851
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Egeler RM, Katewa S, Leenen PJM, Beverley P, Collin M, Ginhoux F, Arceci RJ, Rollins BJ. Langerhans cell histiocytosis is a neoplasm and consequently its recurrence is a relapse: In memory of Bob Arceci. Pediatr Blood Cancer 2016; 63:1704-12. [PMID: 27314817 DOI: 10.1002/pbc.26104] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/19/2016] [Accepted: 05/19/2016] [Indexed: 01/01/2023]
Abstract
Langerhans cell histiocytosis (LCH) remains a poorly understood disorder with heterogeneous clinical presentations characterized by focal or disseminated lesions that contain excessive CD1a+ langerin+ cells with dendritic cell features known as "LCH cells." Two of the major questions investigated over the past century have been (i) the origin of LCH cells and (ii) whether LCH is primarily an immune dysregulatory disorder or a neoplasm. Current opinion is that LCH cells are likely to arise from hematopoietic precursor cells, although the stage of derailment and site of transformation remain unclear and may vary in patients with different extent of disease. Over the years, evidence has provided the view that LCH is a neoplasm. The demonstration of clonality of LCH cells, insufficient evidence alone for neoplasia, is now bolstered by finding driver somatic mutations in BRAF in up to 55% of patients with LCH, and activation of the RAS-RAF-MEK-ERK (where MEK and ERK are mitogen-activated protein kinase and extracellular signal-regulated kinase, respectively) pathway in nearly 100% of patients with LCH. Herein, we review the evidence that recurrent genetic abnormalities characterized by activating oncogenic mutations should satisfy prerequisites for LCH to be called a neoplasm. As a consequence, recurrent episodes of LCH should be considered relapsed disease rather than disease reactivation. Mapping the complete genetic landscape of this intriguing disease will provide additional support for the conclusion that LCH is a neoplasm and is likely to provide more potential opportunities for molecularly targeted therapies.
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Affiliation(s)
- R Maarten Egeler
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children/University of Toronto, Toronto, Ontario, Canada
| | - Satyendra Katewa
- Department of Pediatric Hematology/Oncology & BMT, Soni Manipal Hospital, Main Sikar Road, Sector 5, Jaipur, Rajasthan, India
| | - Pieter J M Leenen
- Department of Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Matthew Collin
- Department of Haematological Sciences, Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Florent Ginhoux
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), Singapore, 138648
| | - Robert J Arceci
- Department of Child Health, University of Arizona, College of Medicine - Phoenix, Ron Matricaria Institute of Molecular Medicine, Phoenix, Arizona
| | - Barrett J Rollins
- Division of Medical Oncology, Dana-Farber Cancer Institute, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
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852
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853
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18F-fluorodeoxyglucose positron emission tomography-computed tomography in the management of adult multisystem Langerhans cell histiocytosis. Eur J Nucl Med Mol Imaging 2016; 44:598-610. [DOI: 10.1007/s00259-016-3521-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 09/07/2016] [Indexed: 01/03/2023]
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854
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Johnstone K, Tsikleas G, Pool L, Barksdale S. S100/CD1a positive dermal infiltrate as an initial presentation of chronic myelomonocytic leukaemia. Pathology 2016; 48:628-31. [PMID: 27569552 DOI: 10.1016/j.pathol.2016.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/12/2016] [Accepted: 06/22/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Kate Johnstone
- Sullivan Nicolaides Pathology, Brisbane, Qld, Australia; Pathology Queensland, Brisbane, Qld, Australia; School of Medicine, The University of Queensland, Brisbane, Qld, Australia.
| | | | - Louis Pool
- Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
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855
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Kuzyk A, Silver S, Wallace S, Hamza S, Toole J. A Case Indistinguishable Between Indeterminate Cell Histiocytosis and Cutaneous Rosai-Dorfman Disease. J Cutan Med Surg 2016; 21:68-71. [PMID: 27507795 DOI: 10.1177/1203475416664038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alexandra Kuzyk
- 1 Department of Biochemistry and Medical Genetics, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shane Silver
- 2 Section of Dermatology, Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Sate Hamza
- 4 Department of Pathology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John Toole
- 2 Section of Dermatology, Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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856
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Zhu P, Li N, Yu L, Miranda MN, Wang G, Duan Y. Erdheim-Chester Disease with Emperipolesis: A Unique Case Involving the Heart. Cancer Res Treat 2016; 49:553-558. [PMID: 27488869 PMCID: PMC5398381 DOI: 10.4143/crt.2016.078] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 07/08/2016] [Indexed: 12/31/2022] Open
Abstract
Histiocytosis is an uncommon disease characterized by excessive accumulation of histiocytes. Here, we report a rare case of non-Langerhans-cell histiocytosis in a 51-year-old woman who presented with severe symptoms of pericardial effusion. Radiologic investigation also detected multiple bone (lower limbs, vertebrae, ribs, and ilium) lesions. Resected pericardium showed abundant mono- or multi-nucleated non-foamy histiocytes (CD68+/CD163+/S-100+/CD1α−/langerin−) in a fibroinflammatory background. The histiocytes demonstrated emperipolesis of lymphocytes, a hallmark feature of Rosai-Dorfman disease (RDD). However, molecular analysis revealed a BRAF V600E mutation of the proliferating histiocytes, highlighting the neoplastic features frequently observed in another non-Langerhans-cell histiocytosis known as Erdheim-Chester Disease (ECD). We consider this case to be a unique presentation of ECD harboring some RDD-like cells with emperipolesis, but not a case of RDD with a BRAF mutation concerning its clinical manifestation (involvement of the heart and bones) and neoplastic features.
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Affiliation(s)
- Pengcheng Zhu
- Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Pathology, School of Basic Medical Science, Huazhong University of Science and Technology, Wuhan, China
| | - Naping Li
- Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Pathology, School of Basic Medical Science, Huazhong University of Science and Technology, Wuhan, China
| | - Lu Yu
- Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Pathology, School of Basic Medical Science, Huazhong University of Science and Technology, Wuhan, China
| | - Mariajose Navia Miranda
- Department of Pathology, School of Basic Medical Science, Huazhong University of Science and Technology, Wuhan, China
| | - Guoping Wang
- Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Pathology, School of Basic Medical Science, Huazhong University of Science and Technology, Wuhan, China
| | - Yaqi Duan
- Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Pathology, School of Basic Medical Science, Huazhong University of Science and Technology, Wuhan, China
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857
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Liao X, Thorson JA, Hughes T, Nguyen JC, Wang HY, Lin GY. Erdheim-Chester disease with novel gene mutations discovered as an incidental finding in explanted liver of a patient with hepatitis C cirrhosis: A case report and literature review. Pathol Res Pract 2016; 212:849-54. [PMID: 27445228 DOI: 10.1016/j.prp.2016.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 05/06/2016] [Accepted: 07/01/2016] [Indexed: 11/19/2022]
Abstract
Erdheim-Chester disease (ECD) is a rare form of non-Langerhans cell histiocytosis characterized by xanthogranulomatous infiltration of foamy histiocytes frequently involving bone and other organ systems. We herein report a unique case of ECD discovered incidentally in an explanted liver in a 65-year-old male with end-stage liver disease secondary to hepatitis C cirrhosis. Histological examination and immunohistochemical studies in the explanted liver revealed prominent foamy histiocytes that were CD68 positive, but CD1a and S100 negative. Mutational hotspot analysis of the explanted liver using a panel of 47 most common cancer-related genes performed by next generation sequencing (NGS) revealed likely somatic mutations in the PDGFRA, PTEN, and HNF1A genes, but no BRAF codon 600 mutations were detected. The bone marrow showed similar findings as in the liver. Whole body PET and bone scans demonstrated increased heterogeneous uptake in bilateral humeral and femoral diaphysis, most compatible with ECD. To our knowledge, this is the first case report of ECD that involves mainly bone marrow and liver with novel genomic alterations. Our case highlights the diversity and complexity of this disease entity and the importance of multi-modality approach integrating clinical and radiologic features with histopathologic and molecular/genomic findings.
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Affiliation(s)
- Xiaoyan Liao
- Department of Pathology, University of California San Diego Health System, La Jolla, CA, USA
| | - John A Thorson
- Department of Pathology, University of California San Diego Health System, La Jolla, CA, USA
| | - Tudor Hughes
- Department of Radiology, University of California San Diego Health System, La Jolla, CA, USA
| | - John C Nguyen
- Department of Pathology, University of California San Diego Health System, La Jolla, CA, USA
| | - Huan-You Wang
- Department of Pathology, University of California San Diego Health System, La Jolla, CA, USA.
| | - Grace Y Lin
- Department of Pathology, University of California San Diego Health System, La Jolla, CA, USA.
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858
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Sunnapwar A, Menias CO, Ojili V, Policarpio Nicolas M, Katre R, Gangadhar K, Nagar A. Abdominal manifestations of histiocytic disorders in adults: imaging perspective. Br J Radiol 2016; 89:20160221. [PMID: 27332519 DOI: 10.1259/bjr.20160221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Histiocytic disorders (HDs) are a diverse group of diseases characterized by pathologic infiltration of normal tissues by cells of the mononuclear phagocyte system. The spectrum of these diseases ranges from treatable infectious diseases to rapidly progressive, life-threatening conditions. Although they are rare and difficult diagnoses, HDs can be diagnosed with the help of clinical and laboratory analyses, imaging features and tissue biopsy. The clinicopathology and imaging spectrum of select entities belonging to this disorder are presented in this review.
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Affiliation(s)
- Abhijit Sunnapwar
- 1 University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Vijaynadh Ojili
- 1 University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Rashmi Katre
- 1 University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Arpit Nagar
- 4 Ohio State University, Wexner Medical Center, Columbus, OH, USA
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859
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