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Follicular dendritic cell sarcoma arising from the lymph node of the pancreatic head: a case report with literature review

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Abstract

A 72-year-old man was referred to our hospital for the examination of a pancreatic head mass. Abdominal computed tomography revealed a contrasted 8-cm-diameter tumor extending from the dorsal pancreatic head to the porta hepatis. The preoperative diagnosis was challenging due to the absence of specific imaging findings and the inability to perform a biopsy. Positron emission tomography/computed tomography and diffusion-weighted imaging suggested a malignant tumor originating from the organs surrounding the pancreatic head. Subtotal stomach-preserving pancreaticoduodenectomy with regional lymph node dissection was performed, as dissection from the pancreatic head proved unfeasible. Pathological examination identified the tumor as an enlarged lymph node consisting of pleomorphic large cells forming clusters, positive for follicular dendritic cell markers cluster of differentiation (CD) 21 and CD23. No evidence of tumor capsule infiltration, other organ infiltration, or metastasis to other lymph nodes was observed. The final diagnosis was nodal follicular dendritic cell sarcoma (FDCS) originating from the pancreatic head lymph nodes. No recurrence occurred at 3 years postoperatively with no postoperative treatment. Intraperitoneal nodal FDCS is extremely rare, and occasionally, it can lead to postoperative recurrence and progression. It is crucial to differentiate neoplastic lymph node enlargement around the pancreatic head from nodal FDCS.

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Acknowledgements

We sincerely thank Shari Joy Berman for professionally editing the English draft of this manuscript.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8563, Japan

    Takahiro Yamada, Keinosuke Ishido, Norihisa Kimura, Taiichi Wakiya, Hayato Nagase & Kenichi Hakamada

  2. Department of Pathology and Bioscience, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8563, Japan

    Shintaro Goto, Tadashi Yoshizawa & Hiroshi Kijima

  3. Center for Clinical Pathology, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan

    Seiichi Kato

Authors
  1. Takahiro Yamada
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  2. Keinosuke Ishido
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  3. Norihisa Kimura
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  10. Kenichi Hakamada
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Contributions

Takahiro Yamada wrote the first draft of the manuscript. Keinosuke Ishido and Kenichi Hakamada contributed to the review and/or critical revision of the manuscript. All authors have approved the final article. Taiichi Wakiya, Keinosuke Ishido, Norihisa Kimura and Hayato Nagase performed the surgical resection and collected the clinical data. Shintaro Goto, Tadashi Yoshizawa, Hiroshi Kijima and Seiichi Kato contributed to the pathological assessment.

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Correspondence to Takahiro Yamada.

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Yamada, T., Ishido, K., Kimura, N. et al. Follicular dendritic cell sarcoma arising from the lymph node of the pancreatic head: a case report with literature review. Clin J Gastroenterol (2024). https://doi.org/10.1007/s12328-024-01956-5

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