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Kuang GM, Loo NN, Gao Q, Li J, Luo L, Chen S, Cheung JPY, Cheung KMC. A solitary osteolytic lesion with pathological fracture in the cervical spine - a case report. BMC Musculoskelet Disord 2023; 24:436. [PMID: 37254107 PMCID: PMC10228027 DOI: 10.1186/s12891-023-06543-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 05/16/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a rare disorder. The treatment options vary depending on how many organs are involved and how extensive the disease is. In this report, a case of LCH with isolated 6th cervical vertebra (C6) collapse was presented. This case was treated with anterior corpectomy and instrumented fusion, followed by local radiotherapy (RT), with a good clinical outcome up to postoperative six months. CASE PRESENTATION This was a 47-year-old female patient with a complaint of neck pain and bilateral shoulder pain for two months before consultation. She was initially treated with analgesics, but the pain was persistent. Further radiological evaluations revealed an osteolytic lesion within the C6 vertebral body with a pathological fracture. Magnetic resonance imaging (MRI) with contrast of the cervical spine revealed diffused hypointense signal changes on the T1-weighted images and hyperintense signal changes on the T2-weighted images in the C6 vertebral body, with significant contrast-enhanced infiltration signals. Furthermore, in positron emission tomography-computed tomography (PET-CT), focal hypermetabolism and abnormal uptake signals were seen only in the C6 vertebral body. The patient underwent an anterior cervical corpectomy with instrumented fusion. The histopathological results confirmed the diagnosis of LCH. The patient reported significant pain relief on postoperative day one. Moreover, she was treated by local RT at postoperative one month. Good clinical outcomes were achieved in the form of no pain and recovery in neck mobility up to postoperative six months. No evidence of recurrence was observed at the final follow-up. CONCLUSIONS This case report describes a treatment option for a solitary C6 collapse with LCH managed by anterior corpectomy and instrumented fusion, followed by local RT, with a good clinical outcome at postoperative six months. More studies are needed to elucidate whether such a treatment strategy is superior to surgery or RT alone.
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Affiliation(s)
- Guan-Ming Kuang
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
| | - Nga-Nuen Loo
- International school, Jinan University, Guangzhou, Guangdong, China
| | - Qingpeng Gao
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Jishi Li
- Department of Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Lin Luo
- Department of Radiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Shuang Chen
- Department of Pathology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Kenneth M C Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
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152
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Yan K, Xu X. Sporadic Red Papules on the Face: A Quiz. Acta Derm Venereol 2023; 103:adv11662. [PMID: 37219502 DOI: 10.2340/actadv.v103.11662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/21/2023] [Indexed: 05/24/2023] Open
Abstract
Abstract is missing (Quiz)
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Affiliation(s)
- Kexin Yan
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Xiulian Xu
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China.
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153
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Geerlinks AV, Abla O. Treatment of Langerhans Cell Histiocytosis and Histiocytic Disorders: A Focus on MAPK Pathway Inhibitors. Paediatr Drugs 2023:10.1007/s40272-023-00569-8. [PMID: 37204611 DOI: 10.1007/s40272-023-00569-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 05/20/2023]
Abstract
Histiocytic disorders are rare diseases defined by the clonal accumulation of a macrophage or dendritic cell origin. These disorders include Langerhans cell histiocytosis, Erdheim-Chester disease, juvenile xanthogranuloma, malignant histiocytoses, and Rosai-Dorfman-Destombes disease. These histiocytic disorders are a diverse group of disorders with different presentations, management, and prognosis. This review focuses on these histiocytic disorders and the role of pathological ERK signaling due to somatic mutations in the mitogen--activated protein kinase (MAPK) pathway. Over the last decade, there has been growing awareness of the MAPK pathway being a key driver in many histiocytic disorders, which has led to successful treatment with targeted therapies, in particular, BRAF inhibitors and MEK inhibitors.
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Affiliation(s)
- Ashley V Geerlinks
- Pediatric Hematology/Oncology, Western University and Children's Hospital London Health Sciences Centre, London, ON, Canada.
| | - Oussama Abla
- Division of Haematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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154
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Lazzarini G, Abramo F, Albanese F, Pirone A, Miragliotta V. Combined immunohistochemical protocols to differentiate macrophages within the mononuclear-phagocyte system. Ann Anat 2023:152107. [PMID: 37207851 DOI: 10.1016/j.aanat.2023.152107] [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: 12/02/2022] [Revised: 04/29/2023] [Accepted: 05/13/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND The "mononuclear phagocyte system" (MPS) refers to dispersed mononuclear monocytes and macrophages and is used to distinguish them from polymorphonuclear cells. The term "histiocyte" indicates large cells with voluminous granulated cytoplasm, sometimes containing engulfed particles, recognized as fully differentiated end cells of the MPS. Dendritic cells (DC) represent another diversified population whose inclusion in the MPS is still debated. The diverse cells of the MPS cannot all be characterized by single antigen markers or unique functions expressed at all stages of cell differentiation or activation. Nevertheless, in a diagnostic setting, their reliable identification plays a major role when a specific therapy must be established. Understanding the heterogeneity among MPS cell populations is indeed relevant to define different therapeutic approaches that can range from the use of antibiotics to immunomodulatory agents. For this reason, we attempted to establish a protocol to reliably identify the proportion of macrophages within the mononuclear phagocyte system in a tissue and/or in a given inflammatory population. METHODS the Tafuri method was used in different double immunofluorescence protocols using an anti-Iba-1, anti-MAC387, and anti-CD11b-CD68-CD163-CD14-CD16 antibody. RESULTS AND DISCUSSION in normal canine skin the anti-Iba-1 antibody stained an epidermal cell population (i.e. Langerhans cells) and scattered cells within the dermal compartment. MAC387 was unable to stain cells containing Leishmania amastigotes in leishmaniasis-diagnosed samples as the anti-CD11b-CD68-CD163-CD14-CD16 antibody did. By using a combination of staining protocols to differentiate macrophages within the whole histiocytic infiltrate we validated the use of a cocktail of rabbit monoclonal antibodies raised against CD11b, CD68, CD163, CD14, CD16 to stain skin macrophages.
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Affiliation(s)
- G Lazzarini
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy.
| | - F Abramo
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - F Albanese
- Veterinary Diagnostic Laboratory MyLav-La Vallonea, Passirana di Rho (MI), Italy
| | - A Pirone
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - V Miragliotta
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
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155
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Hao L, Li Y, Xiong Z, Jiang Y, Hu X, Hu D, Li Z, Shen Y. Imaging Phenotypes and Evolution of Hepatic Langerhans Cell Histiocytosis on CT/MRI: A Retrospective Study of Clinical Cases and Literature Review. Bioengineering (Basel) 2023; 10:bioengineering10050598. [PMID: 37237668 DOI: 10.3390/bioengineering10050598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: pathological changes in hepatic Langerhans cell histiocytosis (LCH) have been observed; however, corresponding imaging findings can appear vague to physicians and radiologists. The present study aimed to comprehensively illustrate the imaging findings of hepatic LCH and to investigate the evolution of LCH-associated lesions. (2) Methods: LCH patients with liver involvement treated at our institution were retrospectively reviewed along with prior studies in PubMed. Initial and follow-up computed tomography (CT) and magnetic resonance imaging (MRI) were systematically reviewed, and three imaging phenotypes were created based on the lesion distribution pattern. Clinical features and prognoses were compared among the three phenotypes. Liver fibrosis was evaluated visually on T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) values of the fibrotic areas were measured. Descriptive statistics and a comparative analysis were used to analyze the data. (3) Results: based on the lesion distribution pattern on CT/MRI scans, patients with liver involvement were categorized as the disseminated lesion phenotype, scattered lesion phenotype, and central periportal lesion phenotype. Patients with scattered lesion phenotype were typically adults, and only a few of them had hepatomegaly (npresent = 1, 1/6, 16.7%) and liver biochemical abnormalities (npresent = 2, 2/6, 33.3%); patients with central periportal lesion phenotype were typically young children, and hepatomegaly and biochemical abnormalities were more apparent in these patients than those with another phenotype; and those with the disseminated lesion phenotype were found in all age groups, and the lesions evolved rapidly on medical imaging. Follow-up MRI scans show more details and can better document the evolution of lesions than CT. T2-hypointense fibrotic changes, including the periportal halo sign (npresent = 2, 2/9, 22.2%), patchy liver parenchyma changes (npresent = 6, 6/9, 66.7%), and giant hepatic nodules close to the central portal vein (npresent = 1, 1/9, 11.1%), were found, while fibrotic changes were not observed in patients with the scattered lesion phenotype. The mean ADC value for the area of liver fibrosis in each patient was lower than the optimal cutoff for significant fibrosis (METAVIR Fibrosis Stage ≥ 2) in a previous study that assessed liver fibrosis in chronic viral hepatitis. (4) Conclusions: The infiltrative lesions and liver fibrosis of hepatic LCH can be well characterized on MRI scans with DWI. The evolution of these lesions was well demonstrated on follow-up MRI scans.
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Affiliation(s)
- Luwen Hao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430032, China
| | - Yuanqiu Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430032, China
| | - Ziman Xiong
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430032, China
| | - Yuchen Jiang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430032, China
| | - Xuemei Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430032, China
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430032, China
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430032, China
| | - Yaqi Shen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430032, China
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156
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Lu X, Wang R, Zhu Z. The value of 18F-FDG PET/CT in the systemic evaluation of patients with Rosai-Dorfman disease: a retrospective study and literature review. Orphanet J Rare Dis 2023; 18:116. [PMID: 37179326 PMCID: PMC10182668 DOI: 10.1186/s13023-023-02711-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Rosai-Dorfman disease (RDD) is a rare form of non-Langerhans cell histiocytic disease. The aim of this study was to review the characteristics of RDD using 18F-FDG PET/CT and determine its efficacy in the disease management. RESULTS A total of 28 RDD patients underwent 33 18F-FDG PET/CT scans for systematic assessment and follow-up. The common involved sites included the lymph nodes (17, 60.7%), upper respiratory tract (11, 39.3%), and skin (9, 32.1%). Five patients had more lesions detected in PET/CT images than in CT and/or MRI, including inapparent nodules (n = 5) and bone destruction (n = 3). After thorough treatment evaluation using PET/CT, the treatment strategies of 14 patients (14/16, 87.5%) were changed. Five patients underwent PET/CT twice during follow-up and the SUVs were significantly decreased (15.3 ± 3.4 vs. 4.4 ± 1.0, p = 0.02), which demonstrated disease improvement. CONCLUSIONS 18F-FDG PET/CT contributed to displaying the holistic characteristics of RDD, in particular during initial assessment, treatment strategy adjustment, or efficacy evaluation, and could compensate for some disadvantages of CT and MRI images.
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Affiliation(s)
- Xinyu Lu
- Department of Nuclear Medicine, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- State Key Laboratory of Complex Severe and Rare Diseases, Beijing, 100730, China
| | - Rongxi Wang
- Department of Nuclear Medicine, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- State Key Laboratory of Complex Severe and Rare Diseases, Beijing, 100730, China
| | - Zhaohui Zhu
- Department of Nuclear Medicine, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
- State Key Laboratory of Complex Severe and Rare Diseases, Beijing, 100730, China.
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157
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Faria C, Tzankov A. Progression in Myeloid Neoplasms: Beyond the Myeloblast. Pathobiology 2023; 91:55-75. [PMID: 37232015 PMCID: PMC10857805 DOI: 10.1159/000530940] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/28/2023] [Indexed: 05/27/2023] Open
Abstract
Disease progression in myelodysplastic syndromes (MDS), myelodysplastic-myeloproliferative neoplasms (MDS/MPN), and myeloproliferative neoplasms (MPN), altogether referred to as myeloid neoplasms (MN), is a major source of mortality. Apart from transformation to acute myeloid leukemia, the clinical progression of MN is mostly due to the overgrowth of pre-existing hematopoiesis by the MN without an additional transforming event. Still, MN may evolve along other recurrent yet less well-known scenarios: (1) acquisition of MPN features in MDS or (2) MDS features in MPN, (3) progressive myelofibrosis (MF), (4) acquisition of chronic myelomonocytic leukemia (CMML)-like characteristics in MPN or MDS, (5) development of myeloid sarcoma (MS), (6) lymphoblastic (LB) transformation, (7) histiocytic/dendritic outgrowths. These MN-transformation types exhibit a propensity for extramedullary sites (e.g., skin, lymph nodes, liver), highlighting the importance of lesional biopsies in diagnosis. Gain of distinct mutations/mutational patterns seems to be causative or at least accompanying several of the above-mentioned scenarios. MDS developing MPN features often acquire MPN driver mutations (usually JAK2), and MF. Conversely, MPN gaining MDS features develop, e.g., ASXL1, IDH1/2, SF3B1, and/or SRSF2 mutations. Mutations of RAS-genes are often detected in CMML-like MPN progression. MS ex MN is characterized by complex karyotypes, FLT3 and/or NPM1 mutations, and often monoblastic phenotype. MN with LB transformation is associated with secondary genetic events linked to lineage reprogramming leading to the deregulation of ETV6, IKZF1, PAX5, PU.1, and RUNX1. Finally, the acquisition of MAPK-pathway gene mutations may shape MN toward histiocytic differentiation. Awareness of all these less well-known MN-progression types is important to guide optimal individual patient management.
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Affiliation(s)
- Carlos Faria
- Department of Anatomical Pathology, Coimbra University Hospital, Coimbra, Portugal
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Alexandar Tzankov
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
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158
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Ravindran A, Rech KL. How I Diagnose Rosai-Dorfman Disease. Am J Clin Pathol 2023:7160235. [PMID: 37167084 DOI: 10.1093/ajcp/aqad047] [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: 01/26/2023] [Accepted: 04/05/2023] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVES Rosai-Dorfman disease (RDD) is one of 3 major types of histiocytosis, along with Erdheim-Chester disease and Langerhans cell histiocytosis. While historically, RDD was considered a benign self-limited condition, current data show MAPK/ERK pathway mutations in 30% to 50% of cases, indicative of a clonal process. Rosai-Dorfman disease was incorporated as a histiocytic neoplasm in the fifth edition of the World Health Organization classification of hematopoietic tumors and the International Consensus Classification. METHODS We discuss the diagnosis of RDD using 2 illustrative cases, interpretative challenges, and a diagnostic algorithm. RESULTS Rosai-Dorfman disease involves nodal and extranodal sites, including skin, sinuses, salivary gland, orbit, central nervous system, kidney, and bone. In a subset, RDD can coexist with other neoplasms (lymphomas, other histiocytosis) or autoimmune disease. Morphologically, RDD histiocytes are characterized by enlarged round to oval nuclei, distinct nucleoli, and voluminous cytoplasm with engulfment of inflammatory cells (emperipolesis). By immunohistochemistry, they express CD68, CD163 (majority), S100, OCT2, and cyclin D1. Appropriate use of ancillary studies is important to support the diagnosis of RDD while excluding other histiocytic neoplasms and reactive histiocytic proliferations. CONCLUSIONS Management of RDD is dependent on the extent of organ involvement and clinical symptoms. In patients who require therapy, next-generation sequencing is recommended to identify MAPK/ERK pathway mutations for targeted therapy.
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Affiliation(s)
- Aishwarya Ravindran
- Department of Pathology, Division of Laboratory Medicine-Hematopathology, University of Alabama at Birmingham, Birmingham, AL, US
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester, MN, US
| | - Karen L Rech
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester, MN, US
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159
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Alexander B, Alshaikhli A, Bartl M, Ng-Wong YK, Dulgheru EC. A Rare Cause of Lymphadenopathy in a Young Hispanic Female: Unmasking Recurrent Nodal Rosai-Dorfman Disease. Cureus 2023; 15:e39131. [PMID: 37378192 PMCID: PMC10292128 DOI: 10.7759/cureus.39131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/29/2023] Open
Abstract
Rosai-Dorfman disease (RDD) is a rare histiocytic disorder that can present with painless bilateral symmetrical cervical lymphadenopathy, mimicking lymphomas. RDD is characterized by excessive tissue infiltration by dendritic cells, macrophages, or monocyte-derived cells, with a histopathologic diagnosis based on the presence of CD68+, CD163+, and S100+ histiocytes, which differentiate it from other histiocytic neoplasms. In this case report, we present a young Hispanic female with recurrent subcutaneous growths and lymphadenopathy, initially thought to be lymphoma, who was diagnosed with RDD after a significant diagnostic workup. Treatment initially consisted of surgical excision; however, due to recurrence, the patient was successfully treated with corticosteroids and a steroid-sparing agent, 6-mercaptopurine, with significant improvement in symptoms. RDD should be considered a differential diagnosis for patients with cervical lymphadenopathy, and an interdisciplinary approach is essential to managing this rare disorder effectively. The report highlights the need for an interdisciplinary approach to managing this rare disorder effectively and underscores the importance of multimodal treatment in disease suppression. As a rare disease with slow advancement of defined guidelines for diagnostic and treatment strategies, this case report adds to the existing literature on RDD.
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Affiliation(s)
- Blesset Alexander
- Internal Medicine, University of Texas Rio Grande Valley, Edinburg, USA
- Internal Medicine, DHR Health, Edinburg, USA
| | | | - Mery Bartl
- Internal Medicine, University of Texas Rio Grande Valley, Edinburg, USA
| | - Yilen K Ng-Wong
- Internal Medicine, University of Texas Rio Grande Valley, Edinburg, USA
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160
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Hong HG, Chung YE, Park J, Kim YE. Erdheim-Chester Disease Involving the Biliary System and Mimicking Immunoglobulin G4-Related Disease: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:757-762. [PMID: 37324994 PMCID: PMC10265239 DOI: 10.3348/jksr.2022.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/11/2022] [Accepted: 11/13/2022] [Indexed: 06/17/2023]
Abstract
First described in 1930 as a lipoid granulomatosis, Erdheim-Chester disease (ECD) is a rare histiocytosis encompassing a group of disorders caused by overproduction of histiocytes, a subtype of white blood cells. This disease most commonly involves the bones and can affect organs in the abdomen; however, biliary involvement is rarely reported. We report a case of ECD with biliary involvement, which rendered it difficult to radiologically distinguish ECD from immunoglobulin G4-related disease.
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161
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Angelini A, Mosele N, Gnassi A, Baracco R, Rodà MG, Cerchiaro M, Ruggieri P. Vertebra Plana: A Narrative Clinical and Imaging Overview among Possible Differential Diagnoses. Diagnostics (Basel) 2023; 13:diagnostics13081438. [PMID: 37189540 DOI: 10.3390/diagnostics13081438] [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: 03/27/2023] [Revised: 04/14/2023] [Accepted: 04/15/2023] [Indexed: 05/17/2023] Open
Abstract
Vertebra plana is a rare radiologic condition characterized by a uniform loss of height of a vertebral body that represents a diagnostic challenge for surgeons. The purpose of this study was to review all possible differential diagnoses that may present with a vertebra plana (VP) described in the current literature. For that purpose, we performed a narrative literature review in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, analyzing 602 articles. Patient demographics, clinical presentation, imaging characteristics and diagnoses were investigated. VP is not a pathognomonic feature of Langerhans cell histiocytosis, but other oncologic and non-oncologic conditions should be considered. The list of differential diagnoses, based on our literature review, can be recalled with the mnemonic HEIGHT OF HOMO: H-Histiocytosis; E-Ewing's sarcoma; I-Infection; G-Giant cell tumor; H-Hematologic neoplasms; T-Tuberculosis; O-Osteogenesis imperfecta; F-Fracture; H-Hemangioma; O-Osteoblastoma; M-Metastasis; O-Osteomyelitis, chronic.
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Affiliation(s)
- Andrea Angelini
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Nicolò Mosele
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Andrea Gnassi
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Riccardo Baracco
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Maria Grazia Rodà
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Mariachiara Cerchiaro
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
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162
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Gallo JR, Paira S, Hernández-Molina G, Delgado-de la Mora J, Montante-Montes de Oca D, Martín-Nares E. Immunoglobulin G4-Associated Rosai-Dorfman Disease: Report of 3 Cases. Eur J Rheumatol 2023; 10:57-61. [PMID: 37249306 PMCID: PMC10543072 DOI: 10.5152/eurjrheum.2023.22064] [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: 05/17/2022] [Accepted: 03/02/2023] [Indexed: 05/31/2023] Open
Abstract
Rosai-Dorfman disease is characterized by dilated lymph node sinuses filled with lymphocytes, plasma cells, and histiocytes. Many of these histiocytes classically exhibit emperipolesis of lymphocytes and plasma cells. Abundant immunoglobulin G4+ plasma cells occur in some cases, and a potential relationship with immunoglobulin G4-related disease has been suggested. Here, we report 3 cases of immunoglobulin G4-associated Rosai-Dorfman disease. Immunoglobulin G4-related disease was suspected based on immunoglobulin G4+ plasma cell infiltration, but the final diagnosis was immunoglobulin G4-associated Rosai-Dorfman disease. At present, the evidence does not support a link between immunoglobulin G4-associated Rosai-Dorfman disease and immunoglobulin G4-related disease, and one condition should not be considered part of the spectrum of the other. We believe it is of paramount importance to increase the awareness of immunoglobulin G4-associated Rosai-Dorfman disease for pathologists who interpret the biopsies and clinicians who integrate the diagnosis and treat such patients to not overdiagnose immunoglobulin G4-related disease.
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Affiliation(s)
- Jesica Romina Gallo
- Section of Rheumatology, Hospital Central de Reconquista, Santa Fe, Argentina
| | - Sergio Paira
- Section of Rheumatology, Hospital J. M. Cullen, Santa Fe, Argentina
| | - Gabriela Hernández-Molina
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - Jesús Delgado-de la Mora
- Department of Pathology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, Mexico City, Mexico
| | - Daniel Montante-Montes de Oca
- Department of Pathology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, Mexico City, Mexico
| | - Eduardo Martín-Nares
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
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163
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Sakurai M, Yamamoto Y, Tamaru M, Shimoda H, Sakai Y, Morimoto M. Disseminated histiocytic sarcoma in a squirrel monkey (Saimiri sciureus). J Med Primatol 2023; 52:121-124. [PMID: 36286409 DOI: 10.1111/jmp.12625] [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: 04/07/2022] [Revised: 09/25/2022] [Accepted: 10/03/2022] [Indexed: 11/29/2022]
Abstract
A 14-years-old squirrel monkey was euthanized due to weakness. Histopathological examination revealed multifocal growth of oval cells with severe atypia in the liver, spleen, and bone marrow. The neoplastic cells were positive for histiocytic markers (Iba1, HLA-DR, CD204). This is the fourth case of histiocytic sarcoma in non-human primates.
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Affiliation(s)
- Masashi Sakurai
- Department of Veterinary Pathology, Joint Faculty of Veterinary Medicine, Yamaguchi University, Yoshida, Yamaguchi, Japan
| | - Yukihiro Yamamoto
- Department of Veterinary Pathology, Joint Faculty of Veterinary Medicine, Yamaguchi University, Yoshida, Yamaguchi, Japan
| | | | - Hiroshi Shimoda
- Department of Veterinary Microbiology, Joint Faculty of Veterinary Medicine, Yamaguchi University, Yoshida, Yamaguchi, Japan
| | - Yusuke Sakai
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Masahiro Morimoto
- Department of Veterinary Pathology, Joint Faculty of Veterinary Medicine, Yamaguchi University, Yoshida, Yamaguchi, Japan
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164
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Buschulte K, Cottin V, Wijsenbeek M, Kreuter M, Diesler R. The world of rare interstitial lung diseases. Eur Respir Rev 2023; 32:32/167/220161. [PMID: 36754433 PMCID: PMC9910344 DOI: 10.1183/16000617.0161-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/21/2022] [Indexed: 02/10/2023] Open
Abstract
The world of rare interstitial lung diseases (ILDs) is diverse and complex. Diagnosis and therapy usually pose challenges. This review describes a selection of rare and ultrarare ILDs including pulmonary alveolar proteinosis, pulmonary alveolar microlithiasis and pleuroparenchymal fibroelastosis. In addition, monogenic ILDs or ILDs in congenital syndromes and various multiple cystic lung diseases will be discussed. All these conditions are part of the scope of the European Reference Network on rare respiratory diseases (ERN-LUNG). Epidemiology, pathogenesis, diagnostics and treatment of each disease are presented.
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Affiliation(s)
- Katharina Buschulte
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), ERN-LUNG, Heidelberg, Germany
| | - Vincent Cottin
- National Reference Centre for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, UMR 754, Claude Bernard University Lyon 1, ERN-LUNG, Lyon, France
| | - Marlies Wijsenbeek
- Center for Interstitial Lung Diseases and Sarcoidosis, Department of Respiratory Medicine, Erasmus MC-University Medical Center, ERN-LUNG, Rotterdam, The Netherlands
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), ERN-LUNG, Heidelberg, Germany
| | - Rémi Diesler
- National Reference Centre for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, UMR 754, Claude Bernard University Lyon 1, ERN-LUNG, Lyon, France
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165
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Inoue N, Schulert GS. Mouse models of systemic juvenile idiopathic arthritis and macrophage activation syndrome. Arthritis Res Ther 2023; 25:48. [PMID: 36964620 PMCID: PMC10039518 DOI: 10.1186/s13075-023-03032-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/16/2023] [Indexed: 03/26/2023] Open
Abstract
Macrophage activation syndrome (MAS) is a life-threatening complication of pediatric rheumatic diseases, occurring most commonly in children with systemic juvenile idiopathic arthritis (SJIA). Despite several classes of currently available treatment options for SJIA, including biologic agents targeting IL-1 or IL-6, there remain severe cases suffering from refractory disease and recurrent MAS. The phenotype of MAS is similar to hemophagocytic lymphohistiocytosis (HLH), but the underlying pathophysiology of MAS complicating SJIA or other disorders has not been fully clarified. These facts make it challenging to develop and utilize animal models to study MAS. To date, there is no "perfect" model replicating MAS, but several models do demonstrate aspects of SJIA and/or MAS. In this review, we examine the proposed animal models of SJIA and MAS, focusing on how they reflect these disorders, what we have learned from the models, and potential future research questions. As we better understand the key features of each, animal models can be powerful tools to further define the pathophysiology of SJIA and MAS, and develop new treatment targets and strategies.
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Affiliation(s)
- Natsumi Inoue
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Grant S Schulert
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, MLC 4010, USA.
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166
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Giardino FR, Cuomo R, Pozzi M, Marcaccini G, Bacchini S, Marzouk El Araby M, Grimaldi L, Nisi G. Erdheim–Chester Disease of the Breast: First Review and First Case of Isolated Severe Gynecomastia. Diagnostics (Basel) 2023; 13:diagnostics13071239. [PMID: 37046457 PMCID: PMC10093613 DOI: 10.3390/diagnostics13071239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/11/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
(1) Introduction: Erdheim–Chester disease (ECD) is a life-threatening condition and often a diagnostic challenge. It has recently been classified as a hematopoietic tumour, and the cases of ECD reported in the literature has dramatically increased during the last 15 years. (2) Methods: We describe the case of a 57-year-old male patient with severe gynecomastia, with a detailed description of his diagnostic iter and consequent surgical operation. We provide the first systematic review of the literature of breast involvement in ECD, following PRISMA guidelines, including 13 studies and 16 patients. (3) Results: Our report resulted to be the first case of gynecomastia as a single clinical and imaging feature of ECD described in English literature. A total of 81.3% of patients included were female. Among them, 76.9% had unilateral and nodular presentation, while male patients presented bilateral heterogeneous breast enlargement. Globally, 87.5% expressed breast alterations as their first manifestations of ECD. Only 50% presented skeletal involvement. (4) Conclusion: The reported case represents a unique addition to the literature. We found two different patterns in ECD-related breast involvement between male and female patients, an unusual M/F ratio, and a lower rate of bone involvement. Breast involvement is frequently the first clinical feature; therefore, breast caregivers should be aware of this dangerous and most likely underestimated condition.
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167
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sCD25 as an independent adverse prognostic factor in adult patients with HLH: results of a multicenter retrospective study. Blood Adv 2023; 7:832-844. [PMID: 35973195 PMCID: PMC9986715 DOI: 10.1182/bloodadvances.2022007953] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/11/2022] [Accepted: 08/02/2022] [Indexed: 11/20/2022] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare but often fatal hyperinflammatory syndrome caused by an inborn or acquired error of immunity. In adults, the underlying immunodeficiency generally arises alongside severe infections, malignancies, autoimmune diseases, and immunosuppressive treatment. To analyze risk factors and outcome in adults, we conducted a multicenter retrospective study. A total of 62 adult (age ≥18 years) patients met at least one of the following inclusion criteria: (1) ≥5 of 8 HLH-2004 criteria, (2) HScore ≥ 200 plus 4 HLH-2004 criteria, or (3) mutation compatible with an HLH diagnosis. Most patients (65%) were male, and the median age at diagnosis was 53.5 years (range, 19-81 years). All patients were assigned to 4 etiologic subgroups based on their most likely HLH trigger. The survival probability of the 4 etiologic subgroups differed significantly (P = .004, log-rank test), with patients with an underlying malignancy having the worst clinical outcome (1-year survival probability of 21%). The parameters older age, malignant trigger, elevated serum levels of aspartate transferase, creatinine, international normalized ratio, lactate dehydrogenase, sCD25, and a low albumin level and platelet count at treatment initiation were significantly (P < .1) associated with worse overall survival in the univariate Cox regression model. In multivariate analysis, sCD25 remained the only significant prognostic factor (P = .005). Our results suggest that sCD25 could be a useful marker for the prognosis of patients with HLH that might help to stratify therapeutic interventions.
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168
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Liu W, Liu HJ, Wang WY, Tang Y, Zhao S, Zhang WY, Yan JQ, Liu WP. Multisystem ALK-positive histiocytosis: a multi-case study and literature review. Orphanet J Rare Dis 2023; 18:53. [PMID: 36915094 PMCID: PMC10010018 DOI: 10.1186/s13023-023-02649-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 02/27/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Anaplastic lymphoma kinase (ALK)-positive histiocytosis, a novel rare histiocytic proliferation, was first described in 2008; it occurs in early infancy with liver and hematopoietic involvement. The spectrum was subsequently broadened to include localized diseases in older children and young adults. However, its full clinicopathological features and molecular lineage have not been fully elucidated. RESULTS Here, we report four cases of multisystem ALK-positive histiocytosis without hematopoietic involvement. Clinically, three patients were adults aged between 32 and 51 years. Two patients', whose main manifestations were intracranial mass and numerous micronodules in the thoracoabdominal cavity organs and skin papules respectively, had a partial response to ALK inhibitors after surgery. One patient presented with mediastinal neoplasm without surgical treatment, and progressive disease occurred after two years of ALK inhibitor therapy. The fourth patient was a 17-month-old male with a large intracranial mass and presented with a poor response to ALK inhibitor and chemoradiotherapy; he died eight months after surgery. Pathologically, the histiocytes were large, with abundant eosinophilic cytoplasm, and mixed with variable numbers of foamy cells and Touton giant cells. Interstitial fibrosis was also observed. Histiocytes were positive for macrophage markers (CD68 and CD163) and ALK. KIF5B-ALK fusions were detected in two cases, EML4-ALK in one, and both DCTN1-ALK and VRK2-ALK fusions were detected in one case. CONCLUSIONS We observed that ALK inhibitors present robust and durable responses in adult patients but a poor response in young children with central nervous system involvement. There is no consensus on the optimal treatment regimen and long-term prognosis requires further observation. Moreover, every unusual histiocytic proliferative lesion, especially unresectable and multisystem involvement, should be routinely tested for ALK immunohistochemical staining to identify this rare disease.
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Affiliation(s)
- Wei Liu
- Department of Pathology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Hong-Jie Liu
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, China
| | - Wei-Ya Wang
- Department of Pathology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Yuan Tang
- Department of Pathology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Sha Zhao
- Department of Pathology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Wen-Yan Zhang
- Department of Pathology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Jia-Qi Yan
- Department of Pathology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Wei-Ping Liu
- Department of Pathology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China.
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169
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Wu L, Zhang Y, Guo X, Tang X, Xin K, Yang L, Wang Z, Jian W, Zhao F. Primary diffuse Rosai-Dorfman disease in central airway: a case report and literature review. BMC Pulm Med 2023; 23:82. [PMID: 36894897 PMCID: PMC9999564 DOI: 10.1186/s12890-023-02363-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 02/19/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Rosai-Dorfman disease (RDD) is a rare benign non-langerhans cell histiocytosis, mainly involving lymph nodes and skin. It is even rarer occurring only in central airway of lung and in diffuse form. Central airway RDD is similar to malignant tumor in imaging by radiological method and in bronchoscopy features. It is difficult to differentiate it from primary airway malignant tumor and to diagnose correctively in time. CASE PRESENTATION Here we present a rare case of 18-year-old male diagnosed with primary diffuse RDD in central airway. Although the features examined by enhanced chest computed tomography, positron emission tomography/computed tomography, diffusion-weighted imaging of enhanced chest MRI and bronchoscopy indicate to be malignant tumor, the patient was definitely confirmed by multiple transbronchial biopsies and immunohistochemistry. After two transbronchial resections, the patient's symptoms of paroxysmal cough, whistle sound and shortness of breath were significantly reduced, as well as the airway stenosis was significantly improved. After 5 months of follow-up, the patient had no symptoms and the central airway were unobstructed. CONCLUSIONS Primary diffuse RDD in central airway is characterized by intratracheal neoplasm, which is usually suspected as malignant tumor according to radiological image and bronchoscopy. Pathology and immunohistochemistry are necessary for definite diagnosis. Transbronchial resection is effective and safe for patients with primary diffuse RDD in central airway.
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Affiliation(s)
- Lei Wu
- Department of Respiratory and Critical Care Medicine, Xijing Hospital, Fourth Military Medical University, No. 127 West Changle Road, Xi'an, 710032, Shaanxi, China
| | - Yan Zhang
- Department of Respiratory and Critical Care Medicine, Xijing Hospital, Fourth Military Medical University, No. 127 West Changle Road, Xi'an, 710032, Shaanxi, China
| | - Xiaoya Guo
- Department of Respiratory and Critical Care Medicine, Xijing Hospital, Fourth Military Medical University, No. 127 West Changle Road, Xi'an, 710032, Shaanxi, China
| | - Xing Tang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, No. 127 West Changle Road, Xi'an, 710032, Shaanxi, China
| | - Keke Xin
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, No. 127 West Changle Road, Xi'an, 710032, Shaanxi, China
| | - Li Yang
- Department of Pathology, Xijing Hospital and Basic Medicine School, Fourth Military Medical University, No. 127 West Changle Road, Xi'an, 710032, Shaanxi, China
| | - Zhe Wang
- Department of Pathology, Xijing Hospital and Basic Medicine School, Fourth Military Medical University, No. 127 West Changle Road, Xi'an, 710032, Shaanxi, China
| | - Wen Jian
- Department of Respiratory and Critical Care Medicine, Xijing Hospital, Fourth Military Medical University, No. 127 West Changle Road, Xi'an, 710032, Shaanxi, China.
| | - Feng Zhao
- Department of Respiratory and Critical Care Medicine, Xijing Hospital, Fourth Military Medical University, No. 127 West Changle Road, Xi'an, 710032, Shaanxi, China.
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170
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Koster SBL, Vinke ME, van den Bos C, van Heel WJM, Kranendonk MEG, Natté R, van Tuyll van Serooskerken AM. A case report of a blueberry muffin baby caused by congenital self-healing indeterminate cell histiocytosis. BMC Pediatr 2023; 23:111. [PMID: 36890472 PMCID: PMC9993593 DOI: 10.1186/s12887-023-03922-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 02/19/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Blueberry muffin is a descriptive term for a neonate with multiple purpuric skin lesions. Many causes are known, amongst them life-threatening diseases like congenital infections or leukemia. Indeterminate cell histiocytosis (ICH) is an exceptionally rare cause of blueberry muffin rash. ICH is a histiocytic disorder which can be limited to the skin or can present with systemic involvement. A mutation that has been described in histiocytic disorders is a MAP2K1 mutation. In ICH, this mutation has previously been described in merely one case. CASE PRESENTATION A term male neonate was admitted to the neonatology ward directly after birth because of a blueberry muffin rash. ICH was diagnosed on skin biopsy. The lesions resolved spontaneously. The patient is currently 3 years old and has had no cutaneous lesions or systemic involvement so far. This disease course is similar to that of the Hashimoto-Pritzker variant of LCH. CONCLUSIONS ICH can manifest in neonates as resolving skin lesions. It is limited to the skin in most cases, but systemic development is possible. Therefore, it is essential to confirm the diagnosis with a biopsy before the lesions resolve and to monitor these patients closely with routine follow-up.
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Affiliation(s)
- S B L Koster
- Department of Dermatology, Erasmus Medisch Centrum, Doctor Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands.
| | - M E Vinke
- Department of Hemato-oncology, Prinses Máxima Centrum, Heidelberglaan 25, 3584, CS, Utrecht, The Netherlands
| | - C van den Bos
- Department of Hemato-oncology, Prinses Máxima Centrum, Heidelberglaan 25, 3584, CS, Utrecht, The Netherlands
| | - W J M van Heel
- Department of Pediatrics, HagaZiekenhuis/Juliana Kinderziekenhuis, Els Borst-Eilersplein 275, 2545, AA, Den Haag, The Netherlands
| | - M E G Kranendonk
- Department of Pathology, Prinses Máxima Centrum, Heidelberglaan 25, 3584, CS, Utrecht, The Netherlands
| | - R Natté
- Department of Pathology, HagaZiekenhuis, Els Borst-Eilersplein 275, 2545, AA, Den Haag, The Netherlands
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171
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Xu H, Zhang H, Li W, Zhang C, Wang H, Wang D. Nasal Presentations of Rosai-Dorfman Disease: Clinical Manifestation and Treatment Outcomes. EAR, NOSE & THROAT JOURNAL 2023:1455613231162226. [PMID: 36884341 DOI: 10.1177/01455613231162226] [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: 03/09/2023] Open
Abstract
PURPOSE There has been a lack of evidence-based management strategies on the nasal presentations of Rosai-Dorfman disease (RDD). We aim to investigate the clinical manifestation, treatment, and outcomes in patients with nasal RDD. METHODS We retrospectively reviewed available medical records of patients diagnosed with nasal RDD from 2014 to 2021 at our department. RESULTS A total of 26 patients were included with a marked female preponderance (2.25:1). The most common symptom and affected sites were nasal congestion (31%) and nasal cavity (73%), respectively. The average times of biopsies was 1.5 times (range: 1-3). The histiocytes were positive about S100 and CD68 and negative for CD1a with common emperipolesis. The mean duration of follow-up was 34 months (range, 3-87). One patient with concomitant nasal small B-cell lymphoma achieved complete remission after chemoradiotherapy. Recommended treatments were endoscopic resection (92%) and oral corticosteroids (21%). Surgery was performed to remove the resectable lesion as completely as possible. Corticosteroids induced almost 100% overall remission. Of the relapses, two patients achieved an overall response and one remained in progressive stage after subsequent excision. Two patients only received dissection biopsy that responded to oral corticosteroid administration and combined therapies of lenalidomide and dexamethasone, respectively. CONCLUSIONS Diffuse lesions in nasal cavity and sinuses, and even widely affected nasal skull base, laryngopharynx, orbit, and cavernous sinus, should be considered the possibility of Rosai-Dorfman disease. Characteristic immunohistochemical staining is helpful for the diagnosis. Endoscopic surgical therapy remains the mainstream treatment for patients enduring an unbearable course. Oral corticosteroid administration serves as an adjuvant therapy for first-line treatments.
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Affiliation(s)
- Haoyuan Xu
- ENT Institute and Department of Otorhinolaryngology, Affiliated ENT Hospital, Fudan University, Shanghai, China
| | - Huankang Zhang
- ENT Institute and Department of Otorhinolaryngology, Affiliated ENT Hospital, Fudan University, Shanghai, China
| | - Wanpeng Li
- ENT Institute and Department of Otorhinolaryngology, Affiliated ENT Hospital, Fudan University, Shanghai, China
| | - Chen Zhang
- ENT Institute and Department of Otorhinolaryngology, Affiliated ENT Hospital, Fudan University, Shanghai, China
| | - Huan Wang
- ENT Institute and Department of Otorhinolaryngology, Affiliated ENT Hospital, Fudan University, Shanghai, China
| | - Dehui Wang
- ENT Institute and Department of Otorhinolaryngology, Affiliated ENT Hospital, Fudan University, Shanghai, China
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172
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Zhao Y, Deng Y, Jiang Y, Zheng W, Tan Y, Yang Z, Wang Z, Xu F, Cheng Z, Yuan L, Peng H. Case report: Targeting the PD-1 receptor and genetic mutations validated in primary histiocytic sarcoma with hemophagocytic lymphohistiocytosis. Front Immunol 2023; 14:1127599. [PMID: 36969238 PMCID: PMC10030599 DOI: 10.3389/fimmu.2023.1127599] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/22/2023] [Indexed: 03/10/2023] Open
Abstract
Histiocytic sarcoma (HS) is a rare hematological malignancy with limited treatment options, and it is also prone to complications such as hemophagocytic lymphohistiocytosis (HLH) in the later stages of the disease, leading to difficulties in treatment and poor prognosis. It highlights the importance of developing novel therapeutic agents. Herein, we present a case of a 45-year-old male patient who was diagnosed with PD-L1-positive HS with HLH. The patient was admitted to our hospital with recurrent high fever, multiple skin rashes with pruritus throughout the body and enlarged lymph nodes. Subsequently, pathological biopsy of the lymph nodes revealed high expression of CD163, CD68, S100, Lys and CD34 in the tumor cells and no expression of CD1a and CD207, confirming this rare clinical diagnosis. Concerning the low remission rate by conventional treatment in this disease, the patient was administered with sintilimab (an anti-programmed cell death 1 [anti-PD-1] monoclonal antibody) at 200 mg/d combined with a first-line chemotherapy regimen for one cycle. Further exploration of pathological biopsy by using next-generation gene sequencing led to the use of targeted therapy of chidamide. After one cycle of combination therapy (chidamide+sintilimab, abbreviated as CS), the patient achieved a favorable response. The patient showed remarkable improvement in the general symptoms and laboratory examination results (e.g., elevated indicators of inflammation); even the clinical benefits was not persistent, he survived one more month after his cessation of treatment by himself due to economic difficulty. Our case suggests that PD-1 inhibitor coupled with targeted therapy might constitute a potential therapeutic option for primary HS with HLH.
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Affiliation(s)
- Yan Zhao
- Department of Hematology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yating Deng
- Department of Hematology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yi Jiang
- Department of Pathology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wenli Zheng
- Department of Hematology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yanlin Tan
- Department of Imaging, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhiwu Yang
- Department of Hematology, Yiyang Central Hospital, Yiyang, Hunan, China
| | - Zhihua Wang
- Department of Hematology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Feng Xu
- Department of Thyroid and Breast Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhao Cheng
- Department of Hematology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lingli Yuan
- Department of Hematology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- *Correspondence: Lingli Yuan, ; Hongling Peng,
| | - Hongling Peng
- Department of Hematology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Engineering Research Center of Cell Immunotherapy for Hematopoietic Malignancies, Changsha, Hunan, China
- *Correspondence: Lingli Yuan, ; Hongling Peng,
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173
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Saggini A, Cerroni L, Ortins-Pina A, Kraft S. Expression of Cyclin D1 in Cutaneous Xanthogranuloma and Solitary Reticulohistiocytoma. Am J Dermatopathol 2023; 45:208-210. [PMID: 36730793 DOI: 10.1097/dad.0000000000002186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Andrea Saggini
- Center for Dermatopathology, Freiburg Im Breisgau, Germany
| | - Lorenzo Cerroni
- Research Unit Dermatopathology, Department of Dermatology, Medical University of Graz, Austria
| | | | - Stefan Kraft
- Center for Dermatopathology, Freiburg Im Breisgau, Germany
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174
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Bonometti A, Carbone R, Cassani C, Dioli C, Lucato E, Spinillo A, Paulli M, Cesari S. Intralymphatic Histiocytosis Associated With Tubo-ovarian High-grade Serous Carcinoma: Case Report and Review of the Literature. Int J Gynecol Pathol 2023; 42:192-195. [PMID: 35639346 DOI: 10.1097/pgp.0000000000000878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Intralymphatic histiocytosis is a condition characterized by the accumulation of mononuclear phagocytes within lymphatic vessels and lymph nodes that may be isolated or secondary to autoimmune or neoplastic diseases. Secondary intralymphatic histiocytosis frequently involves the skin and is associated with malignancies in up to a tenth of cases. We describe a case of intralymphatic histiocytosis associated with high-grade serous carcinoma and reviewed the literature on neoplasia associated with the broader category of histiocytoses with raisinoid nuclei. Moreover, we try to elucidate the pathogenesis of these rare and intriguing disorders.
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175
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Sun F, Sun J, Shu Z, He L, Fu L, Zhang R, Duan X, Peng Y, Gong C, Zhang X, Wang X, Han T, Zhang G, Ni X, Mao H. Xanthomatous erosive arthritis: A new disease entity? Pediatr Blood Cancer 2023; 70:e30018. [PMID: 36317415 DOI: 10.1002/pbc.30018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 08/10/2022] [Accepted: 09/05/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Fei Sun
- Department of Immunology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jiapeng Sun
- Department of Immunology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhou Shu
- Department of Immunology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Lejian He
- Department of Pathology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Libing Fu
- Department of Pathology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Rui Zhang
- Department of Hematology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaomin Duan
- Department of Center Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yun Peng
- Department of Center Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Chunxiu Gong
- Department of Endocrinology, Genetics, Metabolism and Adolescent Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xuejun Zhang
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xingang Wang
- Department of Stomatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Tongxin Han
- Department of Immunology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Guojun Zhang
- Department of Functional Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xin Ni
- Department of Otorhinolaryngology head and neck surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Huawei Mao
- Department of Immunology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Xu J, Huang X, Wen Y, Pan Z, Lian H, Zhao M, Li M, Duan Z, Zhang Y, Zhang G, Qi X, Tang J, Xu Z, Gao Z, Fu L, Ma L. Systemic juvenile xanthogranuloma has a higher frequency of ALK translocations than BRAFV600E mutations. J Am Acad Dermatol 2023; 88:656-659. [PMID: 32822792 DOI: 10.1016/j.jaad.2020.08.053] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/04/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Jiaosheng Xu
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing
| | - Xin Huang
- Department of Pathology, Health Science Center, Peking University, Beijing
| | - Yang Wen
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zenggang Pan
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Hongyun Lian
- Department of Hematology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing
| | - Mutong Zhao
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing
| | - Min Li
- Department of Pathology, Health Science Center, Peking University, Beijing
| | - Zejun Duan
- Department of Pathology, Sanbo Brain Hospital, Capital Medical University, Beijing
| | - Yanping Zhang
- Department of Pathology, the First Affiliated Hospital of Zhengzhou University, Henan
| | - Gaolei Zhang
- Department of Dermatology, Capital Institute of Pediatrics, Peking University Teaching Hospital, Beijing
| | - Xueling Qi
- Department of Pathology, Sanbo Brain Hospital, Capital Medical University, Beijing
| | - Jianping Tang
- Department of Dermatology, Hunan Children's Hospital, Hunan
| | - Zigang Xu
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing
| | - Zifen Gao
- Department of Pathology, Health Science Center, Peking University, Beijing
| | - Libing Fu
- Department of Pathology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
| | - Lin Ma
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing.
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Alarcon-Calderon A, Vassallo R, Yi ES, Ryu JH. Smoking-Related Interstitial Lung Diseases. Immunol Allergy Clin North Am 2023; 43:273-287. [PMID: 37055089 DOI: 10.1016/j.iac.2023.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Smoking-related interstitial lung diseases (ILDs) are a group of heterogeneous, diffuse pulmonary parenchymal disease processes associated with tobacco exposure. These disorders include pulmonary Langerhans cell histiocytosis, respiratory bronchiolitis-associated ILD, desquamative interstitial pneumonia, acute eosinophilic pneumonia, and combined pulmonary fibrosis and emphysema. This review summarizes the current evidence of pathogenesis, clinical manifestations, diagnostic approach, prognosis, and treatment modalities for these diseases. We also discuss the interstitial lung abnormalities incidentally detected in radiologic studies and smoking-related fibrosis identified on lung biopsies.
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Affiliation(s)
- Amarilys Alarcon-Calderon
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, 200 1st Street, Southwest, Rochester, MN 55905, USA
| | - Robert Vassallo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, 200 1st Street, Southwest, Rochester, MN 55905, USA
| | - Eunhee S Yi
- Department of Laboratory Medicine & Pathology, Mayo Clinic College of Medicine and Science, 200 1st Street, Southwest, Rochester, MN 55905, USA
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, 200 1st Street, Southwest, Rochester, MN 55905, USA.
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Li Y, Chen F, Cheng J, Liang H, Chen K, Li J, Wang J, Cai P, Zhu J, Lu H, Li X. An unusual case of necrobiotic xanthogranuloma with IgG-λ monoclonal gammopathy presenting as cerebral manifestations. Quant Imaging Med Surg 2023; 13:1983-1988. [PMID: 36915298 PMCID: PMC10006097 DOI: 10.21037/qims-22-622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 12/20/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Yiman Li
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Fengxi Chen
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jie Cheng
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Hongqin Liang
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Kang Chen
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jing Li
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jian Wang
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Ping Cai
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jiang Zhu
- Institute of Pathology and Southwest Cancer Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hong Lu
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xiaoming Li
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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179
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Jridi M, Ben Achour T, Naceur I, Smiti M, Ben Ghorbel I, Lamloum M, Said F, Houman MH. Erdheim-Chester disease: A multisystem disease case illustration with rare manifestations and treatment challenges. Clin Case Rep 2023; 11:e6996. [PMID: 36852124 PMCID: PMC9957994 DOI: 10.1002/ccr3.6996] [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] [Received: 08/02/2022] [Revised: 10/23/2022] [Accepted: 02/06/2023] [Indexed: 02/26/2023] Open
Abstract
Erdheim-Chester disease is a rare multisystemic disease. A 50-year-old woman, presented with a recurrent pain and swelling of the left knee. Bone scintigraphy showed increased tracer uptake of peripheral skeleton. The computed tomography showed tissular infiltration in the retroperitoneum, around the vessels. Immunohistochemistry showed CD68 (+) and CD1a (-).
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Affiliation(s)
| | | | - Ines Naceur
- Rabta University Hospital CenterTunisTunisia
| | - Monia Smiti
- Rabta University Hospital CenterTunisTunisia
| | | | | | - Fatma Said
- Rabta University Hospital CenterTunisTunisia
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180
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Ungureanu IA, Cohen-Aubart F, Héritier S, Fraitag S, Charlotte F, Lequain H, Hélias-Rodzewicz Z, Haroche J, Donadieu J, Emile JF. OCT2 expression in histiocytoses. Virchows Arch 2023:10.1007/s00428-023-03508-7. [PMID: 36754897 DOI: 10.1007/s00428-023-03508-7] [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: 01/10/2023] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 02/10/2023]
Abstract
Diagnosis of histiocytosis can be difficult and one of the biggest challenges is to distinguish between reactive and neoplastic histiocytes on histology alone. Recently, OCT2 nuclear expression was reported in Rosai-Dorfman disease (RDD). Our purpose was to expand the testing of OCT2 on a broader variety of sporadic or H syndrome-related histiocytoses. Cases of histiocytoses were retrieved from the files of Ambroise Paré Pathology Department. All slides and molecular analyses were reviewed, and staining was completed with immunohistochemistry for OCT2. A total of 156 samples from different localizations were tested. Among sporadic cases, 52 patients had RDD, and 10 patients had mixed histiocytosis combining RDD with Erdheim Chester disease (ECD, n = 8), Langerhans cell histiocytosis (LCH, n = 2) or juvenile xanthogranuloma (JXG, n = 1). All these patients were positive for OCT2 in RDD characteristic histiocytes. Twenty-three patients had ECD and all but two (91% - 21/23) were negative for OCT2. By contrast, OCT2 was positive in 11/27 (41%) LCH and 6/16 (38%) JXG. Among the 10 samples of H syndrome-associated histiocytosis, 3 had typical RDD histology, 6 had unclassified histiocytosis, and one had mixed RDD-LCH; all were positive for OCT2. On 16 samples of granulomatous lymphadenitis, OCT2 was negative in epithelioid histiocytes. Our study shows that OCT2 has a sensitivity of 100% for RDD cases and mixed histiocytoses with an RDD component. It is negative in 92% of ECD but expressed in at least 38% of LCH, JXG, and C group histiocytoses. Finally, OCT2 is positive in all H syndrome-related histiocytoses, independent of their histology.
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Affiliation(s)
- Irena Antonia Ungureanu
- Pathology Department, Paris-Saclay University, Versailles SQY University (UVSQ), EA4340-BECCOH, Assistance Publique-Hôpitaux de Paris (APHP), Ambroise-Paré Hospital, 9 Avenue Charles de Gaulle, 92104, Boulogne-Billancourt, France
| | - Fleur Cohen-Aubart
- Internal Medicine Department 2, Sorbonne University, APHP, Pitié-Salpêtrière Hospital, French National Referral Center for Rare Systemic Diseases and Histiocytoses, Paris, France
| | - Sébastien Héritier
- Department of Pediatric Oncology and Hematology, Sorbonne University, APHP, Armand-Trousseau Hospital, Referral Center for Histiocytoses, Paris, France
| | - Sylvie Fraitag
- Pathology Department, Necker-Enfants-Malades Hospital, Paris, France
| | - Frédéric Charlotte
- Pathology Department, Pierre Et Marie Curie University, APHP, Pitié-Salpétrière Hospital, Paris, France
| | - Hippolyte Lequain
- Department of Internal Medicine, Claude Bernard-Lyon1 University, Hôpital de La Croix-Rousse, Lyon, France
| | - Zofia Hélias-Rodzewicz
- Pathology Department, Paris-Saclay University, Versailles SQY University (UVSQ), EA4340-BECCOH, Assistance Publique-Hôpitaux de Paris (APHP), Ambroise-Paré Hospital, 9 Avenue Charles de Gaulle, 92104, Boulogne-Billancourt, France
| | - Julien Haroche
- Internal Medicine Department 2, Sorbonne University, APHP, Pitié-Salpêtrière Hospital, French National Referral Center for Rare Systemic Diseases and Histiocytoses, Paris, France
| | - Jean Donadieu
- Pediatric Oncology and Hematology, Armand-Trousseau Hospital, APHP, EA4340-BECCOH, Referral Center for Histiocytoses UVSQ, Paris, France
| | - Jean-François Emile
- Pathology Department, Paris-Saclay University, Versailles SQY University (UVSQ), EA4340-BECCOH, Assistance Publique-Hôpitaux de Paris (APHP), Ambroise-Paré Hospital, 9 Avenue Charles de Gaulle, 92104, Boulogne-Billancourt, France.
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181
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Clinical features, diagnosis, treatment and prognosis of otolaryngological extranodal sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease, RDD). Eur Arch Otorhinolaryngol 2023; 280:861-867. [PMID: 36153784 DOI: 10.1007/s00405-022-07646-7] [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: 07/25/2022] [Accepted: 09/05/2022] [Indexed: 01/26/2023]
Abstract
PURPOSE To investigate the clinical features, diagnosis, treatment and prognosis of otolaryngological extranodal RDD. METHODS A retrospective analysis was performed on 16 patients who were initially diagnosed and treated with otolaryngological extranodal RDD in our hospital from January 2013 to January 2019. RESULTS There were 9 females and 7 males. The mean diagnostic age was 45.35. Nasal, laryngeal and otic RDD were, respectively, accounting for 56.25%, 31.25% and 12.5%. The median interval diagnostic time was individually 1, 0.5 and 0.2 year for nasal, laryngeal and otic RDD. The most common symptoms were separately progressive nasal congestion, dyspnea, otorrhea in nasal, laryngeal and otic RDD. 13 had cervical lymph node swelling on MRI. Surgery or postoperative radiotherapy were conformed. In the end, 14 patients with RDD survived. The survival rate is as high as 87.5%. One of them died of RDD in the fifth year. One case was lost to follow-up 2 years after treatment. Patients survive for at least 2 years and up to 9 years. There was no significant difference in life expectancy of extranodal RDD among different parts of ENT (P = 0.508 > 0.05). The average ages of laryngeal and nasal RDD were similar (P = 0.898 > 0.05). However, the age of both was significantly higher than ear RDD (P = 0.023 and 0.019 < 0.05). CONCLUSIONS The average diagnostic age was more than 20 years. Nasal RDD was the most common in this area. All laryngeal RDD had infiltrated subglottis. Functional surgery and postoperative radiotherapy can be used to achieve long-term remission and survival.
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Leboyan A, Esselin F, Bascou AL, Duflos C, Ion I, Charif M, Castelnovo G, Carra-Dalliere C, Ayrignac X, Kerschen P, Chbicheb M, Nguyen L, Maria ATJ, Guilpain P, Carriere M, de Champfleur NM, Vincent T, Jentzer A, Labauge P, Devaux JJ, Taieb G. Immune-mediated diseases involving central and peripheral nervous systems. Eur J Neurol 2023; 30:490-500. [PMID: 36366904 DOI: 10.1111/ene.15628] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 10/03/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND PURPOSE In addition to combined central and peripheral demyelination, other immune diseases could involve both the central nervous system (CNS) and peripheral nervous system (PNS). METHODS To identify immune-mediated diseases responsible for symptomatic combined central/peripheral nervous system involvement (ICCPs), we conducted a multicentric retrospective study and assessed clinical, electrophysiological, and radiological features of patients fulfilling our ICCP criteria. RESULTS Thirty patients (20 males) were included and followed during a median of 79.5 months (interquartile range [IQR] = 43-145). The median age at onset was 51.5 years (IQR = 39-58). Patients were assigned to one of four groups: (i) monophasic disease with concomitant CNS/PNS involvement including anti-GQ1b syndrome (acute polyradiculoneuropathy + rhombencephalitis, n = 2), checkpoint inhibitor-related toxicities (acute polyradiculoneuropathy + encephalitis, n = 3), and anti-glial fibrillary acidic protein astrocytopathy (subacute polyradiculoneuropathy and meningoencephalomyelitis with linear gadolinium enhancements, n = 2); (ii) chronic course with concomitant CNS/PNS involvement including paraneoplastic syndromes (ganglionopathy/peripheral hyperexcitability + limbic encephalitis, n = 4); (iii) chronic course with sequential CNS/PNS involvement including POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes) syndrome (polyradiculoneuropathy + strokes, n = 2), histiocytosis (polyradiculoneuropathy + lepto-/pachymeningitis, n = 1), and systemic vasculitis (multineuropathy + CNS vasculitis/pachymeningitis, n = 2); and (iv) chronic course with concomitant or sequential CNS/PNS involvement including combined central and peripheral demyelination (polyradiculoneuropathy + CNS demyelinating lesions, n = 10) and connective tissue diseases (ganglionopathy/radiculopathy/multineuropathy + limbic encephalitis/transverse myelitis/stroke, n = 4). CONCLUSIONS We diagnosed nine ICCPs. The timing of central and peripheral manifestations and the disease course help determine the underlying immune disease. When antibody against neuroglial antigen is identified, CNS and PNS involvement is systematically concomitant, suggesting a common CNS/PNS antigen and a simultaneous disruption of blood-nerve and blood-brain barriers.
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Affiliation(s)
- Aurelie Leboyan
- Department of Neurology, Gui de Chauliac University Hospital Center, Montpellier, France
| | - Florence Esselin
- Department of Neurology, Gui de Chauliac University Hospital Center, Montpellier, France
| | - Anne-Laure Bascou
- Clinical Research and Epidemiology Unit, University Hospital Center, University of Montpellier, Montpellier, France
| | - Claire Duflos
- Clinical Research and Epidemiology Unit, University Hospital Center, University of Montpellier, Montpellier, France
| | - Ioana Ion
- Department of Neurology, Caremeau University Hospital Center, Nîmes, France
| | - Mahmoud Charif
- Department of Neurology, Gui de Chauliac University Hospital Center, Montpellier, France
| | | | | | - Xavier Ayrignac
- Department of Neurology, Gui de Chauliac University Hospital Center, Montpellier, France
| | - Philippe Kerschen
- Department of Neurology, Luxembourg Hospital Center, Luxembourg City, Luxembourg
| | - Mohamed Chbicheb
- Department of Neurology, Narbonne Hospital Center, Narbonne, France
| | - Ludovic Nguyen
- Department of Neurology, Perpignan Hospital Center, Perpignan, France
| | - Alexandre T J Maria
- Department of Internal Medicine, Saint Eloi University Hospital Center, Montpellier, France
| | - Philippe Guilpain
- Department of Internal Medicine, Saint Eloi University Hospital Center, Montpellier, France
| | - Mathilde Carriere
- Department of Neuroradiology, Gui de Chauliac University Hospital Center, Montpellier, France
| | | | - Thierry Vincent
- Department of Immunology, Saint Eloi University Hospital Center, Montpellier, France
| | - Alexandre Jentzer
- Department of Immunology, Saint Eloi University Hospital Center, Montpellier, France
| | - Pierre Labauge
- Department of Neurology, Gui de Chauliac University Hospital Center, Montpellier, France
| | - Jérôme J Devaux
- Institute of Functional Genomics, National Center for Scientific Research UMR5203, Montpellier, France
| | - Guillaume Taieb
- Department of Neurology, Gui de Chauliac University Hospital Center, Montpellier, France
- Institute of Functional Genomics, National Center for Scientific Research UMR5203, Montpellier, France
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183
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Kaplan TM, Salomao DR, Dalvin LA. An Amelanotic Choroidal Lesion in a 68-Year-Old Man. JAMA Ophthalmol 2023; 141:206-207. [PMID: 36520450 DOI: 10.1001/jamaophthalmol.2022.5336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A 68-year-old man with a history of keratoconus was referred for evaluation of a choroidal lesion in his left eye. Fundus autofluorescence demonstrated hyperautofluorescence in a leopard-spotting pattern. What would you do next?
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Affiliation(s)
- Tyler M Kaplan
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Diva R Salomao
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Lauren A Dalvin
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
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184
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Liu Z, Cao X, Wan C. Stupendous skin nodules: Necrobiotic xanthogranuloma with IgA-λ and IgG-κ monoclonal gammopathy. J Dermatol 2023; 50:e89-e91. [PMID: 36317505 DOI: 10.1111/1346-8138.16622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Zhezhang Liu
- Department of Dermatology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xianwei Cao
- Department of Dermatology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chuan Wan
- Department of Dermatology, The First Affiliated Hospital of Nanchang University, Nanchang, China
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185
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Portegys J, Heidemeier A, Rosenwald A, Gernert M, Fröhlich M, Hueper S, Strunz PP, Rasche L, Schmalzing M. Erdheim-Chester disease with Rosai-Dorfman-like lesions: treatment with methotrexate, anakinra and upadacitinib. RMD Open 2023; 9:rmdopen-2022-002852. [PMID: 36693681 PMCID: PMC9884847 DOI: 10.1136/rmdopen-2022-002852] [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] [Received: 11/09/2022] [Accepted: 12/29/2022] [Indexed: 01/26/2023] Open
Abstract
Erdheim-Chester disease (ECD) is a non-Langerhans cell histiocytosis characterised by clonal expansion of histiocytes in various organs. These induce an inflammatory environment, which leads to damage of the affected areas. Recently, a new disease entity was proposed encompassing key features of ECD but also of Rosai-Dorfman-Destombes disease, another histiocytosis. Mitogen-activated protein kinase kinase 1 (MAP2K1) mutations seem to present a specific genetic lesion for this subtype.Here, we describe a case of this new disease entity with clinical, radiological and genetic findings compatible with ECD but histological findings compatible with Rosai-Dorfman-Destombes disease. In particular, there were intraabdominal and retroperitoneal lesions, which tested positive for a (c.167A>C; p.Q56P) mutation of the MAP2K1 gene. On histological examination, S100-positive, giant histiocytes with focal emperipolesis of haematological cells in addition to infiltration by lymphocytes and granulocytes were seen.As described for this rare variant of ECD, there was also bilateral testicular infiltration. We also describe a manifestation of oligoarthritis in this patient with ECD.The patient was treated with methotrexate and prednisolone. While radiological response to this regime was excellent, arthritis persisted. We added anakinra, which induced a response of the arthritis for more than a year. Due to treatment failure therapy was switched to upadacitinib, which induced a remission of the arthritis as well.This case adds a rare phenotype to an already rare presentation of ECD. The patient responded to immunosuppressive therapy.
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Affiliation(s)
- Jan Portegys
- Department of Internal Medicine II, Rheumatology/Clinical Immunology, University of Würzburg, Wuerzburg, Germany
| | - Anke Heidemeier
- Institute for diagnostic and interventional radiology, University of Würzburg, Wuerzburg, Germany
| | | | - Michael Gernert
- Department of Internal Medicine II, Rheumatology/Clinical Immunology, University of Würzburg, Wuerzburg, Germany
| | - Matthias Fröhlich
- Department of Internal Medicine II, Rheumatology/Clinical Immunology, University of Würzburg, Wuerzburg, Germany,Department of Internal Medicine II, Rheumatology and Clinical Immunology, University of Würzburg, Wuerzburg, Germany
| | - Sebastian Hueper
- Department of Internal Medicine II, Rheumatology/Clinical Immunology, University of Würzburg, Wuerzburg, Germany
| | - Patrick Pascal Strunz
- Department of Internal Medicine II, Rheumatology/Clinical Immunology, University of Würzburg, Wuerzburg, Germany
| | - Leo Rasche
- Department of Internal Medicine II, University of Würzburg, Wuerzburg, Germany
| | - Marc Schmalzing
- Department of Internal Medicine II, Rheumatology/Clinical Immunology, University of Würzburg, Wuerzburg, Germany
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186
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Brink A, Hlongwa KN, More S. The Impact of PET/CT on Paediatric Oncology. Diagnostics (Basel) 2023; 13:diagnostics13020192. [PMID: 36673002 PMCID: PMC9857884 DOI: 10.3390/diagnostics13020192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/01/2022] [Accepted: 01/02/2023] [Indexed: 01/06/2023] Open
Abstract
This review paper will discuss the use of positron emission tomography/computed tomography (PET/CT) in paediatric oncology. Functional imaging with PET/CT has proven useful to guide treatment by accurately staging disease and limiting unnecessary treatments by determining the metabolic response to treatment. 18F-Fluorodeoxyglucose (2-[18F]FDG) PET/CT is routinely used in patients with lymphoma. We highlight specific considerations in the paediatric population with lymphoma. The strengths and weaknesses for PET/CT tracers that compliment Meta-[123I]iodobenzylguanidine ([123I]mIBG) for the imaging of neuroblastoma are summarized. 2-[18F]FDG PET/CT has increasingly been used in the staging and evaluation of disease response in sarcomas. The current recommendations for the use of PET/CT in sarcomas are given and potential future developments and highlighted. 2-[18F]FDG PET/CT in combination with conventional imaging is currently the standard for disease evaluation in children with Langerhans-cell Histiocytosis (LCH) and the non-LCH disease spectrum. The common pitfalls of 2-[18F]FDG PET/CT in this setting are discussed.
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187
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MORA LINDAB, HOUGH MORGAN, MOSCINSKI LYNN, GOMEZ JUSTIN, COPPOLA DOMENICO. Incidental Gastric Langerhans Cell Histiocytosis and Synchronous Adenocarcinoma of the Colon: An Interesting Case Report and Literature Review. CANCER DIAGNOSIS & PROGNOSIS 2023; 3:102-106. [PMID: 36632587 PMCID: PMC9801445 DOI: 10.21873/cdp.10186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/17/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND/AIM Langerhans cell histiocytosis (LCH) is an uncommon disorder characterized by an abnormal monoclonal proliferation of pathologic Langerhans cells. The clinical presentation of LCH is very unpredictable, ranging from single-system limited disease to severe multi-organ disease with a high mortality rate. LCH usually affects children and very rarely adults. The most common body parts affected by LCH are the bones, skin, lungs, pituitary glands, and lymph nodes. Gastrointestinal tract involvement by LCH is exceptionally rare, and only a few cases have been reported. CASE REPORT We present the case of a 50-year-old woman who was referred to our clinic by her primary care physician for an upper endoscopy and colonoscopy and was diagnosed with H. pylori-related gastritis and a synchronous gastric LCH and primary colonic adenocarcinoma. We describe the histologic characteristics and clinical implications of the LCH diagnosis. A review of the published literature revealed that LCH presenting as a gastric solitary lesion is rare. CONCLUSION This case highlights the importance of recognizing this rare condition to ensure proper patient follow-up.
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Affiliation(s)
- LINDA B. MORA
- Department of Pathology, Florida Digestive Health Specialists, Lakewood Ranch, FL, U.S.A
| | - MORGAN HOUGH
- Department of Pathology, Florida Digestive Health Specialists, Lakewood Ranch, FL, U.S.A
| | - LYNN MOSCINSKI
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, U.S.A
| | - JUSTIN GOMEZ
- Department of Pathology, Florida Digestive Health Specialists, Lakewood Ranch, FL, U.S.A
| | - DOMENICO COPPOLA
- Department of Pathology, Florida Digestive Health Specialists, Lakewood Ranch, FL, U.S.A.,Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, U.S.A
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188
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Bhargava P, Choudhary GR, Elhence P, Jena R. Extranodal Rosai-Dorfman disease: A rare mimicker of metastatic renal cell carcinoma. Indian J Urol 2023; 39:70-72. [PMID: 36824105 PMCID: PMC9942222 DOI: 10.4103/iju.iju_265_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/24/2022] [Accepted: 11/28/2022] [Indexed: 02/25/2023] Open
Abstract
A 29-year-old female presented with the history of pain in the abdomen and a palpable lump in the right hypochondrium, lumbar, and the umbilical regions for the past 2 months. On evaluation with contrast-enhanced computed tomography (CECT) and positron emission tomography CT, she was found to have a heterogeneously enhancing mass entirely replacing the mid and the lower pole of the right kidney, the pelvis, and the upper ureter with loss of fat planes with the inferior vena cava, psoas muscle, and the hepatic flexure, along with pericardial deposits and soft tissue lesions at multiple paravertebral regions and the right thigh. Owing to a high suspicion of metastatic renal cell carcinoma (RCC), a right cytoreductive nephrectomy was performed. Histopathology revealed extranodal Rosai-Dorfman disease, which was mimicking a metastatic RCC on imaging. The patient was started on oral steroids to control the distant lesions and to prevent progression of the disease and is doing well at follow up.
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Affiliation(s)
| | | | - Poonam Elhence
- Department of Pathology, AIIMS, Jodhpur, Rajasthan, India
| | - Rahul Jena
- Department of Urology, AIIMS, Jodhpur, Rajasthan, India
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Alzahem T, Alkatan HM, Maktabi AM, Alsulaiman N, Cruz AAV. Ophthalmic histiocytic lesions (diseases of the L group): A multicenter clinicopathological study of 18 cases and review of literature. Eur J Ophthalmol 2023; 33:556-566. [PMID: 35816372 DOI: 10.1177/11206721221113431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Langerhans cell histiocytosis (LCH) and Erdheim-Chester disease (ECD) are rare histiocytic disorders in the L (Langerhans) group diseases. They range from self-limited benign diseases to lethal disseminated forms. METHODS This retrospective study was conducted in 3 tertiary hospitals in Saudi Arabia and Brazil. Histopathological records were searched for all patients diagnosed with ocular and periocular histiocytic disorders from January 1993 to December 2018. Histopathological slides and medical files were reviewed for data collection and simple analysis of demographics, clinical manifestations, and management. The relevant literature is reviewed. RESULTS Twenty-two eyes of 18 patients with biopsy-proven histiocytic disorders in the L group were included. Female-to-male ratio was 1.25:1. Average age at presentation was 14 years (range, 1-54). LCH was diagnosed in 14 eyes, while eight eyes had ECD. All LCH cases were unilateral and confined to the bone as cases of eosinophilic granuloma (EG), while patients with ECD were bilateral. Commonest presentations in EG and ECD were eyelid swelling (85.7%) and periocular xanthomas (75%), respectively. Orbit was involved in 100% of EG cases, with bony erosion in 54.5%. Relevant systemic involvement was found in 100% of ECD and 21% of EG cases. Surgical intervention was needed in 16 of the 22 eyes (72.7%). All EG and 25% of patients with ECD required surgical excision. CONCLUSIONS Histiocytic disorders are a rare group of diseases, including the L group. Relevant systemic associations require specific and selective therapy. A high clinical index and multidisciplinary collaboration are essential for the proper evaluation and management of these patients.
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Affiliation(s)
- Tariq Alzahem
- Ophthalmology Department, College of Medicine, 37850King Saud University, Riyadh, Saudi Arabia.,King Saud University Medical City, 37850King Saud University, Riyadh, Saudi Arabia.,Vitreoretinal Division, 46670King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Hind M Alkatan
- Ophthalmology Department, College of Medicine, 37850King Saud University, Riyadh, Saudi Arabia.,King Saud University Medical City, 37850King Saud University, Riyadh, Saudi Arabia.,Pathology and Laboratory Medicine Department, College of Medicine, 37850King Saud University, Riyadh, Saudi Arabia
| | - Azza My Maktabi
- Pathology and Laboratory Medicine Department, 46670King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Naif Alsulaiman
- Oculoplastics Division, 46670King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Antonio Augusto V Cruz
- Ophthalmology Department, 42496School of Medicine of Ribeirão-Preto, University of São Paulo, São Paulo, Brazil
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190
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Taibo A, Martin I, Almagro M, Rego I, Sacristan F, Fonseca E. PUVA therapy in persistent cutaneous histiocytosis: Case report and literature review. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2023; 39:16-20. [PMID: 35624530 DOI: 10.1111/phpp.12809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/26/2022] [Accepted: 05/24/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Cutaneous and mucocutaneous histiocytosis (group C) comprise a wide variety of entities affecting skin and/or mucosae. Although they are considered as reactive proliferations, their exact pathophysiology remains unknown and, therefore, they lack a specific treatment. AIMS The aim of this study is to review the evidence on cases of histiocytosis treated with UVB and/or UVA and to report a new case of relapsing group C histiocytosis that has been successfully treated with PUVA therapy. MATERIALS & METHODS We have conducted a review of the literature published over the last 40 years on the treatment of histiocytosis with phototherapy in the online PubMed database. We also describe a new case of successful treatment of histiocytosis with PUVA therapy. RESULTS Our patient was a 27-year-old man with persistent outbreaks of cutaneous histiocytosis over the previous 8 years. He responded successfully to PUVA therapy, and no relapse has been detected after one year of follow-up. DISCUSSION Self-involution is usual in group C histiocytosis, so conservative management is usually the first approach. Relapsing cases pose a therapeutic challenge. Reported treatment options for these patients include isotretinoin, cryotherapy, immunosuppressants, low-dose chemotherapy, CO2 laser, radiotherapy, and surgery. Phototherapy and photochemotherapy have been used in a small number of patients with considerable success. The main limitation to provide firm recommendations on histiocytosis therapy is the absence of solid evidence, as the articles published are mainly case reports with a short follow-up. In our patient, despite the short follow-up we have considered photochemotherapy to be effective since no spontaneous remission had been achieved in the previous 8 years. CONCLUSION PUVA therapy could be a safe and effective option to treat persistent cutaneous manifestations in patients with histiocytosis, although more evidence is required to support this statement.
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Affiliation(s)
- Ana Taibo
- Department of Dermatology, University Hospital of A Coruna, A Coruna, Spain
| | - Ignacio Martin
- Department of Dermatology, University Hospital of A Coruna, A Coruna, Spain
| | - Manuel Almagro
- Department of Dermatology, University Hospital of A Coruna, A Coruna, Spain
| | - Isidro Rego
- Department of Dermatology, University Hospital of A Coruna, A Coruna, Spain
| | - Felipe Sacristan
- Department of Pathology, University Hospital of A Coruna, A Coruna, Spain
| | - Eduardo Fonseca
- Department of Dermatology, University Hospital of A Coruna, A Coruna, Spain
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191
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Kendall W, Chengot P, Munir T, Moor JW. Langerhans' cell histiocytosis of the retropharynx: first reported case. Ann R Coll Surg Engl 2023; 105:91-93. [PMID: 35904328 PMCID: PMC9773268 DOI: 10.1308/rcsann.2021.0337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 12/24/2022] Open
Abstract
Langerhans' cell histiocytosis (LCH) is a rare condition characterised by histiocyte proliferation leading to destructive granulomatous lesions. It may occur anywhere in the body but extraosseous manifestations affecting the head and neck are particularly uncommon. Here, we present the first reported case of a mass arising in the retropharyngeal space caused by LCH. The patient was a 33-year-old man with various symptoms which are presented. Although rare, LCH can affect a variety of tissues in the head and neck. Clinicians need to be cognisant of its inclusion in the differential diagnoses for similar cases in their practice, in particular because of potential difficulties in diagnosis.
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Affiliation(s)
- W Kendall
- Leeds Teaching Hospitals NHS Trust, UK
| | - P Chengot
- Leeds Teaching Hospitals NHS Trust, UK
| | - T Munir
- Leeds Teaching Hospitals NHS Trust, UK
| | - JW Moor
- Leeds Teaching Hospitals NHS Trust, UK
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192
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Chazal T, Pegoraro F, Manari G, Bettiol A, Maniscalco V, Gelain E, Charlotte F, Mazor RD, Renard-Penna R, Amoura Z, Cohen-Aubart F, Haroche J, Izzedine H, Vaglio A. Clinical phenotypes and long-term outcome of kidney involvement in Erdheim-Chester histiocytosis. Kidney Int 2023; 103:177-186. [PMID: 36374823 DOI: 10.1016/j.kint.2022.09.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/10/2022] [Accepted: 09/01/2022] [Indexed: 11/07/2022]
Abstract
Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis that frequently infiltrates the peri-kidney space ("hairy kidney" appearance), kidney pelvis and proximal ureters, leading to obstructive uropathy. Here, we analyzed the clinical characteristics, imaging findings and long-term kidney outcome of a large multicenter cohort comprising 195 consecutive patients with ECD. Retroperitoneal peri-kidney or peri-ureteral involvement was detected at diagnosis in 147 patients. Of them, 70 had hydronephrosis (bilateral in 47), and 16 with kidney atrophy (unilateral in 14). Kidney vascular peduncle infiltration was found in 60 patients, and kidney artery stenosis in 31. The estimated glomerular filtration rate (eGFR) at diagnosis was significantly lower in patients with than in those without peri-kidney involvement (median 74 vs. 98 mL/min/1.73 m2). Ureteral stenting often failed to achieve kidney function recovery. A total of 181 patients received medical therapies: first-line treatments included interferon-α (61%), BRAF-inhibitors (17%), mTOR-inhibitors (7%), or other drugs (15%). These therapies were efficacious for ECD but rarely induced kidney function improvement (one-year eGFR increase over 25% in under 10% of patients). After a median of 43 months, 19% of patients died and 5% developed kidney failure. Among patients with peri-kidney involvement, 44% developed chronic kidney disease (CKD) 3-5 at five years vs. 5% of those without. Unadjusted predictors of advanced CKD and kidney failure/death were age over 50 years, hypertension, BRAFV600E mutation, and baseline eGFR. At multivariable analysis, cardiovascular comorbidities were associated with advanced CKD, and age over 50 years with kidney failure/death. Thus, kidney involvement is common in ECD and can lead to CKD or kidney failure despite effective medical therapies or urological procedures.
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Affiliation(s)
- Thibaud Chazal
- Service de Médecine Interne, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Maladies Auto-Immunes et Systémiques, Centre National de Référence des Histiocytoses, Hôpital Pitié-Salpêtrière, Paris, France; Internal Medicine Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | | | - Gaia Manari
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | | | - Elena Gelain
- Nephrology and Dialysis Unit, Meyer Children's Hospital, Firenze, Italy
| | - Frédéric Charlotte
- Service d'Anatomie Pathologique, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Roei D Mazor
- Clinic of Histiocytic Neoplasms, Institute of Hematology, Assuta Medical Center, Tel Aviv, Israel
| | - Raphaele Renard-Penna
- Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Zahir Amoura
- Service de Médecine Interne, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Maladies Auto-Immunes et Systémiques, Centre National de Référence des Histiocytoses, Hôpital Pitié-Salpêtrière, Paris, France
| | - Fleur Cohen-Aubart
- Service de Médecine Interne, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Maladies Auto-Immunes et Systémiques, Centre National de Référence des Histiocytoses, Hôpital Pitié-Salpêtrière, Paris, France
| | - Julien Haroche
- Service de Médecine Interne, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Maladies Auto-Immunes et Systémiques, Centre National de Référence des Histiocytoses, Hôpital Pitié-Salpêtrière, Paris, France.
| | - Hassan Izzedine
- Department of Nephrology, Peupliers Hospital, Paris, France; Department of Nephrology, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Augusto Vaglio
- Nephrology and Dialysis Unit, Meyer Children's Hospital, Firenze, Italy; Department of Biomedical, Experimental and Clinical Sciences "Mario Serio," University of Firenze, Firenze, Italy.
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193
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Abdulgayoom M, Mudawi D, Lengyel Z, Abo Samra H, Alshurafa A, Yassin MA. Langerhans Cell Histiocytosis with Good Response to Low-Dose Imatinib: Case Report and Literature Review. Case Rep Oncol 2023; 16:511-518. [PMID: 37476563 PMCID: PMC10355039 DOI: 10.1159/000531230] [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] [Received: 01/25/2023] [Accepted: 05/09/2023] [Indexed: 07/22/2023] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare neoplastic disease characterized by infiltration of histiocytes and dendritic cells into body organs. While treatment is better established in pediatrics, there is still no consensus on therapy in the adult population. Imatinib has shown promising results in some case reports and a small clinical trial. We present here a fifty-nine-year-old patient with LCH in the lung, liver, and bone who responded well to an imatinib dose of 100 mg daily. Her symptoms improved within 3 months of treatment, and subsequent positron emission tomography-computed tomography (PET/CT) showed resolution of 18F-fluorodeoxyglucose (FDG)-avid lesions.
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Affiliation(s)
- Mohammed Abdulgayoom
- Department of Hematology, National Center for Cancer Care and Research, HMC, Doha, Qatar
| | - Deena Mudawi
- Department of Hematology, National Center for Cancer Care and Research, HMC, Doha, Qatar
| | - Zsolt Lengyel
- Department of PET/CT and Nuclear Medicine, HMC, Doha, Qatar
| | - Hayan Abo Samra
- Department of Laboratory Medicine and Pathology, HMC, Doha, Qatar
| | - Awni Alshurafa
- Department of Hematology, National Center for Cancer Care and Research, HMC, Doha, Qatar
| | - Mohamed A Yassin
- Department of Hematology, National Center for Cancer Care and Research, HMC, Doha, Qatar
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194
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Guo Y, Huang Q. Diagnosis and treatment of isolated rib Langerhans cell histiocytosis in an adult: A case report. Front Surg 2023; 10:1084137. [PMID: 36911612 PMCID: PMC9992715 DOI: 10.3389/fsurg.2023.1084137] [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: 10/30/2022] [Accepted: 01/31/2023] [Indexed: 02/24/2023] Open
Abstract
Langerhans cell histiocytosis (LCH) was first proposed in 1987 to define the disorder characterized by the proliferation of abnormal Langerhans cells. It is more likely to occur in children younger than 15 years of age. Single-site and single-system LCH of rib is rare in adults. We present a rare case of isolated rib LCH in a 61-year-old male patient and expound the diagnosis and treatment of the disease. A 61-year-old male patient who presented with a 15-day history of dull pain in the left chest was admitted to our hospital. PET/CT image showed obvious osteolytic bone destruction and abnormal fluorodeoxy-glucose (FDG) uptake (maximum standardized uptake value: 14.5) in the right fifth rib with local soft tissue mass formation. The patient was eventually confirmed the diagnosis of LCH by immunohistochemistry stain and treated with rib surgery. A thorough review of the literature regarding diagnosis and treatment of LCH is presented in this study.
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Affiliation(s)
- Yaxin Guo
- Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - QiFeng Huang
- Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
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195
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Bedics G, Csóka M, Reiniger L, Varga E, Liptai Z, Papp G, Bekő A, Cervi C, Bödör C, Scheich B. Novel actionable ROS1::GIT2 fusion in non-Langerhans cell histiocytosis with central nervous system involvement. Acta Neuropathol 2023; 145:153-156. [PMID: 36416966 PMCID: PMC9807475 DOI: 10.1007/s00401-022-02520-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/05/2022] [Accepted: 11/12/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Gábor Bedics
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Üllői út 26., Budapest, 1085, Hungary
- HCEMM-SU Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer Research, Semmelweis University, Üllői út 26., Budapest, 1085, Hungary
| | - Monika Csóka
- 2nd Department of Pediatrics, Semmelweis University, Tűzoltó u. 7-9., Budapest, 1094, Hungary
| | - Lilla Reiniger
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Üllői út 26., Budapest, 1085, Hungary
| | - Edit Varga
- 2nd Department of Pediatrics, Semmelweis University, Tűzoltó u. 7-9., Budapest, 1094, Hungary
| | - Zoltán Liptai
- 2nd Department of Pediatrics, Semmelweis University, Tűzoltó u. 7-9., Budapest, 1094, Hungary
| | - Gergő Papp
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Üllői út 26., Budapest, 1085, Hungary
| | - Anna Bekő
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Üllői út 26., Budapest, 1085, Hungary
- HCEMM-SU Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer Research, Semmelweis University, Üllői út 26., Budapest, 1085, Hungary
| | - Catherine Cervi
- 2nd Department of Pediatrics, Semmelweis University, Tűzoltó u. 7-9., Budapest, 1094, Hungary
| | - Csaba Bödör
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Üllői út 26., Budapest, 1085, Hungary
- HCEMM-SU Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer Research, Semmelweis University, Üllői út 26., Budapest, 1085, Hungary
| | - Bálint Scheich
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Üllői út 26., Budapest, 1085, Hungary.
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Wu X, Lu W, Xu C, Jiang C, Zhuo Z, Wang R, Zhang D, Cui Y, Chang L, Zuo X, Wang Y, Mei H, Zhang W, Zhang M, Li C. Macrophages Phenotype Regulated by IL-6 Are Associated with the Prognosis of Platinum-Resistant Serous Ovarian Cancer: Integrated Analysis of Clinical Trial and Omics. J Immunol Res 2023; 2023:6455704. [PMID: 37124547 PMCID: PMC10132904 DOI: 10.1155/2023/6455704] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/06/2022] [Accepted: 03/22/2023] [Indexed: 05/02/2023] Open
Abstract
Background The treatment of platinum-resistant recurrent ovarian cancer (PROC) is a clinical challenge and a hot topic. Tumor microenvironment (TME) as a key factor promoting ovarian cancer progression. Macrophage is a component of TME, and it has been reported that macrophage phenotype is related to the development of PROC. However, the mechanism underlying macrophage polarization and whether macrophage phenotype can be used as a prognostic indicator of PROC remains unclear. Methods We used ESTIMATE to calculate the number of immune and stromal components in high-grade serous ovarian cancer (HGSOC) cases from The Cancer Genome Atlas database. The differential expression genes (DEGs) were analyzed via protein-protein interaction network, Kyoto Encyclopedia of Genes and Genomes (KEGG) and gene ontology (GO) analysis to reveal major pathways of DEGs. CD80 was selected for survival analysis. IL-6 was selected for gene set enrichment analysis (GSEA). A subsequent cohort study was performed to confirm the correlation of IL-6 expression with macrophage phenotype in peripheral blood and to explore the clinical utility of macrophage phenotype for the prognosis of PROC patients. Results A total of 993 intersecting genes were identified as candidates for further survival analysis. Further analysis revealed that CD80 expression was positively correlated with the survival of HGSOC patients. The results of GO and KEGG analysis suggested that macrophage polarization could be regulated via chemokine pathway and cytokine-cytokine receptor interaction. GSEA showed that the genes were mainly enriched in IL-6-STAT-3. Correlation analysis for the proportion of tumor infiltration macrophages revealed that M2 was correlated with IL-6. The results of a cohort study demonstrated that the regulation of macrophage phenotype by IL-6 is bidirectional. The high M1% was a protective factor for progression-free survival. Conclusion Thus, the macrophage phenotype is a prognostic indicator in PROC patients, possibly via a hyperactive IL-6-related pathway, providing an additional clue for the therapeutic intervention of PROC.
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Affiliation(s)
- Xiaoqing Wu
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Wenping Lu
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Chaojie Xu
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Cuihong Jiang
- Department of Oncology, Guang'anmen Hospital South Campus, China Academy of Chinese Medical Sciences, Beijing 102627, China
| | - Zhili Zhuo
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Ruipeng Wang
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Dongni Zhang
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Yongjia Cui
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Lei Chang
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Xi Zuo
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Ya'nan Wang
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Heting Mei
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Weixuan Zhang
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Mengfan Zhang
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Chen Li
- Department of Biology, Chemistry, and Pharmacy, Free University of Berlin, Berlin 14195, Germany
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197
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Cen H, Xu P, Zou H, Wang J, Wang X, Han C. Progressive eschar-like wound and peripheral neurological dysfunction with severe inflammatory status: infection or unnatural immune response? World J Emerg Med 2023; 14:416-418. [PMID: 37908795 PMCID: PMC10613791 DOI: 10.5847/wjem.j.1920-8642.2023.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/02/2023] [Indexed: 11/02/2023] Open
Affiliation(s)
- Hanghui Cen
- Department of Burns & Wound Care Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Pengqin Xu
- Department of Burns & Wound Care Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Hong Zou
- Department of Pathology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Jialiang Wang
- Department of Burns & Wound Care Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Xingang Wang
- Department of Burns & Wound Care Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Chunmao Han
- Department of Burns & Wound Care Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
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198
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Khalatbari H, Shulkin BL, Parisi MT. Emerging Trends in Radionuclide Imaging of Infection and Inflammation in Pediatrics: Focus on FDG PET/CT and Immune Reactivity. Semin Nucl Med 2023; 53:18-36. [PMID: 36307254 DOI: 10.1053/j.semnuclmed.2022.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
The most common indication for 18F-FDG PET/CT is tumor imaging, which may be performed for initial diagnosis, staging, therapeutic response monitoring, surveillance, or suspected recurrence. In the routine practice of pediatric nuclear medicine, most infectious, inflammatory, and autoimmune processes that are detected on 18F-FDG PET/CT imaging - except for imaging in fever or inflammation of unknown origin - are coincidental and not the main indication for image acquisition. However, interpreting these "coincidental" findings is of utmost importance to avoid erroneously attributing these findings to a neoplastic process. We review the recent literature on fever of unknown origin as well as inflammation of unknown origin in pediatrics and then focus on the 18F FDG PET/CT imaging findings seen in two specific entities with increased immune reactivity: hemophagocytic lymphohistiocytosis syndrome and the immune-related adverse events associated with checkpoint inhibitors. We will subsequently close with two sections highlighting related topics and relevant references for further reading.
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Affiliation(s)
- Hedieh Khalatbari
- Department of Radiology, Seattle Children's Hospital, Seattle, WA; Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Barry L Shulkin
- Department of Diagnostic Radiology, St. Jude Children's Research Hospital, Memphis, TN.
| | - Marguerite T Parisi
- Department of Radiology, Seattle Children's Hospital, Seattle, WA; Department of Radiology, University of Washington School of Medicine, Seattle, WA
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199
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Kherabi Y, Chazal T, Emile JF, Allaham W, Mallart E, de Lastours V, Haroche J, Nguyen Y. A recurrent pleuropneumonia revealing Erdheim-Chester Disease. Respir Med Case Rep 2023; 43:101843. [PMID: 37091897 PMCID: PMC10119796 DOI: 10.1016/j.rmcr.2023.101843] [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: 11/28/2022] [Accepted: 04/06/2023] [Indexed: 04/25/2023] Open
Abstract
Erdheim-Chester disease (ECD) is a rare form of L group histiocytosis, accounting for up to 1500 cases to date worldwide, which mainly affects men between their 5th and 7th decade of life. The most frequent manifestations are bone involvement, perirenal infiltration with an evocating appearance of "hairy kidneys", and a "coated aorta" aspect. Lung involvement in ECD is less common and includes pleural infiltration and interstitial lung disease. Herein, we report the case of a 76-year-old woman with recurrent pleuropneumonia revealing ECD.
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Affiliation(s)
- Yousra Kherabi
- Service de Médecine Interne, AP-HP.Nord, Hôpital Beaujon, Université Paris Cité, Clichy, France
| | - Thibaud Chazal
- Service de Médecine Interne 2, Institut E3M, Inserm UMRS, Centre D'Immunologie et des Maladies Infectieuses (CIMI-Paris), Assistance Publique-Hôpitaux de Paris (APHP), Groupement Hospitalier Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | | | - Wassim Allaham
- Service de Radiologie, AP-HP.Nord, Hôpital Beaujon, Université Paris Cité, Clichy, France
| | - Elise Mallart
- Service de Médecine Interne, AP-HP.Nord, Hôpital Beaujon, Université Paris Cité, Clichy, France
| | - Victoire de Lastours
- Service de Médecine Interne, AP-HP.Nord, Hôpital Beaujon, Université Paris Cité, Clichy, France
- IAME Research Group, UMR-1137, Université de Paris, INSERM, Paris, France
| | - Julien Haroche
- Service de Médecine Interne 2, Institut E3M, Inserm UMRS, Centre D'Immunologie et des Maladies Infectieuses (CIMI-Paris), Assistance Publique-Hôpitaux de Paris (APHP), Groupement Hospitalier Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Yann Nguyen
- Service de Médecine Interne, AP-HP.Nord, Hôpital Beaujon, Université Paris Cité, Clichy, France
- Corresponding author. Service de Médecine Interne, Hôpital Beaujon, 100 boulevard du Général Leclerc, 92100, Clichy, France.
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Neurological Erdheim-Chester Disease Manifesting with Subacute or Progressive Cerebellar Ataxia: Novel Case Series and Review of the Literature. Brain Sci 2022; 13:brainsci13010026. [PMID: 36672008 PMCID: PMC9856726 DOI: 10.3390/brainsci13010026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022] Open
Abstract
Neurological involvement is relatively common in Erdheim-Chester disease (ECD), a rare clonal disorder of histiocytic myeloid precursors characterized by multisystem involvement. In ECD patients, neurological symptoms can occur either at onset or during the disease course and may lead to various degrees of neurological disability or affect patients' life expectancy. The clinical neurological presentation of ECD often consists of cerebellar symptoms, showing either a subacute or progressive course. In this latter case, patients manifest with a slowly progressive cerebellar ataxia, variably associated with other non-specific neurological signs, infratentorial leukoencephalopathy, and cerebellar atrophy, possibly mimicking either adult-onset degenerative or immune-mediated ataxia. In such cases, diagnosis of ECD may be particularly challenging, yet some peculiar features are helpful to address it. Here, we retrospectively describe four novel ECD patients, all manifesting cerebellar symptoms at onset. In two cases, slow disease progression and associated brain MRI features simulated a degenerative cerebellar ataxia. Three patients received a definite diagnosis of histiocytosis, whereas one case lacked histology confirmation, although clinical diagnostic features were strongly suggestive. Our findings regarding existing literature data focused on neurological ECD will be also discussed to highlight those diagnostic clues helpful to address diagnosis.
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