A 47-year-old man complained of chest malaise and pain that had persisted for about eight months. He had no fever, cough, expectoration or decompensation during the course of disease.
The unenhanced CT images of the chest demonstrated a well-defined mass of homogeneous attenuation in the posterior mediastinum, and the mass measured 7.5 × 4 cm in diameter on CT. An arborizing-pattern of coarse calcifications could be seen within the lesion (). After the administration of intravascular contrast media, the mass showed intense homogeneous enhancement to a degree that was similar to the enhancement of the adjacent great vessels (). The mass compressed the left atrium and the right pulmonary artery. The esophagus was posterolaterally displaced. A small hypodense region could also be seen in the tumor. Enlarged lymph nodes were found in the paratracheal and aortopulmonary regions.
Follicular dendritic cell sarcoma in mediastinum in 47-year-old man.
Surgical excision of the tumor was attempted at an outside hospital under the impression of a neurogenic tumor, but this failed due to massive tumoral hemorrhage during the surgery and a biopsy could only be performed. The histopathological and immunohistochemical examinations revealed follicular dendritic cell sarcoma. The patient then underwent radiotherapy and he has been alive with the disease for 14 months.
A 28-year-old woman presented with an insidious onset of upper abdominal pain and this was accompanied by sour regurgitation and eructation, and this had all started two months ago. She had been treated under the diagnosis of having gastritis for four weeks at an outside hospital, but the symptoms had not improved.
An air-barium double-contrast upper gastrointestinal series disclosed wall stiffness in the lesser curvature of the stomach and broadening of the incisura, suggesting an extrinsic compression. The gastric mucosal surface appeared smooth and regular. No obvious niche sign or filling defect was detected (). An unenhanced CT scan showed a large well-circumscribed mass of heterogeneous attenuation between the lesser curvature of the stomach and the left lobe of the liver, and the mass was about 11 × 7 × 10 cm in dimension, as measured on CT. The lesion was generally hypodense compared with the liver and there were even lower density regions scattered within the lesion (). After intravenous contrast enhancement, the tumor was moderately enhanced and it was somewhat heterogeneously enhanced on the arterial phase. Several prominent feeding vessels were noted in the periphery of the tumor (). The mass was heterogeneously hypodense compared with the hepatic parenchyma during the portal phase (). No enlarged lymph nodes were found in the retroperitoneum.
Follicular dendritic cell sarcoma in upper abdomen in 28-year-old woman.
A gastrointestinal stromal tumor was suspected and so radical subtotal gastrectomy was then performed. The excised mass measured 15 cm in diameter and it was found to have originated in the submucosa of the stomach. Central necrosis was observed in the tumor. The overlying gastric mucosa was intact. The histopathological and immunohistochemical findings () confirmed the diagnosis of follicular dendritic cell sarcoma.
Three months after the surgery, a follow-up MRI showed a 1.7-cm nodule in the right lobe of the liver, and the nodule had low signal intensity on the T1-weighted images () and hyperintensity on the T2-weighted images with a hypointense center (). On the T1-weighted gadolinium-enhanced images, the nodule showed homogeneous enhancement during the arterial phase, making it appear isointense compared to the surrounding normal liver (). The lesion appeared slightly hypointense compared to the liver during the portal venous phase (). Wedge lobectomy of the liver with including the tumor was performed and this was followed by adjuvant chemotherapy. Pathological examination confirmed a metastatic follicular dendritic cell sarcoma. Metastases re-developed in the liver nine months thereafter. The MRI features of the new metastatic lesions were similar to those of the prior metastasis. The patient has been alive with the disease for the following two years.
A 38-year-old man presented with a two-week history of a common cold and a painless right cervical mass. The axial unenhanced CT demonstrated a 4.5-cm right submandibular mass () that was displacing the right submandibular gland anteromedially, the right sternocleidomastoid muscle posterolaterally and the right carotid artery and the right internal jugular vein anteromedially. The mass had a well-delineated margin and it generally showed homogeneous soft-tissue attenuation that was similar to the attenuation of the submandibular gland and slightly lower than that of the adjacent neck muscles. A small area of slightly lower attenuation was also seen in the mass. Subsequently, the mass was excised and it was diagnosed as follicular dendritic cell sarcoma of a cervical lymph node. The patient underwent adjuvant radiation therapy to the right side of the neck and he is alive with no evidence of disease recurrence for 16 months.
Follicular dendritic cell sarcoma of cervical lymph node in 38-year-old man.
A 35-year-old woman first presented in 1998 with a left postauricular mass that was then excised at an outside hospital (the pathological diagnosis was unavailable). In 2005, a mass, which was presumably a local recurrence of the previous disease, developed in the similar left periauricular location and this was re-excised at another hospital, and the mass was pathologically confirmed as an ectopic meningioma. In late 2007, the patient visited our hospital for recurred masses in the left periauricular location. Fine needle aspiration of the periauricular masses was performed, and the results were suspicious for a malignant tumor.
The axial contrast-enhanced CT scan of the neck () demonstrated multiple masses, which were assumed to be enlarged lymph nodes, in the left parotid gland region and in the retrocervical space, and the masses ranged from 1.5 to 3 cm in diameter. The nodes showed homogeneous moderate enhancement.
Follicular dendritic cell sarcoma of cervical lymph nodes in 35-year-old woman.
The patient underwent a left radical neck dissection. The histopathological examination confirmed the diagnosis of follicular dendritic cell sarcoma that originated from the cervical lymph nodes. The patient has remained disease-free for eight months after the surgery.