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Nakamine H, Yamakawa M, Yoshino T, Fukumoto T, Enomoto Y, Matsumura I. Langerhans Cell Histiocytosis and Langerhans Cell Sarcoma: Current Understanding and Differential Diagnosis. J Clin Exp Hematop 2017; 56:109-118. [PMID: 27980300 DOI: 10.3960/jslrt.56.109] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Langerhans cell (LC) histiocytosis (LCH) and LC sarcoma (LCS) are proliferative processes consisting of cells having morphologic and phenotypic features of Langerhans cells (LCs), although the latter may have lost some of these features. Because neoplastic nature of LCH as well as LCS is more likely by recent studies, a category of LC hyperplasia can be better characterized. LCH and LCS are rarely seen in daily pathology practice, but it is important to accurately characterize these lesions. For this purpose, an outline covering proliferations of LC and related cells was constructed. The scheme of this outline is based especially on evaluating borderline lesions, neoplastic trans-differentiation, and degree of similarity with the normal counter-parts. In addition, the organization and update of the current classification scheme for histiocytic and dendritic-cell proliferations is presented.
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Cardoso JC, Cravo M, Cardoso R, Brites MM, Reis JP, Tellechea O, Eloy C, Figueiredo A. Langerhans cell histiocytosis in an adult: good response of cutaneous lesions to acitretin. Clin Exp Dermatol 2010; 35:627-30. [DOI: 10.1111/j.1365-2230.2010.03784.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dewan M, Al-Ghamdi AA, Zahrani MB. Lessons to be learned--Langerhans' cell histiocytosis. ACTA ACUST UNITED AC 2008; 128:41-6. [PMID: 18274329 DOI: 10.1177/1466424007085224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Langerhans' cell histiocytosis (LCH) is a neoplastic disease due to uncontrolled proliferation of Langerhans' cells (LCs); damage to organs involved appears to be due to the various cytokines secreted. The true cause of LCH remains a mystery. LCH can present at any age; there is female predominance and the skin is often the first site to be involved. Scaly papules, vesicles, purpuric nodules, plaques and ulcers are the main diverse presentations typically found on the scalp, flexures (including the perineum), crease below the breast, palms, soles and nails. The patient described here is a 35-year-old Saudi Arabian woman with a vulval ulcer that had been misdiagnosed as an infective lesion 11 months before the correct diagnosis of LCH was made by means of biopsy examination. Diffuse infiltration of LCs with large pale reniform/convoluted nuclei and abundant amphophilic cytoplasm in the company of neutrophils, eosinophils, lymphocytes and plasma cells were observed on light microscopy. Immunohistochemical staining, indicating S100 protein positivity in LCs and the demonstration of Birbeck granules by means of electron microscopy, confirmed the diagnosis. The 'skin-only' LCH may later progress to involve other organs; alternatively skin lesions may be part of the multisystem, disseminated disease. There is need for careful follow-up of all LCH patients, as the course of the disease cannot be reliably predicted from either the clinical presentation or histology of the lesion. In many cases the prognosis is good, there being limited involvement that does not progress. Surgery or local steroids might suffice as therapy. However, for severely symptomatic disease, in which there are complications associated with dysfunction (or failure) of vital organs such as the liver, lungs, and central nervous system, the use of a variety of immunosuppressive treatments--and the recently described 2-chloro-2-deoxyadenosine (2CdA) (cladribine)--have been suggested; however, the type and extent of disease that will respond to this therapy has not yet been clarified. Solid laboratory research and rigorous clinical trials are required for more effective and less toxic therapies for patients with progressive LCH.
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Affiliation(s)
- Madhu Dewan
- Assir Central Hospital, Abha, PO Box 34, Assir Region, Saudi Arabia.
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A case of adult Langerhans cell histiocytosis showing successfully regenerated osseous tissue of the skull after chemotherapy. Int J Hematol 2008; 87:284-8. [PMID: 18259837 DOI: 10.1007/s12185-008-0033-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Revised: 11/29/2007] [Accepted: 12/14/2007] [Indexed: 10/22/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a proliferative disorder of Langerhans cells and extremely rare in adults. Adult LCH is often associated with osteolytic bone lesions, but large bone-defective lesions have been rarely reported. We report an adult case of LCH accompanied by large osteolytic lesions in the skull that successfully responded to chemotherapy. A 47-year-old woman with LCH who had multiple, large osteolytic areas of more than 3 cm in diameter in the skull was admitted to our hospital. She was treated with systemic chemotherapy consisting of prednisolone, vinblastine, and 6-mercaptopurine. Twelve months later, when she completed the treatment, osteolytic areas were covered with hard osseous tissue, and X-ray examination confirmed regeneration of the bone. This case indicates that chemotherapy can be effective even for the treatment of large osteolytic lesions in adult LCH patients.
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Pauluzzi P, Trevisan G, Sartori P. Langerhans-cell histiocytosis confined to the skin of an elderly patient. J Eur Acad Dermatol Venereol 2006. [DOI: 10.1111/j.1468-3083.1994.tb00404.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kinra P, Mukherjee B, Srinivas V, Thind SS, Subramanya H. Langerhans' Cell Histiocytosis - Case Report. Med J Armed Forces India 2005; 61:88-90. [PMID: 27407715 DOI: 10.1016/s0377-1237(05)80132-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2003] [Accepted: 05/08/2003] [Indexed: 11/16/2022] Open
Affiliation(s)
- P Kinra
- Graded Specialist (Pathology), 7 Air Force Hospital, Kanpur
| | - B Mukherjee
- Classified Specialist (Pathology), Military Hospital Agra
| | - V Srinivas
- Classified Specialist (Pathology & Onco Pathology), Command Hospital (Eastern Command), Kolkata
| | - S S Thind
- Classified Specialist (Radiology) 167 MH, Bangalore
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MESH Headings
- Histiocytosis, Langerhans-Cell/diagnosis
- Histiocytosis, Langerhans-Cell/epidemiology
- Histiocytosis, Langerhans-Cell/pathology
- Histiocytosis, Langerhans-Cell/therapy
- Histiocytosis, Non-Langerhans-Cell/diagnosis
- Histiocytosis, Non-Langerhans-Cell/epidemiology
- Histiocytosis, Non-Langerhans-Cell/pathology
- Histiocytosis, Non-Langerhans-Cell/therapy
- Histiocytosis, Sinus/diagnosis
- Histiocytosis, Sinus/epidemiology
- Histiocytosis, Sinus/pathology
- Histiocytosis, Sinus/therapy
- Humans
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Affiliation(s)
- Jan Inge Henter
- Department of Pediatric Hematology/Oncology, Karolinska Hospital, Childhood Cancer Research Unit, Karolinska Institutet, Stockholm, Sweden.
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Yu FC, Gibbon GW, Klaustermeyer WB. Refractory atopic dermatitis treated with low dose cyclosporin. Ann Allergy Asthma Immunol 2002; 89:127-31. [PMID: 12197567 DOI: 10.1016/s1081-1206(10)61927-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Francis C Yu
- Allergy and Immunology Section, Greater Los Angeles VA Medical Center, and UCLA, California 90073, USA.
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Pather S, Moodley JM, Bramdev A. Isolated Langerhans cell histiocytosis of the vulva: a case report. J Obstet Gynaecol Res 2001; 27:111-5. [PMID: 11561825 DOI: 10.1111/j.1447-0756.2001.tb01233.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We present a case of isolated vulval Langerhans cell histiocytosis (LCH) that was initially treated with an excision biopsy but recurred 2 months later. Local vulval radiotherapy resulted in complete resolution of the lesion and there was no evidence of recurrence after 24 months of follow-up.
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Affiliation(s)
- S Pather
- Department of Obstetrics and Gynaecology, Christchurch School of Medicine, New Zealand
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Lazova R, Shapiro PE. Juvenile xanthogranuloma versus Langerhans cell histiocytosis (histiocytosis X). SEMINARS IN CUTANEOUS MEDICINE AND SURGERY 1999; 18:71-7. [PMID: 10188845 DOI: 10.1016/s1085-5629(99)80011-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- R Lazova
- Department of Dermatology, Yale University School of Medicine, New Haven 06520, USA
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Abstract
A 76-year-old man with Langerhans cell histiocytosis was admitted with an asymptomatic, dark red nodule on his left buttock. Histologic examination of the nodule showed a dense dermal infiltrate of histiocytic cells with bean-shaped nuclei; these cells reacted with antibodies to S-100 and CD1a. Ultrastructural analysis showed Birbeck granules in the cytoplasm of the histiocytic cells. Inguinal lymph node involvement subsequently developed in the patient and cutaneous nodules recurred three times in the inguinal area. Four years have passed since he first was admitted to our hospital with the cutaneous nodule on his buttock, and he is doing well without any intensive treatment except wide excision of the nodules and inguinal lymph nodes. We believe this case should be classified as one of "benign" primary cutaneous Langerhans cell histiocytosis based on the clinical course.
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Affiliation(s)
- M Aoki
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
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Abstract
Langerhans cell histiocytosis in the adult is rare, but it is important to recognize its occurrence, as it must be differentiated from lymphoma, myeloma, and a variety of skin conditions and endocrinopathies. It has been reported in patients up to the ninth decade of life, and occurs equally in men and women. Local disease has a good prognosis, but associated diseases--particularly malignancy--may be the cause of death in some adults. The optimal treatment is not known. Coordinated investigation of the epidemiology and therapy of this disease is needed.
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Affiliation(s)
- J S Malpas
- Imperial Cancer Research Fund, Department of Medical Oncology, St. Bartholomew's Hospital, London, United Kingdom
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Baumgartner I, von Hochstetter A, Baumert B, Luetolf U, Follath F. Langerhans'-cell histiocytosis in adults. MEDICAL AND PEDIATRIC ONCOLOGY 1997; 28:9-14. [PMID: 8950330 DOI: 10.1002/(sici)1096-911x(199701)28:1<9::aid-mpo3>3.0.co;2-p] [Citation(s) in RCA: 173] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Guided by a long-term retrospective observation, the clinical course and treatment of Langerhans'-cell histiocytosis (LCH) in adult patients are represented. The series included 19 patients meeting the histopathologic criteria of presumptive LCH who were followed for 1.5-20 years (average 7.7 years). Most frequently, skeletal lesions (16 patients), diffuse interstitial lung infiltrates (seven patients), and pituitary gland involvement with diabetes insipidus (four patients) were present. Bone lesions of the skull and axial skeleton were associated with an infiltration of adjacent soft tissues in 10 of 16 patients. Liver, lymph node, and bone marrow involvement appeared sporadically. LCH was divided into localized or multifocal form. Localized disease took a benign course with remission of bone (n = 4) or lymph node lesions (n = 2). Also, in isolated pulmonary LCH (n = 2), spontaneous transition to inactive disease occurred. With the exception of isolated bone lesions (n = 27), which remained asymptomatic or showed a remission to treatment, multifocal LCH had a more aggressive course. Osseous lesions with adjacent soft tissue infiltration (n = 20) showed a relapse rate in excess of 80% independent of the treatment applied. Pulmonary involvement led to a more marked functional impairment compared to the isolated form, and systemic treatment yielded no convincing effect. In three patients with liver or bone marrow involvement, LCH showed a persistent, serious disease activity. One patient died of transition into acute monomyelocytic leukemia 18 months after diagnosis without preceding chemotherapy. In adults, LCH seems to be limited to a few organ systems. Multifocal LCH represents the more aggressive form with unfavorable prognosis in patients with bone lesions spreading into the adjacent soft tissue and liver or bone marrow involvement.
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Affiliation(s)
- I Baumgartner
- Department of Internal Medicine, University Hospital, Zürich, Switzerland
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Sakai H, Ibe M, Takahashi H, Matsuo S, Okamoto K, Makino I, Oomori Y, Iizuka H. Satisfactory remission achieved by PUVA therapy in Langerhans cell hisiocytosis in an elderly patient. J Dermatol 1996; 23:42-6. [PMID: 8720257 DOI: 10.1111/j.1346-8138.1996.tb03966.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Langerhans cell histiocytosis is currently regarded as a reactive proliferative process of Langerhans cells rather than a malignancy. The disease is characterized by Langerhans cell infiltration of skin, lung, bone and other organs. We report a 74-year-old man with Langerhans cell histiocytosis who had generalized hemorrhagic and crusted papules. He also had diabetes insipidus. Because he did not have any severe constitutional symptoms or failure of vital organs, we applied topical PUVA treatment to his skin lesions, which responded well to the therapy. Diabetes insipidus, however, remained, in spite of X ray radiotherapy for the pituitary lesion.
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Affiliation(s)
- H Sakai
- Department of Dermatology, Asahikawa Medical College, Japan
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Egeler RM, Nesbit ME. Langerhans cell histiocytosis and other disorders of monocyte-histiocyte lineage. Crit Rev Oncol Hematol 1995; 18:9-35. [PMID: 7695824 DOI: 10.1016/1040-8428(94)00117-c] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
MESH Headings
- Adolescent
- Adult
- Aged
- Bone and Bones/pathology
- Child
- Child, Preschool
- Clinical Trials as Topic
- Cytokines/physiology
- Female
- Growth Substances/physiology
- Histiocytosis/classification
- Histiocytosis/pathology
- Histiocytosis, Langerhans-Cell/classification
- Histiocytosis, Langerhans-Cell/epidemiology
- Histiocytosis, Langerhans-Cell/etiology
- Histiocytosis, Langerhans-Cell/pathology
- Histiocytosis, Langerhans-Cell/therapy
- Humans
- Incidence
- Infant
- Infant, Newborn
- Leukemia, Monocytic, Acute/pathology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Multicenter Studies as Topic
- Phagocytes/pathology
- Prognosis
- Skin/pathology
- Viscera/pathology
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Affiliation(s)
- R M Egeler
- Erasmus University of Rotterdam, Sophia Children's Hospital/Dijkzigt Hospital, Department of Pediatrics, The Netherlands
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 40-1993. A 61-year-old woman with jaundice, anemia, thrombocytopenia, and leukocytosis. N Engl J Med 1993; 329:1108-15. [PMID: 8257528 DOI: 10.1056/nejm199310073291509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Forrest E, Gallacher SJ, Hadley D, Soukop M, Boyle IT. Central nervous system histiocytosis X--imaging and responses to chemotherapy. Scott Med J 1993; 38:148-9. [PMID: 8290941 DOI: 10.1177/003693309303800507] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Histiocytosis X is the term first coined by Lichtenstein in 1953 to describe a heterogeneous group of disorders which is considered now to include Hand-Schuller-Christian disease, Letterer-Siwe disease and Eosinophilic Granuloma of bone. Gagel, in 1941, first described involvement of the central nervous system (CNS) in Histiocytosis X--in this case the hypothalamus and posterior pituitary were the areas principally affected. CNS involvement outwith these areas is rare, generally difficult to diagnose, and little information on treatment is available. In this case we describe a man with cranial histiocytosis X who was treated with intrathecal and systemic chemotherapy and cranial irradiation, and we comment upon the value of magnetic resonance imaging (MRI) in this condition.
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Affiliation(s)
- E Forrest
- University Department of Medicine, Glasgow Royal Infirmary
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Yamashita H, Nagayama M, Kawashima M, Hidano A, Yamada O, Mizoguchi H. Langerhans-cell histiocytosis in an adult patient with multiple myeloma. Clin Exp Dermatol 1992; 17:275-8. [PMID: 1451321 DOI: 10.1111/j.1365-2230.1992.tb02167.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A 44-year-old man who had suffered for 6 years from multiple myeloma developed multiple papules on the face and chest. Histological examination of these papules revealed the infiltration of predominantly histiocytic cells into the dermis and into parts of the epidermis. These cells were seen on electron-microscopic study to have Langerhans granules in the cytoplasm, which led to a diagnosis of Langerhans-cell histiocytosis concomitant with multiple myeloma. Possible explanations for this unusual association are discussed.
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Affiliation(s)
- H Yamashita
- Department of Dermatology, Tokyo Women's Medical College, Japan
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Granger JK, Houn HY. Eosinophilic granuloma of lymph node: case report with cytohistologic, immunohistochemical, and flow cytometric observations. Diagn Cytopathol 1991; 7:402-7. [PMID: 1935519 DOI: 10.1002/dc.2840070413] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A case study of eosinophilic granuloma (Langerhans cell histiocytosis) of lymph node in a 32-year-old white man is presented. Clinical, cytologic, histologic, immunohistochemical, and flow cytometric findings are reported. Intraoperative cytologic findings can serve as valuable adjuncts to the frozen section, in this case serving as the sole method for diagnosis. This case is presented in light of the rarity of node-based eosinophilic granuloma and the absence of flow cytometric immunophenotypic findings in the literature.
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Affiliation(s)
- J K Granger
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock 72205
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