PMC4898009_01
84-year-old woman with histiocytic sarcoma, one year after presentation. Axial reformatted image of the lower abdomen reveals marked interval increase in the area of thickening (arrows) in the terminal ileum.
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Abdominal CT obtained after oral and intravenous contrast agents, was successful in depicting a mild circumferential bowel wall thickening in the terminal ileum (Fig. 1).
84-year-old woman with histiocytic sarcoma, at initial presentation. Coronal reformatted CT of abdomen and pelvis at initial presentation, showing moderate bowel wall thickening (arrows) with contrast enhancement.
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Mucosal ulceration and mural involvement was present without obvious perforation or stranding of mesenteric fat (Fig. 2).
84-year-old woman with histiocytic sarcoma, one year after presentation. Coronal reformatted CT of abdomen and pelvis showing marked interval increase in circumferential bowel wall thickening (arrows) with narrowing of the segment of ileum.
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Findings at gross examination indicated an irregular ulcerated infiltrating mass involving the distal ileum measuring 10.0 cm in maximum dimension (Fig 3).
84-year-old woman with histiocytic sarcoma, after surgery. Gross surgical specimen obtained after segmental resection of ileum shows an irregular ulcerated mass (arrows).
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Microscopic examination showed full thickness infiltration of small bowel wall by malignant tumor composed of many sheets of spindle to epithelioid cells with abundant eosinophilic cytoplasm, oval to irregular nuclei, vesicular chromatin, and large nucleoli (Fig. 4a). There were interspersed bizarre multinucleated cells, xanthomatous histiocytes and inflammatory cells, such as lymphocytes and plasma cells (Fig. 4b).
84-year-old woman with histiocytic sarcoma, after surgery. A, Photomicrograph shows infiltration of the bowel wall by malignant cells (Hematoxylin-eosin, original magnification x 20). B, Sheets of spindle cells arranged in storiform pattern and scattered bizarre multinucleated cells (Hematoxylin-eosin, original magnification x 40).
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The tumor cells were positive for leukocyte common antigen CD45 (LCA), CD45RO (UCHL-1), CD68 (KP1), CD4 (a T-cell antigen present in a subset of histiomonocytic cells), HLA-DR, vimentin, and lysozyme (Fig. 5 a-c).