Huang K, Columbie AF, Allan RW, Misra S. Thrombocytopenia with multiple splenic lesions - histiocytic sarcoma of the spleen without splenomegaly: A case report. World J Clin Oncol 2020; 11(3): 162-168 [PMID: 32257847 DOI: 10.5306/wjco.v11.i3.162]
Corresponding Author of This Article
Subhasis Misra, FACS, MD, Surgical Oncologist, Department of General Surgery, Brandon Regional Hospital, HCA West Florida Division/USF Consortium, 205 South Moon Ave, Brandon, FL 33511, United States. subhasis.misra@hcahealthcare.com
Research Domain of This Article
Oncology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Oncol. Mar 24, 2020; 11(3): 162-168 Published online Mar 24, 2020. doi: 10.5306/wjco.v11.i3.162
Thrombocytopenia with multiple splenic lesions - histiocytic sarcoma of the spleen without splenomegaly: A case report
Kai Huang, Alvaro Frometa Columbie, Robert W Allan, Subhasis Misra
Kai Huang, Subhasis Misra, Department of General Surgery, Brandon Regional Hospital, HCA West Florida Division/USF Consortium, Brandon, FL 33511, United States
Alvaro Frometa Columbie, Department of Pathology and Laboratory Medicine, Brandon Regional Hospital, University of South Florida, HCA West Florida Division, Brandon, FL 33511, United States
Robert W Allan, Chief Pathology and Laboratory Medicine Service, North Florida and Southern Georgia VA System, Clinical Professor of Pathology, University of Florida, Gainesville, FL 32611, United States
Author contributions: Huang K contributed to the concept design and drafting of the manuscript; Columbie AF contributed to data acquisition and analysis and participated in drafting the article; Allan RW and Misra S critically reviewed the article for important intellectual content and gave final approval of the version to be submitted; All the authors reviewed and contributed to the final version.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and accompanying images.
Conflict-of-interest statement: We declare there is no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Subhasis Misra, FACS, MD, Surgical Oncologist, Department of General Surgery, Brandon Regional Hospital, HCA West Florida Division/USF Consortium, 205 South Moon Ave, Brandon, FL 33511, United States. subhasis.misra@hcahealthcare.com
Received: October 21, 2019 Peer-review started: October 21, 2019 First decision: November 5, 2019 Revised: December 9, 2019 Accepted: December 13, 2019 Article in press: December 13, 2019 Published online: March 24, 2020
Abstract
BACKGROUND
Histiocytic sarcoma (HS) of the spleen is reported to be a rare and lethal disease. The clinicopathological features of splenic HS have not been well described. The objective of this paper is to describe the diagnosis and treatment of a case of this rare disease and provide a review of the literature.
CASE SUMMARY
In this article, we discuss the case of a 40-year-old Hispanic female who presented with progressive thrombocytopenia and multiple hypoechoic lesions in the spleen without splenomegaly. Positron emission tomography-computed tomography showed increased activity in cervical lymph nodes, as well as multiple bone and splenic lesions with positive uptake. Two bone marrow biopsies and fine-needle aspiration of the cervical lymph node were inconclusive. Laparoscopic splenectomy was performed, and gross examination showed a 110.1 g spleen with multiple rubbery, nodular lesions within the subcapsular sinus and splenic parenchyma. The microscopic findings showed multinodular histiocyte proliferation with atypia and multilobulated nuclei, which were positive for CD163, CD4, and CD68 by immunohistochemical analysis. The final pathologic diagnosis was difficult and was found to be low-grade HS of the spleen, after consultations with two renowned hematopathology institutions. At the patient’s five-month follow-up visit, her bone marrow metastasis had progressed. She is waiting to be enrolled in a clinical trial.
CONCLUSION
Pathologic diagnosis of splenic HS can be challenging. Low-grade differentiation may be associated with a slow progressive disease.
Core tip: Histiocytic sarcoma (HS) of the spleen is a rare and potentially lethal condition. We report a patient with thrombocytopenia of unknown etiology, multiple splenic lesions, and disseminated bone metastasis treated by laparoscopic splenectomy. The final pathologic diagnosis showed low-grade HS of the spleen. It is very rare that HS occurs without splenomegaly.
