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Pawińska-Wa Sikowska K, Cwiklinska M, Wyrobek E, Balwierz W, Bukowska-Strakova K, Dluzniewska A, Gozdzik J, Drabik G, Rygielska M, Stepien K, Skoczen S. Disseminated Juvenile Xanthogranuloma and Hemophagocytic Lymphohistiocytosis Developed During Treatment of Acute Lymphoblastic Leukemia: Case Report. Front Oncol 2020; 10:921. [PMID: 32719740 PMCID: PMC7350519 DOI: 10.3389/fonc.2020.00921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/11/2020] [Indexed: 12/02/2022] Open
Abstract
The association between acute lymphoblastic leukemia (ALL), non-Langerhans cell histiocytosis (non-LCH), and hemophagocytic lymphohistiocytosis (HLH), to the best of our knowledge, has not been published to date. Juvenile xanthogranuloma (JXG), as a type of non-LCH, is usually a benign disease limited to the skin. Systemic involvement is rarely reported. The present case report describes a 15-year-old boy diagnosed with disseminated JXG involving skin and bone marrow concurrent with severe symptoms of HLH during ALL therapy. Examination of immunoglobulin heavy chain genes in B-cell precursor leukemic blasts and histiocytes in the skin and bone marrow revealed identical rearrangements, confirming clonal relationship between both diseases. Implementation of corticosteroids, vinblastine, etoposide, cyclosporine, and tocilizumab resulted in partial skin lesion resolution with no improvement of bone marrow function; therefore, hematopoietic stem cell transplantation (HSCT) was eventually performed. The patient's hematological and general status has improved gradually; however, remarkable recovery of skin lesions was observed after empirical antitubercular therapy. Mycobacterium spp. infection should be considered as a possible secondary HLH trigger. Triple association of ALL, non-LCH, and HLH highlights heterogeneity of histiocytic disorders and possible common origin of dendritic and lymphoid cells.
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Affiliation(s)
- Katarzyna Pawińska-Wa Sikowska
- Department of Pediatric Oncology and Hematology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland.,Department of Oncology and Hematology, University Children's Hospital of Krakow, Krakow, Poland
| | - Magdalena Cwiklinska
- Department of Pediatric Oncology and Hematology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland.,Department of Oncology and Hematology, University Children's Hospital of Krakow, Krakow, Poland
| | - Elzbieta Wyrobek
- Department of Oncology and Hematology, University Children's Hospital of Krakow, Krakow, Poland
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland.,Department of Oncology and Hematology, University Children's Hospital of Krakow, Krakow, Poland
| | - Karolina Bukowska-Strakova
- Department of Clinical Immunology and Transplantation, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Dluzniewska
- Department of Clinical Immunology and Transplantology, Stem Cell Transplant Center, University Children's Hospital of Krakow, Jagiellonian University Medical College, Krakow, Poland
| | - Jolanta Gozdzik
- Department of Clinical Immunology and Transplantology, Stem Cell Transplant Center, University Children's Hospital of Krakow, Jagiellonian University Medical College, Krakow, Poland
| | - Grazyna Drabik
- Department of Pathology, University Children's Hospital of Krakow, Krakow, Poland
| | - Monika Rygielska
- Department of Biochemistry, University Children's Hospital of Krakow, Krakow, Poland
| | - Konrad Stepien
- Student Scientific Group of Pediatric Oncology and Hematology, Jagiellonian University Medical College, Krakow, Poland
| | - Szymon Skoczen
- Department of Pediatric Oncology and Hematology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland.,Department of Oncology and Hematology, University Children's Hospital of Krakow, Krakow, Poland
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2
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Langerhans Cell Histiocytosis Associated With Underlying Hematolymphoid Disorders in Adults: Report of 2 Cases and Review of the Literature. Am J Dermatopathol 2018; 40:588-593. [PMID: 30035752 DOI: 10.1097/dad.0000000000001072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Langerhans cell histiocytosis (LCH) is an uncommon disorder characterized by proliferation of abnormal LCs usually affecting children and adolescents. LCH in adults first presenting in the skin is rare. Although LCH and even LCH with a second malignancy may be more common in children, cutaneous LCH with a second hematologic malignancy has been more commonly identified in adults. The authors report 2 new cases of LCH in adult patients with underlying myelodysplasia and follicular lymphoma. The specimens were examined by routine microscopy and immunohistochemical stains for S100 protein and CD1a. Patients were elderly men with established diagnoses of follicular lymphoma and myelodysplasia, presented with follicular lesions and erythematous plaques involving intertriginous areas. Histologic examination revealed collections of mononuclear cells in upper dermis, which demonstrated strong positivity for S100 and CD1a, confirming their identity as LCs. BRAF analysis returned negative for detection of BRAF V600E mutation in both patients. The authors have recently encountered 2 cases of adult patients with skin-limited LCH predated by other lymphoproliferative disorders. The association between LCH and hematopoietic disorders may be explained by a common bone marrow precursor that is differentiating along different cell lines. Cutaneous LCH may be associated with underlying lymphoproliferative disorders and should be considered in the differential diagnosis of cutaneous eruptions in patients with hematopoietic disorders. Clinical follow-up evaluation of patients diagnosed with LCH for peripheral blood abnormalities and lymphadenopathy or "B symptoms" may be prudent in patients not already carrying a diagnosis of an underlying hematologic disorder.
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3
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Huang W, Qiu T, Zeng L, Zheng B, Ying J, Feng X. High frequency of clonal IG and T-cell receptor gene rearrangements in histiocytic and dendritic cell neoplasms. Oncotarget 2018; 7:78355-78362. [PMID: 27823979 PMCID: PMC5346644 DOI: 10.18632/oncotarget.13058] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 10/25/2016] [Indexed: 12/26/2022] Open
Abstract
The 2008 World Health Organization (WHO) diagnostic criteria of histiocytic and dendritic cell neoplasms from hematopoietic and lymphoid tissues no longer required the absence of clonal B-cell/T-cell receptor gene rearrangements. It is true that the clonal B-cell/T-cell receptor gene rearrangements have been identified in rare cases of histiocytic and dendritic cell neoplasms, such as those with or following lymphoma/leukemia or in some sporadic histiocytic/dendritic cell sarcomas, but the clonal features of such group of tumor are still not clear. Here we investigated the clonal status of 33 samples including Langerhans cell histiocytosis (LCH), Langerhans cell sarcoma (LCS), follicular dendritic cell sarcoma (FDCS), interdigitating dendritic cell sarcoma (IDCS) and histiocytic sarcoma (HS). Among them, twenty-eight cases were sporadic without current or past lymphoma/leukemia. Three cases were found with a past history of T-cell lymphoma, one case was followed by extraosseous plasmacytoma, and one case was found with diffuse large B-cell lymphoma (DLBCL). Our results showed that there was a high frequency of clonal IG and T-cell receptor gene rearrangements in these cases. Notably, 4 cases of LCH and 2 cases of FDCS showed both B and T cell receptor gene rearrangements concurrently. One case of FDCS synchronous with DLBCL showed identical clonal IGH in both tumor populations and clonal TCRβ in FDCS alone. No matter if the presence of clonal receptor gene rearrangements was associated with the tumor origin or tumorigenesis, it might serve as a novel tumor marker for developing target therapy.
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Affiliation(s)
- Wenting Huang
- Department of Pathology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tian Qiu
- Department of Pathology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Linshu Zeng
- Department of Pathology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Zheng
- Department of Pathology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianming Ying
- Department of Pathology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoli Feng
- Department of Pathology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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4
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Pina-Oviedo S, Torres-Cabala CA, Miranda RN, Tetzlaff MT, Singh S, Rapini RP, Prieto VG, Aung PP. Concomitant Cutaneous Langerhans Cell Hystiocytosis and Leukemia Cutis. Am J Dermatopathol 2017; 39:388-392. [DOI: 10.1097/dad.0000000000000775] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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5
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Elkin VD, Sedova TG, Kopytova EA, Plotnikova EV. Langerhans cell histiocytosis: Skin diseases and visceral lesions. TERAPEVT ARKH 2017; 89:115-120. [DOI: 10.17116/terarkh2017894115-120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a rare clonal proliferative disorder that belongs to class I histiocytoses and is characterized by infiltration of one or many organs by Langerhans cells to form granulomas. The literature analysis could identify a lot of etiological, pathogenetic, and trigger factors and mechanisms for LCH development, which determine the diversity of the clinical picture and course of the disease. The clinical manifestations of LCH are very variable and depend on the severity of lesions and the age of patients. In addition to skin lesions, there is involvement of one or more visceral organs. Difficulties in diagnosing the disease lead to statistical variations of LCH in different countries of the world and require more attention by physicians of all specialties.
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Ambrosio MR, De Falco G, Rocca BJ, Barone A, Amato T, Bellan C, Lazzi S, Leoncini L. Langerhans cell sarcoma following marginal zone lymphoma: expanding the knowledge on mature B cell plasticity. Virchows Arch 2015; 467:471-80. [PMID: 26286813 DOI: 10.1007/s00428-015-1814-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/08/2015] [Accepted: 07/16/2015] [Indexed: 12/27/2022]
Abstract
The concept of unidirectional differentiation of the haematopoietic stem cell has been challenged after recent findings that human B cell progenitors and even mature B cells can be reprogrammed into histiocytic/dendritic cells by altering expression of lineage-associated transcription factors. The conversion of mature B cell lymphomas to Langerhans cell neoplasms is not well documented. Three previous reports have described clonally related follicular lymphoma and Langerhans cell tumours, whereas no case has been published of clonally related marginal zone lymphoma and Langerhans cell sarcoma. We describe the case of a 77-year-old patient who developed a Langerhans cell sarcoma and 6 years later a nodal marginal zone lymphoma. Mutation status examination showed 100 % gene identity to the germline sequence, suggesting direct trans-differentiation or dedifferentiation of the nodal marginal zone lymphoma to the Langerhans cell sarcoma rather than a common progenitor. We found inactivation of paired box 5 (PAX-5) in the lymphoma cells by methylation, along with duplication of part of the long arm of chromosomes 16 and 17 in the sarcoma cells. The absence of PAX-5 could have triggered B cells to differentiate into macrophages and dendritic cells. On the other hand, chromosomal imbalances might have activated genes involved in myeloid lineage maturation, transcription activation and oncogenesis. We hypothesize that this occurred because of previous therapies for nodal marginal zone lymphoma. Better understanding of this phenomenon may help in unravelling the molecular interplay between transcription factors during haematopoietic lineage commitment and may expand the spectrum of clonally related mature B cell neoplasms and Langerhans cell tumours.
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Affiliation(s)
| | - Giulia De Falco
- Department of Medical Biotechnologies, Section of Pathology, University of Siena, Siena, Italy.,School of Biological and Chemical Sciences, Queen Mary University of London, London, UK
| | - Bruno Jim Rocca
- Department of Medical Biotechnologies, Section of Pathology, University of Siena, Siena, Italy.,Pathology Unit, Ospedale di Circolo di Busto Arsizio, Busto Arsizio, Italy
| | - Aurora Barone
- Department of Medical Biotechnologies, Section of Pathology, University of Siena, Siena, Italy
| | - Teresa Amato
- Department of Medical Biotechnologies, Section of Pathology, University of Siena, Siena, Italy
| | - Cristiana Bellan
- Department of Medical Biotechnologies, Section of Pathology, University of Siena, Siena, Italy
| | - Stefano Lazzi
- Section of Pathology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Lorenzo Leoncini
- Department of Medical Biotechnologies, Section of Pathology, University of Siena, Siena, Italy
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7
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Yokokawa Y, Taki T, Chinen Y, Kobayashi S, Nagoshi H, Akiyama M, Morimoto A, Ida H, Taniwaki M. Unique clonal relationship between T-cell acute lymphoblastic leukemia and subsequent Langerhans cell histiocytosis withTCRrearrangement andNOTCH1mutation. Genes Chromosomes Cancer 2015; 54:409-17. [DOI: 10.1002/gcc.22252] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 02/09/2015] [Indexed: 12/31/2022] Open
Affiliation(s)
- Yuichi Yokokawa
- Department of Molecular Diagnostics and Therapeutics; Kyoto Prefectural University of Medicine Graduate School of Medical Science; Kyoto Japan
- Department of Pediatrics; The Jikei University School of Medicine; Tokyo Japan
| | - Tomohiko Taki
- Department of Molecular Diagnostics and Therapeutics; Kyoto Prefectural University of Medicine Graduate School of Medical Science; Kyoto Japan
| | - Yoshiaki Chinen
- Department of Molecular Hematology and Oncology; Kyoto Prefectural University of Medicine Graduate School of Medical Science; Kyoto Japan
| | - Satoru Kobayashi
- Department of Molecular Hematology and Oncology; Kyoto Prefectural University of Medicine Graduate School of Medical Science; Kyoto Japan
| | - Hisao Nagoshi
- Department of Molecular Hematology and Oncology; Kyoto Prefectural University of Medicine Graduate School of Medical Science; Kyoto Japan
| | - Masaharu Akiyama
- Department of Pediatrics; The Jikei University School of Medicine; Tokyo Japan
- Division of Molecular Genetics, Institute of DNA Medicine, The Jikei University School of Medicine; Tokyo Japan
| | - Akira Morimoto
- Department of Pediatrics; Jichi Medical University School of Medicine; Shimotsuke Tochigi Japan
| | - Hiroyuki Ida
- Department of Pediatrics; The Jikei University School of Medicine; Tokyo Japan
| | - Masafumi Taniwaki
- Department of Molecular Hematology and Oncology; Kyoto Prefectural University of Medicine Graduate School of Medical Science; Kyoto Japan
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8
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Shon W, Peters MS, Reed KB, Ketterling RP, Dogan A, Gibson LE. Atypical generalized eruptive histiocytosis clonally related to chronic myelomonocytic leukemia with loss of Y chromosome. J Cutan Pathol 2013; 40:725-9. [DOI: 10.1111/cup.12168] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 04/23/2012] [Accepted: 05/28/2012] [Indexed: 12/31/2022]
Affiliation(s)
| | | | - Kurtis B. Reed
- Department of Dermatology; Mayo Clinic; Rochester; MN; USA
| | | | - Ahmet Dogan
- Laboratory Medicine and Pathology; Mayo Clinic; Rochester; MN; USA
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10
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Benharroch D, Guterman G, Levy I, Shaco-Levy R. High content of Langerhans cells in malignant lymphoma--incidence and significance. Virchows Arch 2010; 457:63-7. [PMID: 20473767 DOI: 10.1007/s00428-010-0931-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 04/25/2010] [Accepted: 04/26/2010] [Indexed: 11/30/2022]
Abstract
We describe 25 patients, 14 with classical Hodgkin lymphoma and 11 with non-Hodgkin lymphoma, in all of whom an excess of Langerhans cells was evident. Except for the first three cases, in which the excess of Langerhans cells was identified on routine slides, the remaining cases were disclosed by actively investigating lymphomas with excess of CD68+ histiocytes and performing CD1a and S-100 protein immunostains. Although no clonality study was performed on the Langerhans cells, we endorse the view which states that in the above association, the Langerhans cells are polyclonal. Fourteen cases of Hodgkin lymphoma with a large number of Langerhans cells were identified in a cohort of 231 classical Hodgkin lymphomas. We compared the features of classical Hodgkin lymphoma with abundant Langerhans cells with those without Langerhans cells. Our analysis reveals that Hodgkin lymphoma with Langerhans cell excess shows greater LMP1/EBV expression (P = .007) and lower p53 expression (P = .042) in the Hodgkin-Reed-Sternberg cells but is not associated with a poorer outcome.
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Affiliation(s)
- Daniel Benharroch
- Department of Pathology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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11
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Castro ECC, Blazquez C, Boyd J, Correa H, de Chadarevian JP, Felgar RE, Graf N, Levy N, Lowe EJ, Manning JT, Proytcheva MA, Senger C, Shayan K, Sterba J, Werner A, Surti U, Jaffe R. Clinicopathologic features of histiocytic lesions following ALL, with a review of the literature. Pediatr Dev Pathol 2010; 13:225-37. [PMID: 19642834 DOI: 10.2350/09-03-0622-oa.1] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We describe the clinicopathologic features of 15 patients who had histiocytic lesions that followed acute lymphoblastic leukemia (ALL). Twenty-one separate histiocytic lesions were evaluated that covered a wide spectrum, some conforming to the usual categories of juvenile xanthogranulomas (5), Langerhans' cell histiocytosis (1), Langerhans' cell sarcoma (4), Rosai-Dorfman disease (1), and histiocytic sarcoma (4). Most were atypical for the category by histology, phenotype, or abnormally high turnover rate. Seven low-grade lesions defied easy categorization and were characterized only as "atypical histiocytic lesion" following ALL. For those evaluated, the molecular signature of the prior leukemia was present in the histiocytic lesion. In 3 of 15 patients, the leukemia and histiocytic lesion shared immunoglobulin H or monoclonal TCR gene rearrangements and, in 4 of 15 patients, clonal identity was documented by fluorescence in situ hybridization. Four patients died of progressive disease, 3 of whom had histiocytic sarcoma and 1 who had an atypical lesion. One patient died of recurrent ALL. The other 10 patients are alive, 7 after recurrences and treatment with surgery and/or chemotherapy. The post-ALL lesions are more aggressive than their native counterparts, but despite the demonstration of the presence of the leukemia signature in 7 of 15 patients, the prognosis is generally favorable, except for patients with histiocytic sarcoma. It remains unclear whether the histiocytic lesions arise as a line from the original ALL or whether transdifferentiation is involved.
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Affiliation(s)
- Eumenia C C Castro
- Department of Pathology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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12
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Hirsh R, Giri D, Griffith R, Stone R, Ready N. Langerhans cell histiocytosis following acute leukemia in an adult. Am J Hematol 2009; 84:693-4. [PMID: 19691100 DOI: 10.1002/ajh.21490] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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13
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Fomina TI, Perelmuter VM, Vtorushin SV, Zavjalova MV, Borovskaja TG, Timina EA. Carcinogenic effect of an antitumor drug etoposide in laboratory animals. Bull Exp Biol Med 2008; 144:725-7. [PMID: 18683507 DOI: 10.1007/s10517-007-0416-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Intravenous injection of antitumor drug etoposide in the maximum tolerated dose was followed by the development of breast cancer in 38.1% female Wistar rats and 6.7% female outbred mice.
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Affiliation(s)
- T I Fomina
- Institute of Pharmacology, Tomsk Research Center, Siberian Division of the Russian Academy of Medical Sciences.
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14
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Sakata N, Toguchi N, Kimura M, Nakayama M, Kawa K, Takemura T. Development of Langerhans cell histiocytosis associated with chronic active Epstein-Barr virus infection. Pediatr Blood Cancer 2008; 50:924-7. [PMID: 17474115 DOI: 10.1002/pbc.21249] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Chronic active Epstein-Barr virus (CAEBV) infection is characterized by a status of lymphoproliferative disease of EBV-infected cells, resulting in chronic or recurrent infectious mononucleosis-like symptoms. CAEBV is always accompanied by life-threatening complications. We report the case of a 2-year-old female patient with CAEBV who subsequently developed Langerhans cell histiocytosis (LCH) presenting with bilateral exophthalmos, bone, and skin involvement. In situ hybridization for EBER revealed EBV-infected B-cells present in lesional tissue implying that interactions between EBV-infected B-cells and lesional Langerhans cells may be associated with the development of LCH.
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Affiliation(s)
- Naoki Sakata
- Department of Pediatrics, Kinki University School of Medicine, Osaka, Japan.
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Billings SD, Hans CP, Schapiro BL, Martin RW, Fivenson D, Fruland JE, Moores WB, Cotton J. Langerhans cell histiocytosis associated with myelodysplastic syndrome in adults. J Cutan Pathol 2006; 33:171-4. [PMID: 16420314 DOI: 10.1111/j.0303-6987.2006.00299.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Myelodysplastic syndrome (MDS) is a group of bone marrow disorders associated with dyplasia of myeloid elements that may have cutaneous manifestations including infections, vasculitis, Sweet's syndrome, pyoderma gangrenosum, erythema elevatum diutinum, and leukemia cutis. These cutaneous manifestations are attributed to the underlying bone marrow defect. Langerhans cell histiocytosis (LCH) is primarily a pediatric disease, and rarely LCH has been described in association with pediatric MDS. We are aware of only a single case report of LCH associated with MDS in an adult. METHODS We report two new cases of LCH in elderly patients with underlying MDS. The specimens were examined by routine microscopy as well as immunohistochemical stains for S100 protein and CD1a. RESULTS Both patients were elderly men with established diagnoses of MDS. One presented with a solitary pruritic papule while the other had a 2-year history of erythematous papules involving the trunk and extremities. Histologic examination revealed intraepidermal and dermal collections of mononuclear cells with reniform nuclei. The cells were strongly positive for S100 and CD1a, confirming their identity as Langerhans cells. CONCLUSION Cutaneous LCH may be associated with underlying MDS in adults and should be considered in the differential diagnosis of cutaneous eruptions in patients with MDS.
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Affiliation(s)
- Steven D Billings
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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