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Mehta A, Luyten S, Abdulhak A, Mahmud H, Gillen W, Gru AA. Malignant Dendritic Cell Sarcomas in the Skin: 2 Cases of Rare Sarcoma Subtypes With Literature Review. Am J Dermatopathol 2024; 46:e106-e111. [PMID: 39008474 DOI: 10.1097/dad.0000000000002797] [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: 07/17/2024]
Abstract
ABSTRACT Interdigitating dendritic cell sarcoma is a rare, aggressive hematological malignancy primarily originating in lymph nodes, with only 10 reported cases presenting in the skin (primary cutaneous interdigitating dendritic cell sarcoma). Past presentations showed erythematous nodules on the proximal extremities, back, or face. Morphologically, these neoplasms are similar to melanomas and other dendritic cell (DC) tumors, making their diagnosis difficult. Here, we present 1 case of primary cutaneous interdigitating dendritic cell sarcomas and another 1 of malignant indeterminate dendritic cell tumor (indeterminate DC sarcoma). The first case is an 83-year-old man who presented with recent ulceration and bleeding of an asymptomatic, slow growing lesion on his right thigh with biopsy revealing a large, well-circumscribed polypoid spindle cell tumor in the dermis with atypical cells with vesicular nuclei in a lymphoplasmacytic background and immunohistochemistry positivity for CD45, CD68, S100, and Cyclin D1. The second case is a 74-year-old man who presented with a progressively darkening and enlarging abdominal skin lesion with biopsy revealing a diffuse infiltrate of atypical poorly differentiated pleomorphic nuclear cells and immunohistochemistry positivity for S100, CD1a, CD56, CD43, cyclin D1, CD31, CD4, and BRAF V600E. Our findings contribute to expand the reported literature on primary cutaneous DC sarcomas.
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Affiliation(s)
- Apoorva Mehta
- Department of Dermatology, Columbia University Medical Center, New York, NY
| | - Sophia Luyten
- Department of Dermatology, Columbia University Medical Center, New York, NY
| | - Abraham Abdulhak
- Department of Dermatology, Virginia Commonwealth University Health System, Richmond, VA
| | - Haseeb Mahmud
- Virginia Commonwealth University School of Medicine, Richmond, VA
| | - William Gillen
- Absolute Dermatology & Skin Cancer Center, Glen Allen, VA; and
- Departments of Pathology and Dermatology, University of Virginia School of Medicine, Charlottesville, VA
| | - Alejandro A Gru
- Department of Dermatology, Columbia University Medical Center, New York, NY
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Abeck F, Vehring J, Varwig-Janßen D, Menz A, Christolouka M, Schneider SW. A case of COVID-19-associated generalized indeterminate cell histiocytosis successfully treated with systemic PUVA. J Eur Acad Dermatol Venereol 2023; 37:e1372-e1374. [PMID: 37595957 DOI: 10.1111/jdv.19444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/14/2023] [Indexed: 08/20/2023]
Affiliation(s)
- Finn Abeck
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Justus Vehring
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Domenica Varwig-Janßen
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Menz
- Institute for Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maria Christolouka
- 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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Li Y, Zhang C, Xiong J. Recurrent Chemotherapy Treated Indeterminate Dendritic Cell Tumor: Case Report and Literature Review. Clin Cosmet Investig Dermatol 2023; 16:2985-2993. [PMID: 37881204 PMCID: PMC10596097 DOI: 10.2147/ccid.s429566] [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: 07/08/2023] [Accepted: 09/30/2023] [Indexed: 10/27/2023]
Abstract
Indeterminate dendritic cell tumor (IDCT) is an extremely uncommon histiocytic and dendritic neoplasms subtype that presents as single or multiple papules. There is currently no standard method for diagnosis and treatment, and the selection of therapeutic approaches is mainly based on successful examples of folk medicine. We describe a case of a pathology diagnosed indeterminate dendritic cell tumor, which shows the presence of CD1a, S100, and CD68, but lack langerin. She was treated with multi-chemotherapy regimens used to treat lymphoma and gained good results short term but was easy to recur. In addition, we reviewed the literature on the effectiveness and safety of chemotherapy in IDCT patients.
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Affiliation(s)
- Yujuan Li
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Chun Zhang
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Jing Xiong
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
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Koster SBL, Vinke ME, van den Bos C, van Heel WJM, Kranendonk MEG, Natté R, van Tuyll van Serooskerken AM. A case report of a blueberry muffin baby caused by congenital self-healing indeterminate cell histiocytosis. BMC Pediatr 2023; 23:111. [PMID: 36890472 PMCID: PMC9993593 DOI: 10.1186/s12887-023-03922-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 02/19/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Blueberry muffin is a descriptive term for a neonate with multiple purpuric skin lesions. Many causes are known, amongst them life-threatening diseases like congenital infections or leukemia. Indeterminate cell histiocytosis (ICH) is an exceptionally rare cause of blueberry muffin rash. ICH is a histiocytic disorder which can be limited to the skin or can present with systemic involvement. A mutation that has been described in histiocytic disorders is a MAP2K1 mutation. In ICH, this mutation has previously been described in merely one case. CASE PRESENTATION A term male neonate was admitted to the neonatology ward directly after birth because of a blueberry muffin rash. ICH was diagnosed on skin biopsy. The lesions resolved spontaneously. The patient is currently 3 years old and has had no cutaneous lesions or systemic involvement so far. This disease course is similar to that of the Hashimoto-Pritzker variant of LCH. CONCLUSIONS ICH can manifest in neonates as resolving skin lesions. It is limited to the skin in most cases, but systemic development is possible. Therefore, it is essential to confirm the diagnosis with a biopsy before the lesions resolve and to monitor these patients closely with routine follow-up.
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Affiliation(s)
- S B L Koster
- Department of Dermatology, Erasmus Medisch Centrum, Doctor Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands.
| | - M E Vinke
- Department of Hemato-oncology, Prinses Máxima Centrum, Heidelberglaan 25, 3584, CS, Utrecht, The Netherlands
| | - C van den Bos
- Department of Hemato-oncology, Prinses Máxima Centrum, Heidelberglaan 25, 3584, CS, Utrecht, The Netherlands
| | - W J M van Heel
- Department of Pediatrics, HagaZiekenhuis/Juliana Kinderziekenhuis, Els Borst-Eilersplein 275, 2545, AA, Den Haag, The Netherlands
| | - M E G Kranendonk
- Department of Pathology, Prinses Máxima Centrum, Heidelberglaan 25, 3584, CS, Utrecht, The Netherlands
| | - R Natté
- Department of Pathology, HagaZiekenhuis, Els Borst-Eilersplein 275, 2545, AA, Den Haag, The Netherlands
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Indeterminate Dendritic Cell Tumor as Cutaneous Involvement of Chronic Myelomonocytic Leukemia Successfully Treated With Phototherapy. Am J Dermatopathol 2021; 42:876-880. [PMID: 32568837 DOI: 10.1097/dad.0000000000001703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Indeterminate dendritic cell tumor (IDCT) is a rare disease composed of so-called indeterminate cells, a dendritic cell subset displaying histological and some ultrastructural and immunophenotypic features of Langerhans cells, but lacking Birbeck granules. We report a case of cutaneous IDCT occurring in a patient with chronic myelomonocytic leukemia (CMML) successfully treated with UV-A phototherapy. Next-generation sequencing studies of the CMML demonstrated mutations in TET2, ASXL1, and ZRS2 genes, also detected in the IDCT, demonstrating a clonal relationship between both tumors and confirming IDCT as a specific subtype in the spectrum of CMML-related cutaneous lesions.
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Abstract
Indeterminate cell histiocytosis (ICH) is a rare proliferative disorder of histiocytes, which display morphologic and immunophenotypic characteristics of both Langerhans cell histiocytosis (LCH) and non-Langerhans cell histiocytosis (NLCH). We describe an unusual clinical presentation of ICH mimicking rosacea and provide a relevant review of the literature.
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Affiliation(s)
| | - Angela G Zaladonis
- Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, USA
| | - Paul Subrt
- Dermatology, Katy Westside Dermatology, Katy, USA
| | - Jaime Tschen
- Dermatology, Baylor College of Medicine, Houston, USA
| | - Sylvia Hsu
- Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, USA
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Akdogan N, Demircan C, Bolek EC, Gokoz O, Karaduman A. Indeterminate cell histiocytosis in a patient with systemic lupus erythematosus and antiphospholipid antibody syndrome: an unusual association. Lupus 2019; 29:74-78. [PMID: 31789127 DOI: 10.1177/0961203319890675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Indeterminate cell histiocytosis (ICH) is an extremely rare clonal proliferative disorder of dendritic cells which presents with skin lesions in the majority of cases. Although extra-cutaneous manifestations are very rare, ICH may involve the mucosa, cornea, and conjunctiva as well as the visceral organs. Since the clinical appearance of cutaneous lesions of ICH is not distinctive, it is diagnosed with histopathological and immunohistochemical findings after clinical suspicion. Herein, we report a 27-year-old man with a two-year history of asymptomatic reddish papules and papulonecrotic lesions on his face, arms and buttocks. He was previously diagnosed with systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (APS), and he had been treated with hydroxychloroquine and low-dose aspirin. Diffuse dermal infiltration of a mixture of histiocytes and lymphocytes accompanied with multinuclear giant cells, the positive CD68 and Factor XIIIa and negative Langerin immunoreactions, along with the positive staining with CD1a and S100, led us to the diagnosis of ICH. To the best of our knowledge, this is the first case of ICH associated with SLE and APS.
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Affiliation(s)
- N Akdogan
- Department of Dermatology and Venereology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - C Demircan
- Department of Dermatology and Venereology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - E C Bolek
- Department of Internal Medicine, School of Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - O Gokoz
- Department of Pathology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - A Karaduman
- Department of Dermatology and Venereology, School of Medicine, Hacettepe University, Ankara, Turkey
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Indeterminate Dendritic Cell Tumor: A Report of Two New Cases Lacking the ETV3-NCOA2 Translocation and a Literature Review. Am J Dermatopathol 2019; 40:736-748. [PMID: 29877893 DOI: 10.1097/dad.0000000000001191] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Indeterminate dendritic cell tumor (IDCT) is a cutaneous proliferation of histiocytes that share morphologic and immunophenotypic properties with Langerhans cells. IDCT was recently included in the updated WHO classification of tumors of hematopoietic and lymphoid tissues. Recent studies have shown that some cases of IDCT demonstrate an ETV3-NCOA2 translocation, supporting the idea that IDCT is a clonal neoplasm. We report 2 new cases of IDCT at our institution lacking the ETV3-NCOA2 translocation. We also present a comprehensive review of reported cases of IDCT in the medical literature. Eighty-five cases of IDCT were reported in the literature between 1985 and 2016. The median age at diagnosis was 45 years. In contrast to Langerhans cell histiocytosis, IDCT is limited to the skin in the majority of cases (88%) and generally follows an indolent clinical course. Most reported lesions are cured with complete excision. However, the histologic features of IDCT and langerhans cell histiocytosis are similar. Conjoint immunostaining for CD1a and langerin is necessary for optimal classification.
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Kiyohara T, Nakamaru S, Miyamoto M, Shijimaya T, Nagano N, Makimura K, Takama H, Akiyama M, Tanimura H. Indeterminate dendritic cell neoplasm accompanied by eosinophilic pneumonia successfully treated by systemic steroid therapy: Report of the first case with muscular and parotid involvement and review of published work. J Dermatol 2018; 45:1444-1447. [PMID: 30320463 DOI: 10.1111/1346-8138.14673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 09/03/2018] [Indexed: 11/29/2022]
Abstract
A 34-year-old Japanese man presented with an indolent nodule on the right flank. Computed tomography of the chest and abdomen demonstrated a large nodule measuring 55 mm × 50 mm in the abdominal oblique muscle layer of the right flank, and several small nodules were seen in the muscle layer throughout the body and subcutaneous tissue of the lower abdomen. 18 F-fluorodeoxyglucose-positron emission tomography/computed tomography revealed nodular lesions in the bilateral parotid glands, bilateral cervical lymph nodes and lower lobe of the right lung. Intermittently, ground-glass shadows developed in the bilateral lungs. Histologically, sheet-like nodules in the abdominal oblique muscle layer and parotid gland were composed of large polygonal cells with convoluted nuclei and ample eosinophilic cytoplasm. Several lymphocytes and considerable eosinophils were intermingled. Lung biopsy demonstrated an inflammatory infiltrate of lymphocytes and considerable eosinophils in the alveoli. Immunohistochemically, polygonal cells were positive for S100 protein and CD1a, but negative for langerin and BRAFV600E . Some cells were positive for CD68. Electron microscopy demonstrated histiocytic cells with phagosomes and interdigitating processes. However, no Birbeck granules were observed. Eosinophilia was seen in the peripheral blood. Multifocal nodules and ground-glass shadows gradually diminished following systemic administration of oral prednisolone. We describe a case of indeterminate dendritic cell neoplasm with multifocal involvement of the muscle, subcutis, lymph node and parotid gland accompanied by chronic eosinophilic pneumonia that was successfully treated by systemic steroid therapy. Neither muscular nor parotid indeterminate dendritic cell neoplasms accompanied by eosinophilic pneumonia have been previously reported.
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Affiliation(s)
- Takahiro Kiyohara
- Department of Dermatology, Kansai Medical University Medical Center, Osaka, Japan
| | - Sei Nakamaru
- Department of Dermatology, Kansai Medical University Medical Center, Osaka, Japan
| | - Mari Miyamoto
- Department of Dermatology, Kansai Medical University Medical Center, Osaka, Japan
| | - Takako Shijimaya
- Department of Dermatology, Kansai Medical University Medical Center, Osaka, Japan
| | - Naoko Nagano
- Department of Dermatology, Kansai Medical University Medical Center, Osaka, Japan
| | - Kaoru Makimura
- Department of Dermatology, Kansai Medical University Medical Center, Osaka, Japan
| | - Hiroyuki Takama
- Department of Dermatology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Masashi Akiyama
- Department of Dermatology, Nagoya University School of Medicine, Nagoya, Japan
| | - Hirotsugu Tanimura
- Department of Dermatology, Kansai Medical University Medical Center, Osaka, Japan
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Sahuquillo-Torralba A, Navarro-Mira M, Llavador-Ros M, Botella-Estrada R. Indeterminate Cell Histiocytosis in Children: A Case Report. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2017.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Sahuquillo-Torralba A, Navarro-Mira M, Llavador-Ros M, Botella-Estrada R. Histiocitosis de células indeterminadas en edad pediátrica: a propósito de un caso. ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:871-874. [DOI: 10.1016/j.ad.2017.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 01/10/2017] [Accepted: 01/13/2017] [Indexed: 01/19/2023] Open
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Horna P, Shao H, Idrees A, Glass LF, Torres-Cabala CA. Indeterminate dendritic cell neoplasm of the skin: A 2-case report and review of the literature. J Cutan Pathol 2017; 44:958-963. [PMID: 28880462 DOI: 10.1111/cup.13017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 06/29/2017] [Accepted: 08/06/2017] [Indexed: 11/27/2022]
Abstract
Indeterminate dendritic cell neoplasm (IDCN) is an exceedingly rare and mostly cutaneous histiocytosis, frequently associated with other hematopoietic malignancies. We report 2 cases of multilesional cutaneous IDCN. A 55-year-old male with no associated malignancy and complete response to ultraviolet phototherapy; and a 72-year-old male with chronic myelomonocytic leukemia (CMML). Both cases showed histiocytoid cytology, positivity for CD1a and no expression of langerin or BRAFV600E . With our patients, the literature describes 79 cases of IDCNs, including 65 (82%) with only skin involvement, 7 cases (9%) with involvement of skin and a second site, 5 cases (6%) involving lymph nodes only, 1 splenic lesion and 1 systemic disease. Seventeen cases (22%) were associated with other hematopoietic malignancies, most commonly CMML (6 cases), follicular lymphoma (4 cases) and acute myeloid leukemia (3 cases). All IDCNs associated with myeloid malignancies were limited to the skin, while most cases associated with lymphoma were limited to lymph nodes. Reported responses of cutaneous lesions to ultraviolet phototherapy are encouraging, while systemic chemotherapy is appropriate for clinically aggressive cases and treatment of associated malignancies. Recognition of the clinico-morphologic spectrum of IDCNs should prevent misdiagnoses and prompt investigation of possible associated neoplasms.
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Affiliation(s)
- Pedro Horna
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota
| | - Haipeng Shao
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Afshan Idrees
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - L Frank Glass
- Department of Dermatology, George Washington University, Washington, District of Columbia
| | - Carlos A Torres-Cabala
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, Texas
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Cutaneous Indeterminate Cell Histiocytosis of Donor Origin After Allogeneic Hematopoietic Stem-Cell Transplantation. Am J Dermatopathol 2017; 39:696-699. [DOI: 10.1097/dad.0000000000000935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zerbini MCN, Sotto MN, de Campos FPF, Abdo ANR, Pereira J, Sanches JA, Martins JC. Indeterminate cell histiocytosis successfully treated with phototherapy. AUTOPSY AND CASE REPORTS 2016; 6:33-8. [PMID: 27547741 PMCID: PMC4982782 DOI: 10.4322/acr.2016.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 06/10/2016] [Indexed: 11/23/2022] Open
Abstract
First described in 1985, intermediate cell histiocytosis is a rare disorder of the cutaneous dendritic cell group with a varied clinical presentation and evolution. The pathologic substrate is constituted by the proliferation of indeterminate cells (ICs) that are immunophenotypically characterized by the positivity of CD1a, CD68, and faint/focal S100, plus the negativity for CD207 (langerin). The authors present the case of a healthy elderly woman who presented generalized dome-shaped reddish cutaneous nodules over her trunk, neck, face, and extremities over a period of 18 months. A laboratory and imaging work-up ruled out internal involvement. The skin biopsy was consistent with IC histiocytosis. The patient was treated with narrowband ultraviolet B phototherapy, which resulted in an excellent short-term outcome.
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Affiliation(s)
| | - Mirian Nacagami Sotto
- Department of Pathology - Faculty of Medicine - University of São Paulo, São Paulo/SP - Brazil
| | | | | | - Juliana Pereira
- Hematologic Oncology Department - Instituto do Câncer de São Paulo, São Paulo/SP - Brazil.; Department of Hematology - Faculty of Medicine - University of São Paulo, São Paulo/SP - Brazil
| | - José Antônio Sanches
- Dermatology Department - Faculty of Medicine - Hospital das Clínicas - University of São Paulo, São Paulo/SP - Brazil
| | - Jade Cury Martins
- Dermatology Department - Faculty of Medicine - Hospital das Clínicas - University of São Paulo, São Paulo/SP - Brazil
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Abstract
Primary indeterminate dendritic cell tumor (IDCT) is an extremely neoplastic dendritic cell disorder. Little is known about its pathogenesis, etiology, and prognostic factors because of its rarity. Herein, we present a case report of a skin IDCT that arose in mosquito bite and discuss the correlation between hypersensitivity to mosquito bites and leukemia/lymphoma.A 28-year old man presented with multiple widespread cutaneous plaques and nodules 8 months after being bitten by a mosquito on his back. Dermatological examination revealed multiple skin-colored, well-demarcated plaques and nodules measuring approximately 0.5 to 1.8 cm in diameter all over the body. A biopsy of the skin lesion was taken. Morphologically, the dermis was effaced by round or polygonal cells with oval nuclei and abundant eosinophilic cytoplasm, arranged in nests and in some areas in a sheet-like pattern. The tumor cells were positive for CD68, CD1a, and S-100, whereas negative for Langerin and lack Birbeck granules ultrastructurally. A diagnosis of IDCT was made. No treatment was given. The patient was alive with spontaneous disease regression after 17 months of follow-up.IDCT is an extremely rare disease and may be associated with mosquito bite.
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Affiliation(s)
- Xianglan Mo
- From the Department of Pathology (XM, WG), People's Hospital of Guangxi Province, Nanning, Guangxi, China; and Department of Histopathology (HY), Royal National Orthopaedic Hospital NHS Trust, Middlesex, UK
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Bakry OA, Samaka RM, Kandil MA, Younes SF. Indeterminate cell histiocytosis with naïve cells. Rare Tumors 2013; 5:e13. [PMID: 23772299 PMCID: PMC3682452 DOI: 10.4081/rt.2013.e13] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 12/19/2012] [Accepted: 01/14/2013] [Indexed: 11/28/2022] Open
Abstract
Histiocytoses are a heterogeneous group of disorders characterized by proliferation and accumulation of cells of mononuclear-macrophage system and dendritic cells. Histiocytoses are categorized according to the cell of origin into Langerhans cell histiocytosis (LCH), Non Langerhans cell histiocytoses and indeterminate cell histiocytosis (ICH). ICH is an extraordinary rare neoplastic dendritic cell disorder that has poorly understood histogenesis and pathogenesis. It is characterized by a proliferation of dendritic cells, which mimic Langerhans cells immunophenotypically (positive for CD1a and S-100 protein), but lack Birbeck granules characteristic of Langerhans cells. Twenty-four year-old Egyptian male was presented with reddish brown chest wall nodule. Clinical, histopathological, immunohistochemical and ultrastructure features are typical for ICH. He was in a good state without any evidence of recurrence or metastasis after 24 months follow up. Peculiar histopathological features were detected in the present case. Many unidentified cells with Hematoxylin & Eosin Langerhans like features showed negative staining for S-100, CD1a, Langerin and CD68. In absence of cellular atypia and mitosis, the infiltrating cells showed epidermotropism that was reported once in ICH as well as neural and perineural invasion that were not previously reported. Therefore we prefer using a tentatively designated diagnosis; dendritic cell tumor, not otherwise specified or newly proposed diagnosis (Indeterminate cell histocytosis with naïve cells) for the present case.
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Affiliation(s)
- Ola A Bakry
- Department of Dermatology, Andrology and STDs
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Bard S, Torchia D, Connelly EA, Duarte AM, Badiavas EV, Schachner LA. S100-negative indeterminate cell histiocytosis in an African American child responsive to narrowband ultraviolet B. Pediatr Dermatol 2011; 28:524-7. [PMID: 21916959 DOI: 10.1111/j.1525-1470.2011.01305.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Indeterminate cell histiocytosis is a rare cutaneous disease characterized by the presence of dendritic cells that lack Birbeck granules and immunophenotypically shares features of both Langerhans cells and macrophages. We describe a case of a 4-year-old African American boy affected by a disseminated, exclusively mucocutaneous form of indeterminate cell histiocytosis. The eruption was successfully treated with narrowband ultraviolet B. The peculiar negativity of the Langerhans cell marker S100 is also discussed.
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Affiliation(s)
- Susan Bard
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida 33125, USA.
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Ferrara G, Vallone R, Di Blasi A. Monoblastic leukaemia/sarcoma of the skin with an indeterminate cell immunophenotype: cyto-haematological correlation. Cytopathology 2010; 21:407-10. [PMID: 20109163 DOI: 10.1111/j.1365-2303.2009.00730.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- G Ferrara
- Pathologic Anatomy Unit, Gaetano Rummo General Hospital, Benevento, Italy.
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Randrianasolo MP, Beylot-Barry M, Vergier B, Cipriano G, Jegou-Penouil MH, Doutre MS. Aggressive intermediate cell histiocytosis successfully treated by 2-chlorodeoxyadenosine. J Eur Acad Dermatol Venereol 2008; 22:1153-6. [PMID: 18384558 DOI: 10.1111/j.1468-3083.2008.02703.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Caputo R, Marzano AV, Passoni E, Berti E. Unusual variants of non-Langerhans cell histiocytoses. J Am Acad Dermatol 2007; 57:1031-45. [PMID: 17485142 DOI: 10.1016/j.jaad.2007.03.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2006] [Revised: 01/31/2007] [Accepted: 03/06/2007] [Indexed: 11/23/2022]
Abstract
Histiocytic syndromes represent a large, heterogeneous group of diseases resulting from proliferation of histiocytes. In addition to the classic variants, the subset of non-Langerhans cell histiocytoses comprises rare entities that have more recently been described. These last include both forms that affect only the skin or the skin and mucous membranes, and usually show a benign clinical behavior, and forms involving also internal organs, which may follow an aggressive course. The goal of this review is to outline the clinical, histologic, and ultrastructural features and the course, prognosis, and management of these unusual histiocytic syndromes.
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Affiliation(s)
- Ruggero Caputo
- Institute of Dermatological Sciences, University of Milan-Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy
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Vener C, Soligo D, Berti E, Gianelli U, Servida F, Ceretti E, Caputo R, Passoni E, Lambertenghi Deliliers G. Indeterminate cell histiocytosis in association with later occurrence of acute myeloblastic leukaemia. Br J Dermatol 2007; 156:1357-61. [PMID: 17459045 DOI: 10.1111/j.1365-2133.2007.07880.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Indeterminate cell histiocytosis (ICH) is a proliferation of indeterminate CD1a+, CD68+, S100+ and CD207- dermal dendritic cells. We describe a 39-year-old man who developed diffuse ICH and, 6 years later, acute myeloblastic leukaemia (AML). He was treated with cyclophosphamide, etoposide and vinblastine until 2003. In August 2004, he presented dyspnoea, hyperpyrexia and infiltration of the lung parenchyma, compatible with an AML invasion, and died after a course of induction chemotherapy. Cytomorphology and immunophenotype analyses suggested an ICH clonal evolution. The leukaemogenic role of etoposide is discussed. ICH has previously been reported in association with B-cell malignancy, but only one case has shown systemic progression.
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Affiliation(s)
- C Vener
- Hematology I, Bone Marrow Transplant Unit, Policlinico IRCCS Hospital, Mangiagalli and Regina Elena Foundation, University of Milan, Milan, Italy.
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Abstract
Indeterminate cell histiocytosis is an exceptional and controversial entity with variable clinical, histopathologic or immunohistochemical findings, sharing morphologic and immunophenotypic features from both Langerhans and non-Langerhans cell histiocytoses. Neoplastic cells express S-100 and CD1a antigens, but lack Birbeck granules. It has been reported in both adults and children, as solitary or multiple cutaneous lesions with rare extracutaneous involvement. We describe a 12-year-old boy with an indeterminate cell histiocytosis manifesting as a solitary verrucous papule on the mucosa of the glans penis. The morphologic features and diagnostic criteria of cutaneous indeterminate cell histiocytic proliferations are reviewed. The possible relationship between indeterminate cell and Langerhans cell histiocytoses is discussed.
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Affiliation(s)
- Marta Ferran
- Department of Dermatology, Hospital del Mar, IMAS, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Nakahigashi K, Ohta M, Sakai R, Sugimoto Y, Ikoma Y, Horiguchi Y. Late-onset self-healing reticulohistiocytosis: Pediatric case of Hashimoto?Pritzker type Langerhans cell histiocytosis. J Dermatol 2007; 34:205-9. [PMID: 17291304 DOI: 10.1111/j.1346-8138.2007.00251.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
An 8-year-old otherwise healthy girl presented with a 3-month history of multiple asymptomatic, reddish-brown papules over the face and upper limbs. Histopathological and immunohistochemical examinations demonstrated an infiltrate of mononuclear cells containing abundant histiocytic cells in the dermis, and microabscess-like accumulation of the histiocytic cells in the epidermis. The histiocytic cells were positive for antibodies against S-100 protein and CD1a, but negative for anti-CD68. Lag and anti-langerin monoclonal antibodies reacted more weakly with these histiocytic cells than with Langerhans cells in the surrounding epidermis. The skin lesions spontaneously regressed within the following 3 months, and neither systemic involvement nor local recurrence was observed during the next 10 months. This case should be categorized as congenital self-healing reticulohistiocytosis (Hashimoto-Pritzker), although the onset was not early in life.
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Affiliation(s)
- Kyoko Nakahigashi
- Department of Dermatology, Osaka Red Cross Hospital, Ten'noji-ku, Osaka, Japan
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Frater JL, Kling CW, Obadiah JM, Gardner LJ, Grosso LE, Resh B, Hurley MY. Histiocytic sarcoma with secondary involvement of the skin and expression of CD1a: evidence of indeterminate cell differentiation? J Cutan Pathol 2006; 33:437-42. [PMID: 16776720 DOI: 10.1111/j.0303-6987.2006.00453.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Histiocytic sarcoma is an exceedingly rare malignant neoplasm composed of cells with a monocyte/macrophage phenotype. In the current nosology of histiocytic neoplasms, histiocytic sarcoma is separate from indeterminate cell histiocytosis, a generally benign disorder characterized by proliferation of a CD1a+ and S-100+ population of cells lacking Birbeck granules usually limited to the skin. METHODS We present a case of histiocytic sarcoma in a 64-year-old man presenting as a peritonsillar mass and secondarily involving the skin. RESULTS The malignant cells in the extracutaneous foci of disease expressed macrophage-associated antigens including S-100 but were CD1a-. The malignant cells in the skin coexpressed CD1a and S-100 but lacked ultrastructural features of Langerhans cells, findings indicative of indeterminate cells. CONCLUSIONS We discuss the clinical and histopathologic differential diagnosis in association with prior reported cases of histiocytic sarcoma, particularly in cases involving the skin and cases expressing the Langerhans cell-associated antigen CD1a.
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Affiliation(s)
- John L Frater
- Department of Pathology, Saint Louis University School of Medicine, St Louis, MO 63104, USA
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Ratzinger G, Burgdorf WHC, Metze D, Zelger BG, Zelger B. Indeterminate cell histiocytosis: fact or fiction? J Cutan Pathol 2005; 32:552-60. [PMID: 16115054 DOI: 10.1111/j.0303-6987.2005.00382.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Indeterminate cell histiocytosis is a rare disorder, in which the predominant cells have the characteristics of both Langerhans cells and macrophages. We, in this study, describe 18 patients and compare them with those previously published. Most patients were adults with either solitary or multiple red-brown papules or nodules. While most lesions were confined to the skin, both conjunctival and bony involvement was seen. Histologically, the lesions showed patterns resembling those described for xanthogranulomas, with predominantly oncocytic (nine patients), spindled (five patients), scalloped (two patients) or vacuolated (two patients) macrophages. The accompanying infiltrate was mainly lymphocytic, although eosinophils and occasionally plasma cells were seen. All lesions were positive for macrophage markers, such as KP1 (CD68) and Ki-M1p, as well as for S-100 protein and showed variable reactivity for CD1a. No Birbeck granules were seen ultrastructurally in one patient. Some patients shared features with sinus histiocytosis with massive lymphadenopathy. It is unclear whether this disorder is a separate entity or represents various macrophage disorders identified at various time points in the inflammatory response. Ratzinger G, Burgdorf WHC, Metze D, Zelger BG, Zelger B. Indeterminate cell histiocytosis: fact or fiction? A clinicopathological series of 18 patients.
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Affiliation(s)
- Gudrun Ratzinger
- Clinical Department of Dermatology and Venereology, Innsbruck Medical University, Innsbruck, Austria.
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Abstract
Indeterminate cell histiocytosis is a rare neoplasm composed of cells with mixed characteristics of Langerhans cells and non-Langerhans cells. An otherwise healthy, 36-year-old woman presented with asymptomatic generalized papules and nodules that had appeared on all four extremities, the trunk, and cheeks in the previous 6 months. The lesions were firm, painless, non-pruritic, and slightly flesh-yellow or reddish-brown in color. Histopathologic, immunohistochemical examination and electron microscopic studies showed characteristic findings of indeterminate cell histiocytosis: diffuse proliferative histiocytes infiltrating the dermis without epidermotropism or atypia; neoplastic cells expressing markers characteristic of both Langerhans cells (CD1a, S-100) and focal monocytes/macrophages (Factor XIIIa, CD68); and no Birbeck granules within the cytoplasm of the neoplastic cells. Flow cytometry revealed more CD34+ cells in the peripheral blood of the patient than in peripheral blood from a control. Interestingly, the patient responded favorably to psoralen ultraviolet A-range treatment. Herein, we present this case and review the literature.
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Affiliation(s)
- Chun-Hua Wang
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Rodríguez-Jurado R, Vidaurri-de la Cruz H, Durán-Mckinster C, Ruíz-Maldonado R. Indeterminate cell histiocytosis. Clinical and pathologic study in a pediatric patient. Arch Pathol Lab Med 2003; 127:748-51. [PMID: 12741905 DOI: 10.5858/2003-127-748-ich] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Indeterminate cell histiocytosis is a rare disorder involving altered homing mechanisms of the cutaneous histiocytic/dendritic system. It has been described predominantly in adults, with less than a dozen cases in children. A 13-year-old adolescent girl presented with a 4-year history of asymptomatic erythematous nodules and plaques, measuring from 1 to 5 cm in diameter, that were located mainly on the trunk and proximal portions of her limbs. A skin biopsy showed dermal diffuse infiltration of histiocytic cells. Most of the histiocytic cells were strongly positive for S100 protein. No Birbeck granules were found. Treatment with topical steroid was ineffective. After 6 months of pure coal tar and 5% 5-fluorouracil cream, an almost total clearing of lesions was observed. An accurate diagnosis of this condition is mandatory in order to avoid unnecessary treatments. Conservative management is also discussed.
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Abstract
Until recently, malignant histiocytosis was a clearly defined clinical entity marked by fever, progressive wasting, lymphadenopathy, hepatosplenomegaly, and pancytopenia. However, for many years the morphologic findings in this disease continued to cause a great deal of controversy. Now it seems clear that most cases of malignant histiocytosis represent anaplastic large cell lymphoma (ALCL) with Ki 1 expression, and they are not related to the monocyte/macrophage system. This conclusion is based on histopathologic and immunohistochemical findings, and more recently, on results from genotypic studies. Thus, malignant histiocytosis is a "vanishing disease."
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Affiliation(s)
- D Schmidt
- Institute of Pathology, Mannheim, Germany.
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