Primary histiocytic sarcoma of the central nervous system: A case report with platelet derived growth factor receptor mutation and PD-L1/PD-L2 expression and literature review

Jackson M. May, Mark R. Waddle, Daniel H. Miller, William C. Stross, Tasneem A. Kaleem, Byron C. May, Robert C. Miller, Liuyan Jiang, Gerald W. Strong, Daniel M. Trifiletti, Kaisorn L. Chaichana, Ronald Reimer, Han W. Tun, Jennifer L. Peterson

Research output: Contribution to journalArticle

Abstract

Background: Histiocytic sarcoma (HS) is an aggressive malignant neoplasm. HS in the central nervous system is exceptionally rare and associated with a poor prognosis. This report documents a case of primary HS of the central nervous system with treatment including surgery, radiotherapy, and chemotherapy. Case presentation: Our patient was a 47year old female presenting with progressive ataxia, headaches, imbalance, nausea, vomiting, and diplopia. MRI showed a heterogeneously enhancing lesion approximately 2.9×3.0×2.3cm centered upon the cerebellar vermis with mild surrounding vasogenic edema and abnormal enhancement of multiple cranial nerves. The patient underwent surgical debulking, which revealed histiocytic sarcoma with grossly purulent drainage. Staging revealed diffuse leptomeningeal involvement, primarily involving the brain and lower thoracic and lumbar spine. She underwent adjuvant radiotherapy to the brain and lower spine and was started on high dose methotrexate. However, she experienced progressive disease in the cervical and thoracic spine as well as pulmonary involvement. Genomic sequencing of her tumor showed a mutation in the platelet-derived growth factor receptor A (p.V0681) which could be targeted with Dasatinib. However, she did not tolerate Dasatinib and she succumbed to progressive disseminated disease eight months from original diagnosis. Our pathologic evaluation also revealed expression of PD-L1 and PD-L2 by tumor cells raising the potential therapeutic role for immune checkpoint inhibition. Conclusions: This case provides an example of effective CNS control with resection and moderate doses of radiation therapy. A review of the literature confirms aggressive multidisciplinary treatment is the most effective treatment against this disease. In addition, genomic sequencing may play an important role in determining new therapeutic options. However, CNS histiocytic sarcoma remains an aggressive disease with a propensity for early widespread dissemination and few long term survivors.

Original languageEnglish (US)
Article number167
JournalRadiation Oncology
Volume13
Issue number1
DOIs
StatePublished - Sep 5 2018

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Histiocytic Sarcoma
Platelet-Derived Growth Factor Receptors
Central Nervous System
Mutation
Spine
Radiotherapy
Thorax
Therapeutics
Neoplasms
Adjuvant Radiotherapy
Diplopia
Cranial Nerves
Brain
Ataxia
Methotrexate
Nausea
Vomiting
Headache
Survivors
Drainage

Keywords

  • CNS
  • Histiocytic sarcoma
  • Radiation
  • Review

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Primary histiocytic sarcoma of the central nervous system : A case report with platelet derived growth factor receptor mutation and PD-L1/PD-L2 expression and literature review. / May, Jackson M.; Waddle, Mark R.; Miller, Daniel H.; Stross, William C.; Kaleem, Tasneem A.; May, Byron C.; Miller, Robert C.; Jiang, Liuyan; Strong, Gerald W.; Trifiletti, Daniel M.; Chaichana, Kaisorn L.; Reimer, Ronald; Tun, Han W.; Peterson, Jennifer L.

In: Radiation Oncology, Vol. 13, No. 1, 167, 05.09.2018.

Research output: Contribution to journalArticle

May, JM, Waddle, MR, Miller, DH, Stross, WC, Kaleem, TA, May, BC, Miller, RC, Jiang, L, Strong, GW, Trifiletti, DM, Chaichana, KL, Reimer, R, Tun, HW & Peterson, JL 2018, 'Primary histiocytic sarcoma of the central nervous system: A case report with platelet derived growth factor receptor mutation and PD-L1/PD-L2 expression and literature review', Radiation Oncology, vol. 13, no. 1, 167. https://doi.org/10.1186/s13014-018-1115-x
May, Jackson M. ; Waddle, Mark R. ; Miller, Daniel H. ; Stross, William C. ; Kaleem, Tasneem A. ; May, Byron C. ; Miller, Robert C. ; Jiang, Liuyan ; Strong, Gerald W. ; Trifiletti, Daniel M. ; Chaichana, Kaisorn L. ; Reimer, Ronald ; Tun, Han W. ; Peterson, Jennifer L. / Primary histiocytic sarcoma of the central nervous system : A case report with platelet derived growth factor receptor mutation and PD-L1/PD-L2 expression and literature review. In: Radiation Oncology. 2018 ; Vol. 13, No. 1.
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AB - Background: Histiocytic sarcoma (HS) is an aggressive malignant neoplasm. HS in the central nervous system is exceptionally rare and associated with a poor prognosis. This report documents a case of primary HS of the central nervous system with treatment including surgery, radiotherapy, and chemotherapy. Case presentation: Our patient was a 47year old female presenting with progressive ataxia, headaches, imbalance, nausea, vomiting, and diplopia. MRI showed a heterogeneously enhancing lesion approximately 2.9×3.0×2.3cm centered upon the cerebellar vermis with mild surrounding vasogenic edema and abnormal enhancement of multiple cranial nerves. The patient underwent surgical debulking, which revealed histiocytic sarcoma with grossly purulent drainage. Staging revealed diffuse leptomeningeal involvement, primarily involving the brain and lower thoracic and lumbar spine. She underwent adjuvant radiotherapy to the brain and lower spine and was started on high dose methotrexate. However, she experienced progressive disease in the cervical and thoracic spine as well as pulmonary involvement. Genomic sequencing of her tumor showed a mutation in the platelet-derived growth factor receptor A (p.V0681) which could be targeted with Dasatinib. However, she did not tolerate Dasatinib and she succumbed to progressive disseminated disease eight months from original diagnosis. Our pathologic evaluation also revealed expression of PD-L1 and PD-L2 by tumor cells raising the potential therapeutic role for immune checkpoint inhibition. Conclusions: This case provides an example of effective CNS control with resection and moderate doses of radiation therapy. A review of the literature confirms aggressive multidisciplinary treatment is the most effective treatment against this disease. In addition, genomic sequencing may play an important role in determining new therapeutic options. However, CNS histiocytic sarcoma remains an aggressive disease with a propensity for early widespread dissemination and few long term survivors.

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