http://www.histiocytosis.ucdavis.edu/sarcoma.htmlHistiocytic Sarcoma and Malignant Histiocytosis. The histiocytic sarcoma (HS) complex encompasses a number of distinctive clinical entities which will be described below. Some definitions are in order, and reflect the preferred nomenclature of the writing group of the Histiocyte Society. Histiocytic neoplasia which originates at a single site is called histiocytic sarcoma. This form of histiocytic sarcoma, which is often encountered on the extremities, has the best prognosis if treated early by surgical excision or by amputation of a limb. When spread to distant sites beyond the local lymph node occurs, the disease is then termed disseminated histiocytic sarcoma; this is more likely to occur unnoticed when primary lesions occur in cryptic sites (eg spleen, lung, and bone marrow). This latter form of HS is most like malignant histiocytosis (MH). MH is an aggressive, histiocytic neoplasm which arises in multiple sites simultaneously. Most lesions previously defined as MH are probably more correctly termed disseminated HS. The occurrence of true MH is difficult to establish because the lesions often occur in cryptic sites, and the existence of histiocytic neoplasia is only recognized after clinical signs have appeared and disease progression is advanced. HS and MH are capable of widespread metastasis, hence in time the 2 syndromes merge clinically and it is not always possible to differentiate true multicentric origin (MH) from widespread metastasis of disseminated HS. Also, it is never possible to know exactly how long the disease process has been operative. Hence, the perception is that both disseminated HS and MH follow a rapid clinical progression despite therapeutic intervention. This is certainly true once clinical signs are apparent, but the subclinical period is of unknown duration.