliferation of spindle to oval and polygonal cells within the dermis extending to the subcutaneous tissue. The neoplastic cells were arranged in fascicles and formed whorls in foci. Many atypical cells had vesicular nuclei, indistinct cell borders, and abundant cytoplasm. Atypical mitotic figures and cell necrosis were evident (Figs. 1–3). The inflammatory cells were admixed with neoplastic cells. On immunohistochemical study, the neoplastic cells were strongly positive for S100, positive for CD45, vimentin, and focally positive for NKIC3 (Figs. 4–7); stains for pancytokeratin, melan-A, MITF, smooth muscle actin, desmin, muscle-specific actin, ALK, CD 21, CD23, CD35, CD68, CD163, PU-1, and CD1a were negative. The diagnosis of IDCS was made, and the lesion was surgically excised. At several follow-up visits over the past 2 years, there was no local recurrence, new lesion, or metastasis found. However, because of the rarity and unpredictable behavior of the disease, the patient is still in regular follow-up.
FIGURE 1. Nodular neoplastic proliferation extending to the subcutaneous tissue (H&E, original magnification ·20). www.amjdermatopathology.com |
639
Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Am J Dermatopathol Volume 37, Number 8, August 2015
Shan et al
FIGURE 2. The spindle and oval cells arranged in fascicles and formed whorls. Admixed inflammatory cell infiltrate also noted (H&E, original magnification ·200).
DISCUSSION IDCs belong to the mononuclear phagocytic system and are believed to derive from hematopoietic precursors. IDCs participate in the immune system as antigen-presenting cells to stimulate T lymphocytes. IDCS originates from IDCs and has the same immunophenotypic characteristics as normal IDCs, which express HLA-DR and S100.1,2 IDCS belongs to a group under the dendritic cell neoplasm category according to the WHO classification in 2008.2,3 Clinically, IDCS usually presents as lymph node enlargement initially. In about one third of cases, extra nodal lesions such as in lung, breast, kidney, bladder, spleen, salivary gland, intestine, liver, uterus, testis, nasal cavity, and soft tissue have been reported.5,6 There have also been reported cases of IDCS in association with lymphomas and with leiomyosarcoma.2,7–10 Paraneoplastic pemphigus developing after resection of IDCS of the
FIGURE 4. Tumor cells strongly positive for S100 (original magnification ·20).
mediastinum has been documented.11 Metastatic IDCS mimicking a primary skin lesion has also been described.12 Primary cutaneous IDCS is extremely rare. In 1988, Miracco et al3 reported a solitary cutaneous reticulum cell tumor from the left thigh of a 17-year-old girl who had no lymphadenopathy or internal organ involvement. Histopathologically, the lesion was composed of round to oval and spindle cells with pale nuclei, prominent nucleoli, and abundant fairly eosinophilic cytoplasm. Under electromicroscope, Birbeck granules were not found. Characteristic Golgi apparatus consisted of narrow tubules and vesicles with rare cisternae. The findings excluded an origin from nonhematopoietic cells and were compatible with the fine structures of IDCS. On immunohistochemical study, neoplastic cells were positive
FIGURE 3. Many atypical tumor cells have pleomorphic and hyperchromatic nuclei, abundant cytoplasma. Mitotic figures were evident (H&E, original magnification ·200).
FIGURE 5. S100-positive cells in high magnification (original magnification ·200).
640
Copyright 2014 Wolters Kluwer Health, Inc. All rights reserved.
| www.amjdermatopathology.com
Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Am J Dermatopathol Volume 37, Number 8, August 2015
FIGURE 6. Tumor cells positive for CD45 (original magnification ·20).
for LCA and S100 protein. In enzyme histochemical study, both acid phosphatase and ATPase were detected. Based on their findings, the authors considered the lesion to be the cutaneous counterpart of lymph node interdigitating reticulum cell sarcoma. In 2008, Boldin et al4 reported another cutaneous IDCS, which was presented as a recurrent lesion in the right lower eyelid of a 72-year-old man. No other skin lesion or metastasis was identified at the initial presentation. The histopathologic and immunohistochemical findings were similar to the case described by Miracco et al. In our case, the tumor was located on the shoulder of a 42-year-old woman who also had
Cutaneous Interdigitating Dendritic Cell Sarcoma
no lymph node or internal organ involvement at presentation. On the histological examination, the sections revealed a proliferation of atypical spindle and polygonal cells with indistinct pale cytoplasm and irregular vesicular nuclei, whereas the immunohistochemical examination revealed a combination of S100 and CD45 positivity. The findings are consistent with the diagnosis of IDCS. To our knowledge, there are less than 10 cases of primary cutaneous IDCS in the medical literature,2–4 and only 2 cases are well documented.3,4 Cutaneous IDCS poses a diagnostic challenge to dermatopathologists. On H&E sections alone, it may be difficult to differentiate from follicular dendritic cell sarcoma, Langerhans cell tumor, poorly differentiated carcinoma, lymphoma, nodular melanoma, malignant peripheral nerve sheath tumor, and other soft tissue sarcomas.5,6 The immunohistochemical study is necessary in making the diagnosis of IDCS. Among the differential diagnoses, in addition to positive S100, Langerhans cell tumor is positive for CD1a, nodular melanoma is positive for melan-A and HMB 45, and malignant peripheral nerve sheath tumor is positive for NSE in the epithelioid variant. The perineurial variant is positive for EMA and negative for S100. Follicular dendritic cell sarcoma is variably positive for S100 but positive for follicular dendritic cell markers such as CD21, CD23, and CD35. Poorly differentiated carcinoma is positive for cytokeratin. Hodgkin disease is positive for CD30 and CD15. The other methods including electron microscopy and the molecular genetic studies are also helpful tools. Although IDCS of lymphoid organ or internal organ has aggressive courses, the reported cutaneous IDCS has different outcomes. In the case reported by Miracco et al,3 a subcutaneous nodular lesion reappeared on the same site after surgery. After the second surgery, no further recurrence was identified at 1 year follow-up visit. In the other case reported by Boldin et al,4 after surgery, the patient died 2 years later with local recurrence and metastasis to the lung and liver. In our case, after successful surgery and with regular follow-up, 2 years have passed and no recurrence or metastasis has been identified. In conclusion, IDCS is a very rare neoplasm and has histopathologic similarity to many other spindle cell neoplasms, which makes the diagnosis difficult. In this article, we describe a case of cutaneous IDCS, discuss the histopathologic and immunohistopathologic features, and review the literature. Moreover, it is very important to consider the diagnosis of IDCS when dealing with unusual spindle cell neoplasms. For localized cutaneous IDCS, making early and accurate diagnosis is essential, sufficient surgery is curative, and adequate follow-up is necessary. REFERENCES
FIGURE 7. CD45-positive cells in high magnification (original magnification ·200). Copyright 2014 Wolters Kluwer Health, Inc. All rights reserved.
1. Ohtake H, Yamakawa M. Interdigitating dendritic cell sarcoma and follicular dendritic cell sarcoma: histopathological findings for differential diagnosis. J Clin Exp Hematop. 2013;53:179–184. 2. Saygin C, Uzunaslan D, Ozguroglu M, et al. Dendritic cell sarcoma: a pooled analysis including 462 cases with presentation of our case series. Crit Rev Oncol Hematol. 2013;88:253–271. 3. Miracco C, Raffaelli M, de Santi MM, et al. Solitary cutaneous reticulum cell tumor. Enzyme-immunohistochemical and electronmicroscopic analogies with IDRC sarcoma. Am J Dermatopathol. 1988;10:47–53.
www.amjdermatopathology.com |
641
Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Shan et al
4. Boldin I, Brix-Grünwald G, Scarpatetti MM, et al. Interdigitating dendritic cell sarcoma of the eyelid with a rapidly fatal course. Arch Ophthalmol. 2008;126:738–740. 5. Lee EJ, Hyun DW, Cho HJ, et al. A rare case of interdigitating dendritic cell sarcoma in the nasal cavity. Case Rep Otolaryngol. 2013:913157. 6. Jayaram G, Mun KS, Elsayed EM, et al. Interdigitating dendritic reticulum cell sarcoma: cytologic, histologic and immunocytochemical features. Diagn Cytopathol. 2005;33:43–48. 7. Fraser CR, Wang W, Gomez M, et al. Transformation of chronic lymphocytic leukemia/small lymphocytic lymphoma to interdigitating dendritic cell sarcoma: evidence for transdifferentiation of the lymphoma clone. Am J Clin Pathol. 2009;132:928–939. 8. Feldman AL, Arber DA, Pittaluga S, et al. Clonally related follicular lymphomas and histiocytic/dendritic cell sarcomas: evidence for
642
| www.amjdermatopathology.com
Am J Dermatopathol Volume 37, Number 8, August 2015
9. 10. 11. 12.
transdifferentiation of the follicular lymphoma clone. Blood. 2008; 111:5433–5439. Horschowski N, Guitard AM, Arnoux I, et al. Interdigitating cells sarcoma: occurrence during incomplete remission of a lymphoblastic lymphoma. Pathol Biol. 1993;41:255–259. Zhang J, Liu B, Song N. Interdigitating dendritic cell sarcoma presenting in the kidney combined with retroperitoneal leiomyosarcoma: a case report and literature review. Oncol Lett. 2014;7:466–470. Guo D, Xiao WZ, Hu M, et al. Interdigitating dendritic cell sarcoma complicated with paraneoplastic pemphigus after surgery of resection. Chin Med J (Engl). 2013;126:1797. Lee J, Christensen T, O’Hara C. Metastatic interdigitating dendritic cell sarcoma masquerading as a skin primary tumor: a case report and review of the literature. Am J Dermatopathol. 2009;31:88–93.
Copyright 2014 Wolters Kluwer Health, Inc. All rights reserved.
Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Primary Cutaneous Interdigitating Dendritic Cell Sarcoma: A Case Report and Review of the Literature Shi-Jun Shan, MD,*† Ling-He Meng, MD,‡ Rebecca Lu, MD,§ and Ying Guo, MD*
Abstract: Interdigitating dendritic cell sarcoma (IDCS) is defined as a neoplastic proliferation of spindle to ovoid cells with phenotypic features similar to those of interdigitating dendritic cells, which are present in the T cell–rich areas of lymphoid organs and participate as antigen-presenting cells responsible for initiating primary T lymphocyte immune response. IDCS usually presents with lymphadenopathy. Solitary lymph node involvement is often seen. Extra nodal presentation has been described as well. Cutaneous lesions are extremely rare, and less than 10 cases have been previously documented in medical literature. Here, the authors describe another primary cutaneous IDCS in a 42-year-old patient and review the literature. Key Words: primary, cutaneous, interdigitating dendritic cell sarcoma (Am J Dermatopathol 2015;37:639–642)
INTRODUCTION Interdigitating dendritic cell sarcoma (IDCS) is very rare and has been classified as a lesion under dendritic cell neoplasms according to the WHO classification in 2008. Histopathologically, IDCS is a neoplastic proliferation of spindle to oval cells with phenotypic features resembling those of interdigitating dendritic cells (IDCs). IDCs are located in the T cell–rich areas of lymphoid tissue and participate as antigen-presenting cells responsible for initiating primary lymphocyte immune response. On immunohistochemical staining, IDCs are positive for S100 protein, CD68, and vimentin. Clinically, IDCS mostly occurs in lymph nodes and is presented as solitary lymphadenopathy.1,2 Extra nodal diseases involving multiple organs have been reported. Among those, cutaneous IDCS is exceedingly rare.2–5 Here, we describe and added to the medical literature another case of primary cutaneous IDCS in a 41-year-old patient. From the *Ackerman Academy of Dermatopathology, New York, NY; †Department of Dermatology, Tianjin Medical University General Hospital, Tianjin, China; ‡Graduate School, Tianjin Medical University, Tianjin, China; and §Dermatology Associates of Central New Jersey, Old Bridge, NJ. The authors declare no conflicts of interest. Y. Guo had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: S.-J. Shan. Acquisition of data: R. Lu and L.-H. Meng. Reprints: Ying Guo, MD, Ackerman Academy of Dermatopathology, 145 East 32nd Street, 10th Floor, New York, NY 10016 (e-mail: yguo@ dermpathdiagnostics.com). Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.
Am J Dermatopathol Volume 37, Number 8, August 2015
CASE REPORT A 41-year-old woman presented to her dermatologist with a nodular lesion on the right posterior shoulder without subjective symptoms for several months. On physical examination, a domeshaped 2-cm erythematous firm nodule was noted. No history of trauma, insect bite, or other cutaneous and systemic disease could be elicited from the patient. Initial clinical differential diagnosis included basal cell carcinoma and persistent arthropod reaction. A biopsy was performed, and the sections revealed a nodular proliferation of spindle to oval and polygonal cells within the dermis extending to the subcutaneous tissue. The neoplastic cells were arranged in fascicles and formed whorls in foci. Many atypical cells had vesicular nuclei, indistinct cell borders, and abundant cytoplasm. Atypical mitotic figures and cell necrosis were evident (Figs. 1–3). The inflammatory cells were admixed with neoplastic cells. On immunohistochemical study, the neoplastic cells were strongly positive for S100, positive for CD45, vimentin, and focally positive for NKIC3 (Figs. 4–7); stains for pancytokeratin, melan-A, MITF, smooth muscle actin, desmin, muscle-specific actin, ALK, CD 21, CD23, CD35, CD68, CD163, PU-1, and CD1a were negative. The diagnosis of IDCS was made, and the lesion was surgically excised. At several follow-up visits over the past 2 years, there was no local recurrence, new lesion, or metastasis found. However, because of the rarity and unpredictable behavior of the disease, the patient is still in regular follow-up.
FIGURE 1. Nodular neoplastic proliferation extending to the subcutaneous tissue (H&E, original magnification ·20). www.amjdermatopathology.com |
639
Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Am J Dermatopathol Volume 37, Number 8, August 2015
Shan et al
FIGURE 2. The spindle and oval cells arranged in fascicles and formed whorls. Admixed inflammatory cell infiltrate also noted (H&E, original magnification ·200).
DISCUSSION IDCs belong to the mononuclear phagocytic system and are believed to derive from hematopoietic precursors. IDCs participate in the immune system as antigen-presenting cells to stimulate T lymphocytes. IDCS originates from IDCs and has the same immunophenotypic characteristics as normal IDCs, which express HLA-DR and S100.1,2 IDCS belongs to a group under the dendritic cell neoplasm category according to the WHO classification in 2008.2,3 Clinically, IDCS usually presents as lymph node enlargement initially. In about one third of cases, extra nodal lesions such as in lung, breast, kidney, bladder, spleen, salivary gland, intestine, liver, uterus, testis, nasal cavity, and soft tissue have been reported.5,6 There have also been reported cases of IDCS in association with lymphomas and with leiomyosarcoma.2,7–10 Paraneoplastic pemphigus developing after resection of IDCS of the
FIGURE 4. Tumor cells strongly positive for S100 (original magnification ·20).
mediastinum has been documented.11 Metastatic IDCS mimicking a primary skin lesion has also been described.12 Primary cutaneous IDCS is extremely rare. In 1988, Miracco et al3 reported a solitary cutaneous reticulum cell tumor from the left thigh of a 17-year-old girl who had no lymphadenopathy or internal organ involvement. Histopathologically, the lesion was composed of round to oval and spindle cells with pale nuclei, prominent nucleoli, and abundant fairly eosinophilic cytoplasm. Under electromicroscope, Birbeck granules were not found. Characteristic Golgi apparatus consisted of narrow tubules and vesicles with rare cisternae. The findings excluded an origin from nonhematopoietic cells and were compatible with the fine structures of IDCS. On immunohistochemical study, neoplastic cells were positive
FIGURE 3. Many atypical tumor cells have pleomorphic and hyperchromatic nuclei, abundant cytoplasma. Mitotic figures were evident (H&E, original magnification ·200).
FIGURE 5. S100-positive cells in high magnification (original magnification ·200).
640
Copyright 2014 Wolters Kluwer Health, Inc. All rights reserved.
| www.amjdermatopathology.com
Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Am J Dermatopathol Volume 37, Number 8, August 2015
FIGURE 6. Tumor cells positive for CD45 (original magnification ·20).
for LCA and S100 protein. In enzyme histochemical study, both acid phosphatase and ATPase were detected. Based on their findings, the authors considered the lesion to be the cutaneous counterpart of lymph node interdigitating reticulum cell sarcoma. In 2008, Boldin et al4 reported another cutaneous IDCS, which was presented as a recurrent lesion in the right lower eyelid of a 72-year-old man. No other skin lesion or metastasis was identified at the initial presentation. The histopathologic and immunohistochemical findings were similar to the case described by Miracco et al. In our case, the tumor was located on the shoulder of a 42-year-old woman who also had
Cutaneous Interdigitating Dendritic Cell Sarcoma
no lymph node or internal organ involvement at presentation. On the histological examination, the sections revealed a proliferation of atypical spindle and polygonal cells with indistinct pale cytoplasm and irregular vesicular nuclei, whereas the immunohistochemical examination revealed a combination of S100 and CD45 positivity. The findings are consistent with the diagnosis of IDCS. To our knowledge, there are less than 10 cases of primary cutaneous IDCS in the medical literature,2–4 and only 2 cases are well documented.3,4 Cutaneous IDCS poses a diagnostic challenge to dermatopathologists. On H&E sections alone, it may be difficult to differentiate from follicular dendritic cell sarcoma, Langerhans cell tumor, poorly differentiated carcinoma, lymphoma, nodular melanoma, malignant peripheral nerve sheath tumor, and other soft tissue sarcomas.5,6 The immunohistochemical study is necessary in making the diagnosis of IDCS. Among the differential diagnoses, in addition to positive S100, Langerhans cell tumor is positive for CD1a, nodular melanoma is positive for melan-A and HMB 45, and malignant peripheral nerve sheath tumor is positive for NSE in the epithelioid variant. The perineurial variant is positive for EMA and negative for S100. Follicular dendritic cell sarcoma is variably positive for S100 but positive for follicular dendritic cell markers such as CD21, CD23, and CD35. Poorly differentiated carcinoma is positive for cytokeratin. Hodgkin disease is positive for CD30 and CD15. The other methods including electron microscopy and the molecular genetic studies are also helpful tools. Although IDCS of lymphoid organ or internal organ has aggressive courses, the reported cutaneous IDCS has different outcomes. In the case reported by Miracco et al,3 a subcutaneous nodular lesion reappeared on the same site after surgery. After the second surgery, no further recurrence was identified at 1 year follow-up visit. In the other case reported by Boldin et al,4 after surgery, the patient died 2 years later with local recurrence and metastasis to the lung and liver. In our case, after successful surgery and with regular follow-up, 2 years have passed and no recurrence or metastasis has been identified. In conclusion, IDCS is a very rare neoplasm and has histopathologic similarity to many other spindle cell neoplasms, which makes the diagnosis difficult. In this article, we describe a case of cutaneous IDCS, discuss the histopathologic and immunohistopathologic features, and review the literature. Moreover, it is very important to consider the diagnosis of IDCS when dealing with unusual spindle cell neoplasms. For localized cutaneous IDCS, making early and accurate diagnosis is essential, sufficient surgery is curative, and adequate follow-up is necessary. REFERENCES
FIGURE 7. CD45-positive cells in high magnification (original magnification ·200). Copyright 2014 Wolters Kluwer Health, Inc. All rights reserved.
1. Ohtake H, Yamakawa M. Interdigitating dendritic cell sarcoma and follicular dendritic cell sarcoma: histopathological findings for differential diagnosis. J Clin Exp Hematop. 2013;53:179–184. 2. Saygin C, Uzunaslan D, Ozguroglu M, et al. Dendritic cell sarcoma: a pooled analysis including 462 cases with presentation of our case series. Crit Rev Oncol Hematol. 2013;88:253–271. 3. Miracco C, Raffaelli M, de Santi MM, et al. Solitary cutaneous reticulum cell tumor. Enzyme-immunohistochemical and electronmicroscopic analogies with IDRC sarcoma. Am J Dermatopathol. 1988;10:47–53.
www.amjdermatopathology.com |
641
Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Shan et al
4. Boldin I, Brix-Grünwald G, Scarpatetti MM, et al. Interdigitating dendritic cell sarcoma of the eyelid with a rapidly fatal course. Arch Ophthalmol. 2008;126:738–740. 5. Lee EJ, Hyun DW, Cho HJ, et al. A rare case of interdigitating dendritic cell sarcoma in the nasal cavity. Case Rep Otolaryngol. 2013:913157. 6. Jayaram G, Mun KS, Elsayed EM, et al. Interdigitating dendritic reticulum cell sarcoma: cytologic, histologic and immunocytochemical features. Diagn Cytopathol. 2005;33:43–48. 7. Fraser CR, Wang W, Gomez M, et al. Transformation of chronic lymphocytic leukemia/small lymphocytic lymphoma to interdigitating dendritic cell sarcoma: evidence for transdifferentiation of the lymphoma clone. Am J Clin Pathol. 2009;132:928–939. 8. Feldman AL, Arber DA, Pittaluga S, et al. Clonally related follicular lymphomas and histiocytic/dendritic cell sarcomas: evidence for
642
| www.amjdermatopathology.com
Am J Dermatopathol Volume 37, Number 8, August 2015
9. 10. 11. 12.
transdifferentiation of the follicular lymphoma clone. Blood. 2008; 111:5433–5439. Horschowski N, Guitard AM, Arnoux I, et al. Interdigitating cells sarcoma: occurrence during incomplete remission of a lymphoblastic lymphoma. Pathol Biol. 1993;41:255–259. Zhang J, Liu B, Song N. Interdigitating dendritic cell sarcoma presenting in the kidney combined with retroperitoneal leiomyosarcoma: a case report and literature review. Oncol Lett. 2014;7:466–470. Guo D, Xiao WZ, Hu M, et al. Interdigitating dendritic cell sarcoma complicated with paraneoplastic pemphigus after surgery of resection. Chin Med J (Engl). 2013;126:1797. Lee J, Christensen T, O’Hara C. Metastatic interdigitating dendritic cell sarcoma masquerading as a skin primary tumor: a case report and review of the literature. Am J Dermatopathol. 2009;31:88–93.
Copyright 2014 Wolters Kluwer Health, Inc. All rights reserved.
Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
