1
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Zang Y, Xu L, Fan R, Cheng L, Xu Y. Extensive yellowish masses in bilateral orbit and neck. J Dermatol 2024; 51:e145-e146. [PMID: 38414144 DOI: 10.1111/1346-8138.17166] [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] [Received: 01/28/2024] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/29/2024]
Affiliation(s)
- Yinshan Zang
- Department of Rheumatology and Immunology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, Jiangsu, China
| | - Lingxiao Xu
- Department of Rheumatology and Immunology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, Jiangsu, China
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ran Fan
- Department of Rheumatology and Immunology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, Jiangsu, China
| | - Lu Cheng
- Department of Rheumatology and Immunology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, Jiangsu, China
| | - Yan Xu
- Department of Rheumatology and Immunology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, Jiangsu, China
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2
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Alves RJ, Nunes VS, Junior NCDCB, Nakandakare ER, Quintão ECR. Rare genetic cerebrotendinous xanthomatosis cases (CTX) without cholestanol elevation but with prominent cholesterol-rich tendon xanthomas. J Clin Lipidol 2024:S1933-2874(24)00176-4. [PMID: 38906752 DOI: 10.1016/j.jacl.2024.04.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/09/2024] [Accepted: 04/14/2024] [Indexed: 06/23/2024]
Abstract
Cerebrotendinous xanthomatosis (CTX) is a rare inherited metabolic disease attributed to the mutation of the gene CYP27A1, resulting in sterol 27-hydroxylase deficiency characterized by deposition of cholestanol and cholesterol in several tissues, like the central nervous system and tendons. Furthermore, cataracts, gallstones, diarrhea and premature atherosclerosis have been reported. Nonetheless, clinical development is extremely heterogeneous in CTX. We report here two cases of CTX genetic alteration in the absence of cholestanol elevation in plasma and tendons but with prominent xanthomas. We propose that CTX may not be characteized by increased plasma cholestanol concentration due to alteration in the sterol 27-hydroxylase gene, but is a more complex pathology where there is significant genetic heterogeneity caused by various CYP27A1 mutations.
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Affiliation(s)
- Renato Jorge Alves
- Cardiology Division, Faculty of Medical Science of the Santa Casa of Sao Paulo, Santa Casa Hospital. Dr Cesário Motta Junior street, 112, São Paulo, Brazil (Dr Alves and Junior)
| | - Valéria Sutti Nunes
- Laboratorio de Lipides (LIM10), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR., Av. Dr. Arnaldo 455, room 3305, 01246-000, São Paulo, Brazil (Dr Nunes, Nakandakare and Quintão)
| | - Ney Carter do Carmo Borges Junior
- Cardiology Division, Faculty of Medical Science of the Santa Casa of Sao Paulo, Santa Casa Hospital. Dr Cesário Motta Junior street, 112, São Paulo, Brazil (Dr Alves and Junior)
| | - Edna Regina Nakandakare
- Laboratorio de Lipides (LIM10), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR., Av. Dr. Arnaldo 455, room 3305, 01246-000, São Paulo, Brazil (Dr Nunes, Nakandakare and Quintão)
| | - Eder Carlos Rocha Quintão
- Laboratorio de Lipides (LIM10), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR., Av. Dr. Arnaldo 455, room 3305, 01246-000, São Paulo, Brazil (Dr Nunes, Nakandakare and Quintão).
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3
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Murina A, Allen A. Paraneoplastic Dermatoses and Cutaneous Metastases. Clin Geriatr Med 2024; 40:177-195. [PMID: 38000859 DOI: 10.1016/j.cger.2023.09.005] [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] [Indexed: 11/26/2023]
Abstract
Paraneoplastic syndromes include a variety of cutaneous presentations that have an associated internal malignancy. Some syndromes have a strong correlation to specific internal malignancies, whereas others are associated with a multitude of tumors. There are many cutaneous manifestations that suggest hematologic disorders, which will be reviewed in detail. Cutaneous metastases are commonly from breast and lung cancers and can present as nodules, vascular lesions, eczematous dermatitis, or inflammatory lesions. The most common histologic presentation of cutaneous metastasis is that of a dermal-based or subcutaneous-based nodule with sparing of the epidermis. Determination of origin of tumor requires immunohistochemistry and clinical correlation.
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Affiliation(s)
- Andrea Murina
- Department of Dermatology, Tulane University School of Medicine, 1430 Tulane Avenue #8036, New Orleans, LA 70112, USA.
| | - Ashley Allen
- Department of Dermatology, Tulane University School of Medicine, 1430 Tulane Avenue #8036, New Orleans, LA 70112, USA
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4
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Fourmond S, Pham-Ledard A, Vergier B, Peyrot I, Beylot-Barry M, Ducharme O. Extrafacial necrobiotic xanthogranuloma and a disseminated marginal zone B lymphoma: a unique tissue collision. Int J Dermatol 2024; 63:113-114. [PMID: 37830310 DOI: 10.1111/ijd.16879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/12/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023]
Affiliation(s)
| | - Anne Pham-Ledard
- Dermatology Department, CHU de Bordeaux, Bordeaux, France
- Translational Research on Oncodermatology and Rare Skin Diseases, INSERM U1312, Bordeaux Institute of Oncology, Bordeaux University, Bordeaux, France
| | - Beatrice Vergier
- Translational Research on Oncodermatology and Rare Skin Diseases, INSERM U1312, Bordeaux Institute of Oncology, Bordeaux University, Bordeaux, France
- Pathology Department, CHU Bordeaux, Bordeaux, France
| | - Itzia Peyrot
- Dermatology Department, CHU de Bordeaux, Bordeaux, France
| | - Marie Beylot-Barry
- Dermatology Department, CHU de Bordeaux, Bordeaux, France
- Translational Research on Oncodermatology and Rare Skin Diseases, INSERM U1312, Bordeaux Institute of Oncology, Bordeaux University, Bordeaux, France
| | - Océane Ducharme
- Dermatology Department, CHU de Bordeaux, Bordeaux, France
- Translational Research on Oncodermatology and Rare Skin Diseases, INSERM U1312, Bordeaux Institute of Oncology, Bordeaux University, Bordeaux, France
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5
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Lai KKH, Wong ACC, Ng JKM, Choi PCL, Cheuk W, Yip WWK, Tham CCY, Chong KKL. Immunoglobulin G4-related orbital xanthogranulomatous disease: A case series and literature review. J Fr Ophtalmol 2024; 47:103914. [PMID: 37648548 DOI: 10.1016/j.jfo.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 09/01/2023]
Affiliation(s)
- K K H Lai
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong; Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - A C C Wong
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - J K M Ng
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Hong Kong
| | - P C L Choi
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Hong Kong
| | - W Cheuk
- Department of Anatomical and Cellular Pathology, Queen Elizabeth Hospital, Hong Kong
| | - W W K Yip
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
| | - C C Y Tham
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
| | - K K L Chong
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong; Hong Kong Eye Hospital, Hong Kong.
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6
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Guess R, Harocopos G, Bednarski JJ, Hassmann LM, Bigley TM. Pediatric Necrobiotic Xanthogranuloma as a Novel Phenotype of IKAROS Gain of Function. J Clin Immunol 2023; 44:19. [PMID: 38129715 PMCID: PMC10739487 DOI: 10.1007/s10875-023-01622-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/24/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Rachel Guess
- Division of Rheumatology/Immunology, Department of Pediatrics, Washington University School of Medicine in St Louis, St. Louis, MO, USA
| | - George Harocopos
- Department of Ophthalmology & Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeffrey J Bednarski
- Division or Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Lynn M Hassmann
- Department of Ophthalmology & Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Tarin M Bigley
- Division of Rheumatology/Immunology, Department of Pediatrics, Washington University School of Medicine in St Louis, St. Louis, MO, USA.
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7
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Chen Y, Gao A, Tian X. Bilateral Adult-Onset Orbital Xanthogranuloma: A Case Report. Clin Cosmet Investig Dermatol 2023; 16:3575-3580. [PMID: 38111909 PMCID: PMC10725833 DOI: 10.2147/ccid.s437616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/14/2023] [Indexed: 12/20/2023]
Abstract
Adult-onset xanthogranuloma (AOX) is one of the four rare syndromes collectively referred to as adult xanthogranulomatous disease (AXD). It primarily occurs in the orbit and ocular adnexa and displays distinctive histopathological features, characterized by the infiltration of non-Langerhans-derived foam-like histiocytes and Touton giant cells. The presence of diffuse yellow plaques on the eyelids serves as a highly indicative feature. In this report, we present a compelling case of bilateral periorbital AOX. Initially, the patient received a diagnosis of necrotizing xanthogranuloma (NBX) and underwent treatment with dapsone, which yielded a poor response. Subsequently, through repeated biopsy, immunoprotein electrophoresis, and high-throughput sequencing, the diagnosis was revised to AOX. Subsequently, the patient's treatment was modified to include oral hormone therapy, and no further progression of the periorbital plaque was observed. Notably, the patient's sister was diagnosed with xanthelasma palpebrarum (XP), suggesting a potential genetic association between AOX and XP. Unfortunately, the sister declined further histologic examination and genetic sequencing of her skin lesions, impeding the acquisition of additional evidence regarding the genetic link between these two disorders. Despite the divergent pathological features, pathogenesis, and clinical presentation of AOX and xanthelasma palbrarum, clinicians should remain cognizant of the plausible genetic correlation between these two conditions and pursue further investigations when feasible.
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Affiliation(s)
- Yue Chen
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People’s Republic of China
| | - Aili Gao
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People’s Republic of China
| | - Xin Tian
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People’s Republic of China
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8
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Hansen I, Ghandili S, Abeck F, Booken N, Schneider SW. Therapie des nekrobiotischen Xanthogranuloms - Fallserie und aktuelle Literatur: Therapy of necrobiotic xanthogranuloma - case series and review of the literature. J Dtsch Dermatol Ges 2023; 21:1315-1319. [PMID: 37946640 DOI: 10.1111/ddg.15195_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/26/2023] [Indexed: 11/12/2023]
Abstract
ZusammenfassungDas nekrobiotische Xanthogranulom ist eine seltene Erkrankung, die zu den Nicht‐Langerhans‐Zell‐Histiozytosen gehört. Charakteristisch sind gelbliche Hautveränderungen, die typischerweise periorbital lokalisiert sind. Extrakutane Manifestationen aller Organe sind möglich und können potenziell lebensbedrohliche Komplikationen verursachen. Die Erkrankung gehört zu den fakultativen Paraneoplasien und zeigt eine hohe Assoziation zu Paraproteinämien. Diese Aspekte sollten in der Umfelddiagnostik berücksichtigt werden. Da die Erkrankung sehr selten ist, gibt es bislang keine standardisierten Richtlinien zur Therapie. Als erfolgreiche Therapieregime haben sich insbesondere die Kombination aus Prednisolon und Chlorambucil sowie die intravenösen Immunglobuline herausgestellt. Wir präsentieren vier Fälle aus unserer Klinik sowie die aktuellen Ergebnisse der Literatur in diesem Mini‐Review und möchten damit die therapeutische Herausforderung sowie die Relevanz der Erarbeitung von Richtlinien unterstreichen.
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Affiliation(s)
- Inga Hansen
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Hamburg-Eppendorf
| | - Susanne Ghandili
- II. Medizinische Klinik und Poliklinik, Abteilung für Onkologie, Hämatologie und Knochenmarktransplantation mit der Sektion Pneumologie, Universitätsklinikum Hamburg-Eppendorf
| | - Finn Abeck
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Hamburg-Eppendorf
| | - Nina Booken
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Hamburg-Eppendorf
| | - Stefan W Schneider
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Hamburg-Eppendorf
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9
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Hansen I, Ghandili S, Abeck F, Booken N, Schneider SW. Therapy of necrobiotic xanthogranuloma - case series and review of the literature. J Dtsch Dermatol Ges 2023; 21:1315-1318. [PMID: 37811744 DOI: 10.1111/ddg.15195] [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: 03/19/2023] [Accepted: 06/26/2023] [Indexed: 10/10/2023]
Abstract
Necrobiotic xanthogranuloma is a rare disease that is part of the non-Langerhans cell histiocytoses. It is characterized by yellowish skin lesions, which are typically periorbitally localized. Extracutaneous manifestations of all organs are possible and can cause potentially life-threatening complications. The disease also belongs to the facultative paraneoplasias and is often associated with paraproteinemia. These aspects should be considered regarding further diagnostics. Due to the rarity of the disease, there are no standardized guidelines for therapy so far. The combination of prednisolone and chlorambucil as well as intravenous immunoglobulins seem to be effective therapeutic options. We present four cases from our clinic as well as the current results of the literature in this mini-review and would like to highlight the therapeutic challenge as well as the need for the development of guidelines.
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Affiliation(s)
- Inga Hansen
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Ghandili
- II. Medical Department and Clinic, Department of Oncology, Hematology and Bone Marrow Transplants with the Section Pulmonology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Finn Abeck
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nina Booken
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan W Schneider
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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10
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Fay CJ, Iriarte C, Moslehi D, Lam J, Katsyv I, LeBoeuf NR. Ulcerating necrobiotic xanthogranuloma: A clinical sign to reconsider progression from MGUS to multiple myeloma. JAAD Case Rep 2023; 40:1-3. [PMID: 37663892 PMCID: PMC10470407 DOI: 10.1016/j.jdcr.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Affiliation(s)
- Christopher J. Fay
- Department of Dermatology, Brigham and Women's Hospital, Center for Cutaneous Oncology, Dana-Farber/Brigham Cancer Center, Boston, Massachusetts
| | - Christopher Iriarte
- Department of Dermatology, Brigham and Women's Hospital, Center for Cutaneous Oncology, Dana-Farber/Brigham Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Dorsa Moslehi
- Department of Dermatology, Brigham and Women's Hospital, Center for Cutaneous Oncology, Dana-Farber/Brigham Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Jimmy Lam
- Department of Dermatology, Brigham and Women's Hospital, Center for Cutaneous Oncology, Dana-Farber/Brigham Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Igor Katsyv
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Nicole R. LeBoeuf
- Department of Dermatology, Brigham and Women's Hospital, Center for Cutaneous Oncology, Dana-Farber/Brigham Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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11
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Setoguchi N, Nakayama Y, Amiya E, Takeda N, Komuro I. A long-term follow-up of necrobiotic xanthogranuloma with concomitant large-vessel vasculitis and heart failure with reduced ejection fraction: a case report. Eur Heart J Case Rep 2023; 7:ytad469. [PMID: 37811154 PMCID: PMC10552582 DOI: 10.1093/ehjcr/ytad469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 08/25/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023]
Abstract
Background Necrobiotic xanthogranuloma (NXG) is a non-Langerhans cell histiocytosis and multisystem disorder. Low level of HDL cholesterol associated with a systemic inflammatory profile, which may result from the interaction of monoclonal immunoglobulin and lipoproteins, is a characteristic feature. There is no evidence of NXG-associated large-vessel vasculitis, nor are there any established treatments, although chemotherapy for comorbid multiple myeloma is most often administered. Case summary We describe a case of a 53-year-old male with a first history of heart failure with impaired systolic function. He presented with orbital xanthomas and multiple subcutaneous nodules, and laboratory examination showed elevated levels of C-reactive protein, low HDL, and paraproteinemia. A constellation of these clinical features and pathological findings of skin biopsy led to the diagnosis of NXG. 18F-Fluorodeoxyglucose positron emission tomography (PET)/computed tomography (CT) confirmed increased uptake in the aorta and bilateral common carotid arteries. He began prednisolone treatment with reference to treatment for large-vessel vasculitis. After the treatment, C-reactive protein immediately decreased with markedly increased levels of apolipoprotein A1 (Apo-A1) and HDL. Systolic dysfunction was restored at 6-month follow-up. The patient has not experienced heart failure for 5 years after treatment, and the follow-up PET/CT demonstrated resolution of vascular inflammation. Discussion This is the first report of NXG-associated large-vessel vasculitis. Low-dose prednisolone may benefit for NXG-associated vasculitis and cardiomyopathy. HDL, Apo-A1, and C-reactive protein levels may be useful for monitoring the activity of NXG, and PET/CT was a valuable diagnostic tool for NXG-associated vasculitis.
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Affiliation(s)
- Naoto Setoguchi
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukiteru Nakayama
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- International University of Health and Welfare, Tokyo, Japan
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12
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Lan X, Yang X, Jiang Y. Concurrent acquired cutis laxa and necrobiotic xanthogranuloma without paraproteinemia. J Dermatol 2023; 50:e299-e300. [PMID: 37082805 DOI: 10.1111/1346-8138.16807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 02/11/2023] [Accepted: 03/31/2023] [Indexed: 04/22/2023]
Affiliation(s)
- Xuemei Lan
- Department of Dermatopathology, Hospital for Skin Diseases and Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, Jiangsu, China
| | - Xianhong Yang
- Department of Dermatopathology, Hospital for Skin Diseases and Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, Jiangsu, China
- Center for Plastic & Reconstructive Surgery, Department of Dermatology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Yiqun Jiang
- Department of Dermatopathology, Hospital for Skin Diseases and Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, Jiangsu, China
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13
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Punyamurthy NT, Tjahjono LA, Harris GJ, Wanat KA. Necrobiotic Xanthogranuloma With Associated Monoclonal Gammopathy Presenting as an Eyelid Nodule. Ophthalmic Plast Reconstr Surg 2023; 39:e148-e150. [PMID: 37279015 DOI: 10.1097/iop.0000000000002399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Necrobiotic xanthogranuloma (NXG) is a progressive non-Langerhans cell histiocytosis with a predilection for the periorbital area. NXG is most commonly associated with monoclonal gammopathy and ophthalmic complications. The authors present a 69-year-old man who was evaluated for a left upper eyelid nodule and plaques on the lower extremities, trunk, abdomen, and right upper extremity. Biopsy of the eyelid was supportive for NXG. Serum protein electrophoresis was positive for a monoclonal gammopathy, IgG light chain kappa. MRI showed preseptal involvement. The periocular nodules cleared with a high dose of prednisone; however, the other skin lesions persisted. Bone marrow biopsy showed kappa-restricted 6% plasma cells and he was treated with intravenous immunoglobulin. This case illustrates the importance of clinicopathologic correlations to render an NXG diagnosis.
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Affiliation(s)
| | | | - Gerald J Harris
- Department of Ophthalmology, Section of Orbital and Oculoplastic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Karolyn A Wanat
- Department of Dermatology, Section of Dermatopathology, Medical College of Wisconsin, Milwaukee, WI
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14
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Popoola D, Housley SB, Jacoby WT, Lim J, Cappuzzo JM, Levy EI. Non-dermatologic isolated intracranial necrobiotic xanthogranuloma. BMJ Case Rep 2023; 16:e254122. [PMID: 37648279 PMCID: PMC10471863 DOI: 10.1136/bcr-2022-254122] [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] [Indexed: 09/01/2023] Open
Abstract
Necrobiotic xanthogranuloma is a condition that was first identified in 1980 based on its characteristic histological identity, and it has been known since then as a dermatologic manifestation of an underlying systemic dysproteinemia. Intracranial manifestation is a rare presentation of this condition and has been reported only once in its more than 40 years of existence. Herein and to our knowledge, we report the second observation of an intracranial manifestation and, surprisingly, the first case without the expected dermatologic and systemic dysproteinemia associations. This case identifies an existing knowledge gap in our understanding of necrobiotic xanthogranuloma and emphasises the need for further research into understanding the presentation, comorbidities and management of this condition.
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Affiliation(s)
- Daniel Popoola
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Steven B Housley
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Buffalo General Medical Center, Buffalo, New York, USA
| | - Wady T Jacoby
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Jaims Lim
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Buffalo General Medical Center, Buffalo, New York, USA
| | - Justin M Cappuzzo
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Buffalo General Medical Center, Buffalo, New York, USA
| | - Elad I Levy
- Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
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15
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Fareez F, Moodley J, Popovic S, Lu JQ. Rheumatoid nodules: a narrative review of histopathological progression and diagnostic consideration. Clin Rheumatol 2023:10.1007/s10067-023-06589-6. [PMID: 36991243 DOI: 10.1007/s10067-023-06589-6] [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] [Received: 01/21/2023] [Revised: 02/27/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023]
Abstract
Rheumatoid nodules (RNs) are the most common extra-articular manifestation of rheumatoid arthritis and are also seen in patients with other autoimmune and inflammatory diseases. The development of RNs includes histopathological stages of acute unspecified inflammation, granulomatous inflammation with no or minimal necrosis, necrobiotic granulomas typically with central fibrinoid necrosis surrounded by palisading epithelioid macrophages and other cells, and likely an advanced stage of "ghost" lesions containing cystic or calcifying/calcified areas. In this article, we review RN pathogenesis, histopathological features in different stages, diagnostically related clinical manifestations, as well as diagnosis and differential diagnosis of RNs with an in-depth discussion about challenges in distinguishing RNs from their mimics. While the pathogenesis of RN formation remains elusive, it is hypothesized that some RNs with dystrophic calcification may be in transition and may be in coexistence or collision with another lesion in patients with RA or other soft tissue diseases and comorbidities. The diagnosis of typical or mature RNs in usual locations can be readily made by clinical findings often with classic RN histopathology, but in many cases, particularly with atypical or immature RNs and/or unusual locations, the clinical and histopathological diagnosis can be challenging requiring extensive examination of the lesional tissue with histological and immunohistochemical markers to identify unusual RNs in the clinical context or other lesions that may be coexisting with classic RNs. Proper diagnosis of RNs is critical for appropriate treatment of patients with RA or other autoimmune and inflammatory diseases.
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Affiliation(s)
- Faiha Fareez
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jinesa Moodley
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Snezana Popovic
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jian-Qiang Lu
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
- Department of Pathology and Molecular Medicine, Hamilton General Hospital, 237 Barton Street, Hamilton, Ontario, L8L 2X2, Canada.
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16
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Li Y, Chen F, Cheng J, Liang H, Chen K, Li J, Wang J, Cai P, Zhu J, Lu H, Li X. An unusual case of necrobiotic xanthogranuloma with IgG-λ monoclonal gammopathy presenting as cerebral manifestations. Quant Imaging Med Surg 2023; 13:1983-1988. [PMID: 36915298 PMCID: PMC10006097 DOI: 10.21037/qims-22-622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 12/20/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Yiman Li
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Fengxi Chen
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jie Cheng
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Hongqin Liang
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Kang Chen
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jing Li
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jian Wang
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Ping Cai
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jiang Zhu
- Institute of Pathology and Southwest Cancer Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hong Lu
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xiaoming Li
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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17
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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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18
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Shahriari N, Mazori DR, Merola JF. Intravenous immunoglobulin-refractory necrobiotic xanthogranuloma successfully treated with tofacitinib 2% cream. JAAD Case Rep 2022; 32:41-43. [PMID: 36632562 PMCID: PMC9826807 DOI: 10.1016/j.jdcr.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Neda Shahriari
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts,Correspondence to: Neda Shahriari, MD, Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Avenue Boston, MA 02115.
| | - Daniel R. Mazori
- Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Joseph F. Merola
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts,Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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19
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Tang Z, Ruan J, Cai S. Transfer factor for the treatment of necrobiotic xanthogranuloma. Dermatol Ther 2022; 35:e15894. [PMID: 36196500 DOI: 10.1111/dth.15894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/26/2022] [Accepted: 10/01/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Zhuangli Tang
- Department of Dermatology, the Second Affiliated Hospital to Zhejiang University, Hangzhou, China
| | - Jiali Ruan
- Department of Dermatology, the Second Affiliated Hospital to Zhejiang University, Hangzhou, China
| | - Suiqing Cai
- Department of Dermatology, the Second Affiliated Hospital to Zhejiang University, Hangzhou, China
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20
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Oganesyan A, Gregory A, Malard F, Ghahramanyan N, Mohty M, Kazandjian D, Mekinian A, Hakobyan Y. Monoclonal gammopathies of clinical significance (MGCS): In pursuit of optimal treatment. Front Immunol 2022; 13:1045002. [PMID: 36505449 PMCID: PMC9728929 DOI: 10.3389/fimmu.2022.1045002] [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: 09/15/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022] Open
Abstract
Monoclonal gammopathy of clinical significance (MGCS) represents a new clinical entity referring to a myriad of pathological conditions associated with the monoclonal gammopathy of undetermined significance (MGUS). The establishment of MGCS expands our current understanding of the pathophysiology of a range of diseases, in which the M protein is often found. Aside from the kidney, the three main organ systems most affected by monoclonal gammopathy include the peripheral nervous system, skin, and eye. The optimal management of these MGUS-related conditions is not known yet due to the paucity of clinical data, the rarity of some syndromes, and limited awareness among healthcare professionals. Currently, two main treatment approaches exist. The first one resembles the now-established therapeutic strategy for monoclonal gammopathy of renal significance (MGRS), in which chemotherapy with anti-myeloma agents is used to target clonal lesion that is thought to be the culprit of the complex clinical presentation. The second approach includes various systemic immunomodulatory or immunosuppressive options, including intravenous immunoglobulins, corticosteroids, or biological agents. Although some conditions of the MGCS spectrum can be effectively managed with therapies aiming at the etiology or pathogenesis of the disease, evidence regarding other pathologies is severely limited to individual patient data from case reports or series. Future research should pursue filling the gap in knowledge and finding the optimal treatment for this novel clinical category.
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Affiliation(s)
- Artem Oganesyan
- Department of Hematology and Transfusion Medicine, National Institute of Health, Yerevan, Armenia,Department Of Adult Hematology, Hematology Center after Prof. R. Yeolyan, Yerevan, Armenia,*Correspondence: Artem Oganesyan,
| | - Andrew Gregory
- Wayne State University School of Medicine, Detroit, MI, United States
| | - Florent Malard
- Department of Clinical Hematology and Cellular Therapy, INSERM, Saint-Antoine Research Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Paris, France
| | - Nerses Ghahramanyan
- Department Of Adult Hematology, Hematology Center after Prof. R. Yeolyan, Yerevan, Armenia
| | - Mohamad Mohty
- Department of Clinical Hematology and Cellular Therapy, INSERM, Saint-Antoine Research Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Paris, France
| | - Dickran Kazandjian
- Myeloma Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
| | - Arsène Mekinian
- Department of Internal Medicine (DMU i3), Sorbonne University, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Paris, France,French-Armenian Clinical Research Center, National Institute of Health, Yerevan, Armenia
| | - Yervand Hakobyan
- Department of Hematology and Transfusion Medicine, National Institute of Health, Yerevan, Armenia,Department Of Adult Hematology, Hematology Center after Prof. R. Yeolyan, Yerevan, Armenia
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21
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Cho H. Diagnosis and management of monoclonal gammopathy of clinical significance. Blood Res 2022; 57:20-26. [PMID: 35483921 PMCID: PMC9057659 DOI: 10.5045/br.2022.2022035] [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: 02/05/2022] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/17/2022] Open
Abstract
The term "monoclonal gammopathy of clinical significance" (MGCS) refers to any plasma cell or B-cell clonal disorder that does not meet the current criteria for malignant disorders but produces a monoclonal protein that directly or indirectly results in organ damage. The most commonly affected organs are the kidneys, nerves, and skin. This review summarizes the current classification of MGCS and its diagnostic and treatment approaches.
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Affiliation(s)
- Hyungwoo Cho
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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22
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Sardiña González C, Martínez Vivero C, López Castro J. PARANEOPLASTIC SYNDROMES REVIEW: THE GREAT FORGOTTEN ONES. Crit Rev Oncol Hematol 2022; 174:103676. [PMID: 35378267 DOI: 10.1016/j.critrevonc.2022.103676] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 03/14/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022] Open
Abstract
Paraneoplastic syndromes (PNS) are a group of disorders that can affect the oncologic patient, and which are not directly attributable to tumour invasion, tumour compression or metastasis. In fact, they are due to tumour secretion of functional hormones or peptides or are related to immune cross-reactivity with the host tissue. These syndromes are called paraneoplastic because the components that cause them do not derive from the organ or tissue of origin, but from the neoplasm suffered by the patient. It is estimated that 10-15% of people with cancer suffer from a PNS.(1) PNS is the second direct cause of death (27% of cases) in cancer patients, after cancer itself. Consequently, it is of remarkable importance to recognize and treat SPNs specifically.(2) In view of the above, the aim of this article is to review the state of the art in neurological, haematological, endocrine, and dermatological paraneoplastic syndromes. It is a review in which the most relevant PNS and their symptomatology are described, inquiring into their diagnosis and treatment.
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Affiliation(s)
| | | | - José López Castro
- Internal Medicine Dept. Hospital Público de Monforte de Lemos (Lugo, SPAIN)
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23
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Steinhelfer L, Kühnel T, Jägle H, Mayer S, Karrer S, Haubner F, Schreml S. Systemic therapy of necrobiotic xanthogranuloma: a systematic review. Orphanet J Rare Dis 2022; 17:132. [PMID: 35331271 PMCID: PMC8944121 DOI: 10.1186/s13023-022-02291-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Even though a plethora of systemic therapies have been proposed for necrobiotic xanthogranuloma (NXG), there is no systematic review on this topic in literature. OBJECTIVE To review all existing literature on the systemic therapy of NXG in order to identify the most effective therapies. METHODS All reported papers in the literature were screened for systemic treatments of NXG. Papers without proper description of the therapies, papers describing topical therapy, and articles without assessment of effectiveness were excluded. Subsequently, we analyzed 79 papers and a total of 175 cases. RESULTS The most effective treatments for NXG are intravenous immunoglobulins (IVIG), corticosteroids, and combination therapies including corticosteroids. CONCLUSIONS Corticosteroids and IVIG should therefore be considered first-line treatments in patients with NXG.
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Affiliation(s)
- Lisa Steinhelfer
- Department of Dermatology, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.,Department of Nuclear Medicine, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany.,Department of Radiology, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Thomas Kühnel
- Department of Otorhinolaryngology, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Herbert Jägle
- Department of Ophthalmology, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Stephanie Mayer
- Department of Internal Medicine III, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Sigrid Karrer
- Department of Dermatology, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Frank Haubner
- Department of Otorhinolaryngology, Ludwig Maximilians University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Stephan Schreml
- Department of Dermatology, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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24
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Férnandez-Férnandez J, Rashki M, Rudolphi-Solero T, Rivas-Navas D, Ramos-Font C. [18F]FDG PET/CT in evaluation of disseminated necrobiotic xanthogranuloma associated with monoclonal gammopathy: Report of clinical case. Rev Esp Med Nucl Imagen Mol 2022; 41 Suppl 1:S55-S56. [DOI: 10.1016/j.remnie.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/02/2021] [Accepted: 09/05/2021] [Indexed: 10/18/2022]
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25
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Means A, Marvin EK, Anderson KR, Lehman JS, Hertel D. Necrobiotic xanthogranuloma with type 1 cryoglobulinemia mimicking necrobiosis lipoidica in a young woman with myeloma. JAAD Case Rep 2022; 21:195-197. [PMID: 35252521 PMCID: PMC8894138 DOI: 10.1016/j.jdcr.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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26
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[18F]FDG PET/TC en la evaluación de xantogranuloma necrobiótico diseminado asociado a gammapatía monoclonal: a propósito de un caso. Rev Esp Med Nucl Imagen Mol 2022. [DOI: 10.1016/j.remn.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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27
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Ali FR, Lear JT. Thalidomide for necrobiotic xanthogranuloma. Clin Exp Dermatol 2021; 47:769-770. [PMID: 34856016 DOI: 10.1111/ced.15047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 11/29/2021] [Indexed: 11/26/2022]
Affiliation(s)
- F R Ali
- East Cheshire Dermatology Service, Mid Cheshire NHS Foundation Trust, Macclesfield, UK
| | - J T Lear
- East Cheshire Dermatology Service, Mid Cheshire NHS Foundation Trust, Macclesfield, UK.,Dermatology Centre, University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, Manchester, UK
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28
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Smilga AS, Lavoie M, Jung S, Schreiber A. Long-standing necrobiotic xanthogranuloma limited to the skin: A case report. SAGE Open Med Case Rep 2021; 9:2050313X211057929. [PMID: 34777813 PMCID: PMC8581771 DOI: 10.1177/2050313x211057929] [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: 11/15/2022] Open
Abstract
Necrobiotic xanthogranuloma is a rare non-Langerhans cell histiocytosis with a known association with monoclonal gammopathies and malignant conditions. There is a lack of consensus regarding the management of necrobiotic xanthogranuloma. In this case report, the patient is diagnosed with a long-standing necrobiotic xanthogranuloma limited to the skin. Although all initial investigations were reassuring, the patient remains at a higher risk of developing a malignant condition. The goal of the authors is to highlight the need for clearer investigation and follow-up guidelines.
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Affiliation(s)
| | - Mona Lavoie
- Pathology, Hôtel-Dieu de Lévis, Lévis, QC, Canada
| | - Sungmi Jung
- Pathology, McGill University, Montréal, QC, Canada
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29
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First case report of pre-mortem biopsy-proven kidney involvement by necrobiotic xanthogranuloma with monoclonal gammopathy. J Nephrol 2021; 35:1753-1757. [PMID: 34739712 DOI: 10.1007/s40620-021-01186-9] [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: 05/11/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
Necrobiotic xanthogranuloma (NXG) is a rare non-Langerhans cell histiocytosis with characteristic cutaneous features and rare visceral involvement. More than 80% of individuals with this disease have a detectable paraprotein but the precise pathogenesis remains obscure. A 68-year-old man with known cutaneous necrobiotic xanthogranuloma presented with acute kidney injury and imaging suggestive of bilateral perinephric infiltration. Renal biopsy showed a prominent histiocytic infiltration of renal capsule and cortex with necrobiosis and characteristic 'Touton-type' giant cells suggestive of necrobiotic xanthogranuloma involvement. Kidney function returned to normal and cutaneous lesions improved with a combination of corticosteroid, chlorambucil and rituximab. This case represents only the second reported incidence of kidney involvement by necrobiotic xanthogranuloma and the first with acute kidney injury and pre-mortem histopathology. This report adds to a small body of literature on the diagnosis and management of visceral involvement by this rare disease.
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30
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Madrova M, Hasan ZU, Halpern S, Maguire B. Scar induration and ulceration in small lymphocytic lymphoma. Int J Dermatol 2021; 61:e169-e171. [PMID: 34716579 DOI: 10.1111/ijd.15950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/02/2021] [Accepted: 10/06/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Monika Madrova
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Histopathology, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Zeeshaan-Ui Hasan
- Department of Dermatology, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Saul Halpern
- Department of Dermatology, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Brigid Maguire
- Department of Histopathology, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
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31
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Kim J, Steeples LR, Jones NP. Ocular Involvement in the Histiocytoses: A Literature Review with an Illustrative Case Series. Ocul Immunol Inflamm 2021; 30:600-614. [PMID: 34637661 DOI: 10.1080/09273948.2021.1936566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose: To describe and illustrate recent reclassification and clinical descriptions of the histiocytoses, diagnosis and management, and effects on the eye and adnexaePatients and methods: Literature review with an illustrative case series of seven patients with histiocytosis and ophthalmic involvement from a single tertiary centre.Results: Skin lesions with signs including eyelid mass, orbital bone destruction, bizarre keratic precipitates, limbal or iris mass, haemorrhagic anterior uveitis, subretinal lesions of uncertain etiology, ischaemic retinopathy, optic neuropathy, and apparent steroid-resistant inflammations should be comprehensively investigated.Conclusions: Ophthalmic involvement in histiocytosis is rare. Clinical manifestations vary from limited single-organ disease to lethal systemic infiltration or malignancy. Radiology may identify lesions for biopsy. Histology with appropriate markers is essential. Oncology advice may be required.
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Affiliation(s)
- Jennifer Kim
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Laura R Steeples
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Nicholas P Jones
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
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32
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Aróstegui Aguilar J, Diago A, Carrillo Gijón R, Fernández Figueras M, Fraga J, García Herrera A, Garrido M, Idoate Gastearena M, Christian Laga A, Llamas-Velasco M, Martínez Campayo N, Monteagudo C, Onrubia J, Pérez Muñoz N, Ríos-Martín J, Ríos-Viñuela E, Rodríguez Peralto J, Rozas Muñoz E, Sanmartín O, Santonja C, Santos-Briz A, Saus C, Suárez Peñaranda J, Velasco Benito V, Beato Merino M, Fernandez-Flores A. Granulomas in Dermatopathology: Principal Diagnoses - Part 1. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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33
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Portuguese AJ, Long TH, Linenberger M. Necrobiotic Xanthogranuloma. Mayo Clin Proc 2021; 96:2432-2434. [PMID: 34481598 DOI: 10.1016/j.mayocp.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/17/2021] [Accepted: 05/17/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Andrew J Portuguese
- Division of Hematology, University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Thomas H Long
- Department of Pathology, University of Washington, Seattle, Washington
| | - Michael Linenberger
- Division of Hematology, University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington
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34
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Bergqvist C, Bernigaud C, Ingen-Housz-Oro S, Sujobert P, Hotz C, Lebre C, Ortonne N, Chosidow O. Intravenous immunoglobulins: an eye opener on the successful treatment of severe adult-onset paraprotein-associated xanthogranulomatosis. Clin Exp Dermatol 2021; 46:1346-1348. [PMID: 33969535 DOI: 10.1111/ced.14727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 11/26/2022]
Affiliation(s)
- C Bergqvist
- Departments of, Department of, Dermatology, AP-HP, Henri Mondor Jospital, Créteil, France.,Université Paris-Est Créteil, Créteil, France
| | - C Bernigaud
- Departments of, Department of, Dermatology, AP-HP, Henri Mondor Jospital, Créteil, France.,Université Paris-Est Créteil, Créteil, France
| | - S Ingen-Housz-Oro
- Departments of, Department of, Dermatology, AP-HP, Henri Mondor Jospital, Créteil, France
| | - P Sujobert
- Department of Biological Haematology, Hôpital Lyon-sud, Pierre-Bénite, France
| | - C Hotz
- Departments of, Department of, Dermatology, AP-HP, Henri Mondor Jospital, Créteil, France
| | - C Lebre
- Departments of, Department of, Dermatology, AP-HP, Henri Mondor Jospital, Créteil, France
| | - N Ortonne
- Department of, Pathology, AP-HP, Henri Mondor Jospital, Créteil, France.,Université Paris-Est Créteil, Créteil, France
| | - O Chosidow
- Departments of, Department of, Dermatology, AP-HP, Henri Mondor Jospital, Créteil, France.,Université Paris-Est Créteil, Créteil, France
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35
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Aróstegui Aguilar J, Diago A, Carrillo Gijón R, Fernández Figueras M, Fraga J, García Herrera A, Garrido M, Idoate Gastearena MÁ, Christian Laga Á, Llamas-Velasco M, Martínez Campayo N, Monteagudo C, Onrubia J, Pérez Muñoz N, Ríos-Martín JJ, Ríos-Viñuela E, Rodríguez Peralto JL, Rozas Muñoz E, Sanmartín O, Santonja C, Santos-Briz Á, Saus C, Suárez Peñaranda JM, Velasco Benito V, Beato Merino MJ, Fernandez-Flores A. Granulomas in Dermatopathology: Principal Diagnoses - Part 1. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:S0001-7310(21)00139-3. [PMID: 33887235 DOI: 10.1016/j.ad.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/05/2021] [Indexed: 11/23/2022] Open
Abstract
This series of 2 articles on dermatopathologic diagnoses reviews conditions in which granulomas form. Part 1 clarifies concepts, discusses the presentation of different types of granulomas and giant cells, and considers a large variety of noninfectious diseases. Some granulomatous diseases have a metabolic origin, as in necrobiosis lipoidica. Others, such as granulomatous mycosis fungoides, are related to lymphomas. Still others, such as rosacea, are so common that dermatologists see them nearly daily in clinical practice.
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Affiliation(s)
- J Aróstegui Aguilar
- Servicio de Dermatología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - A Diago
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - R Carrillo Gijón
- Servicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - M Fernández Figueras
- Servicio de Anatomía Patológica, Hospital Universitari General de Catalunya, Barcelona, España
| | - J Fraga
- Servicio de Anatomía Patológica, Hospital Universitario de La Princesa, Madrid, España
| | - A García Herrera
- Servicio de Anatomía Patológica, Hospital Clinic, Barcelona, España
| | - M Garrido
- Departamento de Anatomía Patológica, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación I+12, Madrid, España
| | - M Á Idoate Gastearena
- Servicio de Anatomía Patológica, Hospital Universitario Virgen Macarena, Departamento de Citología, Histología y Anatomía Patológica, Facultad de Medicina, Universidad de Sevilla, Sevilla, España
| | - Á Christian Laga
- Departamento de Patología, Brigham and Women's Hospital, Boston, EE. UU
| | - M Llamas-Velasco
- Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, España
| | - N Martínez Campayo
- Servicio de Dermatología, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - C Monteagudo
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Valencia, Facultad de Medicina, Universidad de Valencia, Valencia, España
| | - J Onrubia
- Servicio de Anatomía Patológica, Hospital Universitario San Juan de Alicante, Alicante, España
| | - N Pérez Muñoz
- Servicio de Anatomía Patológica, Hospital Universitari General de Catalunya, Quirón salud, Barcelona, España
| | - J J Ríos-Martín
- Servicio de Anatomía Patológica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - E Ríos-Viñuela
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - J L Rodríguez Peralto
- Departamento de Anatomía Patológica, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación I+12, Madrid, España
| | - E Rozas Muñoz
- Departamento de Dermatología, Hospital de San Pablo, Coquimbo, Chile
| | - O Sanmartín
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - C Santonja
- Servicio de Anatomía Patológica, Fundación Jiménez Díaz, Madrid, España
| | - Á Santos-Briz
- Servicio de Anatomía Patológica, Hospital Universitario de Salamanca, Salamanca, España
| | - C Saus
- Servicio de Anatomía Patológica, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España
| | - J M Suárez Peñaranda
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, España
| | - V Velasco Benito
- Servicio de Anatomía Patológica, Hospital Universitario de Cruces, Barakaldo, Vizcaya, España
| | - M J Beato Merino
- Servicio de Anatomía Patológica, Hospital Universitario La Paz, Madrid, España
| | - A Fernandez-Flores
- Servicio de Anatomía Patológica, Hospital Universitario El Bierzo, Ponferrada, León, España; Servicio de Anatomía Patológica, Hospital de La Reina, Ponferrada, León, España; Unidad de Investigación, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidad de A Coruña, A Coruña, España.
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Buckley K, Baiocchi RA, Kaffenberger B, Chung CG. Cutaneous involvement of Erdheim-Chester disease in a patient with Burkitt lymphoma. J Cutan Pathol 2021; 48:928-931. [PMID: 33599338 DOI: 10.1111/cup.13988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/16/2020] [Accepted: 11/27/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Kaila Buckley
- Department of Pathology, CORPath/Riverside Methodist Hospital Associates, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Robert A Baiocchi
- Department of Internal Medicine, Divisions of Hematology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Catherine G Chung
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Truong K, Venning V, Wain T, Chou S, Fernandez-Peñas P. Successful treatment of highly refractory necrobiotic xanthogranuloma with peginterferon alfa-2a. Clin Exp Dermatol 2021; 46:731-733. [PMID: 33222242 DOI: 10.1111/ced.14523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 11/30/2022]
Affiliation(s)
- K Truong
- Departments of, Department of, Dermatology, Westmead Hospital, Sydney, NSW, Australia
| | - V Venning
- Departments of, Department of, Dermatology, Westmead Hospital, Sydney, NSW, Australia
| | - T Wain
- Departments of, Department of, Dermatology, Westmead Hospital, Sydney, NSW, Australia
| | - S Chou
- Department of, Tissue Pathology and Diagnostic Oncology, Westmead Hospital, Sydney, NSW, Australia
| | - P Fernandez-Peñas
- Departments of, Department of, Dermatology, Westmead Hospital, Sydney, NSW, Australia
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Dispenzieri A. Monoclonal gammopathies of clinical significance. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2020; 2020:380-388. [PMID: 33275738 PMCID: PMC7727544 DOI: 10.1182/hematology.2020000122] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
"Monoclonal gammopathy of clinical significance" (MGCS) is the term used to describe nonmalignant monoclonal gammopathies causing important disease. MGCS is the differential diagnosis for any patient presenting with what appears to be a monoclonal gammopathy of undetermined significance but is also experiencing other unexplained symptoms. Broadly, these conditions can be separated into symptoms and signs referable to the nerves, the kidneys, and the skin. The first step in making these diagnoses is to consider them. With a particular condition in mind, the next step is to order those tests that can help confirm or dismiss a particular diagnosis. Nearly all of the renal and dermatologic conditions are diagnosed by renal and skin biopsies, respectively. The importance of a highly competent renal pathologist and dermatopathologist cannot be underestimated. Biopsy is less specific for the neuropathic conditions. Because several of the MGCSs are syndromes, recognizing other manifestations is also key. Treatment recommendations for many of these conditions are anecdotal because of their rarity, but for several of the conditions, IV immunoglobulin, rituximab, and plasma cell-directed therapy are the best options.
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Affiliation(s)
- Angela Dispenzieri
- Division of Hematology and Division of Clinical Chemistry, Mayo Clinic, Rochester, MN
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González-López MA, González-Vela MC. Visual Dermatology: Necrobiotic Xanthogranuloma. J Cutan Med Surg 2020; 25:644. [PMID: 32726147 DOI: 10.1177/1203475420943252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Marcos A González-López
- 16516 Division of Dermatology, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Cantabria, Spain
| | - M Carmen González-Vela
- Division of Pathology, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Cantabria, Spain
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