Fig. 1(A) A huge, ulcerofungating mass involving the antrum and pylorus of the stomach is found. (B) The cut section shows a white-tan, solid lesion that runs mainly along the mucosal surface.
Fig. 2(A) Microscopic examination of tumor cells reveals a band-like infiltration with a pushing border. (B) Tumor cells are intimately admixed with inflammatory cells. (C) Tumor cells are singly scattered, and have vesicular nuclei with inconspicuous nucleoli. Since the cytological atypia of tumor cells is not evident, the lesion may be misinterpreted as an inflammatory pseudotumor. (D) In some areas, cells with smudged hyperchromatic nuclei or multinucleated tumor cells are observed. Mitotic figures are only occasionally identified. (E) Metastatic tumor deposits are found in two perigastric lymph nodes.
Fig. 3Immunohistochemical stains for CD68 (A), CD163 (B), and lysozyme (C) demonstrate diffuse cytoplasmic staining of tumor cells. (D) MIB-1 labeling index is approximately 60% to 70%.
Table 1.Clinical characteristics of reported cases of primary gastric histiocytic sarcoma
Reference |
Age (yr) |
Sex |
Tumor location |
Tumor size (cm) |
Accompanying lesion |
Regional LN involvement |
Surgical treatment |
Adjuvant chemotherapy |
Distant metastasis |
Survival |
Hornick et al. [2] (2004) |
89 |
Male |
Stomach+colon |
12 |
No |
Yes |
Gastrectomya
|
No |
Sternum |
Died (5 mo) |
Yoo et al. [6] (2010) |
71 |
Male |
Stomach (F & B) |
3, 1 (2 distinct masses) |
No |
No |
Total gastrectomy |
No |
Spleen and intra-abdominal LNs |
Alive with disease (9 mo) |
Congyang et al. [3] (2011) |
62 |
Female |
Stomach (B & A) |
20 |
DLBCL |
Yes |
Total gastrectomy |
No |
No |
Died (7 mo) |
Sundersingh et al. [5](2012) |
28 |
Female |
Stomach (A & P)+jejunum |
9 |
No |
Yes |
Distal gastrectomy+jejunal resection |
Yes (CHOP, 4 cycles) |
No |
Alive without disease (3 yr) |
Shen et al. [4] (2013) |
52 |
Female |
Stomach (F) |
7 |
No |
No |
Total gastrectomy |
Yes |
No |
Alive without disease (4 mo) |
Present case |
45 |
Female |
Stomach (A & P) |
7.5 |
No |
Yes |
Distal gastrectomy |
Not yet |
No |
Alive with residual disease (1 mo) |