Quiz-summary
0 of 1 questions completed
Questions:
- 1
Information
Presented by Theresa Chan, M.D. and prepared by Maryam Farinola M.D.
Case 6: 57-year-old male with elevated PSA and this pelvic lymph node.
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading...
You must sign in or sign up to start the quiz.
You have to finish following quiz, to start this quiz:
Results
Time has elapsed
Categories
- Not categorized 0%
- 1
- Answered
- Review
-
Question 1 of 1
1. Question
Week 193: Case 6
57-year-old male with elevated PSA and this pelvic lymph node./images/histiocytosis assoc with hip prosthesis 1.jpg
/images/histiocytosis assoc with hip prosthesis 2.jpg
/images/histiocytosis assoc with hip prosthesis 3.jpg
/images/histiocytosis assoc with hip prosthesis 4.jpgCorrect
Answer: Benign sinus histiocytosis
Histology: The pelvic lymph nodes taken during radical prostatectomy show sinus histiocytosis characterized by signet ring cell-like and large polygonal histiocytes filling and expanding sinuses and interfollicular regions. The cells lack cytologic atypia and the cytoplasm appears granular consistent with histiocytes.
Discussion: Although the signet-ring cell appearance of the histiocytes raises a concern for metastatic carcinoma along with the history of prostate cancer (elevated PSA), prostate adenocarcinoma rarely shows signet ring cell features. In addition, the cells in the lymph node lack cytologic atypia and cohesion typical of carcinoma. The cells also show granular cytoplasm typical of histiocytes. The lack of nuclear atypia, irregular nuclei with grooves and folds rules out Langerhans’ cell histiocytosis. Rosai-Dorfman disease is characterized by massive lymphadenopathy in young adults, and the histiocytes often show emperipolesis (phagocytosis of lymphocytes). The histiocytosis in this case is associated with a clinical history of hip prothesis.
Pelvic lymph node histiocytosis associated with hip prostheses is a well described finding in patients undergoing cancer surgery and pelvic lymph node dissection. The histiocytes mimick metastatic adenocarcinoma. In reported cases, the foamy histiocytes contained cobalt-chromium, titanium, and/or polyethylene microparticles by light microscopy, ultrastructure, and energy-dispersive x-ray microanalysis. Pathologists should be aware of this foreign-body tissue response to avoid confusion with other types of sinus histiocytosis and metastatic
Reference(s):
– Bjornsson BL, Truong LD, Cartwright J Jr, Abrams J, Rutledge ML, Wheeler TM.
Pelvic lymph node histiocytosis mimicking metastatic prostatic adenocarcinoma: association with hip prostheses. J Urol. 1995 Aug;154(2 Pt 1):470-3.
– Albores-Saavedra J, Vuitch F, Delgado R, Wiley E, Hagler H. Sinus histiocytosis of pelvic lymph nodes after hip replacement. A histiocytic proliferation induced by cobalt-chromium and titanium. Am J Surg Pathol. 1994 Jan;18(1):83-90.Incorrect
Answer: Benign sinus histiocytosis
Histology: The pelvic lymph nodes taken during radical prostatectomy show sinus histiocytosis characterized by signet ring cell-like and large polygonal histiocytes filling and expanding sinuses and interfollicular regions. The cells lack cytologic atypia and the cytoplasm appears granular consistent with histiocytes.
Discussion: Although the signet-ring cell appearance of the histiocytes raises a concern for metastatic carcinoma along with the history of prostate cancer (elevated PSA), prostate adenocarcinoma rarely shows signet ring cell features. In addition, the cells in the lymph node lack cytologic atypia and cohesion typical of carcinoma. The cells also show granular cytoplasm typical of histiocytes. The lack of nuclear atypia, irregular nuclei with grooves and folds rules out Langerhans’ cell histiocytosis. Rosai-Dorfman disease is characterized by massive lymphadenopathy in young adults, and the histiocytes often show emperipolesis (phagocytosis of lymphocytes). The histiocytosis in this case is associated with a clinical history of hip prothesis.
Pelvic lymph node histiocytosis associated with hip prostheses is a well described finding in patients undergoing cancer surgery and pelvic lymph node dissection. The histiocytes mimick metastatic adenocarcinoma. In reported cases, the foamy histiocytes contained cobalt-chromium, titanium, and/or polyethylene microparticles by light microscopy, ultrastructure, and energy-dispersive x-ray microanalysis. Pathologists should be aware of this foreign-body tissue response to avoid confusion with other types of sinus histiocytosis and metastatic
Reference(s):
– Bjornsson BL, Truong LD, Cartwright J Jr, Abrams J, Rutledge ML, Wheeler TM.
Pelvic lymph node histiocytosis mimicking metastatic prostatic adenocarcinoma: association with hip prostheses. J Urol. 1995 Aug;154(2 Pt 1):470-3.
– Albores-Saavedra J, Vuitch F, Delgado R, Wiley E, Hagler H. Sinus histiocytosis of pelvic lymph nodes after hip replacement. A histiocytic proliferation induced by cobalt-chromium and titanium. Am J Surg Pathol. 1994 Jan;18(1):83-90.
