HISTIOCYTIC SARCOMAS AND MONOBLASTIC LEUKEMIAS - A CLINICAL, HISTOLOGIC, AND IMMUNOPHENOTYPICAL STUDY

Eight histiocytic sarcomas, identified by examination of more than 200 0 malignant lymphomas, are described. For comparison, tumor infiltrate s from five monoblastic leukemias were also analyzed. The histiocytic sarcomas were all high-grade malignancies consisting of markedly pleom orphic large cells with many mitotic figures. At presentation, six of the patients had systemic symptoms (fever, fatigue, loss of weight), s kin infiltrates, and lymphadenopathy. Despite aggressive chemotherapy, clinical remissions were short, and six patients died of disease .5-4 8 months (mean, 6.5 months) after diagnosis. The remaining two patient s are alive and in partial or complete remission 7 and 12 months after diagnosis. Immunotypic examination showed that all the histiocytic sa rcomas were positive for macrophage-related antigens and negative for antigens on B cells, T cells, myeloid cells, epithelial cells, and mel anocytes. T-cell receptor and immunoglobulin genes were studied in thr ee cases and were present in a germline configuration. One of the hist iocytic sarcomas resembled Langerhans' cells in phenotype and morpholo gy; it was classified as a Langerhans' cell sarcoma. The remaining his tiocytic sarcomas did not express accessory cell-associated antigens, but more closely resembled ''ordinary'' tissue macrophages; they were positive for lysozyme and/or CD68, followed in frequency by CD11c, CD4 , CD11B, CDw32, peanut agglutinin receptor, and CD13. Similar features were seen in the monoblastic leukemias. These conditions could only b e distinguished from histiocytic sarcoma by clinical and morphologic, rather than immunophenotypic, criteria. Expression of oncoprotein p53 was studied in nine cases and was positive in six of six histiocytic s arcomas and one of three monoblastic leukemias. Rare malignancies show features consistent with the derivation from macrophages. Two entitie s may be distinguished: those that resemble antigen-presenting accesso ry cells and those that more closely resemble ordinary tissue macropha ges. Recognition of these tumors is important clinically and requires assessment of clinical, morphologic, and immunophenotypic features, su pplemented by analysis of T-cell receptor and immunoglobulin genes. Wh ether (or how) p53 gene mutations are implicated in their pathogenesis will be an important topic for future investigations.