201
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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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202
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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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203
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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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204
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Brink A, Hlongwa KN, More S. The Impact of PET/CT on Paediatric Oncology. Diagnostics (Basel) 2023; 13:192. [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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Affiliation(s)
- Anita Brink
- Division of Nuclear Medicine, Department of Radiation Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7700, South Africa
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205
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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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206
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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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207
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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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208
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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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209
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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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210
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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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211
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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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212
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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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213
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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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215
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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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216
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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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217
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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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218
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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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219
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Lu X, Wu Y, Gong J, Yu X, Zhang Y, Yang C. Pancreatic follicular dendritic cell sarcoma: one case report and literature review. J Int Med Res 2022; 50:3000605221142401. [PMID: 36539966 PMCID: PMC9791293 DOI: 10.1177/03000605221142401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Pancreatic follicular dendritic cell sarcoma (FDCS) is a rare neoplasm with unclear pathological characteristics. In this study, we report one case of pancreatic FDCS and review published cases to summarize the characteristics and treatment of pancreatic FDCS. A man in his early 30 s was admitted for jaundice, abdominal fullness, and weight loss for 15 days. Computed tomography revealed a large capsule solid mass in the pancreatic head together with a dilated bile duct and enlarged retroperitoneal lymph nodes. Serum biochemistry revealed high total bilirubin levels (313.9 μmol/L) and normal tumor marker levels. Pancreatoduodenectomy was performed, but no chemotherapy was administrated at the patient's behest. The pathologic diagnosis was pancreatic FDCS infiltrating the duodenal seromuscular layer and common bile duct. The patient presented with liver metastasis 3 months after surgery and died 8 months after surgery from multiorgan failure. Pancreatic FDCS is a rare disease with high invasiveness. Our previous case exhibited paraneoplastic syndrome together with this disease, and further investigation is needed to confirm whether paraneoplastic syndrome is a typical syndrome of pancreatic FDCS.
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Affiliation(s)
- Xiangyu Lu
- The Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Yilei Wu
- Department of Medical Records Statistics, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Jun Gong
- The Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Xiaojiong Yu
- The Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Yu Zhang
- The Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Chong Yang
- Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province & Organ Transplantation Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China,Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, China,Chong Yang, Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province & Organ Transplantation Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32# W. Sec 2, 1st Ring Rd., Chengdu, Sichuan 610072, China.
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220
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Gao XM, Li J, Cao XX. Signaling pathways, microenvironment, and targeted treatments in Langerhans cell histiocytosis. Cell Commun Signal 2022; 20:195. [PMID: 36536400 PMCID: PMC9764551 DOI: 10.1186/s12964-022-00917-0] [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: 03/21/2022] [Accepted: 06/11/2022] [Indexed: 12/23/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is an inflammatory myeloid malignancy in the "L-group" histiocytosis. Mitogen-activated protein kinase (MAPK) pathway activating mutations are detectable in nearly all LCH lesions. However, the pathogenic roles of MAPK pathway activation in the development of histiocytosis are still elusive. This review will summarize research concerning the landscape and pathogenic roles of MAPK pathway mutations and related treatment opportunities in Langerhans cell histiocytosis. Video abstract.
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Affiliation(s)
- Xue-min Gao
- grid.506261.60000 0001 0706 7839Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730 China ,grid.506261.60000 0001 0706 7839State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Li
- grid.506261.60000 0001 0706 7839Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730 China ,grid.506261.60000 0001 0706 7839State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin-xin Cao
- grid.506261.60000 0001 0706 7839Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730 China ,grid.506261.60000 0001 0706 7839State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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221
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Velletrani G, Francavilla B, Rosati V, Padial B, Anemona L, Girolamo SD. Adult onset Xanthogranuloma presenting as a solitary laryngeal localization: case report and review of literature. Arch Clin Cases 2022; 9:145-149. [PMID: 36628161 PMCID: PMC9769079 DOI: 10.22551/2022.37.0904.10221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Juvenile Xanthogranuloma (XG) is a rare disorder that belongs to the heterogeneous group of histiocytic neoplasms, characterized by a clonal expansion of non-Langerhans cell histiocytes that share a dermal macrophage phenotype. Although the head and neck region is the most common reported site of involvement by the Juvenile Xanthogranuloma family, laryngeal localization is extremely rare. We report a unique case of Adult Onset Xanthogranuloma with subglottic localization, presenting as a solitary laryngeal mass without other systemic or cutaneous lesions. A review of the previously described cases of laryngeal Xanthogranuloma has been performed, highlighting 7 cases of Juvenile Xanthogranuloma and only 3 cases of Adult Onset Xanthogranuloma. Despite the extreme rarity of laryngeal localization of XG, this histiocytic neoplasm should be considered as a differential diagnosis for laryngeal masses causing airway obstruction, even in the absence of other concomitant manifestations.
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Affiliation(s)
- Gianluca Velletrani
- Department of Otorhinolaryngology, University of Rome “Tor Vergata”, Rome, Italy
| | - Beatrice Francavilla
- Department of Otorhinolaryngology, University of Rome “Tor Vergata”, Rome, Italy,Correspondence: Beatrice Francavilla, Department of Otorhinolaryngology, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Roma, Italy.
| | - Valentina Rosati
- Department of Otorhinolaryngology, University of Rome “Tor Vergata”, Rome, Italy
| | - Belen Padial
- Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
| | - Lucia Anemona
- Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
| | - Stefano Di Girolamo
- Department of Otorhinolaryngology, University of Rome “Tor Vergata”, Rome, Italy
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222
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Wirth MA, Khan HM, Rasmussen SL, Hudson N, Rossman DW. Adult orbital xanthogranulomatous disease and myotonic dystrophy type 2: coexistence or association? CANADIAN JOURNAL OF OPHTHALMOLOGY 2022; 58:e136-e139. [PMID: 36535382 DOI: 10.1016/j.jcjo.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 10/05/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Magdalena A Wirth
- University of British Columbia, Vancouver, BC; University Hospital Zurich, Zurich, Switzerland
| | | | - Steve L Rasmussen
- University of British Columbia, Vancouver, BC; Vancouver General Hospital, Vancouver, BC
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223
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Sakamoto K, Kikuchi K, Sako M, Kato M, Takimoto T, Shioda Y. Pilot study to estimate the safety and effectiveness of hydroxyurea and methotrexate recurrent langerhans cell histiocytosis (LCH-HU-pilot). Medicine (Baltimore) 2022; 101:e31475. [PMID: 36550910 PMCID: PMC9771280 DOI: 10.1097/md.0000000000031475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
This study was a non-blinded, multicenter, single-arm study. Recurrent (relapsed) LCH is defined as the appearance of new lesions or the enlargement of preexisting lesions due to LCH. In this study, all patients received hydroxyurea, and if the treatment response was unsatisfactory, methotrexate was added. The duration of treatment was 48 weeks. The primary endpoint was the rate of non-active disease achievement, which was 24 weeks after initiating hydroxyurea administration. No active disease is defined as the resolution of all the signs and symptoms related to LCH.
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Affiliation(s)
- Kenichi Sakamoto
- Children’s Cancer Center, National Center for Child Health and Development, Tokyo, Japan
- Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan
| | - Kayoko Kikuchi
- Department of Clinical Research Promotion, Clinical Research Center, National Center for Child Health and Development, Setagaya, Tokyo, Japan
| | - Mayumi Sako
- Department of Clinical Research Promotion, Clinical Research Center, National Center for Child Health and Development, Setagaya, Tokyo, Japan
| | - Miho Kato
- Department of Cancer Data Management, National Center for Child Health and Development, Tokyo, Japan
| | - Tetsuya Takimoto
- Department of Cancer Data Management, National Center for Child Health and Development, Tokyo, Japan
| | - Yoko Shioda
- Children’s Cancer Center, National Center for Child Health and Development, Tokyo, Japan
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224
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Bone Marrow Infiltration in Rosai-Dorfman Disease. Case Rep Hematol 2022; 2022:3420311. [PMID: 36568338 PMCID: PMC9779991 DOI: 10.1155/2022/3420311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
Rosai-Dorfman disease (RDD) is a rare and benign nonLangerhans cell histiocytosis. RDD commonly affects children and young adults typically presenting with massive, painless, and bilateral cervical lymphadenopathy. Extranodal involvement is present in about 40% of cases, and bone marrow infiltration is rare and unusual. RDD prognosis is usually good, however, involvement of bone marrow is associated with poor prognosis. We report a case of RDD with bone marrow involvement occurring in a 5-year-old female. She was admitted for asthenia, gingival bleeding, and diffuse bone pain without fever. Physical examination showed pallor, petechiae over the abdomen, painless and bilateral cervical lymphadenopathy, and several bony nodules, without splenomegaly or hepatomegaly. Cell blood count revealed microcytic hypochromic anemia with thrombocytopenia. Bone marrow aspiration showed infiltration by large histiocytes with hypochromatic nuclei and abundant vacuolated cytoplasm without emperipolesis. Biopsies of bone marrow, lymph node, and bone revealed immunohistochemical features of RDD: the histiocytes were positive for CD68 and S100 protein, but negative for CD1a. The patient initially received symptomatic treatment. One week after admission, she died of septic shock before the final establishment of RDD diagnosis. This case report highlights that bone marrow involvement in RDD is rare and associated with poor prognosis. We also aim to emphasize the obligation of bone marrow exploration in patients with RDD and presenting cytopenias in order to make an early diagnosis of bone marrow infiltration.
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225
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Surgical Appearance of Aortic Involvement in Erdheim-Chester Disease: A Report of Two Cases. COR ET VASA 2022. [DOI: 10.33678/cor.2022.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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226
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Wiffen J, Kalantary A, Ardakani NM, Turner A. Adult onset xanthogranuloma of the eyelid. Am J Ophthalmol Case Rep 2022; 29:101775. [PMID: 36544751 PMCID: PMC9762145 DOI: 10.1016/j.ajoc.2022.101775] [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: 08/23/2022] [Revised: 11/19/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
Purpose To report a rare case of an eyelid lesion in an adult, with histological features of juvenile xanthogranuloma (JXG). Observations Juvenile xanthogranuloma primarily affects the skin of infants and young children. It infrequently can involve the structures of the eye and orbit and rarely occurs in individuals beyond the second decade of life. We present a case of adult onset xanthogranuloma (AXG) involving the eyelid of a 29-year-old female. This lesion required management with multiple treatment modalities. Conclusions This is a rare example of an eyelid xanthogranuloma in an adult. As such, JXG-like lesions should be included as a differential diagnosis for lesions of the eye and orbit in adults. Surgical management may be required if there is no response to intralesional steroids.
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Affiliation(s)
- James Wiffen
- The Lions Outback Vision, Lions Eye Institute, Nedlands, Western Australia, Australia,Corresponding author. Lions Outback Vision, 2 Verdun Street, Nedlands, Western Australia, 6009, Australia.
| | - Amy Kalantary
- The Lions Outback Vision, Lions Eye Institute, Nedlands, Western Australia, Australia
| | - Nima Mesbah Ardakani
- Department of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, Western Australia, Australia,College of Science, Health, Engineering and Education, Murdoch University, Perth, Western Australia, Australia
| | - Angus Turner
- The Lions Outback Vision, Lions Eye Institute, Nedlands, Western Australia, Australia,Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, Western Australia, Australia
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227
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Fabozzi F, De Vito R, Gaspari S, Leone F, Delvecchio M, Agolini E, Galaverna F, Mastronuzzi A, Pagliara D, De Ioris MA. Case report: A new pathogenic variant of LRBA deficiency with a complex phenotype and Rosai-Dorfman disease. Front Immunol 2022; 13:944810. [PMID: 36569874 PMCID: PMC9780374 DOI: 10.3389/fimmu.2022.944810] [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: 05/15/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
We reported a new pathogenic variant of LRBA deficiency with a complex phenotype-neonatal diabetes, very early-onset inflammatory bowel disease, and polyarthritis-who presented with lymph node enlargement. A case of Rosai-Dorfman's disease (RDD) was confirmed. The occurrence of an RDD lesion in LRBA-deficiency has never been reported so far.
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Affiliation(s)
- Francesco Fabozzi
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy,Department of Pediatrics, University of Tor Vergata, Rome, Italy
| | - Rita De Vito
- Department of Pathology, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Stefania Gaspari
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Fabrizio Leone
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Emanuele Agolini
- Laboratory of Medical Genetics, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Federica Galaverna
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Angela Mastronuzzi
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Daria Pagliara
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Maria Antonietta De Ioris
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy,*Correspondence: Maria Antonietta De Ioris,
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Rehman S, Iqbal R, Sukaina M, Shaik Masthan S, Bint I Munir A, Iqbal Y, Qureshi MH, Husnain A, Ghafoor S, Ghafoor B, Nagarajan JS, Pervaiz F, Haseeb Ul Rasool M. Histiocytic Sarcoma Secondary to Gastrointestinal Stromal Tumors: A Literature Review. Cureus 2022; 14:e33055. [PMID: 36721560 PMCID: PMC9882698 DOI: 10.7759/cureus.33055] [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: 12/28/2022] [Indexed: 12/29/2022] Open
Abstract
Histiocytic sarcoma (HS) is a rare tumor that may result from the transdifferentiation of preexisting hematolymphoid neoplasms in a subset of patients. There are instances of correlation or concurrence between HS and a number of cancers, particularly B-cell-associated hematopoietic tumors. Only three cases of HS occurring subsequent to or concurrently with gastrointestinal stromal tumors (GIST) have been recorded. Our main objective was to give an overview of demographics, clinical signs and symptoms, histopathological findings, and immunohistochemical and molecular analysis when HS develops secondary to or concurrently with GIST. A search of PubMed, Google Scholar, and ScienceDirect was undertaken using Medical Subject Headings (MeSH) keywords. According to the findings of our review, there were two males (66.6%) and one female (33.3%). The average age of patients at presentation was 59.6 years. On the immunohistochemistry, three patients were positive for cluster of differentiation (CD) 68 (100%), two patients were positive for CD 163 (67%), one patient was positive for leukocyte common antigen (LCA) (33%), and only one patient was positive for CD 4, CD 10, CD 31, CD 45, human leukocyte antigen (HLA)-DR, lysozyme, and vimentin (33%). On molecular investigation, the gastric mass of only one patient (33.33%) contained a KIT mutation on exon 11. Emperipolesis was observed in one patient (33.33%) on histological examination. Our study provides an important overview of the available literature and gives insight into important diagnostic markers of HS when it occurs secondary to or concurrently with GIST.
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Affiliation(s)
- Shafi Rehman
- Pathology, Shifa College of Medical Technology, Shifa Tameer-E-Millat University, Islamabad, PAK
| | - Rashid Iqbal
- Medical Biochemistry, Shifa College of Medical Technology, Shifa Tameer-E-Millat University, Islamabad, PAK
| | | | | | | | - Yagana Iqbal
- Internal Medicine, Allama Iqbal Medical College, lahore, PAK
| | | | | | - Sana Ghafoor
- Internal Medicine, Shalimar Clinic, Islamabad, PAK
| | - Bushra Ghafoor
- Research, University of Texas Southwestern Medical Center, Dallas, USA
- Medicine, Dera Ghazi Khan Medical College, Dera Ghazi Khan, PAK
- Internal Medicine, Nishtar Medical University, Multan, PAK
| | - Jai S Nagarajan
- Medicine, Sri Ramaswamy Memorial (SRM) Medical College Hospital and Research Centre, Chennai, IND
| | - Fariyal Pervaiz
- Anatomy, Radiology, Cardiac Catheterization, Shifa College of Medical Technology, Shifa Tameer-E-Millat University, Islamabad, PAK
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229
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Gonzales MR, White JC, Mangum DS, Powell JL. Sporadic extranodal Rosai-Dorfman-Destombes disease treated with tocilizumab. Pediatr Blood Cancer 2022; 69:e29754. [PMID: 35484989 DOI: 10.1002/pbc.29754] [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: 03/21/2022] [Accepted: 04/12/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Manuel R Gonzales
- Department of Pediatrics, Nemours Children's Hospital - Delaware, Wilmington, Delaware, USA
| | - Jason C White
- Nemours Center for Cancer and Blood Disorders, Nemours Children's Hospital - Delaware, Wilmington, Delaware, USA
| | - D Spencer Mangum
- Nemours Center for Cancer and Blood Disorders, Nemours Children's Hospital - Delaware, Wilmington, Delaware, USA
| | - Jonathan L Powell
- Nemours Center for Cancer and Blood Disorders, Nemours Children's Hospital - Delaware, Wilmington, Delaware, USA
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230
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Sharma C, Tiwari A, Goel A, Vashist S, Raheja V, Jakhar A. Rare Cause of CSOM: Langerhans Cell Histiocytosis. Indian J Otolaryngol Head Neck Surg 2022; 74:3678-3681. [PMID: 36742476 PMCID: PMC9895658 DOI: 10.1007/s12070-021-02431-0] [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: 10/28/2020] [Accepted: 01/25/2021] [Indexed: 02/07/2023] Open
Abstract
Langerhans cell histiocytosis (LCH) is a proliferation of dendritic mononuclear cells with infiltration into organs locally or diffusely. Most cases occur in children. LCH can also present as chronic otitis media and otitis externa due to involvement of the mastoid and petrous portions of the temporal bone with partial obstruction of the auditory canal. A 4 year old male child presented with complaints of bilateral ear discharge for 4 months and inability to walk and giddiness for 2 days. On otoscopic examination, in right ear, polypoidal tissue was present in the external auditory canal which bled on touch. CECT head and MRI brain was done which showed large altered intensities in the region of bilateral external and middle ears involving the temporal bone. It also showed a well defined ovoid expansile lesion involving the skull vault in left high parietal region. Biopsy was taken from the polypoidal tissue in the right EAC which on HPE showed features suspicious for LCH. On IHC, the tissue was found out to be immunoreactive for CD 68, CD 1a and S-100 with score of 4+ for all three of the IHC markers. Patient was later put on chemotherapy and steroids which resulted in disease remission.
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Affiliation(s)
- Chandni Sharma
- Department of Otorhinolaryngology, Pt. B.D. Sharma PGIMS, Rohtak, Haryana 124001 India
| | - Abhiraj Tiwari
- Department of Otorhinolaryngology, Pt. B.D. Sharma PGIMS, Rohtak, Haryana 124001 India
| | - Ashiya Goel
- Department of Otorhinolaryngology, Pt. B.D. Sharma PGIMS, Rohtak, Haryana 124001 India
| | - Swati Vashist
- Department of Otorhinolaryngology, Pt. B.D. Sharma PGIMS, Rohtak, Haryana 124001 India
| | - Vinny Raheja
- Department of Otorhinolaryngology, Pt. B.D. Sharma PGIMS, Rohtak, Haryana 124001 India
| | - Aman Jakhar
- Department of Otorhinolaryngology, Maharaja Agrasen Medical College, Agroha, Haryana India
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231
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Nazari MA, Rosenblum JS, Zhuang Z, Malik A, Lonser RR, Pacak K, Aronoff S. A 13-Year-Old Male With Left Eye Swelling. Pediatrics 2022; 150:189930. [PMID: 36353857 DOI: 10.1542/peds.2021-056037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 11/11/2022] Open
Abstract
A 13-year-old male presented with a 10-day history of left eye swelling and pain. These symptoms prompted presentation to the emergency department. He had no significant past medical history and no preceding fevers or chills. He was found on examination of the eyes and the orbit to have left supraorbital erythema, edema, and pain with upward and medial gaze. Examination of the globe, fundus, and visual fields were normal. His white blood cell count was 6.2 (x1000/mm3) with an erythrocyte sedimentation rate of 4 (mm/hr). Diagnostic endoscopic biopsy was performed. Here we present this case alongside clinical reasoning and diagnostic evaluation with relevant input from respective experts. This case discussion reviews the final diagnosis, as well as the corresponding evaluation and management. Diagnostic algorithms based on literature review and clinical experience are also included.
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Affiliation(s)
- Matthew A Nazari
- Department of Internal Medicine and Pediatrics, Georgetown University Hospital, Washington, District of Columbia.,Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | | | - Zhengping Zhuang
- Neuro-Oncology Branch, National Cancer Institute.,Surgical Neurology Branch, National Institute of Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Archana Malik
- Department of Pediatric Diagnostic Radiology, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Russell R Lonser
- Department of Neurologic Surgery, Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Stephen Aronoff
- Department of Pediatrics, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.,Section of Pediatric Infectious Diseases, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
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232
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Mitchell HR, Applebaum AJ, Lynch KA, Reiner AS, Atkinson TM, Buthorn JJ, Sigler AS, Bossert D, Brewer K, Corkran J, Fournier D, Panageas KS, Diamond EL. Challenges and positive impact of rare cancer caregiving: A mixed-methods study of caregivers of patients with Erdheim-Chester disease and other histiocytic neoplasms. EClinicalMedicine 2022; 54:101670. [PMID: 36188434 PMCID: PMC9519468 DOI: 10.1016/j.eclinm.2022.101670] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background The importance of deriving benefit and meaning has been identified among cancer caregivers, but this has yet to be examined in the context of rare cancers. We sought to characterize unmet needs and experiences of caregivers of patients with Erdheim-Chester disease (ECD) and other histiocytic neoplasms (HN) and to identify factors associated with finding benefit and meaning-making in providing care for patients with rare cancers. Methods Caregivers of patients with ECD and other HN completed quantitative surveys. Linear univariable regression modeling examined associations between unmet needs, social and family support, and intolerance of uncertainty with benefit finding and meaning-making. A subset participated in qualitative interviews assessing experiences of rare cancer caregiving that were analyzed with applied thematic analysis (NCT039900428). Findings Of caregivers (N = 92, M = 54 years old, 68% female) of patients with ECD (75%) and other HN (25%), 78% reported moderately or severely unmet support needs, most frequently informational (58%) and psychological/emotional (66%) needs. Caregivers with unmet informational, psychological/emotional, and social support needs, difficulty tolerating uncertainty, a longer duration of the patient's illness, lower social support, more family conflict, and higher anxiety and depression symptoms demonstrated less benefit finding and meaning-making (ps <.05). Qualitative interviews (N = 19) underscored information and support needs and the capacity to derive meaning from caregiving. Interpretation Rare cancer caregivers report numerous unmet information and support needs, needs that arise from disease rarity itself and which are associated with diminished capacity for deriving benefit and meaning from caregiving. Findings highlight targets for interventions to improve support for caregivers with HN and other rare cancers. Funding NIH P30 CA008748 (PI: Craig Thompson, MD), NIH T32 CA009461 (H.M.; PI: Jamie Ostroff, PhD), Frame Family Fund (E.L.D.), Applebaum Foundation (E.L.D.).
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Affiliation(s)
- Hannah-Rose Mitchell
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Allison J. Applebaum
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Kathleen A. Lynch
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Anne S. Reiner
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Thomas M. Atkinson
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Justin J. Buthorn
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Allison S. Sigler
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Dana Bossert
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Kathleen Brewer
- Erdheim-Chester Disease Global Alliance, DeRidder, LA, United States
| | - Jessica Corkran
- Erdheim-Chester Disease Global Alliance, DeRidder, LA, United States
| | | | - Katherine S. Panageas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Eli L. Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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233
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A Rare Case of Thymic Rosai-Dorfman Disease Mimicking Malignancy on 18F-FDG PET/CT. Tomography 2022; 8:2839-2843. [PMID: 36548529 PMCID: PMC9788635 DOI: 10.3390/tomography8060237] [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: 09/17/2022] [Revised: 11/07/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022] Open
Abstract
Background Rosai-Dorfman disease (RDD), the massive lymphadenopathy characterized by the proliferation of sinus histiocytosis, is a relatively idiopathic benign disease with unknown etiology. We reported a rare case of thymic RDD detected by 18F-FDG PET/CT. A 23-year-old man with right-sided chest pain underwent 18F-FDG PET/CT scan, showing increased 18F-FDG uptake in an anterior mediastinal mass corresponding to a thymic lesion at an enhanced CT scan. The patient was referred to surgery with the clinical suspicion of thymic malignancy. The histological examination and immunohistochemical results confirmed RDD. Conclusions This was the first case report of RDD isolated to the thymus and initially presented with chest pain. Moreover, there was no characteristic painless neck lymphadenopathy at any stage of the disease course. Thus, for young patients with thymus mass, RDD should be considered a rare but possible diagnosis.
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234
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Bidner N, Schnack C, Brix JM, Ludvik B. Eine Patientin mit Ohrenschmerzen Polyurie und Polydipsie. Laryngorhinootologie 2022; 102:300-302. [PMID: 36436506 DOI: 10.1055/a-1949-2876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Nora Bidner
- Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie und Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen Klinik Landstraße Wien Austria
| | - Christoph Schnack
- Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie und Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen Klinik Landstraße Wien Austria
| | - Johanna M. Brix
- Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie und Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen Klinik Landstraße Wien Austria
| | - Bernhard Ludvik
- Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie und Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen Klinik Landstraße Wien Austria
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235
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Ramos D, Silva S, Ramos L, Morais S. Nodular lesions in a newborn: what is the diagnosis? BMJ Case Rep 2022; 15:e252229. [PMID: 36396329 PMCID: PMC9677038 DOI: 10.1136/bcr-2022-252229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Daniela Ramos
- Serviço de Neonatologia da Maternidade Bissaya Barreto, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Sónia Silva
- Oncologia Pediátrica, Hospital Pediatrico de Coimbra, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Leonor Ramos
- Dermatologia e Venereologia, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Sofia Morais
- Serviço de Neonatologia da Maternidade Bissaya Barreto, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
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236
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Li YF, Han SH, Qie P, Yin QF, Wang HE. Langerhans cell histiocytosis involving only the thymus in an adult: A case report. World J Clin Cases 2022; 10:12045-12051. [PMID: 36405289 PMCID: PMC9669851 DOI: 10.12998/wjcc.v10.i32.12045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/07/2022] [Accepted: 10/12/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a rare disease of unknown etiology. LCH involving the thymus is mainly seen in pediatric patients and is extremely rare in adults. In this report, we describe a rare case of LCH originating from the thymus in an adult.
CASE SUMMARY A 56-year-old man was admitted in April 2022 with complaints of intermittent dizziness since 2020, which had worsened in the previous 10 d. The physical chest examination was negative, and there was a history of hypertension for > 2 years. Chest computed tomography showed a nodular soft tissue density shadow in the anterior mediastinum measuring approximately 13 mm × 9 mm × 8 mm. Postoperative pathological findings confirmed the diagnosis of LCH.
CONCLUSION It is challenging to differentiate LCH involving the thymus from thymoma in imaging features. Pathological biopsy remains the gold standard when an anterior mediastinal occupying lesion is found.
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Affiliation(s)
- Yi-Fan Li
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang 050000, Hebei Province, China
- Graduate School, Hebei North University, Zhangjiakou 075000, Hebei Province, China
| | - Shao-Hui Han
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang 050000, Hebei Province, China
| | - Peng Qie
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang 050000, Hebei Province, China
| | - Qi-Fan Yin
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang 050000, Hebei Province, China
| | - Hui-En Wang
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang 050000, Hebei Province, China
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237
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Gómez-Herrero J, Luis CH, Moral ET, García GM, Palacid FS, Bustamante-Munguira J, Fuentes RG. Curative Pericardiectomy in Interpheron-Resistant Severe Pericardial Erdheim-Chester Disease. JACC Case Rep 2022; 4:1534-1541. [PMID: 36444187 PMCID: PMC9700060 DOI: 10.1016/j.jaccas.2022.07.031] [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: 04/12/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 06/16/2023]
Abstract
Erdheim-Chester disease is a rare clonal non-Langerhans cell histiocytosis with multisystemic involvement. It affects bones, large vessels, and retroperitoneum. Cardiac involvement is one of the main mortality predictors.1 We present an unusual case that debuted with cardiac tamponade and pericardial constriction requiring pericardiectomy for definitive control. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Javier Gómez-Herrero
- Instituto de Ciencias del Corazón, Cardiology Department, Hospital Clínico Universitario, Valladolid, Valladolid, Spain
| | - Carolina Hernández Luis
- Instituto de Ciencias del Corazón, Cardiology Department, Hospital Clínico Universitario, Valladolid, Valladolid, Spain
| | - Elena Tapia Moral
- Internal Medicine Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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238
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Ríos Y Valles-Valles D, Herrera-Cifuentes SL, Rodríguez-Reyes AA, Rodríguez-Martínez HA, Hernández-Ayuso I, Zárate-Osorno A. Rosai-Dorfman Disease involving the eye and ocular adnexa. Clinicopathologic series of 17 patients. Eur J Ophthalmol 2022; 33:11206721221138319. [PMID: 36373616 DOI: 10.1177/11206721221138319] [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: 02/17/2024]
Abstract
PURPOSE To describe the clinical features and histopathologic findings of Rosai-Dorfman disease (RDD) with ophthalmic involvement diagnosed at a Mexican ophthalmologic referral center in a period of 62 years. RESULTS A total of 17 cases of RDD with ophthalmologic manifestations in Mexican-mestizo patients were collected. Female predominance was observed in 12 of 17 patients. The mean age was 36 years with a range of 12-76 years. The median age at presentation was 32 years. The orbit was the most affected location with 15 cases. Conjunctival disease was seen in 4 cases: two as isolated lesions, the rest with orbital or uveal involvement . One case suggested choroidal RDD associated to conjunctival and orbital lesion. Three cases presented multifocal disease. A patient with orbital affection developed extranodal disease elsewhere. No concurrent lymphadenopathy was observed in any patient.Histopathological examination revealed classic RDD findings in all cases: A polymorphous cellular infiltrate composed by lymphocytes, plasma cells and large histiocytes with emperipolesis hallmark of the disease. Immunohistochemically, histiocytes were positive for S-100 protein and CD68 in 15 cases. CONCLUSION RDD of the eye and ocular adnexa in Mexican-mestizo patients is common in middle-aged women frequently as an isolated orbital lesion. Histopathology is necessary for accurate diagnosis. Most patients had a favourable outcome after medical and surgical treatment. To the best of our knowledge this is the largest case series of RDD of the eye and ocular adnexa in Latin-American patients.
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Affiliation(s)
- Dolores Ríos Y Valles-Valles
- Medical Doctor, Anatomopathology, Ocular Pathology, Ophthalmic Pathology Service, Asociación para Evitar la Ceguera en México, IAP, Mexico City, Mexico
| | - Sharon L Herrera-Cifuentes
- Medical Doctor, Anatomopathology, Surgical Pathology, Ocular Pathology, Pathology Service, Hospital Español de México, Mexico City, Mexico
| | - Abelardo A Rodríguez-Reyes
- Medical Doctor, Anatomopathology, Ocular Pathology, Ophthalmic Pathology Service, Asociación para Evitar la Ceguera en México, IAP, Mexico City, Mexico
| | - Héctor A Rodríguez-Martínez
- Medical Doctor, Anatomopathology, Surgical Pathology, Laboratory of Anatomopathology and Experimental Medicine, "Roberto Ruiz Obregón" Facultad de Medicina, UNAM y Hospital General de México "Eduardo Liceaga", Mexico City, Mexico
| | - Ivette Hernández-Ayuso
- Medical Doctor, Ophthalmology, Ocular Pathology, Ophthalmic Pathology Service, Asociación para Evitar la Ceguera en México, IAP, Mexico City, Mexico
| | - Alejandra Zárate-Osorno
- Medical Doctor, Anatomopathology, Surgical Pathology, Ocular Pathology, Pathology Service, Hospital Español de México, Mexico City, Mexico
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Potapenko VG, Baykov VV, Zinchenko AV, Potikhonova NA. Langerhans cell histiocytosis in adults: literature review. ONCOHEMATOLOGY 2022. [DOI: 10.17650/1818-8346-2022-17-4-16-32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Langerhans cells histiocytosis is a variant of malignant histiocytosis. The course and symptoms vary. patients with localized forms have a better prognosis, because local therapy is effective. patients with multifocal forms of histiocytosis receive systemic drug therapy, which cures some of the patients. This review provides up-to-date data about typical presentation of the organ involvement, diagnosis, course and therapy of various forms of Langerhans cells histiocytosis.
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Affiliation(s)
| | - V. V. Baykov
- I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
| | - A. V. Zinchenko
- I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
| | - N. A. Potikhonova
- Russian Research Institute of Hematology and Transfusiology, Federal Medical and Biological Agency
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240
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Riley G, Pettit T. A rare case of Haemophagocytic Lymphohistiocytosis preceding a diagnosis of Langerhans cell histiocytosis. Pediatr Blood Cancer 2022; 69:e29727. [PMID: 35652532 DOI: 10.1002/pbc.29727] [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: 12/01/2021] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Guy Riley
- Child Haematology and Oncology Centre, Waipapa Hospital, Christchurch, New Zealand
| | - Tristan Pettit
- Child Haematology and Oncology Centre, Waipapa Hospital, Christchurch, New Zealand
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Serrallach BL, Kralik SF, Tran BH, Huisman TAGM, Patel RP, Allen CE, McClain KL, Gulati N, Dillard-Ilboudo CQ, Hicks MJ, Mohila CA, Desai NK. Neuroimaging in Pediatric Patients with Juvenile Xanthogranuloma of the CNS. AJNR Am J Neuroradiol 2022; 43:1667-1673. [PMID: 36265894 PMCID: PMC9731252 DOI: 10.3174/ajnr.a7683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Juvenile xanthogranuloma is a rare clonal, myeloid, neoplastic disorder. Typically, juvenile xanthogranuloma is a self-limited disorder of infancy, often presenting as a solitary red-brown or yellow skin papule/nodule. A small subset of patients present with extracutaneous, systemic juvenile xanthogranuloma, which may include the CNS. The goal of this retrospective study was to evaluate and categorize the neuroimaging findings in a representative cohort of pediatric patients with CNS juvenile xanthogranuloma. MATERIALS AND METHODS The brain and/or spine MR imaging data of 14 pediatric patients with pathology-proven juvenile xanthogranuloma were categorized and evaluated for the location; the signal intensity of xanthogranulomas on T1WI, T2WI, DWI, and a matching ADC map for the pattern and degree of contrast enhancement; and the presence of perilesional edema, cysts, or necrosis. RESULTS Fourteen pediatric patients (8 girls, 6 boys; mean age, 84 months) were included in the study. Patients presented with a wide variety of different symptoms, including headache, seizure, ataxia, strabismus, hearing loss, facial paresis, and diabetes insipidus. Juvenile xanthogranuloma lesions were identified in a number of different sites, including supra- and infratentorial as well as intracranial and spinal leptomeningeal. Five patients were categorized into the neuroradiologic pattern unifocal CNS juvenile xanthogranuloma; 8, into multifocal CNS juvenile xanthogranuloma; and 1, into multifocal CNS juvenile xanthogranuloma with intracranial and spinal leptomeningeal disease. In most cases, xanthogranulomas were small-to-medium intra-axial masses with isointense signal on T1WI (compared with cortical GM), iso- or hyperintense signal on T2WI, had restricted diffusion and perilesional edema. Almost all xanthogranulomas showed avid contrast enhancement. However, we also identified less common patterns with large lesions, nonenhancing lesions, or leptomeningeal disease. Four cases had an additional CT available. On CT, all xanthogranulomas were homogeneously hyperdense (solid component) without evident calcifications. CONCLUSIONS CNS juvenile xanthogranuloma may demonstrate heterogeneous neuroimaging appearances potentially mimicking other diseases, such as primary brain neoplasms, metastatic disease, lymphoma and leukemia, other histiocytic disorders, infections, or granulomatous diseases.
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Affiliation(s)
- B L Serrallach
- From the Edward B. Singleton Department of Radiology (B.L.S., S.F.K., B.H.T., T.A.G.M.H., R.P.P., N.K.D.)
| | - S F Kralik
- From the Edward B. Singleton Department of Radiology (B.L.S., S.F.K., B.H.T., T.A.G.M.H., R.P.P., N.K.D.)
| | - B H Tran
- From the Edward B. Singleton Department of Radiology (B.L.S., S.F.K., B.H.T., T.A.G.M.H., R.P.P., N.K.D.)
| | - T A G M Huisman
- From the Edward B. Singleton Department of Radiology (B.L.S., S.F.K., B.H.T., T.A.G.M.H., R.P.P., N.K.D.)
| | - R P Patel
- From the Edward B. Singleton Department of Radiology (B.L.S., S.F.K., B.H.T., T.A.G.M.H., R.P.P., N.K.D.)
| | - C E Allen
- Department of Pediatrics (C.E.A., K.L.M., N.G., C.Q.D.-I.), Section of Hematology-Oncology
| | - K L McClain
- Department of Pediatrics (C.E.A., K.L.M., N.G., C.Q.D.-I.), Section of Hematology-Oncology
| | - N Gulati
- Department of Pediatrics (C.E.A., K.L.M., N.G., C.Q.D.-I.), Section of Hematology-Oncology
| | - C Q Dillard-Ilboudo
- Department of Pediatrics (C.E.A., K.L.M., N.G., C.Q.D.-I.), Section of Hematology-Oncology
| | - M J Hicks
- Department of Pathology and Immunology (M.J.H., C.A.M.), Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - C A Mohila
- Department of Pathology and Immunology (M.J.H., C.A.M.), Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - N K Desai
- From the Edward B. Singleton Department of Radiology (B.L.S., S.F.K., B.H.T., T.A.G.M.H., R.P.P., N.K.D.)
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242
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Elbaz Younes I, Sokol L, Zhang L. Rosai-Dorfman Disease between Proliferation and Neoplasia. Cancers (Basel) 2022; 14:5271. [PMID: 36358690 PMCID: PMC9654168 DOI: 10.3390/cancers14215271] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 09/20/2023] Open
Abstract
Rosai-Dorfman disease (RDD) is a rare myeloproliferative disorder of histiocytes with a broad spectrum of clinical manifestations and peculiar morphologic features (accumulation of histiocytes with emperipolesis). Typically, the patient with RDD shows bilateral painless, massive cervical lymphadenopathy associated with B symptoms. Approximately 43% of patients presented with extranodal involvement. According to the 2016 revised histiocytosis classification, RDD belongs to the R group, including familial and sporadic form (classical nodal, extranodal, unclassified, or RDD associated with neoplasia or immune disease). Sporadic RDD is often self-limited. Most RDD needs only local therapies. Nevertheless, a small subpopulation of patients may be refractory to conventional therapy and die of the disease. Recent studies consider RDD a clonal neoplastic process, as approximately 1/3 of these patients harbor gene mutations involving the MAPK/ERK pathway, e.g., NRAS, KRAS, MAP2K1, and, rarely, the BRAF mutation. In addition to typical histiocytic markers (S100/fascin/CD68/CD163, etc.), recent studies show that the histiocytes in RDD also express BCL-1 and OCT2, which might be important in pathogenesis. Additionally, the heterozygous germline mutation involving the FAS gene TNFRSF6 is identified in some RDD patients with an autoimmune lymphoproliferative syndrome type Ia. SLC29A3 germline mutation is associated with familial or Faisalabad histiocytosis and H syndrome.
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Affiliation(s)
| | - Lubomir Sokol
- Department of Hematology and Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Ling Zhang
- Department of Pathology, Moffitt Cancer Center, Tampa, FL 33612, USA
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243
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Paolino J, Berliner N, Degar B. Hemophagocytic lymphohistiocytosis as an etiology of bone marrow failure. Front Oncol 2022; 12:1016318. [PMID: 36387094 PMCID: PMC9647152 DOI: 10.3389/fonc.2022.1016318] [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: 08/10/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a syndrome of multiorgan system dysfunction that is caused by hypercytokinemia and persistent activation of cytotoxic T lymphocytes and macrophages. A nearly ubiquitous finding and a diagnostic criterion of HLH is the presence of cytopenias in ≥ 2 cell lines. The mechanism of cytopenias in HLH is multifactorial but appears to be predominantly driven by suppression of hematopoiesis by pro-inflammatory cytokines and, to some extent, by consumptive hemophagocytosis. Recognition of cytopenias as a manifestation of HLH is an important consideration for patients with bone marrow failure of unclear etiology.
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Affiliation(s)
- Jonathan Paolino
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | - Nancy Berliner
- Division of Hematology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Barbara Degar
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States,*Correspondence: Barbara Degar,
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244
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Saito S, Uchiyama A, Shibusawa Y, Motegi S. A case of disseminated extranodal
Rosai–Dorfman
disease diagnosed by skin manifestations. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2022. [DOI: 10.1002/cia2.12286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Shintaro Saito
- Department of Dermatology Gunma University Graduate School of Medicine Maebashi Japan
| | - Akihiko Uchiyama
- Department of Dermatology Gunma University Graduate School of Medicine Maebashi Japan
| | - Yayoi Shibusawa
- Department of Dermatology Gunma University Graduate School of Medicine Maebashi Japan
| | - Sei‐ichiro Motegi
- Department of Dermatology Gunma University Graduate School of Medicine Maebashi Japan
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245
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Diagnosing Hemophagocytic Lymphohistiocytosis with Machine Learning: A Proof of Concept. J Clin Med 2022; 11:jcm11206219. [PMID: 36294539 PMCID: PMC9605669 DOI: 10.3390/jcm11206219] [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: 09/27/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
Hemophagocytic lymphohistiocytosis is a hyperinflammatory syndrome characterized by uncontrolled activation of immune cells and mediators. Two diagnostic tools are widely used in clinical practice: the HLH-2004 criteria and the Hscore. Despite their good diagnostic performance, these scores were constructed after a selection of variables based on expert consensus. We propose here a machine learning approach to build a classification model for HLH in a cohort of patients selected by glycosylated ferritin dosage in our tertiary center in Lyon, France. On a dataset of 207 adult patients with 26 variables, our model showed good overall diagnostic performances with a sensitivity of 71.4% and high specificity, and positive and negative predictive values which were 100%, 100%, and 96.9%, respectively. Although generalization is difficult on a selected population, this is the first study to date to provide a machine-learning model for HLH detection. Further studies will be required to improve the machine learning model performances with a large number of HLH cases and with appropriate controls.
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246
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Kiruthiga KG, Younes S, Natkunam Y. Strong Coexpression of Transcription Factors PU.1 and Oct-2 in Rosai-Dorfman Disease. Am J Clin Pathol 2022; 158:672-677. [PMID: 36239684 DOI: 10.1093/ajcp/aqac119] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/23/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Rosai-Dorfman disease (RDD) is a rare disorder characterized by the accumulation of large S100 protein-positive histiocytes that typically exhibit emperipolesis. The recently reported expression of Oct-2 in RDD histiocytes led us to explore whether PU.1, a transcription factor that is required for monocyte and B-cell development, could similarly function as a diagnostic marker in RDD. METHODS We evaluated the expression of PU.1 and Oct-2 using immunohistochemistry in 19 patients diagnosed with RDD involving nodal, extranodal, and cutaneous sites. RESULTS Both PU.1 and Oct-2 were positive in all cases studied, with a strong intensity of staining in 84% of cases in which more than 50% of the lesional cells were positive. In three patients, both markers showed weak to moderate intensity of staining. Two patients had concomitant RDD and Langerhans cell histiocytosis in which PU.1 stained both types of histiocytes while Oct-2 stained only the RDD component. CONCLUSIONS PU.1 emerged as a robust marker with crisp nuclear staining in RDD histiocytes as well as in engulfed inflammatory cells. Strong coexpression of PU.1 and Oct-2 is a useful diagnostic marker in differentiating histiocytic/dendritic cell proliferations.
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Affiliation(s)
| | - Sheren Younes
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Yasodha Natkunam
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
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Abstract
Histiocytic disorders of childhood represent a wide spectrum of conditions that share the common histologic feature of activated or transformed "histiocytes." Langerhans cell histiocytosis (LCH) is the most common, with an incidence of approximately 5 per million children. LCH may be difficult to distinguish from more ubiquitous causes of skin rashes, bone pain, or fever. Current chemotherapy fails to cure more than 50% of children with multifocal disease, and treatment failure is associated with increased risks of long-term sequelae. Somatic activating mitogen-activated protein kinase (MAPK) pathway-activating mutations (most often BRAFV600E) have been identified in hematopoietic precursors in patients with LCH. Opportunities to improve outcomes with targeted therapies are under investigation. Juvenile xanthogranuloma (JXG) and Rosai-Dorfman disease (RDD) are less common than LCH and are distinguished by specific histologic and clinical features. Recurrent MAPK pathway gene mutations are also identified in JXG and RDD. In many cases, these conditions spontaneously resolve, but disseminated disease can be fatal. Although there has been historic debate regarding the nature of these conditions as inflammatory versus neoplastic, LCH, JXG, and RDD are now considered myeloid neoplastic disorders. In contrast, hemophagocytic lymphohistiocytosis (HLH) is clearly a disorder of immune dysregulation. HLH is characterized by extreme immune activation driven by hyperactivated T cells. HLH arises in approximately 1 child per million and is nearly universally fatal without prompt recognition and immune suppression. Outcomes of treated children are poor, with approximately 60% survival. Emapalumab, which targets interferon-γ signaling, was recently approved for patients with recurrent or refractory HLH, and additional cytokine-directed therapies are under investigation.
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Affiliation(s)
- Olive S Eckstein
- Texas Children's Hospital Cancer and Hematology Centers, Section of Pediatric Hematology and Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Jennifer Picarsic
- Cincinnati Children's Hospital, Department of Pathology and Laboratory Medicine, University of Cincinnati, Cincinnati, OH
| | - Carl E Allen
- Texas Children's Hospital Cancer and Hematology Centers, Section of Pediatric Hematology and Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
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248
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Migaud P, Müller M, Arastéh K, Hentrich M, Stocker H. Hemophagocytic lymphohistiocytosis in HIV-associated lymphoproliferative disorders. Ann Hematol 2022; 101:2281-2287. [PMID: 35982337 DOI: 10.1007/s00277-022-04944-2] [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: 05/02/2022] [Accepted: 08/04/2022] [Indexed: 11/01/2022]
Abstract
Compared to the general population the incidence of lymphoproliferative disorders (LPDs) is significantly elevated among people living with HIV (PLHIV). In high-income countries LPDs have become the most common HIV-associated cause of death among PLHIV. Lymphomas are one of the most frequent triggers of Hemophagocytic Lymphohistiocytosis (HLH), a life-threatening inflammatory syndrome that manifests as a sepsis-like syndrome thus obscuring the underlying condition and delaying its diagnosis and therapy. We performed this retrospective cohort study comprising all adult HIV-infected patients who started treatment for histologically proven LPDs between October 2013 and July 2019, to analyse risk factors, frequency and outcome of HLH among HIV-infected patients with LPDs. Of 75 patients, six (8%) presented with or developed HLH. Three patients had Hodgkin lymphoma and three had HHV-8 associated diseases. There was a significant correlation (p<0.01) between bone marrow involvement and the development of HLH. HLH was associated with lower overall survival (HR: 5.09; 95%CI: 1.53 - 16.91 p=0.008). In conclusion HLH appears to be more frequent in HIV-associated lymphomas than in HIV-negative lymphomas. The probability of developing HLH was particularly high in patients with Hodgkin lymphoma, lymphoma with bone marrow infiltration and HHV-8 associated lymphoma. Mortality was significantly increased in the presence of HLH.
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Affiliation(s)
- Pascal Migaud
- Department of Infectious Diseases, St.Joseph Hospital, Berlin-Tempelhof, Germany.
| | - Markus Müller
- Department of Infectious Diseases, St.Joseph Hospital, Berlin-Tempelhof, Germany
| | - Keikawus Arastéh
- Department of Infectious Diseases, St.Joseph Hospital, Berlin-Tempelhof, Germany
| | - Marcus Hentrich
- Department of Hematology and Oncology, Red Cross Hospital, Munich, Germany
| | - Hartmut Stocker
- Department of Infectious Diseases, St.Joseph Hospital, Berlin-Tempelhof, Germany
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249
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Meek K, Yang YT, Takada M, Parys M, Richter M, Engleberg AI, Thaiwong T, Griffin RL, Schall PZ, Kramer AJ, Yuzbasiyan-Gurkan V. Identification of a Hypomorphic FANCG Variant in Bernese Mountain Dogs. Genes (Basel) 2022; 13:1693. [PMID: 36292578 PMCID: PMC9601343 DOI: 10.3390/genes13101693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/12/2022] [Accepted: 09/19/2022] [Indexed: 05/26/2024] Open
Abstract
Bernese mountain dogs (BMDs), have an overall cancer incidence of 50%, half of which is comprised of an otherwise rare tumor, histiocytic sarcoma (HS). While recent studies have identified driver mutations in the MAPK pathway, identification of key predisposing genes has been elusive. Studies have identified several loci to be associated with predisposition to HS in BMDs, including near the MTAP/CDKN2A region, but no causative coding variant has been identified. Here we report the presence of a coding polymorphism in the gene encoding FANCG, near the MTAP/CDKN2A locus. This variant is in a conserved region of the protein and appears to be specific to BMDs. Canine fibroblasts derived from dogs homozygous for this variant are hypersensitive to cisplatin. We show this canine FANCG variant and a previously defined hypomorphic FANCG allele in humans impart similar defects in DNA repair. However, our data also indicate that this variant is neither necessary nor sufficient for the development of HS. Furthermore, BMDs homozygous for this FANCG allele display none of the characteristic phenotypes associated with Fanconi anemia (FA) such as anemia, short stature, infertility, or an earlier age of onset for HS. This is similar to findings in FA deficient mice, which do not develop overt FA without secondary genetic mutations that exacerbate the FA deficit. In sum, our data suggest that dogs with deficits in the FA pathway are, like mice, innately resistant to the development of FA.
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Affiliation(s)
- Katheryn Meek
- Comparative Medicine and Integrative Biology Program, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
- Department of Microbiology and Molecular Genetics, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Ya-Ting Yang
- Comparative Medicine and Integrative Biology Program, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Marilia Takada
- Comparative Medicine and Integrative Biology Program, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Maciej Parys
- Comparative Medicine and Integrative Biology Program, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Marlee Richter
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Alexander I. Engleberg
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Tuddow Thaiwong
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48190, USA
| | - Rachel L. Griffin
- College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Peter Z. Schall
- Comparative Medicine and Integrative Biology Program, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Alana J. Kramer
- College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Vilma Yuzbasiyan-Gurkan
- Comparative Medicine and Integrative Biology Program, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
- Department of Microbiology and Molecular Genetics, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
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Wang D, Cui Q, Yang YJ, Liu AQ, Zhang G, Yu JC. Application of dendritic cells in tumor immunotherapy and progress in the mechanism of anti-tumor effect of Astragalus polysaccharide (APS) modulating dendritic cells: a review. Biomed Pharmacother 2022; 155:113541. [PMID: 36127221 DOI: 10.1016/j.biopha.2022.113541] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/30/2022] Open
Abstract
Dendritic cells (DCs) are potent antigen-presenting cells (APCs) that are essential in mediating the body's natural and adaptive immune responses. The body can regulate the function of DCs in various ways to enhance their antitumor effects. In the tumour microenvironment (TME), antigen-specific T cell responses are initiated through DC processing and delivery of tumour-associated antigens (TAAs); conversely, tumour cells inhibit DC recruitment by releasing metabolites, cytokines and other regulatory TME and function. Different subpopulations of DCs exist in tumour tissues, and their functions vary. Insight into DC subgroups in TME allows assessment of the effectiveness of tumour immunotherapy. Astragalus polysaccharide (APS) is the main component of the Chinese herb Astragalus membranaceus. The study found that the antitumor effects of APS are closely related to DCs. APS can promote the expression of surface molecules CD80 and CD86, promote the maturation of DCs, and activate CTL to exert antitumor effects. We reviewed the application of DCs in tumor immunotherapy and the mechanism of modulation of DCs by Astragalus polysaccharide to provide new directions and strategies for tumor therapy and new drug development.
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Affiliation(s)
- Dong Wang
- Department of Oncology, First Teaching Hospital, Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China; Graduate School of Tianjin University of traditional Chinese Medicine, Tianjin, China
| | - Qian Cui
- Department of Oncology, First Teaching Hospital, Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China; Graduate School of Tianjin University of traditional Chinese Medicine, Tianjin, China
| | - Yan Jie Yang
- Department of Oncology, First Teaching Hospital, Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China; Graduate School of Tianjin University of traditional Chinese Medicine, Tianjin, China
| | - A Qing Liu
- Department of Oncology, First Teaching Hospital, Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China; Graduate School of Tianjin University of traditional Chinese Medicine, Tianjin, China
| | - Guan Zhang
- Department of Oncology, First Teaching Hospital, Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China; Graduate School of Tianjin University of traditional Chinese Medicine, Tianjin, China
| | - Jian Chun Yu
- Department of Oncology, First Teaching Hospital, Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China.
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