Cytokeratin-positive interstitial reticulum cell (CIRC) tumor in the lymph node: a case report of the transformation fro
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CASE REPORT
Open Access
Cytokeratin-positive interstitial reticulum cell (CIRC) tumor in the lymph node: a case report of the transformation from the epithelioid cell type to the spindle cell type Sachiko Kaji1* , Nobuyuki Hiruta2, Daisuke Sasai3, Makoto Nagashima4, Rintaro Ohe5
and Mitsunori Yamakawa5
Abstract Background: Cytokeratin-positive interstitial reticulum cells (CIRCs), which are a subgroup of fibroblastic reticular cells (FRCs), are known to be present in the lymph nodes. There have been only a few cases of tumors derived from CIRCs. Case presentation: We have reported a new case involving a CIRC tumor in a 75-year-old man and reviewed the literature. The resected mediastinal lymph nodes showed epithelial-like proliferation of large atypical round and polygonal epithelioid cells. The tumor cells expressed CK8, CK18, CAM5.2, AE1/AE3, epithelial membrane antigen, vimentin, fascin, and some FRC markers, which is consistent with the diagnosis of a CIRC tumor. Following chemotherapy, the CIRC tumor was observed to have responded very well and became difficult to confirm on imaging, but a small cell lung carcinoma developed 12 months later. Chemoradiotherapy was performed, but the patient passed away 29 months after the initial diagnosis. The autopsy revealed the recurrence of the CIRC tumor, residual small cell lung carcinoma, and a very small latent carcinoma of the prostate. The relapsed CIRC tumor cells had a spindle shape; they were highly pleomorphic and had invaded the superior vena cava. Conclusion: We first reported autopsy findings of CIRC tumors and demonstrated the transformation of the tumor from the epithelioid cell type to the spindle cell type. Keywords: Cytokeratin-positive interstitial reticulum cells, Fibroblastic reticular cells, Cell morphology, Transform, Autopsy
Background Lymph node structure and function are supported by dendritic/reticular cells, which are divided into three subtypes: follicular dendritic cells (FDCs), interdigitating dendritic cells (IDCs), and fibroblastic reticular cells/fibroblastic reticulum cells (FRCs). FRCs are located in the parafollicular and deep cortex areas and comprise a * Correspondence: [email protected] 1 Department of Diagnostic Pathology, Chiba Kaihin Municipal Hospital, 3-31-1 Isobe, Mihama-ku, Chiba 261-0012, Japan Full list of author information is available at the end of the article
mesh-like reticular network with reticular fibers and fibrous extracellular matrix bundles [1–6]. FRCs are embedded in the extracellular matrix [7] and are in contact with immune cells [3]. A subgroup of FRCs that can express cytokeratins are called cytokeratin-positive interstitial reticulum cells (CIRCs). CIRC tumors are considered a subset of FRC tumors. CIRC tumors are difficult to diagnose because of their nature. The expression pattern of CIRC tumors is a challenge for pathologists, as several neoplasms express cytokeratins and vimentin, which can result in confusion. It
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