Fig. 1Gross finding. (A) Abdominal-pelvic computed tomography (CT) shows a newly developed spelnic mass in a normal-sized spleen (3.4 cm), increasing in size over six months. (B) The mass is a 3.2 cm-sized, well circumscribed, gray-whitish to tan, firm nodule.
Fig. 2Microscopic findings. (A) A well-defined mass is composed of spindle cells admixed with chronic inflammatory cells with a central coagulative necrosis (inset). (B) Many histiocytic granulomas can be identified in the background. (C) The oval to spindle tumor cells (blue arrows) have enlarged twisted/folded nuclei and distinct nucleoli.
Fig. 3The immunohistochemical staining of the tumor cells is positive for CD35 (A), and negative for histiocytes. (B) The histocytic granuloma is composed of CD68-positive cells. (C) Epstein-Barr virus in situ hybridization is detected almost exclusively in spindle tumor cells (inset; high power view), not in histiocytes.
Table 1.Summary of the reported cases of IPT-like FDCT according to occurrence sites [2,9]
Case |
|
Age (yr) |
Sex |
Size (cm) |
Symptoms |
Treatment |
Outcome |
Spleen |
1 |
70 |
M |
5.5 |
Asymptomatic |
NA |
NA |
|
2 |
58 |
F |
22 |
Abdominal dullness, easy bruising |
Splenectomy |
Alive well at 4 mo |
|
3 |
39 |
F |
7.5 |
Weight loss, fever |
Splenectomy |
Alive at 2 mo |
|
4 |
61 |
F |
3.5 |
Asymptomatic |
Splenectomy |
Recent case |
|
5 |
77 |
F |
11 |
Epigastralgia |
Splenectomy |
Alive well (3 yr) |
|
6 |
64 |
F |
5.1 |
NA |
Splenectomy |
Metastasis |
|
7a
|
76 |
M |
3.2 |
Asymptomatic |
Splenectomy |
Alive well (7 mo) |
Liver |
1 |
68 |
F |
11 |
Malaise, weight loss |
Excision of mass |
Alive well (2.5 yr) |
|
2 |
57 |
F |
9.5 |
Intermittent epigastralgia |
No surgery |
Enlarged to 15 cm, no metastasis (3 yr) |
|
3 |
51 |
F |
15 |
Abdominal fullness, weight loss |
Lt. lobectomy |
Alive well (1 yr) |
|
4 |
19 |
F |
12 |
RUQ abdominal pain, weight loss |
Surgical excision |
Alive well (40 mo) |
|
5 |
56 |
F |
15 |
Gastointestinal upset |
Rt. lobectomy |
Recur (× 3), alive with disease (56 mo) |
|
6 |
40 |
F |
12.5 |
Epigastric pain, weight loss |
Lt. hepatectomy |
Intra-abdominal recurrence |
|
7 |
49 |
F |
4.2 |
Asymptomatic |
Surgical excision |
Alive well (9 mo) |
|
8 |
37 |
M |
15 |
Malaise, weight loss, gross hepatomegaly |
Rt. trisegmentectomy |
Alive well (42 mo) |
|
9 |
35 |
F |
20 |
Epigastric discomfort, fever, weight loss |
Rt. hemihepatectomy |
Recur (× 3), died for dissemination (95 mo) |
|
10 |
31 |
F |
15 |
Abdominal distension, weight loss |
Rt. hemihepatectomy |
Subtle involvement of porta hepatis LN; alive well (60 mo) |
|
11 |
49 |
F |
9.5 |
Abdominal distension (peripancreas) |
Whipple’s operation |
Recent case |