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Goyal G, Young JR, Abeykoon JP, Shah MV, Bennani NN, Sartori-Valinotti JC, Vassallo R, Ryu JH, Tobin WO, Koster MJ, Davidge-Pitts CJ, Ravindran A, Rech KL, Go RS. OUP accepted manuscript. Oncologist 2022; 27:144-148. [PMID: 35641201 PMCID: PMC8895750 DOI: 10.1093/oncolo/oyab031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/29/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Materials and Methods Results Conclusion
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Affiliation(s)
- Gaurav Goyal
- Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
- Gaurav Goyal, University of Alabama at Birmingham, 1802 6th Avenue South Suite 2555 NP, Birmingham, AL-35294, USA; Tel: +1 205 934 6770;
| | - Jason R Young
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Mithun V Shah
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Robert Vassallo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - W Oliver Tobin
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Aishwarya Ravindran
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Karen L Rech
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
- Corresponding authors: Ronald S. Go, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; Tel: +1 507 284 5362;
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Synghal G, Bhavan R, Jain SK, Oza UD. Rosai-Dorfman disease in a symptomatic elderly man. Proc AMIA Symp 2022; 35:78-79. [PMID: 34970042 DOI: 10.1080/08998280.2021.1957381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
An 81-year-old man presented with anemia, fatigue, weight loss, and recurrent urinary tract infections and was found to have diffuse large adenopathy and infiltrating renal masses. Surgical excision of a lymph node and histologic evaluation led to the diagnosis of Rosai-Dorfman disease, a rare histioproliferative condition that classically presents with enlarged cervical lymph nodes bilaterally. It also can involve additional nodal chains and/or have extranodal manifestations. The condition can self-resolve or have periods of remission and reactivation.
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Affiliation(s)
- Gaurav Synghal
- Department of Radiology, Baylor University Medical Center, Dallas, Texas
| | - Risha Bhavan
- Department of Radiology, Baylor University Medical Center, Dallas, Texas
| | | | - Umesh D Oza
- Department of Radiology, Baylor University Medical Center, Dallas, Texas
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Cassidy DP, Rosenberg AE, Poveda J, Velez-Torres J, Chapman J. Nonlymphoid Hematopoietic Diseases Presenting in Bone, Soft Tissue, and Other Extranodal Sites. Arch Pathol Lab Med 2021; 146:1144-1159. [DOI: 10.5858/arpa.2021-0229-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 11/06/2022]
Abstract
Context.—
Although rare in everyday practice, the initial presentation of hematopoietic neoplasms other than lymphoma in the musculoskeletal system and other extranodal sites can generate challenging diagnostic problems for surgical pathologists.
Objective.—
To review the morphologic and immunophenotypic features of various nonlymphoid hematopoietic diseases presenting at extranodal sites, with emphasis on the inherent diagnostic pitfalls and differential diagnoses of these entities to aid surgical pathologists in their accurate recognition.
Data Sources.—
Cases reviewed herein represent both in-house and consult cases seen at our institution between 2010 and 2021.
Conclusions.—
Entities that present in this way include myeloid neoplasms and histiocytic/dendritic cell neoplasms. These tumors commonly cause nonspecific symptoms, and their histologic appearance can overlap with a variety of benign neoplasms and reactive processes. This can lead to delay in diagnosis and intervention with potentially lifesaving therapy; thus, accurate and expedient recognition is of paramount importance.
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Affiliation(s)
- Daniel P. Cassidy
- From the Division of Hematopathology (Cassidy, Poveda, Chapman), University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, Florida
- Division of Bone and Soft Tissue Pathology (Cassidy, Rosenberg, Velez-Torres), University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, Florida
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Andrew E. Rosenberg
- Division of Bone and Soft Tissue Pathology (Cassidy, Rosenberg, Velez-Torres), University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, Florida
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Julio Poveda
- From the Division of Hematopathology (Cassidy, Poveda, Chapman), University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, Florida
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Jaylou Velez-Torres
- Division of Bone and Soft Tissue Pathology (Cassidy, Rosenberg, Velez-Torres), University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, Florida
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Jennifer Chapman
- From the Division of Hematopathology (Cassidy, Poveda, Chapman), University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, Florida
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, Florida
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Hazim AZ, Ruan GJ, Hu M, Ravindran A, Rech KL, Young JR, Cox CW, Abeykoon JP, Scheckel C, Vassallo R, Ryu JH, Tobin WO, Koster MJ, Bennani NN, Shah MV, Goyal G, Go RS. Langerhans cell histiocytosis with lung involvement in isolation and multisystem disease: Staging, natural history, and comparative survival. Am J Hematol 2021; 96:1604-1610. [PMID: 34553412 DOI: 10.1002/ajh.26355] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/14/2021] [Accepted: 09/20/2021] [Indexed: 01/20/2023]
Abstract
Langerhans cell histiocytosis (LCH) is a histiocytic neoplasm that can involve the lungs as single system (LCH-SSL) or multisystem disease (LCH-MSL). The role of full-body radiographic staging to determine whether patients have LCH-SSL or LCH-MSL is unclear. Long-term outcomes of LCH-SSL versus LCH-MSL and multisystem without lung involvement (LCH-MSNL) are unknown. A retrospective study of adult LCH patients seen at our center from January 2000 to 2020 was performed. In Part 1, we addressed utility of whole-body staging imaging among those presenting with isolated pulmonary signs or symptoms. Staging was defined as fluorodeoxyglucose positron emission tomography-computed tomography (CT) or whole-body CT obtained within 3 months of diagnosis. In Part 2, we examined the frequency of developing extra-pulmonary disease over time and mortality in patients with LCH-SSL. In Part 3, we compared the overall survival of LCH-SSL, LCH-MSL, and LCH-MSNL. Part 1: 240 patients with LCH were identified. A total of 112 (47%) had pulmonary signs or symptoms at presentation. Thirty-four (30%) underwent radiographic staging and only one showed evidence of extra-pulmonary disease. Part 2: 108 (45%) were LCH-SSL. Median follow-up duration of 4.5 years (95% confidence interval [CI]: 2.9-6.0). None developed extra-pulmonary disease. Part 3: 5-year survival: 94% (95% CI: 84%-98%) for LCH-SSL, 78% (95% CI: 59%-90%) for LCH-MSL, and 75% (95% CI: 53%-89%) for LCH-MSNL. LCH patients presenting with isolated pulmonary signs or symptoms rarely have extra-pulmonary involvement at the time of diagnosis and generally do not develop extra-pulmonary progression. LCH-SSL has the best overall survival, while LCH-MSL and LCH-MSNL have similar clinical outcomes.
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Affiliation(s)
| | - Gordon J. Ruan
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Marie Hu
- Division of Hematology‐Oncology University of Minnesota Minneapolis Minnesota USA
| | - Aishwarya Ravindran
- Department of Laboratory Medicine and Pathology Mayo Clinic Rochester Minnesota USA
| | - Karen L. Rech
- Department of Laboratory Medicine and Pathology Mayo Clinic Rochester Minnesota USA
| | - Jason R. Young
- Department of Radiology Mayo Clinic Rochester Minnesota USA
| | | | | | - Caleb Scheckel
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Robert Vassallo
- Division of Pulmonary and Critical Care Medicine Mayo Clinic Rochester Minnesota USA
| | - Jay H. Ryu
- Division of Pulmonary and Critical Care Medicine Mayo Clinic Rochester Minnesota USA
| | | | | | | | - Mithun V. Shah
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Gaurav Goyal
- Division of Hematology‐Oncology University of Alabama at Birmingham Birmingham Alabama USA
- Research Collaborator (limited‐tenure), Mayo Clinic Rochester Minnesota USA
| | - Ronald S. Go
- Division of Hematology Mayo Clinic Rochester Minnesota USA
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Abeykoon JP, Ravindran A, Rech KL, Young JR, Oliver Tobin W, Shah MV, Nora Bennani N, Vassallo R, Ryu JH, Koster MJ, Davidge-Pitts CJ, Goyal G, Go RS. Mimics of Erdheim-Chester disease. Br J Haematol 2021; 196:984-994. [PMID: 34799853 DOI: 10.1111/bjh.17949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 01/02/2023]
Abstract
Erdheim-Chester disease (ECD) is a rare histiocytic neoplasm with frequent multiorgan involvement. An accurate diagnosis of ECD requires the correlation of clinical features, histopathologic and radiologic findings. We describe a case series of patients with a referral diagnosis of ECD, whereby the diagnosis was changed to non-histiocytic diseases after comprehensive review at a tertiary care center. This accurate revision of the referral diagnosis of ECD enabled initiation of proper disease-directed therapy in a timely manner for these patients and avoided unnecessary exposure to systemic cytotoxic chemotherapy or targeted agents. Our study highlights the value of a multidisciplinary team of histiocytosis experts in confirming the diagnosis of ECD and also brings attention to other conditions to consider that can mimic ECD, including osteopoikilosis, tenosynovial giant cell tumour, IgG4-related disease, fibrous dysplasia and chronic recurrent multifocal osteomyelitis.
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Affiliation(s)
- Jithma P Abeykoon
- Division of Hematology, Department of Internal Medicine, Rochester, MN, USA
| | - Aishwarya Ravindran
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Rochester, MN, USA
| | - Karen L Rech
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Rochester, MN, USA
| | | | | | - Mithun V Shah
- Division of Hematology, Department of Internal Medicine, Rochester, MN, USA
| | - N Nora Bennani
- Division of Hematology, Department of Internal Medicine, Rochester, MN, USA
| | - Robert Vassallo
- Division of Pulmonary and Critical Care Medicine, Rochester, MN, USA
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Rochester, MN, USA
| | | | | | - Gaurav Goyal
- Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL, USA.,Research Collaborator (limited-tenure), Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Ronald S Go
- Division of Hematology, Department of Internal Medicine, Rochester, MN, USA
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Jois B, Ananthasivan R, Rawat PRVS, Rakshit S. Role of 18 F-FDG PET/CT in Erdheim-Chester Disease in the Era of Multimodality Imaging. Indian J Radiol Imaging 2021; 31:729-734. [PMID: 34790325 PMCID: PMC8590557 DOI: 10.1055/s-0041-1736164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Erdheim–Chester disease is a rare disease with systemic non-Langerhans cell histiocytosis, the diagnosis of which with conventional imaging modalities is challenging. We describe a case of a 73-year-old woman who was referred with a progressive history of bilateral proptosis. The magnetic resonance imaging (MRI) orbit demonstrated bilateral orbital masses with optic nerve encasement. A subsequent 18F-FDG PET/CT scan showed multi-organ disease with involvement of the orbits, pericardium, aorta, pararenal fascia, and appendicular bones. Metabolically active, easily accessible areas were selected for CT-guided biopsy. The biopsy showed sheets of foamy histiocytes with the expression of CD 68 and CD 163 consistent with a diagnosis of Erdheim–Chester disease. The FDG PET/CT played a pivotal role in establishing the diagnosis with the assessment of disease extent and further guided in the targeted biopsy.
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Affiliation(s)
- Bhargavi Jois
- Department of Nuclear Medicine, Manipal Hospitals, Bengaluru, Karnataka, India
| | - Rupa Ananthasivan
- Department of Radiology, Manipal Hospitals, Bengaluru, Karnataka, India
| | | | - Susmita Rakshit
- Department of Pathology, Manipal Hospitals, Bengaluru, Karnataka, India
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57
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Rech KL, He R. Challenges in the Histopathologic Diagnosis of Histiocytic Neoplasms. J Natl Compr Canc Netw 2021; 19:1305-1311. [PMID: 34781270 DOI: 10.6004/jnccn.2021.7098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/28/2021] [Indexed: 11/17/2022]
Abstract
Histiocytic neoplasms, including Langerhans cell histiocytosis (LCH), Erdheim-Chester disease (ECD), and Rosai-Dorfman disease (RDD), present a diagnostic challenge due to nonspecific fibroinflammatory infiltrates and a diverse clinical presentation. The pathologist can play a key role in classification of these disorders through multidisciplinary collaboration and correlation of pathologic features with clinical and radiologic findings. The histopathologic differential diagnosis is broad, requiring knowledge of the possible diagnoses at each specific anatomic site, and a careful assessment to exclude other inflammatory and neoplastic disorders. An immunohistochemistry panel including CD163, CD1a, langerin, S100, Factor XIIIa, OCT2, and BRAF V600E can provide definitive diagnosis in LCH and RDD, whereas ECD requires classic clinical features as well as confirmation of an activating MAPK pathway mutation by genetic studies.
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Affiliation(s)
- Karen L Rech
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Rong He
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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58
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Go RS, Jacobsen E, Baiocchi R, Buhtoiarov I, Butler EB, Campbell PK, Coulter DW, Diamond E, Flagg A, Goodman AM, Goyal G, Gratzinger D, Hendrie PC, Higman M, Hogarty MD, Janku F, Karmali R, Morgan D, Raldow AC, Stefanovic A, Tantravahi SK, Walkovich K, Zhang L, Bergman MA, Darlow SD. Histiocytic Neoplasms, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021; 19:1277-1303. [PMID: 34781268 DOI: 10.6004/jnccn.2021.0053] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Histiocytic neoplasms are rare hematologic disorders accounting for less than 1% of cancers of the soft tissue and lymph nodes. Clinical presentation and prognosis of these disorders can be highly variable, leading to challenges for diagnosis and optimal management of these patients. Treatment often consists of systemic therapy, and recent studies support use of targeted therapies for patients with these disorders. Observation ("watch and wait") may be sufficient for select patients with mild disease. These NCCN Guidelines for Histiocytic Neoplasms include recommendations for diagnosis and treatment of adults with the most common histiocytic disorders: Langerhans cell histiocytosis, Erdheim-Chester disease, and Rosai-Dorfman disease.
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Affiliation(s)
| | - Eric Jacobsen
- Dana-Farber/Brigham and Women's Cancer Center
- Massachusetts General Hospital Cancer Center
| | - Robert Baiocchi
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Ilia Buhtoiarov
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute Cleveland Clinic Children's Hospital
| | | | - Patrick K Campbell
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | - Aron Flagg
- Yale Cancer Center/Smilow Cancer Hospital
| | | | | | | | - Paul C Hendrie
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | - Filip Janku
- The University of Texas MD Anderson Cancer Center
| | - Reem Karmali
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
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Go RS. Recommendations for Managing Adults With Histiocytic Neoplasms: New NCCN Guidelines. J Natl Compr Canc Netw 2021. [DOI: 10.6004/jnccn.2021.5103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The histiocytoses, a group of clonal and reactive conditions, arise from monocytic macrophage or dendritic cell lineages. The current NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Histiocytic Neoplasms reflect the most up-to-date, evidence-based data relating to the evaluation and management of this disease. Specifically, the guidelines focus on adult Langerhans cell histiocytosis, Erdheim-Chester disease, and Rosai-Dorfman disease. Because these disorders are rare, challenges have arisen regarding clinical suspicion, histologic diagnosis, treatment, and molecular subtyping. Future versions of the NCCN Guidelines will address the diagnosis and management of pediatric patients, as well as malignant histiocytosis.
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O'Brien K, Dave R, Shekhar S, Hannah-Shmouni F, Comis LE, Solomon BI, Chen M, Gahl WA, FitzGibbon E, Gochuico BR, Estrada-Veras JI. Survivorship Issues in Adult Patients With Histiocytic Neoplasms. J Natl Compr Canc Netw 2021; 19:1312-1318. [PMID: 34781266 PMCID: PMC10481619 DOI: 10.6004/jnccn.2021.7096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022]
Abstract
Adult-onset histiocytoses (AOH), primarily Rosai-Dorfman disease (RDD), Erdheim-Chester Disease (ECD), and adult Langerhans cell histiocytosis (ALCH), are a group of related histiocytic neoplastic disorders featuring multisystemic manifestations. The disorders are largely incurable, and are essentially chronic neoplastic diseases with a variable prognosis. Prompt diagnosis and treatment is important to prevent debilitating and even life-threatening complications. Survivorship issues abound in AOH, due to their multisystemic manifestations and the sometimes recalcitrant chronic inflammation, which can lead to other debilitating complications such as fatigue, weakness, and pain. Because these disorders are rare, few healthcare professionals are proficient in their management; therefore the aim of these guidelines is to offer guidance on how to manage patients, and how to create survivorship care plans through the efforts of an interdisciplinary team.
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Affiliation(s)
- Kevin O'Brien
- Office of the Clinical Director, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Rahul Dave
- Inova Fairfax-Virginia Commonwealth University College of Medicine, Falls Church, Virginia
| | - Skand Shekhar
- Clinical Research Branch, National Institute of Environmental Health Sciences, NIH, Bethesda, Maryland
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, Maryland
| | - Fady Hannah-Shmouni
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, Maryland
| | - Leora E Comis
- Rehabilitation Medicine Department, Clinical Center, NIH, Bethesda, Maryland
| | - Beth I Solomon
- Speech Language Pathology Section, Rehabilitation Medicine Department, Mark O. Hatfield Clinical Research Center, NIH, Bethesda, Maryland
| | - Marcus Chen
- National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland; and
| | - William A Gahl
- Office of the Clinical Director, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | | | - Bernadette R Gochuico
- Office of the Clinical Director, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Juvianee I Estrada-Veras
- Office of the Clinical Director, National Human Genome Research Institute, NIH, Bethesda, Maryland
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Nguyen PX, Nguyen NV, Le TD. Spinal extranodal Rosai-Dorfman disease: A case report and literature review. Int J Surg Case Rep 2021; 88:106491. [PMID: 34656927 PMCID: PMC8523848 DOI: 10.1016/j.ijscr.2021.106491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/03/2021] [Accepted: 10/06/2021] [Indexed: 02/09/2023] Open
Abstract
Introduction Spinal extranodal Rosai-Dorfman disease (RDD) is extremely rare. In this paper, we reported successful management of spinal extranodal RDD and reviewed medical literature. Case presentation A 19-year-old male presented with progressive bilateral leg weakness and back pain for two months before admission. He denied weight loss, fever, night sweats, and lymph node enlargement. On examination, his muscle strength of both legs was grade I with hyperreflexia. Magnetic resonance imaging of the spine (MRI) showed a thoracic extradural mass at a level of T6-T9, which was a heterogeneous hyperintense on T2W, STIR, and isointense on T1W and enhanced contrast vividly. We resected the tumor totally and decompressed the spinal cord. Pathology revealed a histiocytic tumor. Immunohistochemical staining was S100 (+), CD68 (+), CD45 (+), and CD1a (−). Postoperatively, his muscle strength improved gradually to grade IV after four months. Postoperative MRI of the spine showed no residual tumor. No further adjuvant therapy was indicated. Clinical discussion Spinal extranodal RDD has no specific symptoms and pathognomonic imaging features. CT and MRI of the spine are still the essential tools for diagnosing RDD, but biopsy is often mandatory for definitive diagnosis. There have not been consensus guidelines for treating RDD of the spine because of its rarity. Surgical resection remained the mainstay of treatment (78.8%), with or without adjuvant therapies. Conclusion Surgery is the treatment of choice for most cases, while steroid therapy, radiotherapy, and chemotherapy should be adjuvant treatment and tailored individually. Spinal extranodal Rosai-Dorfman disease is extremely rare. Surgery is the mainstay of treatment. Steroid therapy, radiotherapy, and chemotherapy should be tailored individually.
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Affiliation(s)
- Phuong Xuan Nguyen
- Department of Neurosurgery, Military Hospital 103, 12108 Hanoi, Viet Nam; Department of Neurosurgery, Vietnam Military Medical University, 12108 Hanoi, Viet Nam.
| | - Nghi Van Nguyen
- Department of Neurosurgery, Military Hospital 103, 12108 Hanoi, Viet Nam.
| | - Tam Duc Le
- Department of Surgery, Hanoi Medical University, Hanoi, Viet Nam; Department of Neurosurgery and Spine Surgery, Hanoi Medical University Hospital, Hanoi, Viet Nam.
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Kaiafa G, Pilalas D, Koletsa T, Daios S, Arsos G, Hatzidakis A, Protopapas A, Stamatopoulos K, Savopoulos C. Diagnosing a Patient with Erdheim-Chester Disease during the COVID-19 Pandemic. ACTA ACUST UNITED AC 2021; 57:medicina57101001. [PMID: 34684037 PMCID: PMC8540257 DOI: 10.3390/medicina57101001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/14/2021] [Accepted: 09/19/2021] [Indexed: 11/16/2022]
Abstract
Background: Erdheim-Chester disease (ECD) is a rare hematopoietic neoplasm of histiocytic origin characterized by an insidious course. The coronavirus disease 2019 (COVID-19) pandemic has put an enormous strain on healthcare systems worldwide both directly and indirectly, resulting in the disruption of healthcare services to prevent, diagnose and manage non-COVID-19 disease. Case Presentation: We describe the case of a 58-year-old male patient with sporadic episodes of self-resolving mild fever and anemia of chronic disease with onset two years before the current presentation. Positron emission/computed tomography scan revealed the presence of moderately hypermetabolic perirenal tissue masses. In order to achieve diagnosis, repeated perirenal tissue biopsies were performed, and the diagnostic evaluation was complicated by the strain put on the healthcare system by the COVID-19 pandemic. The patient contracted SARS-CoV-2 and required hospitalization, but recovered fully. No further ECD target organ involvement was documented. Treatment options were presented, but the patient chose to defer treatment for ECD. Conclusion: A high index of suspicion and multidisciplinary team collaboration is paramount to achieve diagnosis in rare conditions such as ECD. Disruptions in healthcare services in the pandemic milieu may disproportionately affect people with rare diseases and further study and effort is required to better meet their needs in the pandemic setting.
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Affiliation(s)
- Georgia Kaiafa
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (D.P.); (S.D.); (A.P.); (C.S.)
- Correspondence: ; Tel.: +30-231-099-4779
| | - Dimitrios Pilalas
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (D.P.); (S.D.); (A.P.); (C.S.)
| | - Triantafyllia Koletsa
- Department of Pathology, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Stylianos Daios
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (D.P.); (S.D.); (A.P.); (C.S.)
| | - Georgios Arsos
- 3rd Department of Nuclear Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece;
| | - Adam Hatzidakis
- Radiology Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Adonis Protopapas
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (D.P.); (S.D.); (A.P.); (C.S.)
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Center for Research and Technology Hellas, 57001 Thessaloniki, Greece;
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (D.P.); (S.D.); (A.P.); (C.S.)
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63
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Urinary involvement in Erdheim-Chester disease: computed tomography imaging findings. Abdom Radiol (NY) 2021; 46:4324-4331. [PMID: 33970298 DOI: 10.1007/s00261-021-03106-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/20/2021] [Accepted: 04/24/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To describe the urological manifestations of Erdheim-Chester disease (ECD) and their computed tomography (CT) findings. METHODS We retrospectively reviewed 48 patients diagnosed with ECD at Peking Union Medical College Hospital from January 2014 to January 2020. Twenty-four patients exhibited urological manifestations. Their CT findings, including appearances of the involved area (e.g., perirenal space, renal sinus, ureters, renal arteries, and adrenal glands), occurrence rate of ECD involvement in each area, signal enhancement pattern after CT contrast agent administration, disease progression, and causes of hydronephrosis were discussed. RESULTS In 24 patients with evidence of ECD urological involvement, the most common manifestation was perirenal infiltration, appearing as "hairy kidney" on unenhanced CT scans and moderate signal enhancement on enhanced CT scans (17/24, 70.8%). Other manifestations included renal sinus infiltration (16/24, 66.7%), proximal ureter involvement (14, 58.3%), renal artery sheath (10, 41.7%), hydronephrosis (14, 58.3%), and adrenal glands involvement (8, 33.3%). The histiocytic infiltrate was mostly bilateral, starting from the perirenal space and spreading to the renal sinus and ureters. Hydronephrosis was usually associated with infiltration of ureters. CONCLUSION Kidneys are the most common visceral organs affected by ECD. CT scanning is not only advantageous in early diagnosis, but also critical for designing the treatment regime for patients with ECD.
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Vanhomwegen C, Mestrez F, Faverly D, Holz S, Taylor S, Rossi C. Indolent renal involvement with BRAF V600E mutation: Erdheim-Chester, a rare disease with a wide spectrum of clinical manifestations. Clin Case Rep 2021; 9:e04683. [PMID: 34466245 PMCID: PMC8385182 DOI: 10.1002/ccr3.4683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 07/06/2021] [Accepted: 07/18/2021] [Indexed: 12/02/2022] Open
Abstract
We present the case of a patient with three-year indolent bilateral ureteral and perirenal masses. Clinical presentation, radiological context, and histopathological findings with detection of BRAF V600E mutation confirmed the diagnosis of Erdheim-Chester disease (ECD). A review of current knowledge regarding diagnosis, clinical assessment, management, and treatment of ECD is also presented.
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Affiliation(s)
| | - Fabienne Mestrez
- Nephrology DepartmentAmbroise Paré Hospital Université Libre de BruxellesBruxellesBelgium
| | - Daniel Faverly
- Pathology DepartmentAmbroise Paré Hospital Université Libre de BruxellesBruxellesBelgium
| | - Serge Holz
- Urology DepartmentAmbroise Paré Hospital Université Libre de BruxellesBruxellesBelgium
| | - Stephen Taylor
- Radiology UnitAmbroise Paré Hospital Université Libre de BruxellesBruxellesBelgium
| | - Camelia Rossi
- Infectious Disease DepartmentAmbroise Paré Hospital Université Libre de BruxellesBruxellesBelgium
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Feng S, Han L, Yue M, Zhong D, Cao J, Guo Y, Sun Y, Zhang H, Cao Z, Cui X, Liu R. Frequency detection of BRAF V600E mutation in a cohort of pediatric langerhans cell histiocytosis patients by next-generation sequencing. Orphanet J Rare Dis 2021; 16:272. [PMID: 34116682 PMCID: PMC8196454 DOI: 10.1186/s13023-021-01912-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/07/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a rare neoplastic disease that occurs in both children and adults, and BRAF V600E is detected in up to 64% of the patients. Several studies have discussed the associations between BRAF V600E mutation and clinicopathological manifestations, but no clear conclusions have been drawn regarding the clinical significance of the mutation in pediatric patients. RESULTS We retrieved the clinical information for 148 pediatric LCH patients and investigated the BRAF V600E mutation using next-generation sequencing alone or with droplet digital PCR. The overall positive rate of BRAF V600E was 60/148 (41%). The type of sample (peripheral blood and formalin-fixed paraffin-embedded tissue) used for testing was significantly associated with the BRAF V600E mutation status (p-value = 0.000 and 0.000). The risk of recurrence declined in patients who received targeted therapy (p-value = 0.006; hazard ratio 0.164, 95%CI: 0.046 to 0.583). However, no correlation was found between the BRAF V600E status and gender, age, stage, specific organ affected, TP53 mutation status, masses close to the lesion or recurrence. CONCLUSIONS This is the largest pediatric LCH study conducted with a Chinese population to date. BRAF V600E in LCH may occur less in East Asian populations than in other ethnic groups, regardless of age. Biopsy tissue is a more sensitive sample for BRAF mutation screening because not all of circulating DNA is tumoral. Approaches with low limit of detection or high sensitivity are recommended for mutation screening to avoid type I and II errors.
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Affiliation(s)
- Shunqiao Feng
- Department of Hematology, Children's Hospital of Capital Institute of Pediatrics, Beijing, 100020, China
| | - Lin Han
- Running Gene Inc, Beijing, China
| | - Mei Yue
- Department of Hematology, Children's Hospital of Capital Institute of Pediatrics, Beijing, 100020, China
| | - Dixiao Zhong
- Department of Hematology, Children's Hospital of Capital Institute of Pediatrics, Beijing, 100020, China
| | - Jing Cao
- Department of Hematology, Children's Hospital of Capital Institute of Pediatrics, Beijing, 100020, China
| | | | | | | | | | - Xiaodai Cui
- Department of Key Laboratory, Children's Hospital of Capital Institute of Pediatrics, Beijing, 100020, China.
| | - Rong Liu
- Department of Hematology, Children's Hospital of Capital Institute of Pediatrics, Beijing, 100020, China.
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66
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Thomas KD, Delahoussaye P, Schwartz MR, Ayala AG, Ro JY. Extranodal Rosai-Dorfman disease involving soft tissue associated with increased IgG4 plasma cells. HUMAN PATHOLOGY: CASE REPORTS 2021. [DOI: 10.1016/j.ehpc.2021.200488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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67
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Rajakulasingam R, Siddiqui M, Michelagnoli M, Saifuddin A. Skeletal staging in Langerhans cell histiocytosis: a multimodality imaging review. Skeletal Radiol 2021; 50:1081-1093. [PMID: 33215231 DOI: 10.1007/s00256-020-03670-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/29/2020] [Accepted: 11/08/2020] [Indexed: 02/02/2023]
Abstract
Evaluating the extent of skeletal disease in Langerhans cell histiocytosis (LCH) is a major predictor of patient outcome. Traditionally, whole-body skeletal staging consists of plain radiography and bone scintigraphy. However, more recently whole-body MRI has been shown to be accurate in detecting osseous and extra-osseous lesions, but no large-scale studies analysing its role within the diagnostic algorithm of LCH skeletal staging currently exist. In addition, FDG PET-CT provides useful information regarding disease activity and treatment response, but has an inherent radiation dose which is not ideal in children. Currently, radiographic skeletal survey remains the gold standard with cross-sectional imaging only performed for further characterisation. However, radiographs have shown a wide sensitivity range for skeletal staging and have clear limitations in detecting extra-skeletal disease, a crucial component of stratification in identifying 'at risk' organs. We aim to highlight the various appearances of bony LCH across all the imaging modalities for primary skeletal staging. We will also review the advantages, disadvantages, sensitivity and specificity of each, and establish their role in staging skeletal LCH. Recent studies using whole-body MRI have shown promising results, with radiographs and other modalities playing a more complementary role.
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Affiliation(s)
- Ramanan Rajakulasingam
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.
| | - Mateen Siddiqui
- Department of Radiology, North West Anglia Foundation Trust, Hinchingbrooke Hospital, Huntingdon, Cambridgeshire, PE29 6NT, UK
| | - Maria Michelagnoli
- Department of Paediatric Oncology, University College Hospital, Bloomsbury, London, NW1 2BU, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
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68
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Kanakis M, Petrou P, Lourida G, Georgalas I. Erdheim-Chester disease: a comprehensive review from the ophthalmologic perspective. Surv Ophthalmol 2021; 67:388-410. [PMID: 34081930 DOI: 10.1016/j.survophthal.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 01/18/2023]
Abstract
Erdheim-Chester disease (ECD) is a rare clonal histiocytic neoplasm with less than 1200 documented cases to date. The disease is life-threatening and difficult to recognize, although increasing awareness as well as the integration of clinical, imaging, pathology information , and genetic studies have led to a recent exponential increase in new reported cases. ECD affects multiple organs and systems, including skeletal, neurologic, and cardiovascular. Pulmonary, retroperitoneal, and cutaneous lesions have also been reported in various combinations. Until the discovery that more than half of ECD patients harbor the BRAF-V600E mutation or other mutations in the mitogen-activated protein kinase (MAPK) and RAS pathways, Interferon-a was the first-line treatment. Nowadays BRAF and MEK-inhibitors targeted therapies are the mainstay of treatment. Ophthalmologic involvement occurs in 25% -30% of ECD cases, usually in the form of orbital involvement presenting with exophthalmos and ophthalmoplegia. Other ophthalmologic manifestations include palpebral xanthelasmas, anterior uveitis and vitritis, optic disk edema, choroidal infiltration, recurrent serous retinal detachment, retinal drusen-like deposits and retinal pigment epithelial changes. ECD patients can also present with ocular symptoms as a result of adverse effects of the treatment regimens. In some cases with smoldering or protean symptoms, the emergence of eye manifestations triggered the diagnosis. Ophthalmologists have to be aware of the disease, recognize the constellation of ECD symptoms, and contribute to the diagnosis, treatment, and follow-up of ECD patients.
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Affiliation(s)
| | - Petros Petrou
- G. Genimatas General Hospital, National and Kapodistrian University of Athens, 1st University Eye Clinic, Athens, Greece
| | - Giota Lourida
- Department of Internal Medicine and Infectious Disease, Sotiria Hospital, Athens, Greece
| | - Ilias Georgalas
- G. Genimatas General Hospital, National and Kapodistrian University of Athens, 1st University Eye Clinic, Athens, Greece.
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Cohen Aubart F, Idbaih A, Emile JF, Amoura Z, Abdel-Wahab O, Durham BH, Haroche J, Diamond EL. Histiocytosis and the nervous system: from diagnosis to targeted therapies. Neuro Oncol 2021; 23:1433-1446. [PMID: 33993305 PMCID: PMC8408883 DOI: 10.1093/neuonc/noab107] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Histiocytoses are heterogeneous hematopoietic diseases characterized by the accumulation of CD68(+) cells with various admixed inflammatory infiltrates. The identification of the pivotal role of the mitogen-activated protein kinase (MAPK) pathway has opened new avenues of research and therapeutic approaches. We review the neurologic manifestations of 3 histiocytic disorders with frequent involvement of the brain and spine: Langerhans cell histiocytosis (LCH), Erdheim-Chester disease (ECD), and Rosai-Dorfman-Destombes disease (RDD). Central nervous system (CNS) manifestations occur in 10%-25% of LCH cases, with both tumorous or neurodegenerative forms. These subtypes differ by clinical and radiological presentation, pathogenesis, and prognosis. Tumorous or degenerative neurologic involvement occurs in 30%-40% of ECD patients and affects the hypothalamic-pituitary axis, meninges, and brain parenchyma. RDD lesions are typically tumorous with meningeal or parenchymal masses with strong contrast enhancement. Unlike LCH and ECD, neurodegenerative lesions or syndromes have not been described with RDD. Familiarity with principles of evaluation and treatment both shared among and distinct to each of these 3 diseases is critical for effective management. Refractory or disabling neurohistiocytic involvement should prompt the consideration for use of targeted kinase inhibitor therapies.
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Affiliation(s)
- Fleur Cohen Aubart
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Hôpital Pitié-Salpêtrière, Paris, France
| | - Ahmed Idbaih
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Neurologie 1, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jean-François Emile
- EA4340, Université Versailles-Saint Quentin, Assistance Publique Hôpitaux de Paris, Hôpital Ambroise Paré, Département de Pathologie, Boulogne, France
| | - Zahir Amoura
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Hôpital Pitié-Salpêtrière, Paris, France
| | - Omar Abdel-Wahab
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | | | - Julien Haroche
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Hôpital Pitié-Salpêtrière, Paris, France
| | - Eli L Diamond
- Neurology, Memorial Sloan Kettering Cancer Center, New York, USA
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Radzikowska E. Update on Pulmonary Langerhans Cell Histiocytosis. Front Med (Lausanne) 2021; 7:582581. [PMID: 33763431 PMCID: PMC7982411 DOI: 10.3389/fmed.2020.582581] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 12/21/2020] [Indexed: 12/14/2022] Open
Abstract
Pulmonary Langerhans cell (LC) histiocytosis (PLCH) has unknown cause and is a rare neoplastic disorder characterized by the infiltration of lungs and various organs by bone marrow-derived Langerhans cells with an accompanying strong inflammatory response. These cells carry somatic mutations of BRAF gene and/or NRAS, KRAS, and MAP2K1 genes, which cause activation of the mitogen-activated protein kinase (MAPK)/extracellular signal-regulated kinase (ERK) signaling pathway. PLCH occurs predominantly in young smokers, without gender predominance. Lungs might be involved as an isolated organ or as part of a multiorgan disease. High-resolution computed chest tomography plays an outstanding role in PLCH diagnosis. The typical radiological picture of PLCH is the presence of small intralobular nodules, “tree in bud” opacities, cavitated nodules, and thin- and thick-walled cysts, frequently confluent. Histological examination of the lesion and demonstration of characteristic eosinophilic granulomas with the presence of LCs that display antigen CD1a or CD207 in immunohistochemistry are required for definite diagnosis. Smoking cessation is the most important recommendation for PLCH patients, but treatment of progressive PLCH and multisystem disease is based on chemotherapy. Recently, new targeted therapies have been implemented.
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Affiliation(s)
- Elzbieta Radzikowska
- III Department of Lung Diseases and Oncology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
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71
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Huynh KN, Nguyen BD. Histiocytosis and Neoplasms of Macrophage-Dendritic Cell Lineages: Multimodality Imaging with Emphasis on PET/CT. Radiographics 2021; 41:576-594. [PMID: 33606566 DOI: 10.1148/rg.2021200096] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Histiocytosis is a rare inflammatory process characterized by pathologic infiltration and accumulation of cells derived from the monocytic lineage in normal tissue. It encompasses more than 100 different subtypes of disorders that were recently classified into five main groups: (a) Langerhans-related histiocytosis, (b) Rosai-Dorfman histiocytosis, (c) cutaneous and mucocutaneous histiocytosis, (d) malignant histiocytosis, and (e) hemophagocytic lymphohistiocytosis and macrophage activation syndrome. Langerhans cell histiocytosis is the most common histiocytic disorder. Less common types include Erdheim-Chester disease, Rosai-Dorfman disease, adult and juvenile xanthogranuloma, necrobiotic xanthogranuloma, histiocytic sarcoma, interdigitating dendritic cell sarcoma, Langerhans cell sarcoma, and hemophagocytic lymphohistiocytosis. Although the pathogenesis of these disorders may be attributable to mutations in the oncogenic driver, recent discoveries have shown that inflammation and fibrosis secondary to mutated histiocytes, rather than a proliferative cell mechanism, result in manifestation of the disease. Diagnosis, which relies on a multidisciplinary approach, is challenging and often delayed because clinical findings are nonspecific and may mimic malignant processes at radiologic evaluation. Compared with conventional imaging, PET/CT allows detection of the increased metabolic activity in histiocytes. Diagnostic algorithms for histiocytic disorders should include functional imaging with fluorine 18 (18F) fluorodeoxyglucose (FDG) PET/CT, which provides a comprehensive whole-body evaluation of their potential involvement with multiple organ systems and allows monitoring of therapeutic response. The most recent revised classification, pathophysiologic and clinical manifestations, sites of involvement, and imaging features of histiocytosis are described in this review and a multimodality approach is used, with emphasis on 18F-FDG PET/CT evaluation. ©RSNA, 2021.
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Affiliation(s)
- Kenneth N Huynh
- From the Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259
| | - Ba D Nguyen
- From the Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259
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72
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Erdheim-Chester disease: consensus recommendations for evaluation, diagnosis, and treatment in the molecular era. Blood 2021; 135:1929-1945. [PMID: 32187362 DOI: 10.1182/blood.2019003507] [Citation(s) in RCA: 170] [Impact Index Per Article: 56.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/04/2020] [Indexed: 01/18/2023] Open
Abstract
Erdheim-Chester disease (ECD) is a rare histiocytosis that was recently recognized as a neoplastic disorder owing to the discovery of recurrent activating MAPK (RAS-RAF-MEK-ERK) pathway mutations. Typical findings of ECD include central diabetes insipidus, restrictive pericarditis, perinephric fibrosis, and sclerotic bone lesions. The histopathologic diagnosis of ECD is often challenging due to nonspecific inflammatory and fibrotic findings on histopathologic review of tissue specimens. Additionally, the association of ECD with unusual tissue tropism and an insidious onset often results in diagnostic errors and delays. Most patients with ECD require treatment, except for a minority of patients with minimally symptomatic single-organ disease. The first ECD consensus guidelines were published in 2014 on behalf of the physicians and researchers within the Erdheim-Chester Disease Global Alliance. With the recent molecular discoveries and the approval of the first targeted therapy (vemurafenib) for BRAF-V600-mutant ECD, there is a need for updated clinical practice guidelines to optimize the diagnosis and treatment of this disease. This document presents consensus recommendations that resulted from the International Medical Symposia on ECD in 2017 and 2019. Herein, we include the guidelines for the clinical, laboratory, histologic, and radiographic evaluation of ECD patients along with treatment recommendations based on our clinical experience and review of literature in the molecular era.
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73
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Rosai-Dorfman Disease Displays a Unique Monocyte-Macrophage Phenotype Characterized by Expression of OCT2. Am J Surg Pathol 2021; 45:35-44. [PMID: 33177341 DOI: 10.1097/pas.0000000000001617] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Rosai-Dorfman disease (RDD) is a rare histiocytosis with heterogenous clinical features. In this study, we characterized the histologic and phenotypic features in 33 RDD patients to better define the pathologic diagnosis. Cases included 24 patients with extracutaneous disease ("R" group), and 9 patients with lesions limited to the skin or subcutaneous tissue ("C" group). We identified OCT2 as a novel marker for the monocyte-macrophage phenotype of RDD, expressed in 97% of RDD cases. In contrast, OCT2 expression was seen in 0% of Erdheim-Chester disease cases and 6.7% of Langerhans cell histiocytosis cases. Other markers useful in the diagnosis of RDD included S100 (100%), CD163 (88%), and cyclin D1 (97%). In a subset of cases, RDD showed moderate to strong expression of factor 13a (30%), p16 (64%), and phosphorylated extracellular signal-regulated kinase (45%); RDD was uniformly negative for ZBTB46, CD1a, and langerin. Within the "R group" of RDD, increased expression of factor 13a or phosphorylated extracellular signal-regulated kinase showed a statistically significant association with multifocal disease (P<0.05). Identification of the unique monocyte-macrophage phenotype of RDD with OCT2 expression furthers our understanding of this complex disease and allows for more uniform classification.
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74
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BRAF mutation in overlapping form of Erdheim-Chester and Rosai Dorfman diseases: a unique case restricted to the central nervous system. Rev Neurol (Paris) 2021; 177:708-710. [PMID: 33478735 DOI: 10.1016/j.neurol.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/20/2020] [Accepted: 09/30/2020] [Indexed: 11/21/2022]
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Hu PP, Wei F, Liu XG, Liu ZJ. Diagnosis and treatment of Rosai-Dorfman disease of the spine: a systematic literature review. Syst Rev 2021; 10:31. [PMID: 33461611 PMCID: PMC7814441 DOI: 10.1186/s13643-021-01581-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/02/2021] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To review and summarize the clinical features, diagnosis, treatment strategies, and prognosis of spinal Rosai-Dorfman disease (RDD). METHODS RDD is also termed as sinus histiocytosis with massive lymphadenopathy. We searched the databases of PubMed, Elsevier ScienceDirect, SpringerLink, and OVID. The keywords were Rosai-Dorfman disease and spine/central nervous system. Research articles and case reports with accessibility to full texts regarding spinal RDD were eligible for the inclusion. A total of 62 articles were included, and they contained 69 cases. We extracted the information of interest and analyzed them using SPSS statistics package. RESULTS The average age was 33.1 ± 18.3 years. The ratio of males to females was 1.9/1. Overall, 63 cases presented with spine-related symptoms. A total of 27 cases (39.1%) had multi-organ lesions, and 12 cases had records of massive lymphadenopathy. Among 47 cases who first manifested spine-related symptoms, 93.6% were preoperatively misdiagnosed. The disease had a predilection for cervical spine (38.8%) and thoracic spine (40.3%). 62.9% of lesions were dura-based. Surgery remained the mainstream treatment option (78.8%), with or without adjuvant therapies. Total lesion resection was achieved in 34.8% of cases. The rate of lesion recurrence/progression was 19.5%, which was marginally lower for total resection than for non-total resection. CONCLUSION Spinal RDD has no pathognomonic clinical and imaging features. Most cases first present with spine-relevant symptoms. Massive lymphadenopathy is not common, but a tendency for multi-organ involvement should be considered. Spinal RDD has a high recurrence rate; thus, total resection is the treatment of choice. Adjuvant therapies are indicated for multi-organ lesions and residual lesions. A wait and watch strategy is recommended for asymptomatic patients. Herein, a workflow of diagnosis and treatment of the spinal RDD is established.
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Affiliation(s)
- Pan-Pan Hu
- Department of Orthopaedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing, 100191, China
| | - Feng Wei
- Department of Orthopaedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing, 100191, China.
| | - Xiao-Guang Liu
- Department of Orthopaedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing, 100191, China
| | - Zhong-Jun Liu
- Department of Orthopaedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing, 100191, China
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Salama HA, Jazieh AR, Alhejazi AY, Absi A, Alshieban S, Alzahrani M, Alaskar A, Gmati G, Damlaj M, Abuelgasim KA, Alghamdi A, Alahmari B, Almugairi A, Alzahrani H, Bazarbachi A, Musa MOH, Goyal G. Highlights of the Management of Adult Histiocytic Disorders: Langerhans Cell Histiocytosis, Erdheim-Chester Disease, Rosai-Dorfman Disease, and Hemophagocytic Lymphohistiocytosis. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2021; 21:e66-e75. [PMID: 32943371 PMCID: PMC7434330 DOI: 10.1016/j.clml.2020.08.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 12/11/2022]
Abstract
Histiocytic disorders are an exceptionally rare group of diseases with diverse manifestations and a paucity of approved treatments, thereby leading to various challenges in their diagnosis and management. With the discovery of novel molecular targets and the incorporation of targeted agents in the management of various adult histiocytic disorders, their management has become increasingly complex. In an attempt to improve the understanding of the clinical features and management of common adult histiocytic disorders (Langerhans cell histiocytosis, Erdheim-Chester disease, Rosai-Dorfman disease, and hemophagocytic lymphohistiocytosis), we created this document based on existing literature and expert opinion.
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Affiliation(s)
- Hind Abdin Salama
- Department of Oncology, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdul-Aziz University for Health Science, College of Medicine, Riyadh, Saudi Arabia.
| | - Abdul Rahman Jazieh
- Department of Oncology, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdul-Aziz University for Health Science, College of Medicine, Riyadh, Saudi Arabia
| | - Ayman Yahya Alhejazi
- Department of Oncology, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdul-Aziz University for Health Science, College of Medicine, Riyadh, Saudi Arabia
| | - Ahmed Absi
- Section of Adult Hematology and Hematopoietic Stem Cell Transplant, Princess Nora Oncology Centre, King Abdul-Aziz Medical City, Jeddah, Saudi Arabia
| | - Saeed Alshieban
- King Saud bin Abdul-Aziz University for Health Science, College of Medicine, Riyadh, Saudi Arabia; Departments of Pathology and Clinical Laboratory, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia
| | - Mohsen Alzahrani
- Department of Oncology, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdul-Aziz University for Health Science, College of Medicine, Riyadh, Saudi Arabia
| | - Ahmed Alaskar
- Department of Oncology, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdul-Aziz University for Health Science, College of Medicine, Riyadh, Saudi Arabia
| | - Giamal Gmati
- Department of Oncology, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdul-Aziz University for Health Science, College of Medicine, Riyadh, Saudi Arabia
| | - Moussab Damlaj
- Department of Oncology, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdul-Aziz University for Health Science, College of Medicine, Riyadh, Saudi Arabia
| | - Khadega A Abuelgasim
- Department of Oncology, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdul-Aziz University for Health Science, College of Medicine, Riyadh, Saudi Arabia
| | - Abdulrahman Alghamdi
- King Saud bin Abdul-Aziz University for Health Science, College of Medicine, Riyadh, Saudi Arabia; Department of Clinical Pharmacy, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia
| | - Bader Alahmari
- Department of Oncology, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdul-Aziz University for Health Science, College of Medicine, Riyadh, Saudi Arabia
| | - Areej Almugairi
- King Saud bin Abdul-Aziz University for Health Science, College of Medicine, Riyadh, Saudi Arabia; Departments of Pathology and Clinical Laboratory, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia
| | - Hazza Alzahrani
- Section of Adult Hematology and Stem Cell Transplant, Department of Oncology, King Faisal Specialist and Research Centre, Riyadh, Saudi Arabia
| | - Ali Bazarbachi
- Bone Marrow Transplantation Program, Department of Internal Medicine American University of Beirut, Medical Center, Beirut, Lebanon
| | - M O H Musa
- Department of Hematology, Fedail Hospital, Khartoum, Sudan
| | - Gaurav Goyal
- Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL.
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77
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Ruan GJ, Goyal G, Shah MV, Cohen-Aubart F, Amoura Z, Straetmans N, Benameur N, Haroche J, Go RS. Acute Pancreatitis From Treatment With BRAF Inhibitors in Erdheim-Chester Disease: A Report From 2 Tertiary Referral Centers. Pancreas 2021; 50:e6-e8. [PMID: 33370037 DOI: 10.1097/mpa.0000000000001704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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78
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Reginelli A, Pignatiello M, Urraro F, Belfiore MP, Toni G, Vacca G, Cappabianca S. Langerhans Cell Histiocytosis with Uncommon Liver Involvement: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e923505. [PMID: 33190140 PMCID: PMC7673312 DOI: 10.12659/ajcr.923505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Patient: Female, 60-year-old Final Diagnosis: Langerhans cell histiocytosis Symptoms: Fatigue • weight loss Medication: — Clinical Procedure: — Specialty: Radiology
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Affiliation(s)
- Alfonso Reginelli
- Department of Precision Medicine, University of Campania L. Vanvitelli, Naples, Italy
| | - Maria Pignatiello
- Department of Precision Medicine, University of Campania L. Vanvitelli, Naples, Italy
| | - Fabrizio Urraro
- Department of Precision Medicine, University of Campania L. Vanvitelli, Naples, Italy
| | - Maria Paola Belfiore
- Department of Precision Medicine, University of Campania L. Vanvitelli, Naples, Italy
| | - Giorgio Toni
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania L. Vanvitelli, Naples, Italy
| | - Giovanna Vacca
- Department of Precision Medicine, University of Campania L. Vanvitelli, Naples, Italy
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania L. Vanvitelli, Naples, Italy
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79
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Luna LP, Drier A, Aygun N, Mokhtari K, Hoang-Xuan K, Galanaud D, Donadieu J, Dormont D, Haroche J, Martin-Duverneuil N. MRI features of intra-axial histiocytic brain mass lesions. Clin Radiol 2020; 76:159.e19-159.e28. [PMID: 33077156 DOI: 10.1016/j.crad.2020.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 09/15/2020] [Indexed: 12/29/2022]
Abstract
AIM To describe MRI features, including diffusion-weighted imaging (DWI), magnetic resonance spectroscopy (MRS), and perfusion-weighted imaging (PWI), of intra-axial tumour-like presentations of four different subtypes of histiocytosis. MATERIAL AND METHODS The brain MRI findings of 23 patients with histologically proven histiocytosis were reviewed retrospectively (11 Langerhans cell histiocytosis [LCH], eight Erdheim-Chester disease [ECD], one overlap form LCH/ECD, two Rosai-Dorfman disease [RDD], and one haemophagocytic lymphohistiocytosis [HLH]) with single or multiple enhancing intraparenchymal brain lesions. RESULTS Histiocytic brain mass lesions show some similar MRI features including Supra and/or infratentorial and/or paraventricular subcortical well-delineated masses, linear ependymal enhancement along the ventricles and brain stem lesions. Masses always present with mixed hyper- and hypointense signal on T2-weighted imaging (WI). Their enhancement is often homogeneous. Apparent diffusion coefficient (ADC) values are often normal or elevated. CONCLUSION The presence of multiple periventricular and subcortical enhancing lesions with mixed signal intensity on T2WI and normal or high ADC values should lead radiologists to consider the diagnosis of histiocytic lesions and search for associated systemic lesions.
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Affiliation(s)
- L P Luna
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, The Johns Hopkins University School of Medicine, Baltimore, USA.
| | - A Drier
- APHP, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - N Aygun
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - K Mokhtari
- APHP, Department of Neuropathology, Pitié-Salpêtrière Hospital, Paris, France
| | - K Hoang-Xuan
- APHP, Department of Neuro-oncology, Pitié-Salpêtrière Hospital, Paris, France
| | - D Galanaud
- APHP, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - J Donadieu
- APHP, Department of Hematology, Trousseau Hospital, Paris, France
| | - D Dormont
- APHP, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - J Haroche
- APHP, Department of Internal Medicine, Pitié-Salpêtrière Hospital, Paris, France
| | - N Martin-Duverneuil
- APHP, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
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80
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Garg N, Lavi ES. Clinical and Neuroimaging Manifestations of Erdheim–Chester Disease: A Review. J Neuroimaging 2020; 31:35-44. [DOI: 10.1111/jon.12785] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 01/18/2023] Open
Affiliation(s)
- Neeta Garg
- Department of Neurology Miller School of Medicine University of Miami Miami FL
| | - Efrat Saraf Lavi
- Department of Radiology Miller School of Medicine University of Miami Miami Florida
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81
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Erdheim-Chester disease with intracranial involvement causing hydrocephalus: Case report. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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82
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Dasdelen S, Büschek F. Erdheim-Chester-Erkrankung – eine histiozytäre Multisystemerkrankung mit ungewöhnlicher Nierenbeteiligung. Internist (Berl) 2020; 61:969-979. [DOI: 10.1007/s00108-020-00849-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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83
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Iwata M, Takeichi T, Muro Y, Akiyama M. Late‐onset Langerhans cell histiocytosis without extracutaneous involvement. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2020. [DOI: 10.1002/cia2.12122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Mai Iwata
- Department of Dermatology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Takuya Takeichi
- Department of Dermatology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Yoshinao Muro
- Department of Dermatology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Masashi Akiyama
- Department of Dermatology Nagoya University Graduate School of Medicine Nagoya Japan
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84
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Hassan S, Fanola C, Beckman A, Li F, Nelson AC, Linden M, Beckman JD. Adult Langerhans histiocytosis with rare BRAF mutation complicated by massive pulmonary embolism. Thromb Res 2020; 193:207-210. [PMID: 32768704 DOI: 10.1016/j.thromres.2020.07.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/07/2020] [Accepted: 07/24/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Salma Hassan
- University of Minnesota Medical School, Minneapolis, MN, United States
| | - Christina Fanola
- Department of Medicine, Division of Cardiology, Minneapolis, MN, United States
| | - Amy Beckman
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, United States
| | - Faqian Li
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, United States
| | - Andrew C Nelson
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, United States
| | - Michael Linden
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, United States
| | - Joan D Beckman
- Department of Medicine, Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, United States.
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85
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86
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Costa IBSDS, Costa FADS, Bittar CS, Rizk SI, Abdo ANR, Siqueira SAC, Rocha V, Pereira J, Ky B, Hajjar LA. Cardiac Tamponade as the First Manifestation of Erdheim-Chester Disease. JACC: CARDIOONCOLOGY 2020; 2:324-328. [PMID: 34396240 PMCID: PMC8352341 DOI: 10.1016/j.jaccao.2020.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Isabela B S da S Costa
- Department of Cardio-Oncology of the Cancer Institute of São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Fernanda A de S Costa
- Department of Cardio-Oncology of the Cancer Institute of São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Cristina S Bittar
- Department of Cardio-Oncology of the Cancer Institute of São Paulo, Universidade de São Paulo, São Paulo, Brazil.,Department of Cardio-Oncology of the Heart Institute, Universidade de São Paulo, São Paulo, Brazil
| | - Stéphanie I Rizk
- Department of Cardio-Oncology of the Cancer Institute of São Paulo, Universidade de São Paulo, São Paulo, Brazil.,Department of Cardio-Oncology of the Heart Institute, Universidade de São Paulo, São Paulo, Brazil
| | - André N R Abdo
- Department of Hematology of the Cancer Institute of São Paulo, Universidade de São Paulo, São Paulo, Brazil.,Oncology Center Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Sheila A C Siqueira
- Department of Pathology of the Hospital das Clinicas, Universidade de São Paulo, São Paulo, Brazil
| | - Vanderson Rocha
- Department of Hematology of the Cancer Institute of São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Juliana Pereira
- Department of Hematology of the Cancer Institute of São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Bonnie Ky
- Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Biostatistics, Epidemiology and Informatics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ludhmila A Hajjar
- Department of Cardio-Oncology of the Cancer Institute of São Paulo, Universidade de São Paulo, São Paulo, Brazil.,Department of Cardio-Oncology of the Heart Institute, Universidade de São Paulo, São Paulo, Brazil
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87
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Abstract
Erdheim-Chester disease (ECD) is a rare but increasingly recognized multi-system disorder. Its diagnosis and treatment require integration of clinical information, imaging studies, and pathology studies. Of note, ECD can now be defined as a clonal myeloid disorder due to mutations which activate mitogen-activated protein kinase (MAPK) pathways and where an inflammatory milieu is important in the pathogenesis and clinical manifestations of the disease. Biopsy demonstrating characteristic histopathologic features in addition to clinical and radiographic features, most often sclerosing long bone involvement, is required to establish a diagnosis. Detection of somatic MAPK pathway mutations can also assist in the differential diagnosis of ECD and related histiocytic neoplasms. Also, genetic analysis establishing BRAF and RAS mutational status is critical in all ECD patients, as these features will impact therapy with MAPK inhibition. Therapy is recommended at diagnosis in all patients, except for those patients with minimally symptomatic disease. Prospective therapeutic trials are essential to furthering therapeutic progress in ECD.
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Affiliation(s)
- Gordon Starkebaum
- University of Washington, Division of Rheumatology, 1959 NE Pacific St., Box 356428, Seattle, WA, 98195-6428, USA.
| | - Paul Hendrie
- Division of Hematology, University of Washington, 1959 NE Pacific St., Box 358081, Seattle, WA, 98195-6428, USA.
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88
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Ruan GJ, Goyal G, Go RS. 43-Year-Old Man With Polyuria and Bone Pain. Mayo Clin Proc 2020; 95:e13-e18. [PMID: 32029098 DOI: 10.1016/j.mayocp.2019.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/20/2019] [Accepted: 07/29/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Gordon J Ruan
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Gaurav Goyal
- Fellow in Hematology, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Ronald S Go
- Advisor to resident and fellow and Consultant in Hematology, Mayo Clinic, Rochester, MN.
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89
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Goyal G, Ravindran A, Liu Y, He R, Shah MV, Bennani NN, Patnaik MM, Rech KL, Go RS. Bone marrow findings in Erdheim-Chester disease: increased prevalence of chronic myeloid neoplasms. Haematologica 2020; 105:e84-e86. [PMID: 31624111 DOI: 10.3324/haematol.2019.234187] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
| | | | - Yuanhang Liu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Rong He
- Department of Laboratory Medicine and Pathology, Mayo Clinic
| | | | | | | | - Karen L Rech
- Department of Laboratory Medicine and Pathology, Mayo Clinic
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90
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Namoglu EC, Hughes ME, Plastaras JP, Landsburg DJ, Maity A, Nasta SD. Management and outcomes of sinus histiocytosis with massive lymphadenopathy (Rosai Dorfman Disease). Leuk Lymphoma 2019; 61:905-911. [PMID: 31876204 DOI: 10.1080/10428194.2019.1703971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Sinus histiocytosis with massive lymphadenopathy (Rosai Dorfman Disease [RDD]), is a rare, benign but clinically heterogeneous histiocytic disorder. Our aims were to analyze the clinical characteristics of the disease and explore the outcomes of patients with RDD followed at our institution. Between January 2000 and February 2019, there were 15 patients with a pathologically confirmed diagnosis of RDD. Median age at diagnosis was 48 years old (range 26-78). The majority (87%, n = 13) of the patients had extranodal disease. Frontline approaches included surgical intervention/complete excision (n = 5, 33%), rituximab monotherapy (n = 5, 33%), observation (n = 3, 20%), and radiation (n = 2, 13%). Two of the five patients underwent surgical excision and were subsequently treated with rituximab. Of the 7 patients who were given rituximab, 64% remained progression free 24 months after the initial rituximab administration. Our review parallels previous reports and highlights rituximab as a favorable option for therapy if ineligible for surgery or radiation.
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Affiliation(s)
- Esin C Namoglu
- Division of Hematology Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Mitchell E Hughes
- Division of Hematology Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - John P Plastaras
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel J Landsburg
- Division of Hematology Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Amit Maity
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Sunita D Nasta
- Division of Hematology Oncology, University of Pennsylvania, Philadelphia, PA, USA
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91
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When a Meningioma Isn't: Endoscopic Endonasal Orbital Decompression and Biopsy of Skull Base Rosai-Dorfman Disease Treated Previously with Empiric Radiation Therapy. World Neurosurg 2019; 135:141-145. [PMID: 31843730 DOI: 10.1016/j.wneu.2019.12.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/06/2019] [Accepted: 12/07/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Rosai-Dorfman disease (RDD) is a rare, benign histiocytosis disorder with only approximately 100 reported central nervous system cases in the literature. Even less common is skull base involvement of RDD, with about 41 reported cases. Radiographically, RDD can appear similar to a meningioma; the true diagnosis is only found with histologic analysis. Although "benign," RDD can lead to significant neurologic morbidity from the disease or unnecessary surgical and nonsurgical treatment. While rare, intracranial RDD has been treated with chemotherapy or radiotherapy, with surgery playing a limited role to relieve mass effect. Surgical approaches to the skull base are invasive and pose risk, especially for a benign and self-limiting disease like RDD. CASE DESCRIPTION Here we present the case of a 63-year-old woman with a presumed spheno-orbital meningioma for which the patient previously underwent radiation therapy. On presentation to our facility, the patient noted pressure headaches and blurry vision, and imaging demonstrated progression of her disease. For these reasons, surgical debulking and biopsy were undertaken. CONCLUSIONS This report demonstrates the role of EEA for tissue biopsy and decompression of the affected cranial nerves and orbit. This paradigm seems to provide a safe and effective way to manage patients with compressive symptoms, while also allowing for tissue sampling.
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