Follicular dendritic cell tumour/sarcoma

 a commonly misdiagnosed tumour in the thorax Intrathoracic follicular dendritic cell sarcoma:

Abstract

Aims

Follicular dendritic cell sarcoma (FDCS) is a rare tumour reported to occur occasionally in association with the hyaline-vascular type of Castleman's disease (HVCD). Most cases arise in lymph nodes though extranodal presentation is described.

Methods and Results

Clinical, radiological and histological characteristics, including diagnosis on pre-resection material, were assessed in seven intrathoracic cases from five males and two females with a median age of 38 years. Clinical symptoms were related to mass location, six cases presenting within central and/or posterior mediastinal compartments and one within the lungs. PET/CTs demonstrated marked fluoro-deoxy-glucose (FDG) avidity and the prominent vessels traversing the lesions. Four of six cases (67%) were initially misdiagnosed. HVCD was present in three cases. Two cases with high mitotic rates recurred after resection. All were positive for at least one of the follicular dendritic cell markers (CD21, CD35 and CD23). Six of seven cases (86%) show Cyclin D1 expression ranging from 5% to 90%.

Conclusions

FDCS is often misdiagnosed on biopsy and pathologists need to be aware of the tumour to request the relevant immunohistochemistry, especially in masses presenting in the central/posterior mediastinum with high vascularity and SUV levels. Background HVCD appears more common than previously thought.

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