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Hu S, Graham RP, Choi WT, Wen KW, Putra J, Chen W, Lin J, Gonzalez IA, Panarelli N, Liu Q, Zhao L, Gong S, Mejia-Bautista M, Escobar DJ, Ma C, Shalaby A, Du X, Kang LI, Zhang W, Chen X, Ding X, Chen HH, Ye Z, Pezhouh MK, Liao X, Liu Y, Yang Z, Alpert L, Hart J, Goldblum JR, Allende D, Zheng W, Gonzalez RS, Wang HL, Zhang X, Liu X, Longacre T, Westerhoff M, Xue Y. Clinicopathologic Features of Gastrointestinal Tract Langerhans Cell Histiocytosis. Mod Pathol 2024:100543. [PMID: 38897453 DOI: 10.1016/j.modpat.2024.100543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/21/2024] [Accepted: 06/11/2024] [Indexed: 06/21/2024]
Abstract
Gastrointestinal (GI) tract involvement by Langerhans cell histiocytosis (LCH) is rare and its clinicopathologic characteristics have only been described in case reports and small series. We reviewed hematoxylin and eosin- and CD1a, S100, and Langerin immunohistochemical-stained slides from 47 patients with well-documented demographic and clinical findings. Our cases included 8 children and 39 adults, with a mean follow-up of 63 months. All pediatric patients had concurrent multisystem LCH, presented with GI symptoms, and showed non-polypoid lesions. Seven (88%) showed multifocal GI disease, including five with multiple GI organ involvement. All sampled lesions from children exhibited infiltrative growth. More than half had died of the disease or manifested persistent LCH at last follow-up. Twenty-five of 39 (64%) adults had LCH involving only the GI tract (single-system), with the remaining 14 (36%) exhibiting multi-system disease. Adult single-system GI LCH was typically encountered incidentally on screening/surveillance endoscopy (72%). Most exhibited isolated colorectal involvement (88%) as a solitary polyp (92%), with a well-demarcated/noninfiltrative growth pattern (70%), and excellent prognosis (100%). In comparison, adult patients with multi-system LCH more frequently presented with GI symptoms (92%, P<0.001), non-colorectal GI site involvement (50%, P=0.02), multifocal GI lesions (43%, P=0.005), non-polypoid lesions (71%, P<0.001), infiltrative histologic growth pattern (78%, P=0.04), and persistent disease (57%, P<0.001). Adult multi-system LCH patients appear to exhibit similar clinicopathologic features to those of pediatric patients. These results demonstrate that adults with single-system LCH involving the GI tract have an excellent prognosis, while multi-system LCH occurring at any age carries an unfavorable prognosis. High-risk features of GI LCH include pediatric age, GI symptomatology, non-colorectal GI involvement, multifocal GI disease, non-polypoid lesions, and infiltrative growth pattern.
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Affiliation(s)
| | | | | | | | | | - Wei Chen
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | | | - Qiang Liu
- Montefiore Medical Center, Bronx, NY
| | - Lei Zhao
- Brigham and Women's Hospital, Boston, MA
| | - Shunyou Gong
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - David J Escobar
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Changqing Ma
- University of Pittsburg Medical Center, Pittsburg, PA
| | - Akram Shalaby
- University of Pittsburg Medical Center, Pittsburg, PA
| | - Xiaotang Du
- David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Wei Zhang
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Xiuxu Chen
- Loyola University Medical Center, Chicago, IL
| | | | | | - Zhan Ye
- University of Kansas Medical Center, Kansas City, KS
| | | | | | - Yongjun Liu
- University of Washington Medical Center, Seattle, WA
| | - Zhaohai Yang
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | | | | | | | | | | | - Hanlin L Wang
- David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Xiuli Liu
- Washington University, St. Louis, MO
| | | | | | - Yue Xue
- Northwestern University Feinberg School of Medicine, Chicago, IL.
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Zhu T, Wang CJ, Lian HY, Ma HH, Wang D, Wang TY, Zhang R, Cui L, Li ZG. The plasma-soluble CSF1R level is a promising prognostic indicator for pediatric Langerhans cell histiocytosis. Pediatr Blood Cancer 2024; 71:e30970. [PMID: 38556751 DOI: 10.1002/pbc.30970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 04/02/2024]
Abstract
Langerhans cell histiocytosis (LCH) is a rare hematologic neoplasm characterized by the clonal proliferation of Langerhans-like cells. Colony-stimulating factor 1 receptor (CSF1R) is a membrane-bound receptor that is highly expressed in LCH cells and tumor-associated macrophages. In this study, a soluble form of CSF1R protein (sCSF1R) was identified by plasma proteome profiling, and its role in evaluating LCH prognosis was explored. We prospectively measured plasma sCSF1R levels in 104 LCH patients and 10 healthy children using ELISA. Plasma sCSF1R levels were greater in LCH patients than in healthy controls (p < .001) and significantly differed among the three disease extents, with the highest level in MS RO+ LCH patients (p < .001). Accordingly, immunofluorescence showed the highest level of membrane-bound CSF1R in MS RO+ patients. Furthermore, the plasma sCSF1R concentration at diagnosis could efficiently predict the prognosis of LCH patients treated with standard first-line treatment (AUC = 0.782, p < .001). Notably, dynamic monitoring of sCSF1R levels could predict relapse early in patients receiving BRAF inhibitor treatment. In vitro drug sensitivity data showed that sCSF1R increased resistance to Ara-C in THP-1 cells expressing ectopic BRAF-V600E. Overall, the plasma sCSF1R level at diagnosis and during follow-up is of great clinical importance in pediatric LCH patients.
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Affiliation(s)
- Ting Zhu
- Hematologic Diseases Laboratory, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Beijing Key Laboratory of Pediatric Hematology-Oncology, Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- National Key Discipline of Pediatrics, Capital Medical University, Beijing, China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Chan-Juan Wang
- Beijing Key Laboratory of Pediatric Hematology-Oncology, Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- National Key Discipline of Pediatrics, Capital Medical University, Beijing, China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Hong-Yun Lian
- Beijing Key Laboratory of Pediatric Hematology-Oncology, Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- National Key Discipline of Pediatrics, Capital Medical University, Beijing, China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Hong-Hao Ma
- Beijing Key Laboratory of Pediatric Hematology-Oncology, Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- National Key Discipline of Pediatrics, Capital Medical University, Beijing, China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Dong Wang
- Beijing Key Laboratory of Pediatric Hematology-Oncology, Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- National Key Discipline of Pediatrics, Capital Medical University, Beijing, China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Tian-You Wang
- Beijing Key Laboratory of Pediatric Hematology-Oncology, Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- National Key Discipline of Pediatrics, Capital Medical University, Beijing, China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Rui Zhang
- Beijing Key Laboratory of Pediatric Hematology-Oncology, Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- National Key Discipline of Pediatrics, Capital Medical University, Beijing, China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Lei Cui
- Hematologic Diseases Laboratory, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Beijing Key Laboratory of Pediatric Hematology-Oncology, Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- National Key Discipline of Pediatrics, Capital Medical University, Beijing, China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Zhi-Gang Li
- Hematologic Diseases Laboratory, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Beijing Key Laboratory of Pediatric Hematology-Oncology, Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- National Key Discipline of Pediatrics, Capital Medical University, Beijing, China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
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Henderson VK, Brismée JM. Pediatric neck pain of a 10-year-old child with cervical spinal tumor evaluated and managed in direct access physical therapy: a case report. J Man Manip Ther 2024; 32:335-342. [PMID: 38415682 PMCID: PMC11216264 DOI: 10.1080/10669817.2024.2319427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/10/2024] [Indexed: 02/29/2024] Open
Abstract
INTRODUCTION Differential diagnosis of pediatric neck pain requires age-appropriate communication and assessment tools. Recognizing these age-related nuances is critical, emphasizing the role of physical therapists in assessing and managing pediatric patients while ruling out severe pathologies. CASE DESCRIPTION A 10-year-old male presented to physical therapy with a five-week history of increasing neck pain. A thorough history and segmental cervical examination considering the patient's age and development, led to patient referral to the emergency department. This case underscores the significance of comprehensive evaluation in pediatric neck pain management. OUTCOMES The patient was diagnosed with Langerhans Cell Histiocytosis (LCH). LCH primarily affects children and is treated with chemotherapy. Chemotherapy reduced the tumor, revealing C2 vertebral body damage. The patient underwent C1-C3 fusion surgery, a standard procedure for atlanto-occipital region stabilization in children. The patient was advised to restrict motion for 6 months while monitoring for tumor growth. DISCUSSION-CONCLUSION Pediatric neck cancer presents diagnostic challenges due to varied symptoms, but research highlights specific indicators to assist with differential diagnosis. This case emphasizes the need to recognize the complexities of pediatric neck pain and perform a thorough age-appropriate evaluation.
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Affiliation(s)
| | - Jean-Michel Brismée
- Department of Rehabilitation Sciences, Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Louis M, Copper C, Lelli E, Conway J, Sarmiento D, Singh H. From terminal ileum to terminal diagnosis: The critical role of terminal ileum intubation in diagnosing langerhans cell histiocytosis in a patient with TAR syndrome. Radiol Case Rep 2024; 19:2052-2057. [PMID: 38444598 PMCID: PMC10914551 DOI: 10.1016/j.radcr.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 03/07/2024] Open
Abstract
The co-occurrence of Thrombocytopenia with Absent Radius (TAR) syndrome and Langerhans Cell Histiocytosis (LCH) is exceedingly rare, with scant documentation in existing medical literature. This case report aims to shed light on this unique intersection of conditions, emphasizing the diagnostic and therapeutic challenges it presents. A 27-year-old female with a history of TAR syndrome presented with microcytic anemia, hip pain, and gastrointestinal symptoms. Terminal ileum intubation during colonoscopy revealed superficial ulcerations, leading to a biopsy that confirmed LCH. Subsequent radiologic investigations, including CT and MRI, showed multiple osseous lesions in the pelvis, sacrum, and skull. A treatment plan involving IV Cytarabine was initiated due to concerns of CNS involvement, as indicated by mastoid air cell involvement and symptoms of dizziness and ear fullness. The case highlights the diagnostic value of terminal ileum intubation during colonoscopy, which was pivotal in diagnosing LCH in this patient. It also discusses the use of IV cytarabine, a chemotherapy drug that inhibits DNA synthesis, as a suitable treatment option given the suspected CNS involvement. The case adds to the limited literature on the natural history and management of adult patients with LCH, particularly in the context of TAR syndrome. This case report serves as a compelling addition to medical literature, highlighting the diagnostic complexities and treatment considerations in a patient with both TAR syndrome and LCH. It emphasizes the importance of comprehensive diagnostic approaches, including terminal ileum intubation during colonoscopy, and introduces IV cytarabine as a viable treatment option for cases with suspected CNS involvement.
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Affiliation(s)
- Mena Louis
- Northeast Georgia Medical Center, General Surgery GME Program, Gainesville, Georgia, USA
| | - Chad Copper
- Northeast Georgia Medical Center, Northeast Georgia Physician Group, Gainesville, Georgia, USA
| | - Elaine Lelli
- Northeast Georgia Medical Center, General Surgery GME Program, Gainesville, Georgia, USA
| | - Joseph Conway
- Northeast Georgia Medical Center, Gainesville Regional Pathology Associates, Gainesville, Georgia, USA
| | - Daniel Sarmiento
- Northeast Georgia Medical Center, Northeast Georgia Physician Group, Gainesville, Georgia, USA
| | - Hardeep Singh
- Northeast Georgia Medical Center, Graduate Medical Education, Research Department, Gainesville, Georgia, USA
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5
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Lin HL, Zheng QQ, Huang RL, Hu R, Liu XD, Wang JY. Exploration of treatment in childhood Langerhans cell histiocytosis based on inflammatory and malignant symptoms: a pilot study. Orphanet J Rare Dis 2024; 19:174. [PMID: 38654381 DOI: 10.1186/s13023-024-03151-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 03/24/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Multisystem childhood Langerhans cell histiocytosis (LCH) patients, especially those with risk organ (RO) involved, had not been satisfactorily treated under the international traditional schemes as high incidences of reactivation with late sequelae were largely reported. Over years, we have observed that LCH patients with varied clinical symptoms responded differently to different drugs, suggesting the current grouping strategies based only on the number of organs involved might be inadequate. LCH has been defined as an inflammatory myeloid tumor, thus this study has innovatively divided LCH pediatric patients into inflammatory or malignant symptoms group, and given different intensity treatment regimens to different groups. AIM This clinical study aimed to explore a more appropriate patient grouping system according to the LCH symptom presentations and examine the clinical outcomes of treatment strategies in different groups. METHODS According to the clinical manifestations, 37 cases of children were divided into Group A (only inflammatory symptoms) and Group B (malignant symptoms with or without inflammatory symptoms). Patients in Group A and B were initially treated with vindesine (VDS) and methylprednisolone (PSL), and VDS, PSL, pirarubicin (THP) and cyclophosphamide (CTX), respectively. Treatment responses were evaluated six weeks after the induction therapy in all patients, and the criteria were disease status and clinical scores of symptoms. RESULTS Pre- and post-treatment scores were 1.22 ± 0.547 and 0.00 ± 0.00 in Group A, and 14.79 ± 1.686 and 1.00 ± 1.563 in Group B, respectively. All patients had subsequentlly received maintenance therapy without progressive disease. The 4-year overall survival (OS) rate was 100% in both groups and the 4-year event-free survival (EFS) was 94.4% in Group A and 89.5% in Group B, respectively. There were no obvious adverse events (AE) in Group A, whereas the main AE in Group B were alopecia and non-lethal hematological toxicity. CONCLUSION Stratification according to patients' clinical symptoms, with low-intensity treatment for inflammatory symptoms (mild manifestations) and intensive treatment with multiple drugs for malignant symptoms (severe manifestations), is a positive exploration that simplifies stratification method, achieves good long-term remission of the disease, and obtains a higher survival rate and quality of life, which seemed to be more appropriate for LCH patients.
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Affiliation(s)
- Hui-Ling Lin
- Department of Hematology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, Tianhe District, Guangzhou, 510600, China
| | - Qing-Qing Zheng
- Department of Hematology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, Tianhe District, Guangzhou, 510600, China
| | - Ru-Lin Huang
- Department of Hematology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, Tianhe District, Guangzhou, 510600, China
| | - Rong Hu
- Department of Pharmacy, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510600, China
| | - Xiao-Dan Liu
- Department of Hematology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, Tianhe District, Guangzhou, 510600, China
| | - Jia-Yi Wang
- Department of Hematology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, Tianhe District, Guangzhou, 510600, China.
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Eddin AS, McNeely P, Saad Eldine M, Lai L, Shariftabrizi A. Dural involvement in central nervous system langerhans cells histiocytosis (LCH) on FDG PET/CT: Case report and review of CNS manifestations of LCH on PET/CT. Radiol Case Rep 2024; 19:1391-1396. [PMID: 38268737 PMCID: PMC10803779 DOI: 10.1016/j.radcr.2023.12.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 01/26/2024] Open
Abstract
We report a case of multisystem Langerhans cell histiocytosis in a pediatric patient with central nervous system involvement, highlighting F-18(FDG) uptake characteristics of dural sites of disease. We also highlight the advantages of functional data offered by FDG-PET as a useful follow-up tool to assess viability and, therefore, treatment response of previously known central nervous system lesions. The utility of recognizing characteristic patterns of FDG uptake in dural disease is also applicable in cases of diagnostic uncertainty, such as when evaluating isolated dural lesions or when distinguishing between Langerhans cell histiocytosis and similar appearing lesions such as meningiomas.
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Affiliation(s)
- Assim Saad Eddin
- University of Iowa Hospitals and Clinics; Department of Radiology; Iowa city, IA 52242, USA
| | - Parren McNeely
- University of Iowa Hospitals and Clinics; Department of Radiology; Iowa city, IA 52242, USA
| | - Mothana Saad Eldine
- University of Iowa Hospitals and Clinics; Department of Radiology; Iowa city, IA 52242, USA
| | - Lillian Lai
- University of Iowa Hospitals and Clinics; Department of Radiology; Iowa city, IA 52242, USA
| | - Ahmad Shariftabrizi
- University of Iowa Hospitals and Clinics; Department of Radiology; Iowa city, IA 52242, USA
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Cao Y, Wu QQ, Yan WH, Lu LN, Tao YJ, Feng HX, Chu YJ, Cai W, Wang Y. Langerhans cell histiocytosis in children with refractory diarrhoea and hypoalbuminaemia as the initial presentation: two case reports and a literature review. BMC Pediatr 2024; 24:203. [PMID: 38519924 PMCID: PMC10958846 DOI: 10.1186/s12887-024-04612-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 02/01/2024] [Indexed: 03/25/2024] Open
Abstract
Langerhans cell histiocytosis (LCH) involving the gastrointestinal tract is a rare condition for which clinical experience is limited. We describe the cases of two patients who initially presented with chronic diarrhoea, hypoproteinaemia, and intermittent fever. These findings suggest that in cases of refractory diarrhoea accompanied by recurrent hypoalbuminaemia, especially with abdominal rash, LCH should be considered. Gastrointestinal endoscopy, biopsy, and imaging studies are essential for obtaining a definitive diagnosis. This approach might be helpful for the early recognition of gastrointestinal tract involvement in LCH.
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Affiliation(s)
- Yi Cao
- Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Rd, Shanghai, China
| | - Qing-Qing Wu
- Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Rd, Shanghai, China
| | - Wei-Hui Yan
- Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Rd, Shanghai, China
| | - Li-Na Lu
- Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Rd, Shanghai, China
| | - Yi-Jing Tao
- Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Rd, Shanghai, China
| | - Hai-Xia Feng
- Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Rd, Shanghai, China
| | - Yi-Jing Chu
- Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Rd, Shanghai, China
| | - Wei Cai
- Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Rd, Shanghai, China.
- Shanghai Institute for Pediatric Research, Shanghai, China.
- Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China.
| | - Ying Wang
- Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Rd, Shanghai, China.
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8
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Wei M, Jiang W, Wang R, Xiao B, Zhan Q. Langerhans cell histiocytosis of the skull in 23 children. Eur J Med Res 2024; 29:136. [PMID: 38368348 PMCID: PMC10874530 DOI: 10.1186/s40001-024-01727-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 02/12/2024] [Indexed: 02/19/2024] Open
Abstract
OBJECTIVE To explore the clinical features, diagnosis, treatment and prognosis of Langerhans cell histiocytosis (LCH) of the skull in children. METHODS This study retrospectively summarized the clinical manifestations, treatment methods and follow-up status of children with skull LCH who were admitted to the Department of Neurosurgery of Shanghai Children's Hospital from January 2014 to June 2021. RESULTS A total of 23 patients confirmed by histology as LCH received hospitalization treatment, including 14 males and 9 females, aged (5.76 ± 3.86) years old. The clinical manifestations were mostly incidentally discovered head masses that gradually enlarged (19 cases, 82.61%). Only 2 cases are affected by multiple systems, while the rest are affected by single systems. 9 patients were involved in multiple skull lesions, and 14 patients had local skull lesions. All patients underwent surgical intervention, with 17 patients undergoing total resection and 6 patients undergoing biopsy. 21 patients received chemotherapy after surgery. The median follow-up was 2.46 years (range 0.33-6.83 years). 21 patients had their symptoms and signs under control or even resolved, and 2 patients experienced recurrence during follow-up. The overall control rate reached 91.30%. CONCLUSION Personalized treatment plans according to different clinical types. Regular outpatient follow-up is crucial to monitor disease recurrence and late effects.
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Affiliation(s)
- Min Wei
- Department of Neurosurgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Luding Rd. 355, Shanghai, People's Republic of China
| | - Wenbin Jiang
- Department of Neurosurgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Luding Rd. 355, Shanghai, People's Republic of China
| | - Rui Wang
- Department of Neurosurgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Luding Rd. 355, Shanghai, People's Republic of China
| | - Bo Xiao
- Department of Neurosurgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Luding Rd. 355, Shanghai, People's Republic of China
| | - Qijia Zhan
- Department of Neurosurgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Luding Rd. 355, Shanghai, People's Republic of China.
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Śmieszek A, Marcinkowska K, Małas Z, Sikora M, Kępska M, Nowakowska BA, Deperas M, Smyk M, Rodriguez-Galindo C, Raciborska A. Identification and characterization of stromal-like cells with CD207 +/low CD1a +/low phenotype derived from histiocytic lesions - a perspective in vitro model for drug testing. BMC Cancer 2024; 24:105. [PMID: 38342891 PMCID: PMC10860276 DOI: 10.1186/s12885-023-11807-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 12/28/2023] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND Histiocytoses are rare disorders manifested by increased proliferation of pathogenic myeloid cells sharing histological features with macrophages or dendritic cells and accumulating in various organs, i.a., bone and skin. Pre-clinical in vitro models that could be used to determine molecular pathways of the disease are limited, hence research on histiocytoses is challenging. The current study compares cytophysiological features of progenitor, stromal-like cells derived from histiocytic lesions (sl-pHCs) of three pediatric patients with different histiocytoses types and outcomes. The characterized cells may find potential applications in drug testing. METHODS Molecular phenotype of the cells, i.e. expression of CD1a and CD207 (langerin), was determined using flow cytometry. Cytogenetic analysis included GTG-banded metaphases and microarray (aCGH) evaluation. Furthermore, the morphology and ultrastructure of cells were evaluated using a confocal and scanning electron microscope. The microphotographs from the confocal imaging were used to reconstruct the mitochondrial network and its morphology. Basic cytophysiological parameters, such as viability, mitochondrial activity, and proliferation, were analyzed using multiple cellular assays, including Annexin V/7-AAD staining, mitopotential analysis, BrdU test, clonogenicity analysis, and distribution of cells within the cell cycle. Biomarkers potentially associated with histiocytoses progression were determined using RT-qPCR at mRNA, miRNA and lncRNA levels. Intracellular accumulation of histiocytosis-specific proteins was detected with Western blot. Cytotoxicyty and IC50 of vemurafenib and trametinib were determined with MTS assay. RESULTS Obtained cellular models, i.e. RAB-1, HAN-1, and CHR-1, are heterogenic in terms of molecular phenotype and morphology. The cells express CD1a/CD207 markers characteristic for dendritic cells, but also show intracellular accumulation of markers characteristic for cells of mesenchymal origin, i.e. vimentin (VIM) and osteopontin (OPN). In subsequent cultures, cells remain viable and metabolically active, and the mitochondrial network is well developed, with some distinctive morphotypes noted in each cell line. Cell-specific transcriptome profile was noted, providing information on potential new biomarkers (non-coding RNAs) with diagnostic and prognostic features. The cells showed different sensitivity to vemurafenib and trametinib. CONCLUSION Obtained and characterized cellular models of stromal-like cells derived from histiocytic lesions can be used for studies on histiocytosis biology and drug testing.
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Affiliation(s)
- Agnieszka Śmieszek
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Norwida 31, 50-375, Wroclaw, Poland.
| | - Klaudia Marcinkowska
- Department of Experimental Biology, Faculty of Biology and Animal Science, Wroclaw University of Environmental and Life Sciences, Norwida 27B, 50-375, Wroclaw, Poland
| | - Zofia Małas
- Department of Oncology and Surgical Oncology for Children and Youth, Institute of Mother and Child, Kasprzaka 17a, 01-211, Warsaw, Poland
| | - Mateusz Sikora
- Department of Experimental Biology, Faculty of Biology and Animal Science, Wroclaw University of Environmental and Life Sciences, Norwida 27B, 50-375, Wroclaw, Poland
| | - Martyna Kępska
- Department of Experimental Biology, Faculty of Biology and Animal Science, Wroclaw University of Environmental and Life Sciences, Norwida 27B, 50-375, Wroclaw, Poland
| | - Beata A Nowakowska
- Medical Genetics Department, Cytogenetics Laboratory, Institute of Mother and Child, Kasprzaka 17a, 01-211, Warsaw, Poland
| | - Marta Deperas
- Medical Genetics Department, Cytogenetics Laboratory, Institute of Mother and Child, Kasprzaka 17a, 01-211, Warsaw, Poland
| | - Marta Smyk
- Medical Genetics Department, Cytogenetics Laboratory, Institute of Mother and Child, Kasprzaka 17a, 01-211, Warsaw, Poland
| | | | - Anna Raciborska
- Department of Oncology and Surgical Oncology for Children and Youth, Institute of Mother and Child, Kasprzaka 17a, 01-211, Warsaw, Poland.
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Sakai Y, Ikawa Y, Takenaka M, Noguchi K, Fujiki T, Ikeda H, Wada T. Histopathological maturation in juvenile xanthogranuloma: a blueberry muffin infant mimicking aleukemic leukemia cutis. Int J Hematol 2024; 119:93-98. [PMID: 37989992 DOI: 10.1007/s12185-023-03675-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/27/2023] [Indexed: 11/23/2023]
Abstract
Juvenile xanthogranuloma (JXG) is usually identified by Touton giant cells, so their absence can complicate diagnosis. We encountered a case of non-typical neonatal JXG lacking Touton giant cells, which was difficult to differentiate from aleukemic leukemia cutis because of overlapping histopathological characteristics. A 1 month-old girl presented with a blueberry muffin rash and multiple 1-2 cm nodules within the subcutaneous and deeper soft tissues. Blood tests revealed pancytopenia. The initial nodule biopsy showed mononuclear cell infiltration, suggestive of mature monocytes or histiocytes, but no Touton giant cells. Bone marrow examination showed no evidence of leukemia. Despite worsening of the rash, pancytopenia, and weight gain over the following month, the results of the second biopsy remained consistent with the initial findings. Consequently, we provisionally diagnosed aleukemic leukemia cutis and initiated chemotherapy. After two courses of chemotherapy, the pancytopenia improved, but the nodules only partially regressed. A third biopsy of the nodule was performed to evaluate the histological response, and revealed Touton giant cells, confirming the diagnosis of JXG. In conclusion, distinguishing non-typical JXG from aleukemic leukemia cutis is challenging. This case highlights the importance of multiple biopsies and the potential for histopathological maturation.
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Affiliation(s)
- Yuta Sakai
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Yasuhiro Ikawa
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Mika Takenaka
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kazuhiro Noguchi
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Toshihiro Fujiki
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hiroko Ikeda
- Department of Diagnostic Pathology, Kanazawa University Hospital, Kanazawa, Japan
| | - Taizo Wada
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
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11
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Liu R, Guo Y, Han L, Feng S, Cao J, Sun Y, Cao Z, Cui X. Somatic ARAF mutations in pediatric Langerhans cell histiocytosis: clinicopathologic, genetic and functional profiling. Clin Exp Med 2023; 23:5269-5279. [PMID: 37572153 DOI: 10.1007/s10238-023-01134-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/29/2023] [Indexed: 08/14/2023]
Abstract
ARAF mutations have been identified in a limited subset of patients with Langerhans cell histiocytosis (LCH), a rare disorder characterized by abnormal proliferation of Langerhans cells. LCH is primarily instigated by mutations in the mitogen-activated protein kinase (MAPK) signaling pathway, with BRAFV600E and MAP2K1 mutations constituting most cases. ARAF mutations in LCH highlight the heterogeneity of the disease and provide insights into its underlying molecular mechanisms. However, the occurrence of ARAF-positive LCH cases is extremely rare, with only two reported globally. Although they may be linked to a more aggressive form of LCH and a more severe clinical progression, the clinical significance and functional consequences of these mutations remain uncertain. We performed next-generation sequencing (NGS) to explore driver mutations in 148 pediatric LCH patients and recognized a series of mutations, including an identical novel somatic ARAF mutation, c.1046_1051delAGGCTT (p.Q349_F351delinsL), in four pediatric LCH patients. It was considered an ARAF hotspot mutation. All reported ARAF-positive patients worldwide exhibited characteristic pathological features of LCH, albeit with involvement across multiple systems. In vitro functional studies showed that this mutation could trigger the MAPKinase pathway and phosphorylate its downstream effectors MEK1/2 and ERK1/2 (relatively weaker than BRAFV600E). Over-activation of mutant A-Raf kinase could be inhibited by the BRAF inhibitor vemurafenib. LCH is uncommon, and ARAF mutation is even rarer. In our study, we have identified a novel hotspot somatic ARAF mutation, which has been verified through functional analysis to be an activating mutation. LCH patients with ARAF mutation typically have an unfavorable prognosis due to limited treatment experiences, although they do not exhibit a high relapse rate. To aid in the development of personalized treatment approaches and prognostic markers for LCH patients, it is recommended to conduct typical pathological and immunohistochemical examinations, as well as genetic tests utilizing a targeted gene panel or whole exome sequencing (WES), for LCH diagnosis, thereby promoting the use of inhibitor treatment strategies.
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Affiliation(s)
- Rong Liu
- Department of Hematology, Capital Institute of Pediatrics, Chaoyang District, Beijing, 100020, China
| | - Yibing Guo
- GrandOmics Inc, Haidian District, Beijing, 100081, China
| | - Lin Han
- GrandOmics Inc, Haidian District, Beijing, 100081, China
| | - Shunqiao Feng
- Department of Hematology, Capital Institute of Pediatrics, Chaoyang District, Beijing, 100020, China
| | - Jing Cao
- Department of Hematology, Capital Institute of Pediatrics, Chaoyang District, Beijing, 100020, China
| | - Yanling Sun
- GrandOmics Inc, Haidian District, Beijing, 100081, China
| | - Zhenhua Cao
- GrandOmics Inc, Haidian District, Beijing, 100081, China.
| | - Xiaodai Cui
- Clinical Central Laboratory, Capital Institute of Pediatrics, Beijing, 100020, China.
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12
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Saliba T, Simoni P, Segers V, Boitsios G. Answer: Multiple lesions of the skull in a 30-month-old girl. Skeletal Radiol 2023; 52:2519-2521. [PMID: 36882552 DOI: 10.1007/s00256-023-04315-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/09/2023]
Affiliation(s)
- Thomas Saliba
- Hopital Universitaire Des Enfants Reine Fabiola (HUDERF), Brussels, Belgium.
| | - Paolo Simoni
- Hopital Universitaire Des Enfants Reine Fabiola (HUDERF), Brussels, Belgium
| | - Valérie Segers
- Centre Hospitalier Universitaire Brugmann, Brussels, Belgium
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13
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Cai F, Peng Z, Xu H, Gao H, Liao C, Xu X, Guo X, Gu W, Zhu K, Shu Q, Shen H. Immune microenvironment associated with the severity of Langerhans cell histiocytosis in children. Cytokine 2023; 171:156378. [PMID: 37748334 DOI: 10.1016/j.cyto.2023.156378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/04/2023] [Accepted: 09/20/2023] [Indexed: 09/27/2023]
Abstract
The aim of this study is to investigate the clinical potential of immune microenvironment in peripheral blood for the severity and therapeutic efficacy of Langerhans cell histiocytosis (LCH). A total of 200 newly diagnosed children with LCH during 10 years was enrolled for analysis in this study. Peripheral blood samples were acquired from patients before treatment in our hospital and immune indicators were detected by a four-color flow cytometer. The levels of CD3 + CD8 + T cell, CD3 + CD4 + HLA-DR + T cell, CD3 + CD8 + HLA-DR + T cell, IL-4, IL-6, IL-10 and IFN-γ in peripheral blood were markedly elevated in LCH patients vs. healthy controls. Patients with multiple system with risk organ involvement (MS-RO + ) exhibited higher levels in IL-6, IL-10 and IFN-γ, CD3 + CD4 + HLA-DR + T cell and CD3 + CD8 + HLA-DR + T cell, compared to those in patients without risk organ involvement (RO-). Patients who responded effectively to initial chemotherapy showed significantly lower levels of IL-4, IL-10, IFN-γ, CD3 + CD4 + HLA-DR + T cell and CD3 + CD8 + HLA-DR + T cell in peripheral blood, compared to those in patients who did not respond to initial chemotherapy. Furthermore, univariate analyses were performed that the higher levels of CD3 + CD4 + HLA-DR + T cells, CD3 + CD8 + HLA-DR + T cells and IL-10 in peripheral blood were related to non-response in LCH after initial chemotherapy. Immune microenvironment in peripheral blood may be associated with the severity and treatment response of LCH. The levels of CD3 + CD4 + HLA-DR + T cells, CD3 + CD8 + HLA-DR + T cells and IL-10 may be biomarkers to predict treatment response of LCH patients.
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Affiliation(s)
- Fengqing Cai
- Department of clinical laboratory, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Zhaoyang Peng
- Department of clinical laboratory, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Hui Xu
- Department of clinical laboratory, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Hui Gao
- Department of clinical laboratory, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Chan Liao
- Department of hematology-oncology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xiaojun Xu
- Department of hematology-oncology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xiaoping Guo
- Department of hematology-oncology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Weizhong Gu
- Department of pathology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Kun Zhu
- Department of pathology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Qiang Shu
- Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China; Joint Research Center for Immune Landscape and Precision Medicine in Children, Binjiang Institute of Zhejiang University, China.
| | - Hongqiang Shen
- Department of clinical laboratory, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China; Joint Research Center for Immune Landscape and Precision Medicine in Children, Binjiang Institute of Zhejiang University, China.
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Wang W, Liu X, Yang S, Peng X, Ma Y, Xiong X, Li Y. Serum levels of soluble interleukin 2 receptor (sIL-2R), tumor necrosis factor-alpha (TNF-α), and immunoglobulin M are correlated with the disease extent in childhood Langerhans cell histiocytosis. J Cancer Res Clin Oncol 2023; 149:11431-11442. [PMID: 37389594 DOI: 10.1007/s00432-023-04991-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/15/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE This study aimed to identify peripheral parameters associated with the severity of Langerhans cell histiocytosis (LCH) and to look for indicators associated with improvement in LCH patients with risk-organ involvement. METHODS This study enrolled LCH patients who were assessed as active disease-better (AD-B) after treatment. Patients were divided into the single system (SS) group, multisystem disease without risk-organ involvement (RO- MS) group, and multisystem disease with risk-organ involvement (RO + MS) group. Serum cytokines, immunoglobulins, and lymphocyte subsets were measured at admission for all three groups. Changes in these indicators after treatment were also analyzed. RESULTS From January 2015 to January 2022, a total of 46 patients were recruited in the present study, including 19 patients (41.3%) in the SS group, 16 patients (34.8%) in the RO- MS group, and 11 patients (23.9%) in the RO + MS group. Serum levels of soluble interleukin 2 receptor (sIL-2R) (> 912.5 U/mL), tumor necrosis factor-alpha (TNF-α) (> 20.3 pg/mL), and immunoglobulin M (< 1.12 g/L) were found to be effective in identifying patients in the RO + MS group. Furthermore, the levels of sIL-2R (SS vs RO + MS: P = 0.002, RO- MS vs RO + MS: P = 0.018) and CD8 + T-cell count (SS vs RO + MS: P = 0.028) significantly declined in the RO + MS group after treatment, indicating disease improvement. CONCLUSIONS The levels of sIL-2R and TNF-α were positively correlated with the extent of disease, while the levels of IgM were negatively correlated with the extent of disease. Additionally, the levels of sIL-2R and CD8 + T-cell count could serve as useful indicators to evaluate the treatment response in RO + MS-LCH patients.
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Affiliation(s)
- Wenxia Wang
- Department of Hematology/Oncology, Children's Medical Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoshan Liu
- Department of Hematology/Oncology, Children's Medical Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shu Yang
- Department of Hematology/Oncology, Children's Medical Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaomin Peng
- Department of Hematology/Oncology, Children's Medical Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yuhan Ma
- Department of Hematology/Oncology, Children's Medical Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xilin Xiong
- Department of Hematology/Oncology, Children's Medical Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yang Li
- Department of Hematology/Oncology, Children's Medical Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
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15
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Lu X, Wei A, Wang G, Du J, Feng L, Ou W, Wang T, Wang W, Li J, Zhang M, Zhang R, Yang J. The baseline metabolism parameters of 18F‑FDG PET/CT as promising prognostic biomarkers in pediatric Langerhans cell histiocytosis. Quant Imaging Med Surg 2023; 13:5934-5944. [PMID: 37711802 PMCID: PMC10498231 DOI: 10.21037/qims-23-290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/07/2023] [Indexed: 09/16/2023]
Abstract
Background Langerhans cell histiocytosis (LCH) is a rare myeloid precursor cell inflammatory neoplasia, which agonizes, maims, and even kills patients. Although clinical outcomes have steadily improved over the past decades, the progression/relapse rate of LCH remains high. The purpose of this study was to evaluate the prognostic value of the pre-treatment metabolism parameters of baseline 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F‑FDG PET/CT) in children with LCH. Methods This cross-sectional study retrospectively and consecutively included 37 children (24 males and 13 females; median age, 5.1 years; range, 2.4-7.8 years) with pre-treatment 18F-FDG PET/CT from September 2020 to September 2022 in Nuclear Medicine Department, Beijing friendship hospital, Capital Medical University, Beijing, China. These patients were then all admitted to the hospital and diagnosed with LCH by biopsy, in Hematology Center, Beijing Children's Hospital, Capital Medical University, Beijing, China. Five metabolism parameters of 18F-FDG PET/CT were analyzed, including maximum standardized uptake, tumor-to-normal liver standard uptake value ratio, tumor-to-normal bone marrow standard uptake value ratio, sum of metabolic tumor volume (sMTV), and sum of total lesion glycolysis (sTLG) of all lesions. Patients were followed up for at least 1 year or until disease progression/relapse. Univariate and multivariate analyses of progression-free survival was performed. Results During follow-up, 11 (29.7%) patients had disease progression/relapse. Univariate analysis revealed that the risk organ involvement, the treatment response at the 5th or 11th week, pre-treatment sMTV, and sTLG were significantly associated with progression-free survival (P=0.024, 0.018, 0.006, 0.006, and 0.042, respectively). Multivariate COX analysis revealed that non-response at the 11th week, pre-treatment sMTV >32.55 g/cm3, and sTLG >98.86 g (P=0.002, 0.020, 0.026, respectively) were risk factors for progression-free survival. Conclusions The baseline metabolism parameters of 18F-FDG PET/CT could be promising imaging biomarkers for predicting prognosis in children with LCH.
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Affiliation(s)
- Xia Lu
- Nuclear Medicine Department, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ang Wei
- Hematology Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Guanyun Wang
- Nuclear Medicine Department, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Junye Du
- Hematology Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Lijuan Feng
- Nuclear Medicine Department, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wenxin Ou
- Hematology Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Tianyou Wang
- Hematology Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Wei Wang
- Nuclear Medicine Department, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jixia Li
- Department of Laboratory Medicine, School of Medicine, Foshan University, Foshan, China
| | - Mingyu Zhang
- Nuclear Medicine Department, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Rui Zhang
- Hematology Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Jigang Yang
- Nuclear Medicine Department, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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16
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Cui L, Wang CJ, Lian HY, Zhang L, Ma HH, Wang D, Chen FF, Zhang Q, Yang Y, Wei A, Huang XT, Zhu T, Wang TY, Li ZG, Zhang R. Clinical outcomes and prognostic risk factors of Langerhans cell histiocytosis in children: Results from the BCH-LCH 2014 protocol study. Am J Hematol 2023; 98:598-607. [PMID: 36594188 DOI: 10.1002/ajh.26829] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 01/04/2023]
Abstract
Langerhans cell histiocytosis (LCH) is a rare myeloid neoplasm mainly affecting young children. This study aimed to evaluate the outcomes of 449 pediatric patients enrolled in the BCH-LCH 2014 study. 52.6% of patients were classified with single-system (SS) LCH, 28.1% with multisystem (MS) risk organ negative (RO-) LCH, and 19.4% with MS RO+ LCH. Three hundred ninety-six patients (88.2%) were initially treated with first-line therapy based on the vindesine-prednisone combination. One hundred thirty-nine patients who lacked a response to initial treatment were shifted to second-line therapy, 72 to intensive treatment Arm S1 (a combination of cytarabine, cladribine, vindesine, and dexamethasone), and 67 to Arm S2 (without cladribine). The 5-year overall survival (OS), progression-free survival (PFS), and relapse rates were 98.2% (median: 97.6 months), 54.6% (median: 58.3 months), and 29.9%, respectively. MS RO+ patients had the worst prognosis among the three clinical subtypes. For the patients initially treated with first-line therapy, the 5-year OS, PFS, and relapse rates were 99.2%, 54.5%, and 29.3%, respectively. Patients in Arm S1 had a significantly better prognosis than patients in Arm S2 (5-year PFS: 69.2% vs. 46.5%, p = .042; relapse rate: 23.4% vs. 44.2%, p = .031). Multivariate analysis revealed that early treatment response, the involvement of RO, skin, and oral mucosa, as well as laboratory parameters, including CRP and γ-GT, were independent risk factors for the PFS of LCH. Thus, the prognosis of LCH in children has been improved significantly with stratified chemotherapy, and progression and relapse remained the challenges, especially for RO+ patients.
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Affiliation(s)
- Lei Cui
- Hematologic Diseases Laboratory, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Beijing Key Laboratory of Pediatric Hematology-Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- National Key Discipline of Pediatrics, Capital Medical University, Beijing, China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Chan-Juan Wang
- Beijing Key Laboratory of Pediatric Hematology-Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- National Key Discipline of Pediatrics, Capital Medical University, Beijing, China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
- Hematology Center, Beijing Children's Hospital, Capital Medical University; National Center for Children's Health, Beijing, China
| | - Hong-Yun Lian
- Beijing Key Laboratory of Pediatric Hematology-Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- National Key Discipline of Pediatrics, Capital Medical University, Beijing, China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
- Hematology Center, Beijing Children's Hospital, Capital Medical University; National Center for Children's Health, Beijing, China
| | - Li Zhang
- Beijing Key Laboratory of Pediatric Hematology-Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- National Key Discipline of Pediatrics, Capital Medical University, Beijing, China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
- Hematology Center, Beijing Children's Hospital, Capital Medical University; National Center for Children's Health, Beijing, China
| | - Hong-Hao Ma
- Beijing Key Laboratory of Pediatric Hematology-Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- National Key Discipline of Pediatrics, Capital Medical University, Beijing, China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
- Hematology Center, Beijing Children's Hospital, Capital Medical University; National Center for Children's Health, Beijing, China
| | - Dong Wang
- Beijing Key Laboratory of Pediatric Hematology-Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- National Key Discipline of Pediatrics, Capital Medical University, Beijing, China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
- Hematology Center, Beijing Children's Hospital, Capital Medical University; National Center for Children's Health, Beijing, China
| | - Fen-Fen Chen
- Beijing Key Laboratory of Pediatric Hematology-Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- National Key Discipline of Pediatrics, Capital Medical University, Beijing, China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
- Hematology Center, Beijing Children's Hospital, Capital Medical University; National Center for Children's Health, Beijing, China
| | - Qing Zhang
- Hematologic Diseases Laboratory, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Beijing Key Laboratory of Pediatric Hematology-Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- National Key Discipline of Pediatrics, Capital Medical University, Beijing, China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Ying Yang
- Beijing Key Laboratory of Pediatric Hematology-Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- National Key Discipline of Pediatrics, Capital Medical University, Beijing, China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
- Hematology Center, Beijing Children's Hospital, Capital Medical University; National Center for Children's Health, Beijing, China
| | - Ang Wei
- Beijing Key Laboratory of Pediatric Hematology-Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- National Key Discipline of Pediatrics, Capital Medical University, Beijing, China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
- Hematology Center, Beijing Children's Hospital, Capital Medical University; National Center for Children's Health, Beijing, China
| | - Xiao-Tong Huang
- Hematologic Diseases Laboratory, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Beijing Key Laboratory of Pediatric Hematology-Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- National Key Discipline of Pediatrics, Capital Medical University, Beijing, China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Ting Zhu
- Hematologic Diseases Laboratory, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Beijing Key Laboratory of Pediatric Hematology-Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- National Key Discipline of Pediatrics, Capital Medical University, Beijing, China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Tian-You Wang
- Beijing Key Laboratory of Pediatric Hematology-Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- National Key Discipline of Pediatrics, Capital Medical University, Beijing, China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
- Hematology Center, Beijing Children's Hospital, Capital Medical University; National Center for Children's Health, Beijing, China
| | - Zhi-Gang Li
- Hematologic Diseases Laboratory, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Beijing Key Laboratory of Pediatric Hematology-Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- National Key Discipline of Pediatrics, Capital Medical University, Beijing, China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Rui Zhang
- Beijing Key Laboratory of Pediatric Hematology-Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- National Key Discipline of Pediatrics, Capital Medical University, Beijing, China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
- Hematology Center, Beijing Children's Hospital, Capital Medical University; National Center for Children's Health, Beijing, China
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The 2020 World Health Organization classification of bone tumors: what radiologists should know. Skeletal Radiol 2023; 52:329-348. [PMID: 35852560 DOI: 10.1007/s00256-022-04093-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/12/2022] [Accepted: 06/13/2022] [Indexed: 02/02/2023]
Abstract
Improved understanding of tumor biology through molecular alteration and genetic advances has resulted in a number of major changes in the 2020 World Health Organization's (WHO) classification of bone tumors. These changes include the reclassification of the existing tumors and the introduction of several new entities. A new chapter on undifferentiated small round cell sarcomas of bone and soft tissue was added to classify Ewing sarcoma and the family of Ewing-like sarcomas, which share similar histologies but different molecular and clinical behaviors. Knowledge of the current classification of bone tumors is essential to ensure the appropriate recognition of the inherent biological potential of individual osseous lesions for optimal treatment, follow-up, and overall outcome. This article reviews the major changes to the 2020 WHO's classification of primary bone tumors and the pertinent imaging of selected tumors to highlight these changes.
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18
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Burtsev EA, Bronin GO. Langerhans Cell Histiocytosis in Children: Literature Review. CURRENT PEDIATRICS 2023. [DOI: 10.15690/vsp.v22i1.2520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Relevant information on Langerhans cell histiocytosis development and course in children is presented. The current concepts of disease pathogenesis, principles of its severity evaluation, patients stratification into risk groups, as well as of clinical course features are described. Modern approaches to the disease treatment via targeted therapy are summarized and analyzed.
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19
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Mi B, Wu D, Fan Y, Thong BKS, Chen Y, Wang X, Wang C. Thyroid Langerhans cell histiocytosis concurrent with papillary thyroid carcinoma: A case report and literature review. Front Med (Lausanne) 2023; 9:1105152. [PMID: 36743683 PMCID: PMC9892196 DOI: 10.3389/fmed.2022.1105152] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/30/2022] [Indexed: 01/20/2023] Open
Abstract
Langerhans cell histiocytosis (LCH) is a clonal neoplasm of myeloid dendritic cells, rarely involving the thyroid gland. Papillary thyroid carcinoma (PTC) is the most common histological subtype of thyroid cancer. We report a rare case of a 34-year-old Chinese woman who has LCH with PTC and cervical lymph node metastasis of LCH, with a review of the literature. The patient has thyroid nodules and cervical lymph node enlargement detected by neck ultrasound during physical examination. Fine needle aspiration cytology (FNAC) showed PTC with Hashimoto's thyroiditis and BRAF V600E mutation after thyroidectomy and lymph node dissection. Histopathological examination suggests that LCH was concurrent with classical PTC, accompanied by LCH cervical lymph node metastasis. No BRAF, HRAS, and TERT promoter mutations were detected in LCH metastatic lesions. The patient is in stable clinical condition currently.
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Affiliation(s)
- Bin Mi
- Department of Pathology, Pingyi County People’s Hospital, Linyi, China
| | - Di Wu
- Department of Pathology, Xuzhou Central Hospital, Xuzhou, China
| | - Yue Fan
- Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Yudong Chen
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xue Wang
- Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,*Correspondence: Xue Wang,
| | - Chaofu Wang
- Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Chaofu Wang,
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20
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Detection of Immune Microenvironment Changes and Immune-Related Regulators in Langerhans Cell Histiocytosis Bone Metastasis. BIOMED RESEARCH INTERNATIONAL 2023; 2023:1447435. [PMID: 36714021 PMCID: PMC9879691 DOI: 10.1155/2023/1447435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 12/18/2022] [Accepted: 01/03/2023] [Indexed: 01/21/2023]
Abstract
The inflammation/immune response pathway is considered a key contributor to the development of Langerhans cell histiocytosis (LCH) bone metastasis. However, the dynamic changes in the immune microenvironment of LCH bone metastasis and critical regulators are still unclear. Expression profiling by arrays of GSE16395, GSE35340, and GSE122476 was applied to detect the immune microenvironment changes in the development of LCH bone metastasis. The single-cell high-throughput sequencing of GSE133704, involved in LCH bone lesions, was analyzed. The online database Metascape and gene set variation analysis (GSVA) algorithms were used to detect the gene function of Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG). The protein-protein interaction (PPI) network of hub regulators was constructed by the STRING database. In these results, key immune cells, such as Tem cells, NK T cells, CD8(+) T cells, and Th1 cells, were identified in LCH bone metastasis. These genes, which include LAG3, TSPAN5, LPAR5, VEGFA, CXCL16, CD74, and MARCKS, may significantly correlate with the cellular infiltration of B cells, aDCs, pDCs, cytotoxic cells, T cells, CD8+ T cells, T helper cells, and Tcm cells. In conclusion, our study constructed an atlas of the immune microenvironment of LCH bone metastasis. Genes including LAG3, TSPAN5, LPAR5, VEGFA, CXCL16, CD74, and MARCKS may be involved in the development of LCH bone metastasis. The hub gene-immune cell interactive map may be a potential prognostic biomarker for the progression of LCH bone metastasis and synergetic targets for immunotherapy in LCH patients.
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21
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Yahiaoui S, Ghorbel A, Ben Zid K, Zarraa S, Kchaou L, FidaNoubigh, Kaabia W, Bouguerra F, Mousli A, Abidi R, Yousfi A, Nadia B, Nasr C. Spontaneous regression of an orbital Langerhans cell histiocytosis after biopsy: A case report. Spontaneous regression of an orbital Langerhans cell histiocytosis. Rare Tumors 2022; 14:20363613221135987. [PMID: 36277239 PMCID: PMC9583201 DOI: 10.1177/20363613221135987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022] Open
Abstract
Langerhans histiocytosis or Langerhans cell histiocytosis (LCH) is a rare benign pathology representing less than 1% of orbital tumors. It can cause either localized or generalized lesions, leading to the destruction of hard and soft tissues. Eosinophilic granuloma is the most benign form and the predominant clinical presentation of LCH. We report a case of eosinophilic granuloma with orbital involvement in an 18-year-old male patient. Orbital radiotherapy was initially planned, but finally it was not performed due to a spontaneous regression of the lesion after the incisional biopsy. The presented case supports an expectant attitude given the possibility of a spontaneous regression after the biopsy, especially in small lesions. However, long-term follow-up is essential given the risk of recurrence.
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Affiliation(s)
- Safia Yahiaoui
- Radiotherapy Department, Salah-Azaiz Institute, Bab Saadoun, Tunis, Tunisia
| | - Asma Ghorbel
- Radiotherapy Department, Salah-Azaiz Institute, Bab Saadoun, Tunis, Tunisia,Asma Gorbel, Radiotherapy department,
Salah-Azaiz Institute, Bab Saadoun, Tunis 1006, Tunisia.
| | - Khadija Ben Zid
- Radiotherapy Department, Salah-Azaiz Institute, Bab Saadoun, Tunis, Tunisia
| | - Semia Zarraa
- Radiotherapy Department, Salah-Azaiz Institute, Bab Saadoun, Tunis, Tunisia
| | - Lina Kchaou
- Radiotherapy Department, Salah-Azaiz Institute, Bab Saadoun, Tunis, Tunisia
| | - FidaNoubigh
- Radiotherapy Department, Salah-Azaiz Institute, Bab Saadoun, Tunis, Tunisia
| | - Wael Kaabia
- Radiotherapy Department, Salah-Azaiz Institute, Bab Saadoun, Tunis, Tunisia
| | - Fadoua Bouguerra
- Radiotherapy Department, Salah-Azaiz Institute, Bab Saadoun, Tunis, Tunisia
| | - Alia Mousli
- Radiotherapy Department, Salah-Azaiz Institute, Bab Saadoun, Tunis, Tunisia
| | - Rim Abidi
- Radiotherapy Department, Salah-Azaiz Institute, Bab Saadoun, Tunis, Tunisia
| | - Amani Yousfi
- Radiotherapy Department, Salah-Azaiz Institute, Bab Saadoun, Tunis, Tunisia
| | - Boujelbene Nadia
- Pathology Department, Salah-Azaiz Institute, Bab Saadoun, Tunis, Tunisia
| | - Chiraz Nasr
- Radiotherapy Department, Salah-Azaiz Institute, Bab Saadoun, Tunis, Tunisia
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22
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Seasonality of birth month in patients diagnosed with Langerhans cell histiocytosis (LCH). Pediatr Res 2022; 92:912-914. [PMID: 34997224 DOI: 10.1038/s41390-021-01923-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/08/2021] [Accepted: 12/13/2021] [Indexed: 11/09/2022]
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23
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Kim SJ, Hah SI, Kwak JY, Choi JW, Cho HC, Ha CY, Jung WT, Lee OJ, Lee CM. Langerhans Cell Histiocytosis with the Synchronous Invasion of Stomach and Colon in an Adult Patient: A Case Report. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2022; 80:149-153. [PMID: 36156038 DOI: 10.4166/kjg.2022.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 07/02/2022] [Accepted: 07/17/2022] [Indexed: 06/16/2023]
Abstract
Langerhans cell histiocytosis (LCH) is reported less frequently in adults than in children. The most common site of involvement in adults is the bone, accounting for 30-50% of cases. The gastrointestinal tract is very rare, accounting for approximately 2%. We present a case of Langerhans cell histiocytosis that simultaneously invaded multiple organs, including the stomach and colon, in an adult. A 37-year-old woman with no underlying disease complained of chest discomfort and a palpable right submandibular mass. A right Level II neck mass and mediastinal LN enlargement were confirmed on the pharynx and chest CT scan. Multiple subepithelial masses with central ulceration and erosion were observed in the corpus and fundus on the esophagogastroduodenoscopy and in the right colon on the colonoscopy. The histopathology findings were the same in each tissue biopsied from the stomach, colon, and right neck lymph nodes. Langerhans cells with classical reniform nuclei and prominent eosinophils invaded the normal glands, and S100 and CD1a were positive in the immunohistochemical stain. Gastrointestinal involvement of LCH in adults is rare, asymptomatic,and can involve multiple digestive organs simultaneously, so upper endoscopy and colonoscopy should be considered for a diagnosis.
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Affiliation(s)
- Seong Je Kim
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Korea
| | - Se In Hah
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Korea
| | - Ji Yoon Kwak
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Korea
| | - Jung Woo Choi
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Korea
| | - Hyun Chin Cho
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Chang Yoon Ha
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Woon Tae Jung
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Ok Jae Lee
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Chang Min Lee
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
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24
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Astigarraga I, García-Obregón S, Pérez-Martínez A, Gutiérrez-Carrasco I, Santa-María V, Rodríguez-Vigil Iturrate C, Lorite Reggiori M, Murciano Carrillo T, Torrent M. Histiocitosis de células de Langerhans. Avances en la patogenia y práctica clínica. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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25
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Langerhans cell histiocytosis. Advances in pathogenesis and clinical practice. An Pediatr (Barc) 2022; 97:130.e1-130.e7. [PMID: 35869015 DOI: 10.1016/j.anpede.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 05/02/2022] [Indexed: 11/23/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a type of myeloid neoplasia that can affect different organs or tissues and exhibits substantial variability in its clinical presentation and biological behaviour, so it may mimic different diseases. Performance of different clinical assessments and laboratory and imaging tests is recommended to determine the extent of involvement, which may be of a single location or multisystemic, and the presence or absence of dysfunction in risk organs, such as the haematopoietic system, liver and spleen. The diagnosis must be confirmed by histological examination of a biopsy sample. Molecular tests have identified mutations in the mitogen-activated protein kinase (MAPK) pathway, which has expanded treatment options. The diagnosis is complex and there is controversy regarding the management of certain cases. Treatment recommendations depend on the location of the lesions and the extent of involvement. International collaborative studies have demonstrated the effectiveness of prolonged combination therapies such as vinblastine and prednisone in severe or multisystemic forms, and anti-inflammatory drugs such as indomethacin and other cytostatic combinations have proven beneficial. Langerhans cell histiocytosis is a good example of the importance of precision medicine and the benefit of identifying molecular targets, common to different neoplasms, to develop new therapies. MAPK pathway inhibitors offer an alternative treatment option in refractory cases and neurodegenerative forms of LCH. Molecular testing can contribute to the prognosis, treatment and follow-up of LCH, especially in severe forms of disease.
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26
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Langlois F, Varlamov EV, Fleseriu M. Response to Letter to the Editor From Asa and Mete: "Hypophysitis, the Growing Spectrum of a Rare Pituitary Disease". J Clin Endocrinol Metab 2022; 107:e2208-e2209. [PMID: 35037055 PMCID: PMC9016436 DOI: 10.1210/clinem/dgac026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Fabienne Langlois
- Division of Endocrinology, Department of Medicine, Centre intégré universitaire de santé et de services sociaux de l’Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Elena V Varlamov
- Departments of Medicine (Division of Endocrinology, Diabetes and Clinical Nutrition) and Neurological Surgery, and Pituitary Center, Oregon Health & Science University, Portland, OR, USA
| | - Maria Fleseriu
- Departments of Medicine (Division of Endocrinology, Diabetes and Clinical Nutrition) and Neurological Surgery, and Pituitary Center, Oregon Health & Science University, Portland, OR, USA
- Correspondence: Maria Fleseriu, MD, Oregon Health & Science University, Mail Code CH8N, 3303 SW Bond Ave, Portland, OR 97239, USA.
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27
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Åkefeldt SO, Ismail MB, Belot A, Salvatore G, Bissay N, Gavhed D, Aricò M, Henter JI, Valentin H, Delprat C. Neutralizing Anti-IL-17A Antibody Demonstrates Preclinical Activity Enhanced by Vinblastine in Langerhans Cell Histiocytosis. Front Oncol 2022; 11:780191. [PMID: 35127485 PMCID: PMC8814633 DOI: 10.3389/fonc.2021.780191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/30/2021] [Indexed: 11/13/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is an inflammatory myeloid neoplasm characterised by the accumulation into granulomas of apoptosis-resistant pathological dendritic cells (LCH-DCs). LCH outcome ranges from self-resolving to fatal. Having previously shown that, (i) monocyte-derived DCs (Mo-DCs) from LCH patients differentiate into abnormal and pro-inflammatory IL-17A-producing DCs, and (ii) recombinant IL-17A induces survival and chemoresistance of healthy Mo-DCs, we investigated the link between IL-17A and resistance to apoptosis of LCH-DCs. In LCH granulomas, we uncovered the strong expression of BCL2A1 (alias BFL1), an anti-apoptotic BCL2 family member. In vitro, intracellular IL-17A expression was correlated with BCL2A1 expression and survival of Mo-DCs from LCH patients. Based on the chemotherapeutic drugs routinely used as first or second line LCH therapy, we treated these cells with vinblastine, or cytarabine and cladribine. Our preclinical results indicate that high doses of these drugs decreased the expression of Mcl-1, the main anti-apoptotic BCL2 family member for myeloid cells, and killed Mo-DCs from LCH patients ex vivo, without affecting BCL2A1 expression. Conversely, neutralizing anti-IL-17A antibodies decreased BCL2A1 expression, the downregulation of which lowered the survival rate of Mo-DCs from LCH patients. Interestingly, the in vitro combination of low-dose vinblastine with neutralizing anti-IL-17A antibodies killed Mo-DCs from LCH patients. In conclusion, we show that BCL2A1 expression induced by IL-17A links the inflammatory environment to the unusual pro-survival gene activation in LCH-DCs. Finally, these preclinical data support that targeting both Mcl-1 and BCL2A1 with low-dose vinblastine and anti-IL-17A biotherapy may represent a synergistic combination for managing recurrent or severe forms of LCH.
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Affiliation(s)
- Selma Olsson Åkefeldt
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,UnivLyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Mohamad Bachar Ismail
- UnivLyon, Université Claude Bernard Lyon 1, Villeurbanne, France.,Laboratoire Microbiologie Santé et Environnement, Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon.,Faculty of Science, Lebanese University, Tripoli, Lebanon
| | - Alexandre Belot
- UnivLyon, Université Claude Bernard Lyon 1, Villeurbanne, France.,Centre International de Recherche en Infectiologie (CIRI), Univ Lyon, Inserm, U1111, Université Claude Bernard, Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France.,Pediatric Nephrology, Rheumatology, Dermatology Unit, HFME, Hospices Civils de Lyon, Bron, France
| | - Giulia Salvatore
- UnivLyon, Université Claude Bernard Lyon 1, Villeurbanne, France.,Radiotherapy Unit, Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Firenze, Italy
| | - Nathalie Bissay
- UnivLyon, Université Claude Bernard Lyon 1, Villeurbanne, France.,Unité de recherche "Lymphoma Immuno-Biology", Faculté de Médecine Lyon-Sud, Oullins, France
| | - Désirée Gavhed
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | | | - Jan-Inge Henter
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Hélène Valentin
- Centre de Recherche en Cancérologie de Lyon (CRCL) - INSERM U1052 - CNRS UMR5286 - Centre Léon Bérard, Lyon, France
| | - Christine Delprat
- UnivLyon, Université Claude Bernard Lyon 1, Villeurbanne, France.,Centre de Recherche en Cancérologie de Lyon (CRCL) - INSERM U1052 - CNRS UMR5286 - Centre Léon Bérard, Lyon, France
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28
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Oscier D, Stamatopoulos K, Mirandari A, Strefford J. The Genomics of Hairy Cell Leukaemia and Splenic Diffuse Red Pulp Lymphoma. Cancers (Basel) 2022; 14:697. [PMID: 35158965 PMCID: PMC8833447 DOI: 10.3390/cancers14030697] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 12/12/2022] Open
Abstract
Classical hairy cell leukaemia (HCLc), its variant form (HCLv), and splenic diffuse red pulp lymphoma (SDRPL) constitute a subset of relatively indolent B cell tumours, with low incidence rates of high-grade transformations, which primarily involve the spleen and bone marrow and are usually associated with circulating tumour cells characterised by villous or irregular cytoplasmic borders. The primary aim of this review is to summarise their cytogenetic, genomic, immunogenetic, and epigenetic features, with a particular focus on the clonal BRAFV600E mutation, present in most cases currently diagnosed with HCLc. We then reflect on their cell of origin and pathogenesis as well as present the clinical implications of improved biological understanding, extending from diagnosis to prognosis assessment and therapy response.
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Affiliation(s)
- David Oscier
- Department of Haematology, Royal Bournemouth and Christchurch NHS Trust, Bournemouth BH7 7DW, UK
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology-Hellas, 57001 Thessaloniki, Greece;
| | - Amatta Mirandari
- Cancer Genomics Group, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; (A.M.); (J.S.)
| | - Jonathan Strefford
- Cancer Genomics Group, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; (A.M.); (J.S.)
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29
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Langlois F, Varlamov EV, Fleseriu M. Hypophysitis, the Growing Spectrum of a Rare Pituitary Disease. J Clin Endocrinol Metab 2022; 107:10-28. [PMID: 34528683 PMCID: PMC8684465 DOI: 10.1210/clinem/dgab672] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Indexed: 01/13/2023]
Abstract
Hypophysitis is defined as inflammation of the pituitary gland that is primary or secondary to a local or systemic process. Differential diagnosis is broad (including primary tumors, metastases, and lympho-proliferative diseases) and multifaceted. Patients with hypophysitis typically present with headaches, some degree of anterior and/or posterior pituitary dysfunction, and enlargement of pituitary gland and/or stalk, as determined by imaging. Most hypophysitis causes are autoimmune, but other etiologies include inflammation secondary to sellar tumors or cysts, systemic diseases, and infection or drug-induced causes. Novel pathologies such as immunoglobulin G4-related hypophysitis, immunotherapy-induced hypophysitis, and paraneoplastic pituitary-directed autoimmunity are also included in a growing spectrum of this rare pituitary disease. Typical magnetic resonance imaging reveals stalk thickening and homogenous enlargement of the pituitary gland; however, imaging is not always specific. Diagnosis can be challenging, and ultimately, only a pituitary biopsy can confirm hypophysitis type and rule out other etiologies. A presumptive diagnosis can be made often without biopsy. Detailed history and clinical examination are essential, notably for signs of underlying etiology with systemic manifestations. Hormone replacement and, in selected cases, careful observation is advised with imaging follow-up. High-dose glucocorticoids are initiated mainly to help reduce mass effect. A response may be observed in all auto-immune etiologies, as well as in lymphoproliferative diseases, and, as such, should not be used for differential diagnosis. Surgery may be necessary in some cases to relieve mass effect and allow a definite diagnosis. Immunosuppressive therapy and radiation are sometimes also necessary in resistant cases.
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Affiliation(s)
- Fabienne Langlois
- Department of Medicine, Division of Endocrinology, Centre intégré universitaire de santé et de services sociaux de l’Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Elena V Varlamov
- Departments of Medicine (Division of Endocrinology, Diabetes and Clinical Nutrition) and Neurological Surgery, and Pituitary Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Maria Fleseriu
- Departments of Medicine (Division of Endocrinology, Diabetes and Clinical Nutrition) and Neurological Surgery, and Pituitary Center, Oregon Health & Science University, Portland, Oregon, USA
- Correspondence: Maria Fleseriu, MD, Oregon Health & Science University, Mail Code CH8N, 3303 S Bond Ave, Portland, Oregon 97239, USA.
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30
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Wang G, Zhuo N, Tian F, Li J, Wen Z. Langerhans cell histiocytosis in an adult with hemophagocytic lymphohistiocytosis. Arch Med Sci 2022; 18:1426-1428. [PMID: 36160347 PMCID: PMC9479711 DOI: 10.5114/aoms/151478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/21/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Gang Wang
- Department of Rheumatology and Immunology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, Hunan, China
| | - Ning Zhuo
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Feng Tian
- Department of Rheumatology and Immunology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, Hunan, China
| | - Jingyang Li
- Department of Rheumatology and Immunology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, Hunan, China
| | - Zhenhua Wen
- Department of Rheumatology and Immunology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, Hunan, China
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