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Langerhans cell histiocytosis in children - a disease with many faces. Recent advances in pathogenesis, diagnostic examinations and treatment. Postepy Dermatol Alergol 2018; 35:6-17. [PMID: 29599667 PMCID: PMC5872238 DOI: 10.5114/pdia.2017.67095] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/16/2017] [Indexed: 02/06/2023] Open
Abstract
Langerhans cell histiocytosis is a rare clonal disease characterized by the proliferation of CD1a-positive immature dendritic cells. The purpose of this article was to present an updated review of recent advances in the pathogenesis, clinical features, imaging and treatment of this disease. The discovery of oncogenic BRAF mutations and the presence of proinflammatory cytokines and chemokines confirmed the unusual characteristics of this disease. Currently, children with organ involvement who do not have a good response to chemotherapy and have neurodegeneration or diabetes insipidus are the most problematic patients. Further research is needed to improve the results of treatment.
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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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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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