Histiocytic sarcoma involving lymph nodes: imaging appearance on gallium-67 and F-18 FDG PET/CT.
ABSTRACT This report of an 82-year-old man who presented with a 3-week history of an enlarging left axillary mass and mild fevers, highlights the usefulness of both gallium-67 and F-18 FDG PET/CT imaging in the staging of histiocytic sarcoma. While PET/CT was superior in determining the extent of the disease, gallium can be used to help stage the disease in centers where PET/CT is not available.
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ABSTRACT: Tetrasomy 8 is a relatively rare chromosomal abnormality that has been reported in only 33 cases in hematologic disorders. It is known for its association with aggressive acute myeloid leukemia (AML) and myeloid sarcoma and is considered a very poor prognostic factor. Myeloid sarcoma is a rare hematologic malignancy characterized by tumor masses consisting of immature myeloid cells, presenting at an extramedullary site. We present a case of a 17-year-old boy referred for an 18F-FDG PET/CT for the evaluation of pleural masses and spinal bone lesions seen on CT, after presenting with a 4 month history of chest pain. The PET/CT revealed extensive FDG-avid extramedullary disease in the soft tissues of the chest, abdomen, and pelvis, which were biopsy-proven to be myeloid sarcoma, as well as extensive intramedullary disease biopsy proven to be AML. This is the first report of the use of 18F-FDG PET/CT to stage a subset of aggressive AML and myeloid sarcoma in a patient with an associated chromosomal abnormality (tetrasomy 8).Nuclear Medicine and Molecular Imaging 06/2012; 46(2):119-124.
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ABSTRACT: Histiocytic sarcoma is an extremely rare and aggressive malignancy of bone marrow origin that occurs in lymph nodes, skin, and the gastrointestinal tract. We report on the imaging features of two cases of primary histiocytic sarcoma, one in the retroperitoneum causing a tumor-bowel fistula and another with primary bone involvement.Cancer Imaging 01/2012; 12:253-8. · 1.59 Impact Factor
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ABSTRACT: Histiocytic sarcoma (HS) is a rare malignant neoplasm that originates from a histiocytic hematopoietic lineage characterized by histiocytic differentiation and its corresponding immunophenotypic features. We herein reported a case of primary HS of the stomach which was confirmed through histopathologic examination and immunohistochemical staining. A 52-year-old woman presented with progressive difficulty in feeding and dull pain in the epigastric region. Gastroscopy, endoscopic ultrasonography, double contrast examination, and computed tomography revealed a mass located on the posterior wall of fundus and lesser curvature of the stomach. Microscopically, the cytoplasm of the tumor cells was abundant and eosinophilic. Immunohistochemical staining revealed that the tumor cells were positive for CD45RO and CD68. It is difficult to differentiate HS of stomach from other gastric malignancies by radiological evaluation alone. However, HS may be considered when a protruding and ulcerated mass in stomach shows heterogeneous hypervascular features. To the best of our knowledge, this is the first report in English language literature that emphasizes the imaging findings of human gastric HS.World Journal of Gastroenterology 01/2013; 19(3):422-425. · 2.55 Impact Factor
Histiocytic Sarcoma Involving Lymph Nodes
Imaging Appearance on Gallium-67 and F-18 FDG PET/CT
William Makis, MD,* Anthony Ciarallo, MD,† Vilma Derbekyan, MD,† and Robert Lisbona, MD†
Abstract: This report of an 82-year-old man who presented with a 3-week
history of an enlarging left axillary mass and mild fevers, highlights the
usefulness of both gallium-67 and F-18 FDG PET/CT imaging in the staging
of histiocytic sarcoma. While PET/CT was superior in determining the extent
of the disease, gallium can be used to help stage the disease in centers where
PET/CT is not available.
Key Words: histiocytic sarcoma, gallium, FDG, PET/CT, lymph nodes
(Clin Nucl Med 2011;36: e37–e38)
1. Vos JA, Abbondanzo SL, Barekman CL, et al. Histiocytic sarcoma: a study
of five cases including the histiocyte marker CD163. Mod Pathol. 2005;18:
2. Jaffe ES, Harris NL, Stein H, et al, eds. Pathology and Genetics of Tumours
of Haematopoietic and Lymphoid Tissues. Lyon, France: IARC Press; 2001:
3. Favara BE, Feller AC, Pauli M, et al. Contemporary classification of histiocytic
disorders. The WHO committee on histiocytic/reticulum cell proliferations.
Reclassification working group of the histiocyte society. Med Pediatr Oncol.
4. Fukunaga M, Kato H. Histiocytic sarcoma associated with idiopathic myelo-
fibrosis. Arch Pathol Lab Med. 2004;128:1167–1170.
5. Hornick JL, Jaffe ES, Fletcher CD. Extranodal histiocytic sarcoma: clinico-
pathologic analysis of 14 cases of a rare epithelioid malignancy. Am J Surg
6. Huang SC, Chang CL, Huang CH, et al. Histiocytic sarcoma—a case with evenly
distributed multinucleated giant cells. Pathol Res Pract. 2007;203:683–689.
7. Binkovitz LA, Olshefski RS, Adler BH. Coincidence FDG-PET in the
evaluation of Langerhans’ cell histiocytosis: preliminary findings. Pediatr
8. Nakahara T, Suzuki T, Uno K, et al. 18F-FDG positron emission tomographic
imaging in Erdheim-Chester disease with skeletal and extra-skeletal involve-
ment. Leuk Lymphoma. 2006;47:935–937.
9. Alongi F, Blognesi A, Gajate AM, et al. Inflammatory pseudotumor of
mediastinum treated with tomotherapy and monitored with FDG PET/CT: a
case report and literature review. Tumori. 2010;96:322–326.
10. Yu JQ, Zhuang H, Xiu Y, et al. Demonstration of increased FDG activity in
Rosai-Dorfman disease on positron emission tomography. Clin Nucl Med.
11. Aoki J, Watanabe H, Shinozaki T, et al. FDG PET of primary benign and
malignant bone tumors: standardized uptake value in 52 lesions. Radiology.
12. Rao S, Langston A, Galt JR, et al. Extramedullary acute myeloid leukemia
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of a rare entity. Ann Nucl Med. 2008;22:715–717.
Received for publication August 13, 2010; revision accepted October 17, 2010.
From the *Department of Nuclear Medicine, Brandon Regional Health Centre,
Brandon, MB, Canada; and †Department of Nuclear Medicine, Royal Victoria
Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
None of the authors have any financial or other relationships that might lead to a
conflict of interest.
This manuscript or any containing figures or tables have not been submitted to any
publication previously. None of the authors have any financial or other
relationships that might lead to a conflict of interest. The manuscript has been
read and approved by all the authors, and the requirements for authorship have
been met. Each author believes that the manuscript represents honest work.
Reprint: William Makis, MD, Department of Nuclear Medicine, Brandon Re-
gional Health, 150 McTavish Ave E, Brandon, MB R7A 2B3, Canada.
Copyright © 2011 by Lippincott Williams & Wilkins
Clinical Nuclear Medicine • Volume 36, Number 6, June 2011www.nuclearmed.com | e37
FIGURE 1. An 82-year-old man with no prior history of malignancy presented with a 3-week history of a rapidly enlarging left
axillary mass. The patient was also complaining of mild fevers for the same duration, but no weight loss or night sweats. He
was referred for a gallium-67 scan for the evaluation of possible lymphoma. A, Upper body gallium-67 images with anterior
and posterior views show intense gallium uptake in the left axilla, and mild uptake in the left supraclavicular region. Lower
body images did not show any gallium-avid abnormalities. B, An F-18 FDG PET/CT (Discovery ST, GE Healthcare, Canada)
was performed on the following day. Maximum intensity projection images with anterior and posterior views, showed
intensely FDG-avid left axillary and supraclavicular lymphadenopathy that was more extensive than on the gallium scan.
Maximum standardized uptake value was 18. Transaxial views of the (C) CT portion of the PET/CT, (D) PET, and (E) PET/CT
fusion images show the extent of the axillary adenopathy. Histopathological evaluation of one of the left axillary lymph nodes
showed tissue whose architecture was effaced by a loose proliferation of very large pleomorphic cells with markedly irregular
nuclei having moderately clumped chromatin, variable nucleoli, and moderate numbers of mitoses. Some had the features of
histiocytic cells with reniform nuclei. Immunohistochemistry revealed positivity of CD45 (on many of the large cells), CD45RO,
and CD68; and negativity of CD20, CD30, CD43, CD56, CD57, CD79a, CD138, CD3, CD5, myeloperoxidase, Mart/Melan,
Alk1, perforin, Keratin AE1/3, CK7, CK20, TTF1, compatible with histiocytic sarcoma (HS). HS is a very rare hematological
neoplasm, comprising ?1% of all non-Hodgkin lymphomas.1World Health Organization defines HS as a malignancy with
morphologic and immunophenotypic features that resemble those of mature tissue histiocytes.2Very few cases of true HS
exist in the literature, as advances in immunohistochemistry have shown that many of the previously identified cases were
other types of non-Hodgkin lymphoma and anaplastic large cell lymphoma.3–5HS can arise in lymph nodes, skin, and at
extranodal sites (particularly the gastrointestinal tract), often presenting with clinically advanced disease and pursuing an
aggressive clinical course. Cases arising primarily at extranodal sites often appear to go unsuspected and unrecognized.6F-18
FDG uptake has been noted in several conditions with histiocytic lineage, including Langerhans cell histiocytosis,7
Erdheim-Chester disease,8juvenile xanthogranuloma (also known as inflammatory pseudotumor),9Rosai-Dorfman disease,10
malignant fibrous histiocytoma,11monocytic leukemia,12and HS.13This is a rare report highlighting the usefulness of
gallium-67 and F-18 FDG PET/CT in staging and determining the extent of HS, and while F-18 FDG PET/CT is superior in
determining the extent of the disease, gallium-67 can be used to help stage the disease in centers where a PET/CT is not
Makis et al
Clinical Nuclear Medicine • Volume 36, Number 6, June 2011
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© 2011 Lippincott Williams & Wilkins