New insights inside the interdigitating dendritic cell sarcoma-pooled analysis and review of literature.

Interdigitating dendritic cell sarcoma is a rare haematological neoplasm with high debatable management protocols. The data extracted from 127 case reports published between 1981 and 2018 were analysed. The median age at diagnosis was 58 years with a male to female ratio of 1.65:1. The median OS and PFS of IDCS were 12 and 6 months, respectively, with a disease-specific mortality rate of 36.4%. Two-thirds of patients had a localised disease, while 30% had a disseminated form with 1-year mortality rates of 21.1% and 78.9%, respectively. Twenty per cent of cases were associated with other malignancies. Histologically, the proliferation of large spindle-shaped cells with fascicular growth was described in 84.3% of cases. Based on Cox-regression model, surgical resection was the only treatment modality linked to survival improvement with no recorded survival benefits of radiotherapy and chemotherapy. The 1-year mortality rates in resected and non-resected disease were 17.8% and 63.2%, respectively (P < 0.0001).

Interdigitating dendritic cell sarcoma of the spleen with hepatic failure after chemotherapy: A case report.

RATIONALE: Interdigitating dendritic cell sarcoma (IDCS) is an extremely rare disease originating from dendritic cells (DCs). There are few cases report interdigitating dendritic cell sarcoma of spleen along with their pathological characteristics and treatment. PATIENT CONCERNS: Here we report a case of IDCS in 53-year-old female who presented spleen enlargement and thrombocytopenia. DIAGNOSES: The patient underwent surgical resection of spleen, and the pathology confirmed IDCS. INTERVENTIONS: She received surgical resection of spleen and one cycle of chemotherapy (ABVD with ifosfamide and oxaliplatin) after surgery. OUTCOMES: She died of severe hepatic failure caused by chemotherapy. DISCUSSION: IDCS is a rare disease with insufficient treatment guidelines. We adopted chemotherapy of ABVD with ifosfamide and oxaliplatin which showed no improvement but led to life-threatening liver damage.

Interdigitating dendritic cell tumor: A rare case report with review of literature.

Interdigitating dendritic cell tumor/sarcoma (IDCT) is a very rare and aggressive neoplasm arising from antigen-presenting cells. It usually involves lymph nodes, but extranodal sites can also be involved. Because of the rarity of the disease, consistent standard treatment guidelines have not been established till date. We report a case of a 35-year-old female who presented with right-sided neck swelling and anterior mediastinal mass. Histopathology revealed large mononucleated cells with background of mixed polymorphous inflammatory cells suspicious of Hodgkin's lymphoma. Hence, to confirm the diagnosis, immunohistochemistry was done. Immunohistochemistry revealed that the tumor was CD30 - negative, CD10 - negative, CD2 - negative, leukocyte common antigen - positive, vimentin - positive, and S-100 - positive, diagnostic of IDCT. Patient was treated with eight cycles of cyclophosphamide, doxorubicin, vincristine, and prednisolone regimen chemotherapy followed by involved field radiotherapy and showed dramatic response with complete resolution of mediastinal mass.

Interdigitating dendritic cell sarcoma successfully treated with ABVD therapy in which serum CEA levels correlated with disease activity.

Interdigitating dendritic cell sarcoma (IDCS) is an extremely rare neoplasm of spindle to ovoid cells with phenotypic features similar to those of interdigitating dendritic cells. No standard therapy for advanced IDCS has yet been established. According to past reports, CHOP-like regimens are often chosen as primary therapy. Herein, we report a case with advanced IDCS, for which ABVD achieved remarkable clinical improvement and serial CEA levels correlated with disease status. A 76-year-old man presented with general fatigue and pancytopenia with CEA elevation. Colonoscopy showed erosion and polyps in the colon. FDG-PET showed marked abnormal accumulation throughout the bone marrow. Pathologically, polyps of the colon and IDCS of the bone marrow were diagnosed. Although the patient received CHOP as initial therapy, clinical improvement was not significant. Subsequently, six cycles of ABVD resulted in remarkable regression of both the colonic polyps and the bone marrow infiltration. Moreover, the patient was transfusion-free after ABVD. In addition to these clinical responses, serial CEA levels normalized. Our case highlights the efficacy of ABVD for IDCS and serial CEA measurements might reflect treatment efficacy.

Diffuse lesion and necrosis tied to poorer prognosis of interdigitating dendritic cell sarcoma: cases report and a pooled analysis.

Interdigitating dendritic cell sarcoma is a neoplastic proliferation of interdigitating dendritic cells and no therapeutic consensus exists. This study aimed to investigate the prognostic impacts of tumor lesion, cellular atypia, mitosis and necrosis on the interdigitating dendritic cell sarcoma. Case reports and pooled analyses were designed to explore the relationships. One case was a 40-years old man with localized lesion, moderate to notable cellular atypia, 30 mitoses per 10 high-power fields and no necrosis and the progression-free survival was longer than 20 months. The other case was a 62-years old woman with diffuse lesion, notable cellular atypia, less than one mitosis per 10 high-power fields and diffuse necrosis and the progression-free survival was shorter than 1 month. Cellular atypia and mitosis had not any relationship with survival. Compared with localized lesion, diffuse lesion presented a 2.92-fold risk of progression (HR = 2.92, 95% CI 1.01, 8.51) and an 8.79-fold risk of death (HR = 8.79, 95% CI 1.86, 41.64). Diffuse necrosis presented a 4.39-fold higher progression risk (HR = 5.39, 95% CI 1.78, 16.29) and a 5.37-fold higher death risk (HR = 6.37, 95% CI 1.46, 27.86) than focal or no necrosis. Diffuse lesion and diffuse necrosis were indicators of poorer prognosis and the clinical application should be warranted in further studies.

Impact of surgery, radiation and systemic therapy on the outcomes of patients with dendritic cell and histiocytic sarcomas.

BACKGROUND: Neoplasms of histiocytic and dendritic cell origin, including follicular dendritic cell sarcoma (FDCS), histiocytic sarcoma (HS) and interdigitating dendritic cell sarcoma (IDCS), are extremely rare, and data on their natural history and treatment outcomes are sparse. We evaluated the impact of surgery, radiation and systemic therapies on overall survival (OS). METHODS: We conducted a retrospective chart review of patients with FDCS, IDCS and HS treated at Memorial Sloan Kettering Cancer Center between 1995 and 2014. RESULTS: We identified 31, 15 and 7 patients with FDCS, HS and IDCS, respectively. Median age was 48.7, 42.3 and 58.8years for FDCS, HS and IDCS, respectively. Only a slight disparity in gender distribution existed for FDCS and HS; however, IDCS predominantly affected males (6:1). The most common sites of presentation were abdomen and pelvis (42%), extremities (33%) and head and neck (57%) for FDCS, HS and IDCS, respectively. At diagnosis, 74%, 40% and 86% of patients presented with localised disease in FDCS, HS and IDCS, respectively. Patients with localised disease had significantly improved OS than those with metastatic disease in FDCS (P=0.04) and IDCS (P=0.014) but not in HS (P=0.95). In FDCS and HS, adjuvant or neo-adjuvant therapy was not associated with improved OS compared with observation. In IDCS, surgery alone provided a 5-year overall survival rate of 71%. CONCLUSIONS: Adjuvant or neo-adjuvant treatment in FDCS and HS did not affect OS. Patients with IDCS had an excellent outcome with surgery. In the metastatic setting, chemotherapy and small molecule inhibitors may provide benefit.

Interdigitating dendritic cell sarcoma.

Interdigitating dendritic cell sarcoma (IDCS) is an extremely rare dendritic cell tumor with slightly more than 100 cases reported in the English literature. This report discusses a case of localized IDCS involving cervical lymph nodes and provides a literature review of clinicopathologic aspects and treatment outcomes.

Interdigitating and follicular dendritic cell sarcomas: a SEER analysis.

OBJECTIVES: Follicular dendritic cell sarcoma (FDCS) and interdigitating dendritic cell sarcoma (IDCS) are rare neoplasms of dendritic cell origin. Because of the rarity of these diagnoses, optimal management is unclear. METHODS: In this study, we reviewed the data on FDCS and IDCS available in the Surveillance, Epidemiology, and End Results database. Fifty-four patients with FDCS and 20 with IDCSs were identified between the years 2001 and 2008. RESULTS: Median follow-up was 28 months. Sixty-one percent of FDCS patients and 55% of IDCS patients presented with localized disease. Of the FDCS patients with localized disease, 31/33 (94%) underwent surgical resection. Fifty-five percent (6/11) of localized IDCS patients underwent surgical resection. Radiation therapy was given to 30% of patients. Overall survival was significantly better for patient with FDCS compared to those with IDCS. Median survival was 35 months in patients with IDCS and was not reached in patients with FDCS. There was a trend toward improved overall survival in FDCS patients with localized disease. IDCS patients with localized disease had a significantly improved overall survival compared with those with distant disease with 2-year overall survival of 72% versus 33%, respectively (P = 0.05). CONCLUSIONS: These data demonstrate that most patients with localized disease are treated similar to a soft tissue sarcoma with primary surgical resection with or without radiation. No chemotherapy data were available in the Surveillance, Epidemiology, and End Results database. The role of chemotherapy and radiation therapy remains unclear.

Interdigitating dendritic cell sarcoma: case report with review of the literature.

BACKGROUND: Interdigitating dendritic cell sarcoma (IDCS) is an exceedingly rare tumor. The characteristics of IDCS and its optimal therapeutic approach have not been fully clarified. CASE REPORT: We report the case of a 53-year-old Chinese male patient presenting with a subcutaneous nodule in the right chest wall. The histological and immunohistochemical features of the nodule confirmed the diagnosis of IDCS. Complementary examination excluded other involvement of the tumor. The patient was alive without evidence of disease 1 year after tumor resection followed by radiotherapy. CONCLUSION: With regard to the literature, IDCS presents with a wide spectrum of clinical manifestations, and its correct diagnosis requires awareness of this rare disease and the use of appropriate markers. Surgery with curative potential might remain the first treatment option, and current data do not support adjuvant therapy. Systemic chemotherapy is mainly suggested for extensive disease while the long-term efficacy is unsatisfactory. The prognosis of IDCS seems to be associated with the initial stage of disease.

Interdigitating dendritic cell sarcoma of the tonsil.

Interdigitating dendritic cell sarcoma (IDCS) is an extremely rare malignancy derived from antigen-presenting cells, with 55 cases reported thus far. A standard treatment modality is still being debated. This report describes a 56-year-old female who presented with right tonsillar enlargement and right submandibular swelling for 6 months. Treatment with empiric antibiotics did not result in improvement of her symptoms. Fine needle aspiration of the tonsil revealed no malignant cells. Tonsillectomy was eventually performed due to persistent symptoms. Based on microscopic findings, immunohistochemical stains, and review of the literature, the present case was finally diagnosed as IDCS of the tonsil with cervical lymph node involvement. The patient received four cycles of CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) chemotherapy, and a clinically complete response was achieved followed by adjuvant radiation.

[Interdigitating dendritic cell sarcoma of lower extremities resistant to high dose chemotherapy BEAM with peripheral blood stem cell transplantation]. / Sarkom z interdigitujících dendritických bunek dolní koncetiny rezistentní k vysokodávkované chemoterapii BEAM s autologní transplantací kmenových krvetvorných bunek--popis prípadu a prehled literatury.

Interdigitating dendritic cell sarcoma is a rare neoplasm forming part of the group of malignancies derived from histocytic cell line. This nosological unit can be detected only by special immunohistochemical exams. A young man aged 25 found a tumorous swelling in the proximal part of his left crus. The pathological process affected proximal tibial epiphysis and adjacent soft tissues. The first FDG-PET examination performed in the process of determining the clinical stage of the disease showed a high activity in the site of primary tumour (SUV 7.71) and in the site of regional inguinal node (SUV 4.25). Histological examination of a diagnostic excision specimen of the tumour in the tibia and the extirpated enlarged regional nodes in the left groin led to the diagnosis of interdigitating dendritic cell sarcoma. The diagnosis was confirmed pathologically by another two centres in the Czech Republic and, due to the unusual nature of the diagnosis, also in Regensburg, Germany. Treatment started with chemotherapy, applied to patients with aggressive lymphomas in the framework of clinical studies, i.e. a combination of MegaCHOP. After 4 cycles, however, there was no visible response on the site of primary tumour. MegaCHOP therapy was therefore discontinued after the 4 cycles. Subsequently, we referred the patient for a high-dose chemotherapy with autologous bone marrow transplantation, similarly to aggressive lymphomas. The collection of blood producing stem cells from peripheral blood was successfully performed after ESHAP chemotherapy. A verificatoin FDG-PET examination was performed before high-dose chemotherapy. Increased activity was detected only in left proximal crus, with an SUV of 4.6. One month after ESHAP chemotherapy, BEAM high-dose chemotherapy with autologous transplantation of blood forming tissue was performed. High-dose chemotherapy was followed up by radiotherapy targeted on the primary tumour in the crus (70 Gy). The third verification FDG-PET examination was performed 3 months after radiotherapy. The examination showed a continuing higher activity in the region of the primary tumour (SUV 2.69) and a new centre of activity was detected in the left inguinal nodes region (SUV4.09). The activity corresponded to the presence of viable tumour tissue in the primary nidus and new metastases in inguinal nodes, without proofs of further proliferation at the time. Nodes of the left groin were removed. Histological examination showed affection of the node by the same type of tumour, i.e. a continuing activity of the disease despite chemotherapy. Due to suspected continuation of viable tumour in the crus judging by the intensity of accumulation of FDG-PET and the proof of a new affection of regional nodes, surgical treatment was preferred after the failure of chemotherapy. After the removal of inguinal nodes, left knee joint exarticulation was performed. This was followed by regional inguinal node region radiotherapy (56 Gy). The last fourth PET-CT examination carried out 4 months after the radiation therapy of the inguinal region showed massive dissemination into the region ofileac and paraaortic nodes (lymphadenopathy up to 6 cm in diameter) with an activity of 5.9 to 6.73 SUV units. Currently, we test the sensitiveness of the disease to 2-chlordeoxyadenosin and look for additional therapeutic options. To our knowledge, the above description is the first documented case of interdigitating dendritic cell sarcoma located in the tibia and crus soft tissue. We have not found any description of high-dose therapy supported by autologous transplantation of blood-forming tissue for this type of tumour in relevant literature. In this case, we record chemoresistance to high-dose chemotherapy and certain radiosensitivty of the tumour at the same time.

[Dendritic cell sarcoma: 4 cases report with literature review].

OBJECTIVE: To describe the clinical and pathological features, treatment and prognosis of dendritic cell sarcoma (DCS). METHODS: A group of DCS was described, including two cases of follicular dendritic cell sarcoma (FDCS), one each of interdigitating dendritic cell sarcoma (IDCS) and langerhans cell sarcoma (LCS). The related English literatures were reviewed. RESULTS: Two patients with IDCS were a 19-year-old man and a 45-year-old woman respectively, both exhibited fever of unknown origin and painless lymphadenopathy. Pathological diagnosis of lymph node biopsy was FDCS with positive CD21 and CD35. Both patients achieved complete remission (CR) after 6 cycles of chemotherapy (CHOP: cyclophosphamide, epirubicin, vindesine, and prednisolone). However, the male patient relapsed 5 months later and another patient was still in CR at 5 months follow-up. One case of IDCS was a 42-year-old man, who manifested as paraneoplastic pemphigus. Biopsy of mediastinal lymph node demonstrated IDCS and immunohistochemistry showed positive S-100 staining. This patient died of pneumonia after two cycles of CHOP. One patient of LCS was a 54-years-old woman with fever, painless lymphadenopathy and diffused pulmonary nodules. The diagnosis of LCS was established after excisional biopsy was taken from inguinal lymph node. Positive staining of CD1a and S-100 was displayed by immunohistochemistry. Electron microscope examination confirmed the presence of Birbeck granule in tumor cells. Four cycles of chemotherapy (including ECHOP, FND) were administered, but the disease progressed. CONCLUSION: DCS is a group of very rare sarcoma, FDCS, IDCS and LCS have different characteristic clinical features, immunophenotype and prognosis. The prognosis of most patients is poor.

Dendritic cell sarcoma: an analytic overview of the literature and presentation of original five cases.

Interdigitating and follicular dendritic cell sarcoma (DCS) are very rare diseases, with approximately 184 cases being reported thus far, and their best treatment modality is still on debate. This is a review of all the cases of dendritic cell sarcoma reported from 1981 until April 2006. This review is enriched with the original contribution of five cases occurred at our Institution from 1994 to 2006. The review of the literature pointed out that radical surgery alone was curative in approximately two thirds of these cases, the relapsing rate in patients who received adjuvant treatments being higher than 30%. We pinpoint new five cases of dendritic cell sarcoma (three FDCS and two IDCS). Both the analytic revision of the literature and our data suggest that localized DCS may be effectively treated by radical surgery and do not support the use of adjuvant treatments after radical excision.