Histiocytic Sarcoma Associated With Follicular Lymphoma: Evidence for Dramatic Response With Rituximab and Bendamustine Alone and a Review of the Literature

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Presentation transcript:

Histiocytic Sarcoma Associated With Follicular Lymphoma: Evidence for Dramatic Response With Rituximab and Bendamustine Alone and a Review of the Literature Michael Farris, Ryan T. Hughes, Zanetta Lamar, Michael H. Soike, Joshua R. Menke, Robert S. Ohgami, Karen Winkfield Clinical Lymphoma, Myeloma and Leukemia Volume 19, Issue 1, Pages e1-e8 (January 2019) DOI: 10.1016/j.clml.2018.10.004 Copyright © 2018 Elsevier Inc. Terms and Conditions

Figure 1 Follicular Lymphoma With Histiocytic Sarcoma. (A) Mediastinal Core Biopsy is Completely Effaced by 2 Histologically Distinct but Contiguous Neoplasms, One With Small Lymphocytes in Vaguely Nodular Growth Pattern (Arrow) and One With Sheets of Cells With Voluminous Pink Cytoplasm With Scattered Background of Smaller Lymphocytes (Arrowhead) (Original Magnification, ×40). (B) Higher-Power Magnification of Areas With Vaguely Nodular Pattern and Many Small Lymphocytes Reveals These Lymphocytes to be Small and Cleaved With Fewer Larger Immunoblasts (Original Magnification, ×400). (C) High-Power Magnification of Areas With Sheets of Histiocytic Cells With Voluminous Pink Cytoplasm Shows This Subset to Have Highly Irregularly Cleaved Nuclei With Prominent Nucleoli (Arrow) (Original Magnification, ×400). (D) Immunostaining for CD20 in Areas With Predominantly Small Cleaved Lymphocytes Shows Them to be Diffusely CD20 Positive (Original Magnification, ×400). (E) Immunostaining for CD163 Highlights Atypical Histiocytic Cells (Original Magnification, ×400). (F) Interphase Fluorescence-In-Situ Hybridization Performed on Areas With Numerous Small Cleaved Lymphocytes Reveals Rearrangement of BCL2 (Yellow Arrows) by Break-Apart Probe. (G) Interphase Fluorescence-In-Situ Hybridization Performed on Areas With Histiocytic Large Cells, Also Shows Rearrangement of BCL2 (Yellow Arrows) by Break-Apart probe Clinical Lymphoma, Myeloma and Leukemia 2019 19, e1-e8DOI: (10.1016/j.clml.2018.10.004) Copyright © 2018 Elsevier Inc. Terms and Conditions

Figure 2 Serial PET Imaging Illustrating Response to Therapy Over Time Abbreviation: PET = positron emission tomography. Clinical Lymphoma, Myeloma and Leukemia 2019 19, e1-e8DOI: (10.1016/j.clml.2018.10.004) Copyright © 2018 Elsevier Inc. Terms and Conditions

Supplemental Figure 1 Timeline of Events Describing Medical History and Response to Treatment Abbreviations: CR = complete response; Dx = diagnosis; FL = follicular lymphoma; PET = positron emission tomography; R-CHOP = rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone. Clinical Lymphoma, Myeloma and Leukemia 2019 19, e1-e8DOI: (10.1016/j.clml.2018.10.004) Copyright © 2018 Elsevier Inc. Terms and Conditions