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Matsumoto N, Toriumi N, Sarashina T, Hatakeyama N, Azuma H. Langerhans cell histiocytosis isolated to the thymus in a 7-month-old infant. Pediatr Int 2019; 61:205-206. [PMID: 30767312 DOI: 10.1111/ped.13749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/12/2018] [Accepted: 12/07/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Naoya Matsumoto
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
| | - Naohisa Toriumi
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
| | - Takeo Sarashina
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
| | - Naoki Hatakeyama
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
| | - Hiroshi Azuma
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
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2
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Langerhans Cell Histiocytosis in an Infant Mimicking a Lymphoma at Presentation. Case Rep Hematol 2015; 2015:670843. [PMID: 26587301 PMCID: PMC4637459 DOI: 10.1155/2015/670843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 10/09/2015] [Accepted: 10/13/2015] [Indexed: 11/17/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare disorder characterized by proliferation and accumulation of clonal dendritic cells with varied clinical presentation and an unpredictable course. We report a 5-month-old infant with LCH who presented with severe respiratory distress, a large mediastinal mass, significant generalized lymphadenopathy, and hepatosplenomegaly. Lymphoma, especially T cell lymphoblastic lymphoma, can present with superior mediastinal syndrome needing urgent empirical therapy without biopsy. However, lack of response prompted a biopsy which confirmed it to be a case of LCH and that leads to appropriate therapy and survival. There have been reports of LCH presenting with isolated mediastinal mass or with generalized lymphadenopathy, but the combined presentation of generalized lymphadenopathy with large mediastinal mass, hepatosplenomegaly, and fever in an infant has rarely been reported. Conclusion. LCH should also be considered in the differential diagnosis of an infant presenting with generalized lymphadenopathy, mediastinal mass, hepatosplenomegaly, and fever.
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Picarsic J, Egeler RM, Chikwava K, Patterson K, Jaffe R. Histologic patterns of thymic involvement in Langerhans cell proliferations: a clinicopathologic study and review of the literature. Pediatr Dev Pathol 2015; 18:127-38. [PMID: 25629953 DOI: 10.2350/15-01-1593-oa.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Thymic involvement by Langerhans cell histiocytosis (LCH) has been described mainly in isolated case reports. A description of the histopathologic patterns of LCH proliferations in the thymus, together with therapeutic implications, has not, to our knowledge, been previously addressed. The pathology consultation files at Children's Hospital of Pittsburgh of the University of Pennsylvania Medical Center were reviewed for cases of thymic involvement by LCH. Relevant cases in the literature were also reviewed, and the histopathology and clinical course of those cases were collected. Nine consultation cases of thymic involvement were reviewed, together with 23 cases in the literature, which provided adequate pathologic description and ancillary confirmation (n = 32), revealing 4 distinct pathologic groups. Group 1 showed microscopic collection of hyperplastic LCH-like cells in incidental thymectomies of patients without LCH disease, requiring no further treatment (n = 7; 22%). Group 2 showed solitary and/or cystic LCH of the thymus with gland disruption, and at least 3 cases resolved without systemic therapy (n = 10; 31%). Group 3 showed more variable thymic involvement in multisystemic LCH disease, with either a medullary restricted pattern or more diffuse gland involvement, requiring adjuvant therapy and having a higher mortality rate (n = 13; 41%). Group 4 showed a mixed histiocytic lesion with a concurrent LCH and juvenile xanthogranuloma-like proliferation (n = 2; 6%). Thymic involvement in LCH is quite rare. Based on our cases and those in the literature, we propose 4 distinct pathologic groups of thymic involvement in Langerhans cell proliferations with relevance for diagnosis and treatment.
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Affiliation(s)
- Jennifer Picarsic
- 1 Department of Pathology, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Ramzan M, Yadav SP, Joshi R, Das D, Tamhankar P, Shaikh S, Agrawal A, Shrivastava J, Singh A, Choudhary S, Berwal PK, Khichar S, Baid P, Shruthi TK, Shuba S, Rajakumar PS, Chitrambalam S. Case Reports. Indian Pediatr 2014; 51:397-8. [DOI: 10.1007/s13312-014-0405-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lakatos K, Herbrüggen H, Pötschger U, Prosch H, Minkov M. Radiological features of thymic langerhans cell histiocytosis. Pediatr Blood Cancer 2013; 60:E143-5. [PMID: 23813898 DOI: 10.1002/pbc.24640] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Accepted: 05/13/2013] [Indexed: 12/14/2022]
Abstract
TI was reported in 18/1,264 (1.4%) LCH patients. All nine patients with TI at initial LCH presentation were below 2 years of age and had multisystem LCH (9/242, 4%). Images (sonography, CT, MRI) for central review were available in 15 cases. Characteristic findings of TI were thymus enlargement (67%), few to many cysts (80%), and few to many calcifications (100%). Sonographic and MRI findings were in excellent agreement. We recommend adding sonography of the thymus to the standard for initial clinical evaluation of LCH patients below the age of 2 years.
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Affiliation(s)
- Karoly Lakatos
- Department of Radiology, St. Anna Children's Hospital, University Clinic of Pediatrics, Medical University of Vienna, Vienna, Austria
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Ducassou S, Seyrig F, Thomas C, Lambilliotte A, Marec-Berard P, Berger C, Plat G, Brugiere L, Ouache M, Barkaoui M, Armari-Alla C, Lutz P, Leverger G, Rialland X, Mansuy L, Pacquement H, Jeziorski E, Gandemer V, Chalard F, Chateil JF, Tazi A, Emile JF, Donadieu J. Thymus and mediastinal node involvement in childhood Langerhans cell histiocytosis: long-term follow-up from the French national cohort. Pediatr Blood Cancer 2013; 60:1759-65. [PMID: 23813854 PMCID: PMC3824083 DOI: 10.1002/pbc.24603] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 04/29/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Mediastinal involvement (MI) in Langerhans cell histiocytosis (LCH) has been rarely reported. Here, we describe the clinical, radiological, and biological presentation, and the outcome of childhood LCH with MI. METHOD From the French LCH register, which includes 1,423 patients aged less than 18 years, we retrieved the medical charts of patients with mediastinal enlargement detected on chest X-rays. RESULTS Thirty-seven patients were retrieved, including 18 males; median age of diagnosis was 0.7 years, and median follow-up time was 6.2 years. The prevalence of MI varied with the age at diagnosis, ranging from 7% below 1 year old to less than 1% at >5 years. Thirteen cases (35%) were diagnosed because of MI-related symptoms, including respiratory distress (N = 4), superior venous cava syndrome (N = 2), and/or cough and polypnea (N = 10). CT scans performed in 32 cases at diagnosis showed tracheal compression (N = 5), cava thrombosis (N = 2), and/or calcification (N = 16). All patients presented multi-system disease at LCH diagnosis, and 35/37 were initially treated with vinblastine and corticosteroids. Death occurred in five cases, due to MI (N = 1) or hematological refractory involvement (N = 4). The overall 5-year survival was 87.1%, and immunodeficiency was not detected as a sequel. CONCLUSIONS MI in LCH mainly occurs in young children, and diagnosis was based on CT showing thymus enlargement and calcifications.
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Affiliation(s)
- Stephane Ducassou
- Service D'hémato Oncologie Pédiatrique, CHU de StrasbourgStrasbourg, France,Service D'hémato Oncologie Pédiatrique, CHU de BordeauxBordeaux, France,*Correspondence to: Stephane Ducassou, Service D'hémato Oncologie Pédiatrique, CHU de Bordeaux, Bordeaux, France., E-mail:
| | - Fanny Seyrig
- Service D'hémato Oncologie Pédiatrique, CHU de NantesNantes, France
| | - Caroline Thomas
- Service D'hémato Oncologie Pédiatrique, CHU de NantesNantes, France
| | - Anne Lambilliotte
- Service D'hématologie Oncologie Pédiatrique, Hôpital Jeanne de FlandresLille, France
| | | | - Claire Berger
- Service D'hémato Oncologie Pédiatrique, CHU de Saint EtienneFrance
| | - Genevieve Plat
- Service D'hémato Oncologie Pédiatrique Hopital Purpan, CHU de ToulouseFrance
| | - Laurence Brugiere
- Service D'oncologie Pédiatrique, Institut Gustave RoussyVillejuif, France
| | - Marie Ouache
- Service D'hématologie Pédiatrique, Hopital Robert DébréParis, France
| | - Mohamed Barkaoui
- Service D'hémato Oncologie Pédiatrique, Centre de référence des histiocytoses, registre des histiocytoses, APHP Hôpital A. TrousseauParis, France
| | - Corinne Armari-Alla
- Service de Pédiatrie, Unité D'hémato Oncologie Pédiatrique, CHU MichallonGrenoble, France
| | - Patrick Lutz
- Service D'hémato Oncologie Pédiatrique, CHU de StrasbourgStrasbourg, France
| | - Guy Leverger
- Service D'hémato Oncologie Pédiatrique, Centre de référence des histiocytoses, registre des histiocytoses, APHP Hôpital A. TrousseauParis, France
| | - Xavier Rialland
- Service de Pédiatrie, Unité d'hémato Oncologie Pédiatrique, CHU d'AngersAngers, France
| | - Ludovic Mansuy
- Service de Médecine Infantile II, CHU de Brabois, NancyFrance
| | | | - Eric Jeziorski
- Service de Médecine Infantile, Hopital Arnaud de Villeneuve, CHU de MontpellierMontpellier, France
| | - Virginie Gandemer
- Service D'hémato Oncologie Pédiatrique, Hopital Sud CHURennes, France
| | | | | | - Abdellatif Tazi
- Service de Pneumologie, Centre de référence des histiocytoses, APHP Hôpital Saint LouisParis, France
| | - Jean François Emile
- Laboratoire D'anatomie et Cytologie Pathologique, APHP Hopital A ParéBoulognes, France
| | - Jean Donadieu
- Service D'hémato Oncologie Pédiatrique, Centre de référence des histiocytoses, registre des histiocytoses, APHP Hôpital A. TrousseauParis, France
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Hatakeyama N, Hori T, Yamamoto M, Sogawa I, Inazawa N, Tsutsumi H, Suzuki N. An infant with self-healing cutaneous Langerhans cell histiocytosis followed by isolated thymic relapse. Pediatr Blood Cancer 2009; 53:229-31. [PMID: 19343774 DOI: 10.1002/pbc.22026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Thymic involvement with Langerhans cell histiocytosis (LCH) typically occurs in children as part of multi-system (M-S) LCH. Patients who develop skin-only LCH during infancy may either follow a self-healing course with spontaneous regression or may progress to M-S involvement. We describe a male infant who developed isolated thymic LCH after spontaneous complete regression of isolated cutaneous lesions. His erythrocyte sedimentation rate and C-reactive protein increased temporarily during the skin-only stage of LCH, and increased again considerably during the thymic relapse. Even for patients with skin-only LCH, these laboratory data might indicate possible relapse or late progression of the disease.
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Affiliation(s)
- Naoki Hatakeyama
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
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Yağci B, Varan A, Uner A, Akyüz C, Büyükpamukçu M. Thymic Langerhans cell histiocytosis mimicking lymphoma. Pediatr Blood Cancer 2008; 51:833-5. [PMID: 18680163 DOI: 10.1002/pbc.21690] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a rare disorder characterized by clonal expansion of antigen presenting Langerhans cells. Different clinical features can be seen according to the involved organs and systems. Multisystem disease with organ dysfunction is more common in infants, whereas single system disease is usually observed in older children. The disease can affect any system or organ throughout the body. Thymus is a rarely involvement site reported in LCH and usually is accompanied by skin, bone or lung disease. Here we report a 12-year-old male with thymic involvement by LCH clinically mimicking lymphoma.
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Affiliation(s)
- Begül Yağci
- Department of Pediatric Oncology, Hacettepe University Institute of Oncology, Ankara, Turkey.
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Schmidt S, Eich G, Geoffray A, Hanquinet S, Waibel P, Wolf R, Letovanec I, Alamo-Maestre L, Gudinchet F. Extraosseous langerhans cell histiocytosis in children. Radiographics 2008; 28:707-26; quiz 910-1. [PMID: 18480480 DOI: 10.1148/rg.283075108] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Langerhans cell histiocytosis, a rare disease that occurs mainly in children, may produce a broad range of manifestations, from a single osseous lesion to multiple lesions involving more than one organ or system. The clinical course varies widely in relation to the patient's age. Multisystem disease may demonstrate especially aggressive behavior in very young children, with the outcome depending largely on the stage of disease and the degree of related organ dysfunction at the time of diagnosis. Extraosseous manifestations are less commonly seen than osseous ones and may be more difficult to identify. To accurately detect extraosseous Langerhans cell histiocytosis at an early stage, radiologists must recognize the significance of individual clinical and laboratory findings as well as the relevance of imaging features for the differential diagnosis. The pattern and severity of pulmonary, thymic, hepatobiliary, splenic, gastrointestinal, neurologic, mucocutaneous, soft-tissue (head and neck), and salivary involvement in Langerhans cell histiocytosis generally are well depicted with conventional radiography, ultrasonography, computed tomography, and magnetic resonance imaging. However, the imaging features are not pathognomonic, and a biopsy usually is necessary to establish a definitive diagnosis.
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Affiliation(s)
- Sabine Schmidt
- Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois-CHUV, Rue du Bugnon, 1011 Lausanne, Switzerland.
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Yağci B, Varan A, Cağlar M, Söylemezoğlu F, Sungur A, Orhan D, Yalçin B, Akyüz C, Kutluk T, Büyükpamukçu M. Langerhans cell histiocytosis: retrospective analysis of 217 cases in a single center. Pediatr Hematol Oncol 2008; 25:399-408. [PMID: 18569842 DOI: 10.1080/08880010802107356] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a disorder with unclear etiology and pathogenesis, which is characterized by abnormal clonal proliferation and accumulation of langerhans cells at various tissue and organs. A total of 217 patients with LCH were evaluated retrospectively for clinicopathological features, laboratory findings, treatment modalities, long-term outcome, and factors affecting the outcome. Median age at the time of diagnosis was 3.5 years and male/female ratio was 1.8. The most common complaint at presentation was a bone lesion-related symptom. Fifty percent of the patients younger than 2 years had organ dysfunction (OD). Treatment consisted of surgery, chemotherapy, and radiotherapy alone or in combination. Vinblastine with or without prednisolone was the most common used chemotherapy regimen. Overall (OS) and event-free survival (EFS) rates were 84% and 51.5%, respectively, at an 8-year median follow-up time. Overall survival was significantly lower in patients younger than 2 years of age and patients with OD. The age at diagnosis, pulmonary, liver, or hematological involvement, and elevated acute-phase reactants were found to have a statistically significant effect on the OS or EFS rates.
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Affiliation(s)
- Begül Yağci
- Department of Pediatric Oncology, Hacettepe University Institute of Oncology, Ankara, Turkey.
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Abstract
The predominant clinical and radiological features of Langerhans Cell Histiocytosis (LCH) in children are due to osseous involvement. Extra-osseous disease is far less common, occurring in association with bone disease or in isolation. In the present study, LCH was presumptively diagnosed on Ultrasound guided Fine needle aspiration cytology (FNAC) of the mediastinal lymph node in a 18 month-old child. The diagnosis was confirmed by histological examination of the biopsy material.S-100 protein localization in the LCH cells is often positive on immunohistochemistry.
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