Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
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Case Report

Volume 11, Number 10, October 2020, pages 309-316

Follicular Dendritic Cell Sarcoma of the Tonsil: A Multimodality Approach

Figures

Figure 1.
Figure 1. Punch biopsy specimen of the tonsillar mass on hematoxylin and eosin staining. (a) Scanning 1 × objective of the tumor shows cells that are arranged in nests and vague nodules. In some areas, they are separated by septa of stratified squamous epithelium, which is the normal lining of the tonsil. The tumor cells are also closely admixed with a population of benign lymphocytes. (b) On 10 × objective, the individual cells are ovoid to spindle with vesicular nuclei. Some have indistinct cell borders, exhibiting a slight storiform or whorled pattern.
Figure 2.
Figure 2. Pre-treatment axial contrast-enhanced CT scan images (a and b) show an enhancing mass lesion in the left faucial tonsil (arrowhead) with large submandibular nodal metastasis (arrow) which decreased in size on evaluation after three cycles of gemcitabine and docetaxel (c and d). CT: computed tomography.

Table

Table 1. Summary of Reported Clinical Data on 34 Cases of Advanced FDCS Treated With Various Chemotherapeutic Regimens
 
Author, yearAge (years)SexLocationTreatment and responseOutcomeFollow-up (months)
AIM: doxorubicin + ifosfamide + mesna; BMT: bone marrow transplantation; CHOP: cyclophosphamide + doxorubicin + vincristine + prednisone; COP: cyclophosphamide + vincristine + prednisone; DHAP: dexamethasone + cytarabine + cisplatin; EPOCH: etoposide + prednisone + vincristine + cyclophosphamide + doxorubicin; ESHAP: etoposide + methylprednisolone + cytarabine + cisplatin; Gem/Doce: gemcitabine + docetaxel; ICE: ifosfamide + carboplatin + etoposide; IE: ifosfamide + etoposide; IGEV: ifosfamide + gemcitabine + vinorelbine + prednisolone; RT: radiotherapy; CR: complete response; PR: partial response; SD: stable disease; PD: progressive disease; REC: recurrence; AWD: alive with disease; DOD: died of disease; NED: no evidence of disease.
Fonseca et al [9], 199764MLiverCHOP × 6 → PR → DHAP → PR → cladribine--
Toyoda et al [10], 200071FLymph nodesEPOCH × 1 → PDDOD-
Khalid and Folman [11], 200519MLiverCHOP × 5 → PR → ICE × 4 → PD → gemcitabine → PR → vinorelbine → PR → bortezomibDOD48
Aboujaoude et al [12], 200620FBreastCHOP × 6 → PRDOD2
Soriano et al [13], 200725MNeck(Prior adjuvant CHOP) IE → CRAWD79
Soriano et al [13], 200748MNeck(Prior adjuvant CHOP) DHAP → IE → CRDOD50
Soriano et al [13], 200762FNeckCHOP × 6 + RT → CR → REC → ICE → PD → Gem/Doce → CRAWD21
Soriano et al [13], 200729FMediastinumCHOP → SDAWD14
Soriano et al [13], 200745FMediastinumCHOP + rituximab × 6 → PD → ESHAP → RT → Gem/Doce → PRAWD22
Soriano et al [13], 200766MPleuraCHOP × 6 → PD → ICE × 1 → PDDOD7
Soriano et al [13], 200764FLiver, spleenCHOP × 2 → PD → Gem/Doce → SDAWD29
Azim et al [14], 200749MNeckAIM × 3 → PD → gemcitabine + cisplatin + imatinib × 8 → CRNED8
Li et al [15], 200819MLymph nodesCHOP × 6 → CRAWD5
Li et al [15], 200845FLymph nodesCHOP × 6 → CRNED5
Choi et al [16], 201079FLymph nodesCHOP × 2 → PR--
Cyriac et al [17], 201068MNeckCOP × 1 → PD → RT → PDDOD2
Shinagare et al [18], 201156MLiverCHOP × 4 → PR → embolization → surgeryNED12
Pizzi et al [19], 201166MCervicalIGEV × 6 → PR → carboplatin + etoposide × 6 → CRNED67
Bushan [20], 201437MMediastinumAIM × 3 → PD → surgery → RTNED6
Dimri et al [21], 201436MIntraabdominalAIM × 8 → CR → REC → RTNED72
Conry [22], 201451MDuodenumCHOP × 6 → PR → Gem/Doce × 6 → PR → gemcitabine × 6AWD-
Conry [22], 201436FIntraabdominalRT → Gem/Doce × 9 → PRAWD2
Purkait et al [23], 201527FMediastinumCHOP × 6 → PR → Gem/Doce → PDDOD-
Ma et al [24], 201524MLymph nodesCisplatin + etoposide × 6 → CR → CHOP × 6NED10
Ma et al [24], 201524FIntraabdominalCHOP → PR → ICE → SD → surgeryDOD17
Gu et al [25], 201565MIntraabdominalCHOP → PRAWD-
Sahu et al [26], 201555MLymph nodesCHOP → PRAWD-
Liberale et al [27], 201544FIntraabdominalCHOP × 6 → CR → REC → ESHAP × 5 → CR → BMT → REC → gemcitabine + vinorelbine + dexamethasone × 6 → CRNED29
Spatola et al [28], 201534MMediastinumGemcitabine + cisplatin × 5 → SD → RTNED11
Lemech et al [29], 201673FMediastinum(Prior adjuvant CHOP) carboplatin + veliparib → SDAWD15
Sasaki et al [30], 201742FPancreasGemcitabine + S1 × 1 → PD → doxorubicin × 6 → PR → ifosfamide → PD → CHOP × 1 → PD → ESHAP × 4 → PR → paclitaxel → SD → bendamustineDOD-
Bouriga et al [31], 201848FRetroperitoneumAIM × 3 → PD → ESHAP × 3 → SDAWD14
Chen et al [32], 201966FLiverGem/Doce × 8 → PR → RTAWD12
Present case53MTonsilDoxorubicin × 6 → PR → dacarbazine × 2 → SD → Gem/Doce → PRAWD8