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Bielamowicz K, Dimitrion P, Abla O, Bomken S, Campbell P, Collin M, Degar B, Diamond E, Eckstein OS, El-Mallawany N, Fluchel M, Goyal G, Henry MM, Hermiston M, Hogarty M, Jeng M, Jubran R, Lubega J, Kumar A, Ladisch S, McClain KL, Merad M, Mi QS, Parsons DW, Peckham-Gregory E, Picarsic J, Prudowsky ZD, Rollins BJ, Shaw PH, Wistinghausen B, Rodriguez-Galindo C, Allen CE. Langerhans cell histiocytosis: NACHO update on progress, chaos, and opportunity on the path to rational cures. Cancer 2024; 130:2416-2439. [PMID: 38687639 PMCID: PMC11214602 DOI: 10.1002/cncr.35301] [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: 01/16/2024] [Revised: 02/14/2024] [Accepted: 02/27/2024] [Indexed: 05/02/2024]
Abstract
Langerhans cell histiocytosis (LCH) is a myeloid neoplastic disorder characterized by lesions with CD1a-positive/Langerin (CD207)-positive histiocytes and inflammatory infiltrate that can cause local tissue damage and systemic inflammation. Clinical presentations range from single lesions with minimal impact to life-threatening disseminated disease. Therapy for systemic LCH has been established through serial trials empirically testing different chemotherapy agents and durations of therapy. However, fewer than 50% of patients who have disseminated disease are cured with the current standard-of-care vinblastine/prednisone/(mercaptopurine), and treatment failure is associated with long-term morbidity, including the risk of LCH-associated neurodegeneration. Historically, the nature of LCH-whether a reactive condition versus a neoplastic/malignant condition-was uncertain. Over the past 15 years, seminal discoveries have broadly defined LCH pathogenesis; specifically, activating mitogen-activated protein kinase pathway mutations (most frequently, BRAFV600E) in myeloid precursors drive lesion formation. LCH therefore is a clonal neoplastic disorder, although secondary inflammatory features contribute to the disease. These paradigm-changing insights offer a promise of rational cures for patients based on individual mutations, clonal reservoirs, and extent of disease. However, the pace of clinical trial development behind lags the kinetics of translational discovery. In this review, the authors discuss the current understanding of LCH biology, clinical characteristics, therapeutic strategies, and opportunities to improve outcomes for every patient through coordinated agent prioritization and clinical trial efforts.
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Affiliation(s)
- Kevin Bielamowicz
- College of Medicine at the University of Arkansas for Medical Sciences, Department of Pediatrics; Arkansas Children’s Hospital, Pediatric Hematology and Oncology Little Rock, AR, USA
| | - Peter Dimitrion
- Center for Cutaneous Biology and Immunology, Henry Ford Health, Detroit, Michigan, USA
| | - Oussama Abla
- Division of Hematology/Oncology, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Simon Bomken
- Translational and Clinical Research Institute, Newcastle University; Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Patrick Campbell
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Matthew Collin
- Translational and Clinical Research Institute, Newcastle University; National Institute for Health and Care Research, Newcastle Biomedical Research Centre, Newcastle upon Tyne, United Kingdom
| | - Barbara Degar
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Eli Diamond
- Departments of Neurology and Medicine, Memorial Sloan Kettering Center, New York, NY, USA
| | - Olive S. Eckstein
- Department of Pediatrics, Baylor College of Medicine; Texas Children’s Cancer Center, Texas Children’s Hospital, Houston, TX, USA
| | - Nader El-Mallawany
- Department of Pediatrics, Baylor College of Medicine; Texas Children’s Cancer Center, Texas Children’s Hospital, Houston, TX, USA
| | - Mark Fluchel
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Seattle Children’s Hospital and University of Washington School of Medicine, Seattle, Washington, USA
| | - Gaurav Goyal
- Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael M. Henry
- Center for Cancer and Blood Disorders, Phoenix Children’s Hospital, Phoenix, AZ, USA
| | - Michelle Hermiston
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Michael Hogarty
- Department of Pediatrics, Division of Hematology and Oncology, Children’s Hospital of Philadelphia (CHOP), Philadelphia, PA, USA
| | - Michael Jeng
- Department of Pediatrics, Pediatric Hematology/Oncology, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA, USA
| | - Rima Jubran
- Division of Pediatric Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Joseph Lubega
- Department of Pediatrics, Baylor College of Medicine; Texas Children’s Cancer Center, Texas Children’s Hospital, Houston, TX, USA
| | - Ashish Kumar
- University of Cincinnati College of Medicine, Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Stephan Ladisch
- Marc and Jennifer Lipschultz Precision Immunology Institute; The Tisch Cancer Institute; Department of Oncology Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kenneth L. McClain
- Department of Pediatrics, Baylor College of Medicine; Texas Children’s Cancer Center, Texas Children’s Hospital, Houston, TX, USA
| | - Miriam Merad
- Center for Cancer and Immunology Research, Children’s National Medical Center and George Washington University School of Medicine, Washington, DC, USA
| | - Qing-Sheng Mi
- Center for Cutaneous Biology and Immunology, Henry Ford Health, Detroit, Michigan, USA
| | - D. Williams Parsons
- Department of Pediatrics, Baylor College of Medicine; Texas Children’s Cancer Center, Texas Children’s Hospital, Houston, TX, USA
| | - Erin Peckham-Gregory
- Department of Pediatrics, Baylor College of Medicine; Texas Children’s Cancer Center, Texas Children’s Hospital, Houston, TX, USA
| | - Jennifer Picarsic
- University of Cincinnati College of Medicine and Division of Pathology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Zachary D. Prudowsky
- Department of Pediatrics, Baylor College of Medicine; Texas Children’s Cancer Center, Texas Children’s Hospital, Houston, TX, USA
| | - Barrett J. Rollins
- Department of Medical Oncology, Dana-Farber Cancer Institute and Department of Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter H. Shaw
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Birte Wistinghausen
- Marc and Jennifer Lipschultz Precision Immunology Institute; The Tisch Cancer Institute; Department of Oncology Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carlos Rodriguez-Galindo
- Department of Global Pediatric Medicine and Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Carl E. Allen
- Department of Pediatrics, Baylor College of Medicine; Texas Children’s Cancer Center, Texas Children’s Hospital, Houston, TX, USA
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Rajabi MT, Abdol Homayuni MR, Samiee R, Mobader Sani S, Aghajani AH, Rafizadeh SM, Amanollahi M, Pezeshgi S, Hosseini SS, Rajabi MB, Sadeghi R. Orbital histiocytosis; From A to Z. Int Ophthalmol 2024; 44:236. [PMID: 38902584 DOI: 10.1007/s10792-024-03179-6] [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: 02/13/2024] [Accepted: 06/15/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE Histiocytosis is one of the most challenging diseases in medical practice. Because of the broad spectrum of clinical manifestations, systemic involvements, unknown etiology, and complex management, different types of histiocytosis are still a big question mark for us. Orbital histiocytosis is characterized by the abnormal proliferation of histiocytes in orbital tissues. It could affect the orbit, eyelid, conjunctiva, and uveal tract. Orbital histiocytosis can cause limited eye movement, proptosis, decreased visual acuity, and epiphora. In this study, we review the novel findings regarding the pathophysiology, diagnosis, and treatment of different types of histiocytosis, focusing on their orbital manifestations. METHOD This review was performed based on a search of the PubMed, Scopus, and Embase databases or relevant published papers regarding orbital histiocytosis on October 9th, 2023. No time restriction was proposed, and articles were excluded if they were not referenced in English. RESULTS 391 articles were screened, most of them being case reports. The pathophysiology of histiocytosis is still unclear. However, different mutations are found to be prevalent in most of the patients. The diagnostic path can be different based on various factors such as age, lesion site, type of histiocytosis, and the stage of the disease. Some modalities, such as corticosteroids and surgery, are used widely for treatment. On the other hand, based on some specific etiological factors for each type, alternative treatments have been proposed. CONCLUSION Significant progress has been made in the detection of somatic molecular changes. Many case studies describe various disease patterns influencing the biological perspectives on different types of histiocytosis. It is necessary to continue investigating and clustering data from a broad range of patients with histiocytosis in children and adults to define the best ways to diagnose and treat these patients.
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Affiliation(s)
- Mohammad Taher Rajabi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
| | - Mohammad Reza Abdol Homayuni
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- NCweb Association, Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Samiee
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sheida Mobader Sani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- NCweb Association, Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Aghajani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
| | - Seyed Mohsen Rafizadeh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
| | - Mobina Amanollahi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Saharnaz Pezeshgi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Simindokht Hosseini
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
| | - Mohammad Bagher Rajabi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
| | - Reza Sadeghi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran.
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Bhatt SK, Ashcherkin N, Fanous J, Pai RK, Athale J. Hepatitis and Vasodilatory Shock due to an Unsuspected Culprit: A Rare Presentation of Multisystem Langerhans Cell Histiocytosis. Case Rep Gastroenterol 2024; 18:286-292. [PMID: 38868155 PMCID: PMC11167066 DOI: 10.1159/000538794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 04/06/2024] [Indexed: 06/14/2024] Open
Abstract
Introduction Langerhans cell histiocytosis (LCH) is a rare hematologic condition which can affect multiple organ systems and has variable presentation. LCH is more commonly seen as a malignancy of childhood. LCH in adulthood can have poor outcomes depending on the involvement of critical organs. Case Presentation We report a case of a 71-year-old female who presented with progressive weakness, weight loss, diarrhea, and jaundice, and had been undergoing outpatient workup for elevated liver enzymes for the last 2 years. She required admission to the intensive care unit for vasodilatory shock, requiring vasopressor and chronotropic support. Imaging showed an underlying multiorgan process involving the gastrointestinal tract, liver, spleen, and central nervous system. A repeat liver biopsy after a prior inconclusive one revealed the diagnosis of multisystem LCH presenting as secondary sclerosing cholangitis. Conclusion The uniqueness of this multisystem LCH case lies not only in its rarity but also in the diagnostic journey that necessitated a repeat biopsy for a conclusive diagnosis. Early identification and targeted intervention can help in ensuring better patient outcomes, especially when the presentation can overlap with various other possible conditions.
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Affiliation(s)
| | | | - John Fanous
- Department of Critical Care Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Rish K. Pai
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ, USA
| | - Janhavi Athale
- Department of Critical Care Medicine, Mayo Clinic, Phoenix, AZ, USA
- Department of Hematology and Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA
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Rocamora-Blanch G, Climent F, Solanich X. [Histiocytosis]. Med Clin (Barc) 2023; 161:166-175. [PMID: 37263840 DOI: 10.1016/j.medcli.2023.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 06/03/2023]
Abstract
Histiocytosis is a group of rare diseases characterized by inflammation and accumulation of cells derived from monocytes and macrophages in different tissues. The symptoms are highly variable, from mild forms with involvement of a single organ to severe multisystem forms that can be life compromising. The diagnosis of histiocytosis is based on the clinic, radiological findings and pathological anatomy. A biopsy of the affected tissue is recommended in all cases as it may have therapeutic implications. During the last decade, some mutations have been identified in the affected tissue that condition activation of the MAPK/ERK and PI3K/AKT pathway, in a variable proportion depending on the type of histiocytosis. In this review we mainly focus on Langerhans Cell Histiocytosis, Erdheim-Chester Disease and Rosai-Dorfman Disease.
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Affiliation(s)
- Gemma Rocamora-Blanch
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España.
| | - Fina Climent
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España; Servicio de Anatomía Patológica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Xavier Solanich
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España
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Ji W, Chen X. Hand-Schüller-Christian syndrome combined with empty sella syndrome: A case report and literature review. Medicine (Baltimore) 2023; 102:e33216. [PMID: 36897687 PMCID: PMC9997762 DOI: 10.1097/md.0000000000033216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/16/2023] [Indexed: 03/11/2023] Open
Abstract
RATIONAL Hand-Schüller-Christian syndrome (HCS) is a rare disease with little clinical awareness, but the condition is more dangerous, and it combines with empty sella syndrome (ESS) which is extremely rare. PRESENTATION A 26-year-old male patient who had proptosis, headaches, and diabetes insipidus for more than 10 years, and chronic cough and wheeze for 8 years presented to our hospital due to an abrupt onset of chest pain for 2 days. DIAGNOSIS Hand-Schüller-Christian syndrome is diagnosed based on the typical clinical manifestations of diabetes insipidus and bilateral proptosis, magnetic resonance imaging (MRI) pituitary imaging and pathology. Empty sella syndrome is diagnosed based on hormonal indicators, clinical manifestations and MRI pituitary scan results. Type 1 respiratory failure and severe pneumonia can be diagnosed based on the results of clinical examination, chest imaging (including chest x-ray and computed tomography), pathology and blood gas analysis. Left pneumothorax can be diagnosed with chest imaging. INTERVENTIONS "Meropenem and Cefdinir" were given for antimicrobrial coverage, "Desmopressin acetate" for anti-diuretic treatment, "Forcodine" for cough relief, "Ambroxol and acetylcysteine" for phlegm reduction, and continuous closed chest drainage was performed. OUTCOMES The patient discharged after cough, wheezing, headache and other symptoms improved, and vital signs were stable. The patient has been followed up once a month for 17 months ongoing after discharge. At present, symptoms such as cough, sputum, and wheezing have improved considerably, and the mMRC score of dyspnea is 2 points. The reexamination of the chest X-ray shows that the absorption of lung exudates is better than before, and there is no recurrence of pneumothorax. LESSONS Consider whether isolated diabetic insipidus is related to HSC, and if so, conduct an MRI, a biopsy, and other examinations as soon as possible.
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Affiliation(s)
- Wei Ji
- The Second Clinical College of Fujian Medical University, Quanzhou City, China
| | - Xiaoyang Chen
- Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, Quanzhou City, China
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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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Liu H, Stiller CA, Crooks CJ, Rous B, Bythell M, Broggio J, Rankin J, Nanduri V, Lanyon P, Card TR, Ban L, Elliss‐Brookes L, Broughan JM, Paley L, Wong K, Bacon A, Bishton M, West J. Incidence, prevalence and survival in patients with Langerhans cell histiocytosis: A national registry study from England, 2013-2019. Br J Haematol 2022; 199:728-738. [PMID: 36122574 PMCID: PMC9826274 DOI: 10.1111/bjh.18459] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/15/2022] [Accepted: 08/31/2022] [Indexed: 01/11/2023]
Abstract
This analysis is the largest population-based study to date to provide contemporary and comprehensive epidemiological estimates of all third edition of the International Classification of Diseases for Oncology (ICD-O-3) coded Langerhans cell histiocytosis (LCH) from England. People of all ages were identified from the National Cancer Registration Dataset using ICD-O-3 morphologies 9751-9754 for neoplasms diagnosed in 2013-2019. A total of 658 patients were identified, of whom 324 (49%) were children aged <15 years. The age-standardised incidence rate was 4.46 (95% confidence interval [CI] 3.99-4.98) per million children and 1.06 (95% CI 0.94-1.18) per million adults aged ≥15 years. Prevalence of LCH was 9.95 (95% CI 9.14-10.81) per million persons at the end of 2019. The 1-year overall survival (OS) was 99% (95% CI 97%-100%) for children and 90% (95% CI 87%-93%) for adults. Those aged ≥60 years had poorer OS than those aged <15 years (hazard ratio [HR] 22.12, 95% CI 7.10-68.94; p < 0.001). People in deprived areas had lower OS than those in the least deprived areas (HR 5.36, 95% CI 1.16-24.87; p = 0.03). There will inevitably be other environmental factors and associations yet to be identified, and the continued standardised data collection will allow further evaluation of data over time. This will be increasingly important with developments in LCH management following the large collaborative international trials such as LCH IV.
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Affiliation(s)
- Hanhua Liu
- National Disease Registration ServiceNHS DigitalLeedsUK
| | | | - Colin J. Crooks
- NIHR Nottingham Biomedical Research CentreUniversity of NottinghamNottinghamUK
| | - Brian Rous
- National Disease Registration ServiceNHS DigitalLeedsUK
| | - Mary Bythell
- National Disease Registration ServiceNHS DigitalLeedsUK
| | - John Broggio
- National Disease Registration ServiceNHS DigitalLeedsUK
| | - Judith Rankin
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | | | - Peter Lanyon
- Lifespan and Population HealthUniversity of NottinghamNottinghamUK
| | - Tim R. Card
- Lifespan and Population HealthUniversity of NottinghamNottinghamUK
| | - Lu Ban
- Nottingham Digestive Diseases CentreUniversity of NottinghamNottinghamUK
| | | | | | - Lizz Paley
- National Disease Registration ServiceNHS DigitalLeedsUK
| | - Kwok Wong
- National Disease Registration ServiceNHS DigitalLeedsUK
| | - Andrew Bacon
- National Disease Registration ServiceNHS DigitalLeedsUK
| | - Mark Bishton
- Department of HaematologyNottingham City HospitalNottinghamUK
| | - Joe West
- Lifespan and Population HealthUniversity of NottinghamNottinghamUK
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Akyildiz HS, Basak H, Beton S, Meco C. Endonasal Endoscopic Removal of a Langerhans Cell Histiocytosis from Far Lateral Frontal Sinus. Indian J Otolaryngol Head Neck Surg 2022; 74:4649-4652. [PMID: 36742520 PMCID: PMC9895655 DOI: 10.1007/s12070-021-02968-0] [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: 10/02/2021] [Accepted: 10/24/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction: Langerhans cell histiocytosis (LCH) is a rare disease in adults, and it is even uncommon in pediatric populations, affecting only 1-2 people per million. A LCH located in the frontal sinus is exceptionally unusual. We present a case of LCH located in the far lateral of the frontal sinus and discuss management as well as surgical techniques to control this far lateral frontal sinus lesion. Case Presentation: A 39 year old female, presented with a history of progressive headaches and purulent nasal discharge for three months. Computed tomography (CT) of the sinuses showed an approximately 15 × 10 mm soft tissue with osteolytic bony changes located in lateral wall of the frontal sinus on the left side. Total tumor removal was achieved by minimally invasive endonasal endoscopic surgery with a periorbital suspension technique. Histopathologic analysis revealed LCH and the patient was referred to a hematologist for further treatment. Conclusion: LCH is a rare hematological pathology. It should be diagnosed timely and treated with a multidisciplinary approach. To get a definitive diagnosis a biopsy is mandatory. Having LCH in the far lateral frontal sinus can be challenging for a biopsy even for experienced surgeons. Using curved instruments while performing an endonasal periorbital suspension technique makes it possible to access the lateral wall of the frontal sinus safely and provides an effective surgical route similar to traditional open approaches without causing any external scars.
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Affiliation(s)
- Hatice Secil Akyildiz
- Department of Otorhinolaryngology, Ankara University School of Medicine, Ankara, Turkey
| | - Hazan Basak
- Department of Otorhinolaryngology, Ankara University School of Medicine, Ankara, Turkey
| | - Suha Beton
- Department of Otorhinolaryngology, Ankara University School of Medicine, Ankara, Turkey
| | - Cem Meco
- Department of Otorhinolaryngology, Ankara University School of Medicine, Ankara, Turkey
- Department of Otorhinolaryngology, Salzburg Paracelsus Medical University, Salzburg, Austria
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Abstract
Histiocytic disorders of childhood represent a wide spectrum of conditions that share the common histologic feature of activated or transformed "histiocytes." Langerhans cell histiocytosis (LCH) is the most common, with an incidence of approximately 5 per million children. LCH may be difficult to distinguish from more ubiquitous causes of skin rashes, bone pain, or fever. Current chemotherapy fails to cure more than 50% of children with multifocal disease, and treatment failure is associated with increased risks of long-term sequelae. Somatic activating mitogen-activated protein kinase (MAPK) pathway-activating mutations (most often BRAFV600E) have been identified in hematopoietic precursors in patients with LCH. Opportunities to improve outcomes with targeted therapies are under investigation. Juvenile xanthogranuloma (JXG) and Rosai-Dorfman disease (RDD) are less common than LCH and are distinguished by specific histologic and clinical features. Recurrent MAPK pathway gene mutations are also identified in JXG and RDD. In many cases, these conditions spontaneously resolve, but disseminated disease can be fatal. Although there has been historic debate regarding the nature of these conditions as inflammatory versus neoplastic, LCH, JXG, and RDD are now considered myeloid neoplastic disorders. In contrast, hemophagocytic lymphohistiocytosis (HLH) is clearly a disorder of immune dysregulation. HLH is characterized by extreme immune activation driven by hyperactivated T cells. HLH arises in approximately 1 child per million and is nearly universally fatal without prompt recognition and immune suppression. Outcomes of treated children are poor, with approximately 60% survival. Emapalumab, which targets interferon-γ signaling, was recently approved for patients with recurrent or refractory HLH, and additional cytokine-directed therapies are under investigation.
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Affiliation(s)
- Olive S Eckstein
- Texas Children's Hospital Cancer and Hematology Centers, Section of Pediatric Hematology and Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Jennifer Picarsic
- Cincinnati Children's Hospital, Department of Pathology and Laboratory Medicine, University of Cincinnati, Cincinnati, OH
| | - Carl E Allen
- Texas Children's Hospital Cancer and Hematology Centers, Section of Pediatric Hematology and Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
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Hu X, Buhtoiarov IN, Wang C, Sun Z, Zhu Q, Huang W, Yan W, Sun Y. Langerhans Cell Histiocytosis: A Population-based Study of Anatomical Distribution and Treatment Patterns. J Bone Oncol 2022; 36:100454. [PMID: 36204417 PMCID: PMC9530953 DOI: 10.1016/j.jbo.2022.100454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/26/2022] [Accepted: 09/26/2022] [Indexed: 11/25/2022] Open
Abstract
LCH in bone marrow and lymph node are more likely to have multi-system involvement compared to LHC in other sites. Craniofacial osseous LCH is more likely to be treated with surgery, vertebral LCH is less likely to be treated with surgery. A racial disparity in surgery utilization is identified in pediatric patients with bone LCH.
Background Langerhans cell histiocytosis (LCH) is a rare monoclonal histiocytic neoplasm. Little is known about clinical factors associated with LCH single- vs multi-system involvement at the time of diagnosis. Methods Data on 1549 LCH patients diagnosed between years 2010 and 2018 were extracted from the Surveillance, Epidemiology and End Results Program. Patterns of single- vs multisystem involvement were examined using multivariable logistic regression analysis. Odd ratio (OR) and 95% confidence interval (CI) were reported. Results 968 children and adolescents (0–19 years; median: 4 years) and 581 adults (≥20 years; median: 49 years) were included in the analysis. Multi-system LCH was reported for 30.9 % patients. Bone marrow (BM) (OR = 3.776; 95 %CI = 1.939–7.351; P < 0.001) and lymph node (LN) (OR = 3.274; 95 %CI = 1.443–7.427; P = 0.005) involvement were most commonly associated with multi-system LCH at the time of diagnosis; similar pattern was also observed in adult patients (OR = 17.780; 95 %CI = 6.469–48.867; P < 0.001 for BM LCH; and OR = 5.156; 95 %CI = 2.131–12.471; P < 0.001 for LN LCH). Among pediatric patients, craniofacial osseous LCH was more likely to be treated with surgery (OR = 2.822; 95 %CI = 1.199–6.639; P = 0.018) compared to skeletal lesions in other sites, whereas vertebral body LCH was less likely to be treated with surgery (OR = 0.175; 95 %CI = 0.058–0.527; P = 0.002). In pediatric patients with bone LCH, the non-white patients were less likely to be treated surgically compared to the white patients (OR = 0.470; 95 %CI = 0.272–0.812; P = 0.007). Conclusions BM and LN LCH are associated with the highest risks of multi-system disease, which may require active surveillance. Furthermore, active attempts are needed to mitigate the racial disparity in surgery utilization in pediatric patients with skeletal LCH.
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Incidence, Clinical Features, and Outcomes of Langerhans Cell Histiocytosis in the United States. J Pediatr Hematol Oncol 2022; 44:e1006-e1015. [PMID: 35082244 DOI: 10.1097/mph.0000000000002383] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/13/2021] [Indexed: 11/26/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a disorder with highly diverse clinical manifestations. We explored if age, sex, race, organ system involved, and therapy approaches determine patient survival in the era of modern treatments. LCH patient data reported to the Surveillance, Epidemiology, and End Results (SEER) program in 2010-2016 (n=1282; age: 0 to 100 y) was analyzed. Age-specific LCH incidence flattening to a low level suggests an age cutoff for pediatric patients of 20 years. The overall survival probability is lower for patients 21 to 100 years old ( P <0.0001), irrespective of sex and race. The commonest sites involved in the 0- to 20-year age group were bone, skin, and bone marrow; this shifted to lung, bone, and skin as the commonest disease sites in patients 21 to 100 years of age. The treatments applied differed between age groups, as younger versus older patients were more likely to receive chemotherapy-based treatment (48.4% vs. 17%; P <0.0001). There also was a trend toward nonwhite versus white patients being less likely to receive chemotherapy-based treatment (31.7% vs. 38.2%; P =0.067). Whereas there are treatment disparities related to LCH patient age and perhaps race, patient age is the strongest predictor of survival, with patients 21 to 100 years of age with lung, lymph node, skin, and bone marrow disease having the worst outcomes ( P <0.0001).
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12
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Stathi D, Yavropoulou MP, Allen CE, Abhyankar H, Scull B, Tsoli M, Andreakos E, Kaltsas G, Makras P. Prevalence of the BRAF V600E mutation in Greek adults with Langerhans cell histiocytosis. Pediatr Hematol Oncol 2022; 39:540-548. [PMID: 35139731 DOI: 10.1080/08880018.2022.2029988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a rare inflammatory myeloid neoplasia with a broad spectrum of clinical manifestations. The activation of the MAP kinase pathway plays an integral role in its pathogenesis with genetic alterations found in the majority of cases that most frequently involve a somatic mutation of the oncogenic BRAFV600E variant. In this study we investigated the prevalence of the BRAFV600E mutation and its clinical relevance in adult Greek patients with LCH. Among 37 patients studied, the BRAFV600E mutation was identified in 12 out of 31 (38.7%), whereas in six patients (19.3%) the results were in conclusive. The presence of the mutation did not correlate with age at diagnosis, organ involvement, disease extent, response to initial treatment, development of diabetes insipidus and relapse risk. In our series the prevalence of the BRAFV600E mutation is at the lower range of the relative percentage found in children, but in line to that obtained in previous studies of adult patients with LCH that have found an up to 50% prevalence of the BRAFV600E mutation in these patients. Further studies with a larger number of adults are needed to identify the exact prevalence of mutations in the RAS-RAF-MEK-ERK pathway and their role on clinical parameters and disease outcomes.Supplemental data for this article is available online at https://doi.org/10.1080/08880018.2022.2029988 .
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Affiliation(s)
- Dimitra Stathi
- Department of Medical Research, LCH Adult Clinic, 251 Hellenic Air Force General Hospital, Athens, Greece.,St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Maria P Yavropoulou
- Department of Medical Research, LCH Adult Clinic, 251 Hellenic Air Force General Hospital, Athens, Greece.,Endocrinology Unit, 1st Department of Propedeutic Internal Medicine, National and Kapodistrian University of Athens Medical School, LAIKO General Hospital of Athens, Athens, Greece
| | - Carl E Allen
- Division of Pediatric Hematology-Oncology, Baylor College of Medicine, Houston, USA
| | - Harshal Abhyankar
- Division of Pediatric Hematology-Oncology, Baylor College of Medicine, Houston, USA
| | - Brooks Scull
- Division of Pediatric Hematology-Oncology, Baylor College of Medicine, Houston, USA
| | - Marina Tsoli
- Department of Medical Research, LCH Adult Clinic, 251 Hellenic Air Force General Hospital, Athens, Greece.,Endocrinology Unit, 1st Department of Propedeutic Internal Medicine, National and Kapodistrian University of Athens Medical School, LAIKO General Hospital of Athens, Athens, Greece
| | - Evangelos Andreakos
- Laboratory of Immunobiology, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Gregory Kaltsas
- Department of Medical Research, LCH Adult Clinic, 251 Hellenic Air Force General Hospital, Athens, Greece.,Endocrinology Unit, 1st Department of Propedeutic Internal Medicine, National and Kapodistrian University of Athens Medical School, LAIKO General Hospital of Athens, Athens, Greece
| | - Polyzois Makras
- Department of Medical Research, LCH Adult Clinic, 251 Hellenic Air Force General Hospital, Athens, Greece
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13
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Cai HC, Chen J, Liu T, Cai H, Duan MH, Li J, Zhou DB, Cao XX. Langerhans cell histiocytosis in adolescent patients: a single-centre retrospective study. Orphanet J Rare Dis 2022; 17:268. [PMID: 35841042 PMCID: PMC9288061 DOI: 10.1186/s13023-022-02436-0] [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: 04/18/2022] [Accepted: 06/30/2022] [Indexed: 11/19/2022] Open
Abstract
Background Langerhans cell histiocytosis (LCH) is a myeloid dendritic cell disorder frequently affecting children more than adults. The presentation of LCH varies with age, however, the clinical characteristics and genetic profiles of adolescent LCH remain elusive. To address the knowledge gap, we performed a single-centre retrospective study of 36 adolescent LCH patients aged between 14 and 17 years at Peking Union Medical College Hospital. Results At the time of diagnosis, 10 patients were classified as unifocal single system LCH (27.8%), 2 patients had pulmonary single system LCH (5.6%), 5 patients had multifocal single system LCH with bone involvement (13.9%), and 19 patients had multisystem LCH (52.8%). The most prevalent involvement in multisystem patients was the pituitary gland (78.9%), followed by the bone (42.1%), lung (42.1%), and lymph nodes (42.1%). Eight (42.1%) patients had risk organ involvement. BRAFN486_P490 was detected in 50% of patients who underwent next generation sequencing, and BRAFV600E was detected in one patient. Chemotherapies were the first line treatment in 24 patients. One patient died and thirteen patients relapsed during the follow-up. The estimated 5-year OS rate and EFS rate were 94.7% and 59.0%, respectively. Conclusions In this study, we report a large series of adolescent LCH patients. The clinical characteristics of adolescent LCH patients may be close to adult LCH. Compared with pediatric cases, adolescent LCH tends to have more pituitary lesions and pulmonary involvement, fewer skin and hematopoietic involvement, a higher frequency of BRAF deletion mutation, and a lower frequency of BRAFV600E mutation. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02436-0.
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Affiliation(s)
- Hua-Cong Cai
- Department of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jia Chen
- Department of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ting Liu
- Department of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Cai
- Department of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ming-Hui Duan
- Department of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jian Li
- Department of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Dao-Bin Zhou
- Department of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xin-Xin Cao
- Department of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. .,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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14
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Tran YH, Coven SL, Park S, Mendonca EA. Social determinants of health and pediatric cancer survival: A systematic review. Pediatr Blood Cancer 2022; 69:e29546. [PMID: 35107854 PMCID: PMC8957569 DOI: 10.1002/pbc.29546] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/11/2021] [Accepted: 12/07/2021] [Indexed: 11/07/2022]
Abstract
Despite treatment advancements and improved survival, approximately 1800 children in the United States will die of cancer annually. Survival may depend on nonclinical factors, such as economic stability, neighborhood and built environment, health and health care, social and community context, and education, otherwise known as social determinants of health (SDoH). Extant literature reviews have linked socioeconomic status (SES) and race to disparate outcomes; however, these are not inclusive of all SDoH. Thus, we conducted a systematic review on associations between SDoH and survival in pediatric cancer patients. Of the 854 identified studies, 25 were included in this review. In addition to SES, poverty and insurance coverage were associated with survival. More studies that include other SDoH, such as social and community factors, utilize prospective designs, and conduct analyses with more precise SDoH measures are needed.
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Affiliation(s)
- Yvette H. Tran
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA,Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Scott L. Coven
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA,Riley Children’s Hospital, Indianapolis, Indiana, USA
| | - Seho Park
- Department Biostatistics and Health Data Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA,Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Eneida A. Mendonca
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA,Department Biostatistics and Health Data Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA,Regenstrief Institute, Inc., Indianapolis, Indiana, USA
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15
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Monsereenusorn C, Suwannaying K, Techavichit P, Sathitsamitphong L, Komvilaisak P, Rujkijyanont P, Seksarn P, Charoenkwan P, Pakakasama S. Clinical outcomes and screening for organ involvement in pediatric Langerhans cell histiocytosis in Thailand: multicenter study on behalf of the Thai Pediatric Oncology Group. Int J Hematol 2022; 115:563-574. [DOI: 10.1007/s12185-022-03293-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/19/2022] [Accepted: 01/19/2022] [Indexed: 11/28/2022]
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16
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Manifestation of Langerhans cell histiocytosis in the oral cavity: The authors’ experience. POSTEP HIG MED DOSW 2022. [DOI: 10.2478/ahem-2021-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background. Langerhans cell histiocytosis is a rare reactive proliferative disorder marked by excess proliferation and accumulation of mononuclear phagocytes in tissues and organs. Usually, organs and systems where Langerhans cells are normally found are involved. Lesions may be limited to one system and be single- or multisite, or many systems may be involved. The etiology is not fully known. According to one of the hypotheses, immune dysfunction due to exuberant response to an unknown antigen may be the cause. The most common clinical symptoms include skin lesions, bone pain, exophthalmos, and enlarged lymph nodes, affecting the liver and spleen. Gingivitis, pocket granulation tissue, ulceration of the gingival papilla, alveolar bone atrophy leading to loosening and loss of teeth are observed in the oral cavity. The aim of the study was to determine the type and incidence of oral manifestations in patients diagnosed with Langerhans cell histiocytosis.
Methods. We evaluated patients’ medical records to obtain data on the children’s age at diagnosis, sex, the form of Langerhans cell histiocytosis, clinical picture (systemic and local oral symptoms), and radiological findings. Dental examinations (clinical and radiological) were performed to assess oral mucosa and periodontal tissues, and medical records were analyzed for the course and treatment of histiocytosis.
Results. The analysis included the medical records of 43 patients with Langerhans cell histiocytosis. Oral lesions in the form of gingivitis, pathological tooth mobility, and expansion of alveolar mandibular bone were observed in 7 patients. Conclusions. Langerhans cell histiocytosis may be accompanied by maxillary, gingival, and mucosal lesions.
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17
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Educational Case: Langerhans cell histiocytosis. Acad Pathol 2022; 9:100018. [PMID: 35600746 PMCID: PMC9115723 DOI: 10.1016/j.acpath.2022.100018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/24/2021] [Accepted: 01/03/2022] [Indexed: 11/23/2022] Open
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18
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Tang X, Gao J, Ma ZG, Guo X, Li Q, Wan Z, Sun JJ. Clinical and prognostic characteristics of 95 cases of Langerhans cell histiocytosis in children: a single-institute experience from 2013 to 2020. Ann Med 2021; 53:1537-1546. [PMID: 34459688 PMCID: PMC8409935 DOI: 10.1080/07853890.2021.1966085] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND This study aimed to understand the clinical characteristics and outcomes of children with Langerhans cell histiocytosis (LCH) in China. METHODS We conducted a retrospective study of 95 paediatric patients with LCH in West China Second University Hospital of Sichuan University between July 2013 and August 2020. RESULTS The onset age of multisystem LCH (MS-LCH) patients with risk organ (RO) involvement was younger than that of MS-LCH without RO involvement (p = .002) and single system LCH (p < .001) patients; bone was the most frequently involved organ, followed by the skin. Of all, the BRAF-V600E mutation was detected in 48 out of 84 patients who underwent gene analysis. Additionally, in our study, BRAF p.N486_T491 > K, BRAF p.L485_P490delinsF, BRAF p.R506_K507insLLR, ARAF p.Q349_F351delinsL and MAP2K1 p.Q58_E62del were known mutations in the mitogen-activated protein kinase (MAPK) pathway. The BRAF-V600E genotype in the tissue and plasma prior to therapy were detected in 16 patients, and the concordance was only 37.5% (6/16). According to the modified LCH-III-based-protocol, JLSG-02 protocol chemotherapy, and vemurafenib, the estimated five-year overall survival, event-free survival (EFS) and cumulative reactivation rates of 95 patients were 98.8%, 74.6% and 24.5%, respectively. The EFS rate in good responders was better than that in poor responders at 12-week (HR = 0.022, 95%CI 0.002-0.231, p = .002), and EFS was not affected by age, RO involvement or BRAF-V600E mutation. Regarding sequelae, nine patients had central diabetes insipidus and two had growth retardation. CONCLUSIONS In this study, LCH was a highly heterogeneous disease characterized molecularly by MAPK-pathway activating mutations. Vincristine, prednisone and cytarabine-based chemotherapy combined with vemurafenib improved the prognosis of childhood LCH. In future, prospective clinical trials and novel therapeutic strategies should be developed to improve outcomes in paediatric patients with LCH.KEY MESSAGEChildren with Langerhans cell histiocytosis in China present highly heterogeneous clinical characteristics, with up to 60% of cases harbouring mutations in MAPK pathway.Treatment response at 12-week is associated with EFS in our study.Vincristine, prednisone and cytarabine-based chemotherapy combined with vemurafenib improved the prognosis of Chinese childhood LCH, but the reactivation rate is still high.
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Affiliation(s)
- Xue Tang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Ju Gao
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Zhi-Gui Ma
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Xia Guo
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Qiang Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Zhi Wan
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Jing-Jing Sun
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
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19
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Quddusi FI, Youssef MJ, Davis DMR. Dermatologic Manifestations of Systemic Diseases in Childhood. Pediatr Rev 2021; 42:655-671. [PMID: 34850179 DOI: 10.1542/pir.2020-000679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Molly J Youssef
- Department of Pediatric and Adolescent Medicine.,Department of Dermatology, Mayo Clinic, Rochester, MN
| | - Dawn Marie R Davis
- Department of Pediatric and Adolescent Medicine.,Department of Dermatology, Mayo Clinic, Rochester, MN
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20
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Rodriguez‐Galindo C. Clinical features and treatment of Langerhans cell histiocytosis. Acta Paediatr 2021; 110:2892-2902. [PMID: 34192374 DOI: 10.1111/apa.16014] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/23/2021] [Accepted: 06/29/2021] [Indexed: 12/11/2022]
Abstract
Langerhans cell histiocytosis (LCH) is caused by the expansion of CD1a+/CD207+ cells and is characterised by a wide spectrum of organ involvement and dysfunction, affecting all ages. While almost all organs and systems can be affected, only the involvement and dysfunction of liver, spleen, and haematopoietic system influence survival. The LCH pathogenic cells are defined by universal activation of the mitogen-activated protein kinase (MAPK) signalling pathway. The most common alteration is a somatic BRAFV600E mutation, which is present in approximately two-thirds of the cases, followed by MAP2K1 mutations. Treatment of LCH is risk-adapted; patients with single lesions may respond well to local treatment, whereas patients with multi-system disease require systemic chemotherapy. While survival for patients without organ dysfunction is excellent, mortality rates for patients with organ dysfunction may reach 20%. Despite progress made in the treatment of LCH, disease reactivation rates remain above 30%, and standard second-line treatment has yet to be established. Long-term effects, including neuroendocrine dysfunction and neurodegeneration, represent a major challenge for survivors. Treatment with BRAF or MEK inhibitors results in immediate responses, but reactivations are very common after discontinuation. Their role as single agents and in combination with chemotherapy is being explored.
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Affiliation(s)
- Carlos Rodriguez‐Galindo
- Departments of Global Pediatric Medicine and Oncology St. Jude Children’s Research Hospital Memphis TN USA
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21
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McClain KL, Bigenwald C, Collin M, Haroche J, Marsh RA, Merad M, Picarsic J, Ribeiro KB, Allen CE. Histiocytic disorders. Nat Rev Dis Primers 2021; 7:73. [PMID: 34620874 PMCID: PMC10031765 DOI: 10.1038/s41572-021-00307-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 12/18/2022]
Abstract
The historic term 'histiocytosis' meaning 'tissue cell' is used as a unifying concept for diseases characterized by pathogenic myeloid cells that share histological features with macrophages or dendritic cells. These cells may arise from the embryonic yolk sac, fetal liver or postnatal bone marrow. Prior classification schemes align disease designation with terminal phenotype: for example, Langerhans cell histiocytosis (LCH) shares CD207+ antigen with physiological epidermal Langerhans cells. LCH, Erdheim-Chester disease (ECD), juvenile xanthogranuloma (JXG) and Rosai-Dorfman disease (RDD) are all characterized by pathological ERK activation driven by activating somatic mutations in MAPK pathway genes. The title of this Primer (Histiocytic disorders) was chosen to differentiate the above diseases from Langerhans cell sarcoma and malignant histiocytosis, which are hyperproliferative lesions typical of cancer. By comparison LCH, ECD, RDD and JXG share some features of malignant cells including activating MAPK pathway mutations, but are not hyperproliferative. 'Inflammatory myeloproliferative neoplasm' may be a more precise nomenclature. By contrast, haemophagocytic lymphohistiocytosis is associated with macrophage activation and extreme inflammation, and represents a syndrome of immune dysregulation. These diseases affect children and adults in varying proportions depending on which of the entities is involved.
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Affiliation(s)
- Kenneth L McClain
- Texas Children's Cancer Center, Department of Paediatrics, Baylor College of Medicine, Houston, TX, USA.
| | - Camille Bigenwald
- Department of Oncological Sciences and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthew Collin
- Human Dendritic Cell Lab, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Julien Haroche
- Department of Internal Medicine, Institut E3M French Reference Centre for Histiocytosis, Pitié-Salpȇtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Rebecca A Marsh
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, and University of Cincinnati, Cincinnati, OH, USA
| | - Miriam Merad
- Department of Oncological Sciences and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jennifer Picarsic
- Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Karina B Ribeiro
- Faculdade de Ciȇncias Médicas da Santa Casa de São Paulo, Department of Collective Health, São Paulo, Brazil
| | - Carl E Allen
- Texas Children's Cancer Center, Department of Paediatrics, Baylor College of Medicine, Houston, TX, USA
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22
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Zheng DJ, Li A, Ma C, Ribeiro KB, Diller L, Bona K, Marron JM. Socioeconomic disparities in survival after high-risk neuroblastoma treatment with modern therapy. Pediatr Blood Cancer 2021; 68:e29127. [PMID: 34022098 PMCID: PMC8384664 DOI: 10.1002/pbc.29127] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/18/2021] [Accepted: 04/29/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Modern therapeutic advances in high-risk neuroblastoma have improved overall survival (OS), but it is unclear whether these survival gains have been equitable. This study examined the relationship between socioeconomic status (SES) and overall survival (OS) in children with high-risk neuroblastoma and whether SES-associated disparities have changed over time. PROCEDURE In this population-based cohort study, children <18 years diagnosed with high-risk neuroblastoma (diagnosis at age ≥12 months with metastatic disease) from 1991 to 2015 were identified through the National Cancer Institute's Surveillance, Epidemiology, and End Results database. Associations of county-level SES variables and OS were tested with univariate Cox proportional hazards regression. For a subcohort diagnosed after 2007, insurance status was examined as an individual-level SES variable. Multivariable regression analyses with treatment era and interaction terms were performed when SES variables reached near-significance (p ≤ .1) in univariate and bivariate modeling with treatment era. RESULTS Among 1217 children, 2-year OS improved from 53.0 ± 3.4% in 1991-1998 to 76.9 ± 2.9% in 2011-2015 (p < .001). In univariate analyses, children in high-poverty counties (hazard ratio [HR] = 1.74, 95% confidence interval [CI] = 1.17-2.60, p = .007), and those with Medicaid (HR = 1.40, 95% CI = 1.05-1.86, p = .02) experienced an increased hazard of death. No interactions between treatment era and SES variables were statistically significant in multivariable analyses, indicating that differences in the OS between SES groups did not change over time. CONCLUSIONS Survival disparities among children with high-risk neuroblastoma have not widened over time, suggesting equitable access to and benefit from therapeutic advances. However, children of low SES experience persistently inferior survival. Interventions to narrow this disparity are paramount.
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Affiliation(s)
- Daniel J. Zheng
- Department of Pediatrics, Boston Children’s Hospital, Boston MA
- Department of Pediatrics, Boston Medical Center, Boston MA
| | - Anran Li
- University of Michigan Medical School, Ann Arbor, MI
| | - Clement Ma
- Harvard Medical School, Boston, MA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Karina B. Ribeiro
- Department of Social Medicine, Faculdade de Ciencias Médicas da Santa Casa de São Paulo, Sao Paulo, Brazil
| | - Lisa Diller
- Department of Pediatrics, Boston Children’s Hospital, Boston MA
- Harvard Medical School, Boston, MA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Kira Bona
- Department of Pediatrics, Boston Children’s Hospital, Boston MA
- Harvard Medical School, Boston, MA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
| | - Jonathan M. Marron
- Department of Pediatrics, Boston Children’s Hospital, Boston MA
- Harvard Medical School, Boston, MA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
- Center for Bioethics, Harvard Medical School, Boston, MA
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23
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Kitticharoenjit P, Supakul N, Rujkijyanont P, Traivaree C, Photia A, Monsereenusorn C. Clinical characteristics and outcomes of Langerhans cell histiocytosis at a single institution in Thailand: a 20-year retrospective study. ASIAN BIOMED 2021; 15:171-181. [PMID: 37551332 PMCID: PMC10388756 DOI: 10.2478/abm-2021-0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Langerhans cell histiocytosis (LCH) is a rare disease characterized by the various systems involved and clinical manifestations with a wide range of symptoms. Objectives To describe clinical characteristics, imaging, treatment, and outcomes of pediatric LCH at Phramongkutklao Hospital, Bangkok, Thailand. Methods We conducted a 20-year retrospective review of the medical records of patients diagnosed with LCH from birth to 21 years old from January 1, 1997, to December 31, 2016. Results In all, 14 patients with median age of 2.5 years were studied. Six (43%) patients had single-system (SS) LCH. Five patients (63%) with multisystem (MS) LCH (n = 8. 57%) had risk-organ involvement (RO+). All patients had plain X-ray imaging of their skull with 11 (79%) showing abnormal findings. Tc-99m bone imaging and fluorodeoxyglucose F18 (FDG) positron emission tomography (PET)-computed tomography (CT) demonstrated abnormal findings in 8 (89%) and 4 (29%) patients, respectively. The 5-year event-free survival (EFS) for patients with RO+ MS-LCH was less than that for those without risk-organ involvement (RO-) MS-LCH and SS-LCH (20% vs. 100%, P = 0.005). Hematological dysfunction, hypoalbuminemia, and conjugated hyperbilirubinemia may be worse prognostic factors for RO+ MS-LCH. Conclusion FDG-PET-CT might have a greater accuracy to detect LCH disease than conventional plain X-ray and Tc-99m bone imaging. RO+ MS-LCH has been encountered with relapse and poor outcomes. Hematopoietic involvement, hypoalbuminemia, and conjugated hyperbilirubinemia may be worse prognostic factors for RO+ MS-LCH.
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Affiliation(s)
| | - Nucharin Supakul
- Department of Radiology and Imaging Science, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN46202, United States of America
| | - Piya Rujkijyanont
- Division of Hematology–Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok10400, Thailand
| | - Chanchai Traivaree
- Division of Hematology–Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok10400, Thailand
| | - Apichat Photia
- Division of Hematology–Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok10400, Thailand
| | - Chalinee Monsereenusorn
- Division of Hematology–Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok10400, Thailand
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Feng S, Han L, Yue M, Zhong D, Cao J, Guo Y, Sun Y, Zhang H, Cao Z, Cui X, Liu R. Frequency detection of BRAF V600E mutation in a cohort of pediatric langerhans cell histiocytosis patients by next-generation sequencing. Orphanet J Rare Dis 2021; 16:272. [PMID: 34116682 PMCID: PMC8196454 DOI: 10.1186/s13023-021-01912-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/07/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a rare neoplastic disease that occurs in both children and adults, and BRAF V600E is detected in up to 64% of the patients. Several studies have discussed the associations between BRAF V600E mutation and clinicopathological manifestations, but no clear conclusions have been drawn regarding the clinical significance of the mutation in pediatric patients. RESULTS We retrieved the clinical information for 148 pediatric LCH patients and investigated the BRAF V600E mutation using next-generation sequencing alone or with droplet digital PCR. The overall positive rate of BRAF V600E was 60/148 (41%). The type of sample (peripheral blood and formalin-fixed paraffin-embedded tissue) used for testing was significantly associated with the BRAF V600E mutation status (p-value = 0.000 and 0.000). The risk of recurrence declined in patients who received targeted therapy (p-value = 0.006; hazard ratio 0.164, 95%CI: 0.046 to 0.583). However, no correlation was found between the BRAF V600E status and gender, age, stage, specific organ affected, TP53 mutation status, masses close to the lesion or recurrence. CONCLUSIONS This is the largest pediatric LCH study conducted with a Chinese population to date. BRAF V600E in LCH may occur less in East Asian populations than in other ethnic groups, regardless of age. Biopsy tissue is a more sensitive sample for BRAF mutation screening because not all of circulating DNA is tumoral. Approaches with low limit of detection or high sensitivity are recommended for mutation screening to avoid type I and II errors.
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Affiliation(s)
- Shunqiao Feng
- Department of Hematology, Children's Hospital of Capital Institute of Pediatrics, Beijing, 100020, China
| | - Lin Han
- Running Gene Inc, Beijing, China
| | - Mei Yue
- Department of Hematology, Children's Hospital of Capital Institute of Pediatrics, Beijing, 100020, China
| | - Dixiao Zhong
- Department of Hematology, Children's Hospital of Capital Institute of Pediatrics, Beijing, 100020, China
| | - Jing Cao
- Department of Hematology, Children's Hospital of Capital Institute of Pediatrics, Beijing, 100020, China
| | | | | | | | | | - Xiaodai Cui
- Department of Key Laboratory, Children's Hospital of Capital Institute of Pediatrics, Beijing, 100020, China.
| | - Rong Liu
- Department of Hematology, Children's Hospital of Capital Institute of Pediatrics, Beijing, 100020, China.
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Abstract
Children with Langerhnans cell histiocytosis (LCH) develop granulomatous lesions with characteristic clonal CD207+ dendritic cells that can arise as single lesions or life-threatening disseminated disease. Despite the wide range of clinical presentations, LCH lesions are histologically indistinguishable based on severity of disease, and uncertain classification as an immune versus neoplastic disorder has historically challenged the development of optimal clinical strategies for patients with LCH. Recently, activating somatic mutations in MAPK pathway genes, most notably BRAFV600E, have been discovered in almost all cases of LCH. Further, the stage of myeloid differentiation in which the mutation arises defines the extent of disease and risk of developing LCH-associated neurodegeneration. MAPK activation in LCH precursor cells drives myeloid differentiation, inhibits migration, and inhibits apoptosis, resulting in accumulation of resilient pathologic dendritic cells that recruit and activate T cells. Recurrent somatic mutations in MAPK pathway genes have also been identified in related histiocytic disorders: juvenile xanthogranuloma, Erdheim-Chester disease, and Rosai-Dorfman disease. New insights into pathogenesis support reclassification of these conditions as a myeloid neoplastic disorders. Continued research will uncover opportunities to identify novel targets and inform personalized therapeutic strategies based on cell of origin, somatic mutation, inherited risk factors, and residual disease.
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Affiliation(s)
- Nitya Gulati
- Texas Children's Hospital Cancer and Hematology Center, Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Carl E Allen
- Texas Children's Hospital Cancer and Hematology Center, Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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Histiocytic Diseases of Neonates: Langerhans Cell Histiocytosis, Rosai-Dorfman Disease, and Juvenile Xanthogranuloma. Clin Perinatol 2021; 48:167-179. [PMID: 33583503 DOI: 10.1016/j.clp.2020.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Langerhans cell histiocytosis, Rosai-Dorfman disease, and juvenile xanthogranuloma may present at birth or any time afterward. Some patients have minimal skin or lymph node involvement, but others present with life-threatening pulmonary, hepatic, bone marrow, or central nervous system lesions. There is often a delay in diagnosis because of confusing overlap with more common neonatal diseases. Many treatment regimens have been applied to these diseases, but those directed at myeloid cells, such as cytarabine and clofarabine or mutation-targeting inhibitors, are gaining favor. This article provides information on the pathophysiology, clinical presentation, evaluation guidelines, and treatment of these uncommon tumors of neonates.
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Abstract
Langerhans cell histiocytosis (LCH) is caused by clonal expansion of myeloid precursors that differentiate into CD1a+/CD207+ cells in lesions that leads to a spectrum of organ involvement and dysfunction. The pathogenic cells are defined by constitutive activation of the MAPK signaling pathway. Treatment of LCH is risk-adapted: patients with single lesions may respond well to local treatment, whereas patients with multisystem disease require systemic therapy. Although survival rates for patients without organ dysfunction is excellent, mortality rates for patients with organ dysfunction may reach 20%. Despite progress made in the treatment of LCH, disease reactivation rates remain above 30%, and standard second-line treatment is yet to be established. Treatment failure is associated with increased risks for death and long-term morbidity, including LCH-associated neurodegeneration. Early case series report promising clinical responses in patients with relapsed and refractory LCH treated with BRAF or MEK inhibitors, although potential for this strategy to achieve cure remains uncertain.
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Zhao SS, Yan LF, Feng XL, Du P, Chen BY, Dong WT, Gao Y, He JB, Cui GB, Wang W. Incidence and radiological pattern of eosinophilic granuloma: a retrospective study in a Chinese tertiary hospital. J Orthop Surg Res 2019; 14:123. [PMID: 31072377 PMCID: PMC6507022 DOI: 10.1186/s13018-019-1158-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 04/16/2019] [Indexed: 11/30/2022] Open
Abstract
Background The incidence and radiological patterns of eosinophilic granuloma (EG) in China is not clear. We described the incidence, presentation, and imaging characteristics of Chinese EG patients in a tertiary hospital. Methods A retrospective chart review was performed from January 2004 to October 2017 at a single tertiary general hospital. Seventy-six patients were pathologically identified as EG. Besides, 60 patients with preoperative imaging diagnosis of “EG” were analyzed to reveal the radiological patterns and their diagnostic power. Results Fifty-three male and 23 female EG patients with a mean age of 18.1 ± 16.7 years (range 1–58 years) were retrospectively included. Significant differences were observed in gender (male to female = 2.3:1) and age (the highest incidence at the age of 0~5 years) for EG. EG predominantly involved the skeletal system: flat bones (31.43%) > irregular bones (24.76%) > long bones (22.86%) > other organs (20.95%). No obvious relationships between season, biochemical markers, and EG incidence were observed. The common presenting symptoms were pain followed with local mass, and most patients underwent surgical resection. Among 60 imagingly diagnosed “EG” patients from April 2009 to October 2017, only 22 were with histological confirmation. The correct diagnosis rates were 37.1% (13 out of 35), 16.7% (5 out of 30), and 22.2% (8 out of 36) for plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI), respectively. Conclusions Chinese EG has a varied presentation, age distribution, and gender difference. EG diagnosis is still based on biopsy or histopathology instead of imaging techniques. Electronic supplementary material The online version of this article (10.1186/s13018-019-1158-1) contains supplementary material, which is available to authorized users.
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Abstract
Developments over the past five years have significantly advanced our ability to use genome-scale analyses—including high-density genotyping, transcriptome sequencing, exome sequencing, and genome sequencing—to identify the genetic basis of childhood cancer. This article reviews several key results from an expanding number of genomic studies of pediatric cancer: ( a) Histopathologic subtypes of cancers can be associated with a high incidence of germline predisposition, ( b) neurodevelopmental disorders or highly penetrant cancer predisposition syndromes can result from specific patterns of variation in genes encoding the SMARC family of chromatin remodelers, ( c) genome-wide association studies with relatively small pediatric cancer cohorts have successfully identified single-nucleotide polymorphisms with large effect sizes and provided insight into population differences in cancer risk, and ( d) multiple exome or genome analyses of unselected childhood cancer cohorts have yielded a 7–10% incidence of pathogenic variants in cancer predisposition genes. This work supports the increasing use of genomic sequencing in the care of pediatric cancer patients and at-risk family members.
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Affiliation(s)
- Sharon E. Plon
- Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030, USA
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030, USA
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas 77030, USA
- Dan L Duncan Cancer Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Philip J. Lupo
- Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030, USA
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas 77030, USA
- Dan L Duncan Cancer Center, Baylor College of Medicine, Houston, Texas 77030, USA
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Allen A, Matrova E, Ozgen B, Redleaf M, Emmadi R, Saran N. Langerhans' cell histiocytosis of the temporal bone in an adult with central diabetes insipidus. Radiol Case Rep 2019; 14:847-850. [PMID: 31080537 PMCID: PMC6502742 DOI: 10.1016/j.radcr.2019.03.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/28/2019] [Accepted: 03/31/2019] [Indexed: 11/18/2022] Open
Abstract
We present a case of Langerhans’ cell histiocytosis in a 40-year-old woman presenting with central diabetes insipidus and right ear pain. As this disease process is often clinically challenging, the presence of certain imaging findings should raise the possibility of this diagnosis. We review the pertinent imaging and correlate with histology and immunohistochemistry leading to the diagnosis.
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Affiliation(s)
- Amanda Allen
- University of Illinois at Chicago, 1740 W Taylor St, Chicago, IL 60612, USA
- Corresponding author.
| | - Elza Matrova
- University of Illinois at Chicago, Department of Pathology, 1740 W Taylor St, Chicago, IL 60612, USA
| | - Burce Ozgen
- University of Illinois at Chicago, Department of Radiology, 1740 W Taylor St, Chicago, IL 60612, USA
| | - Miriam Redleaf
- University of Illinois at Chicago, Department of Otolaryngology, 1740 W Taylor St, Chicago, IL 60612, USA
| | - Rajyasree Emmadi
- University of Illinois at Chicago, Department of Pathology, 1740 W Taylor St, Chicago, IL 60612, USA
| | - Nitu Saran
- University of Illinois at Chicago, Department of Radiology, 1740 W Taylor St, Chicago, IL 60612, USA
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Langerhans cell histiocytosis in children: History, classification, pathobiology, clinical manifestations, and prognosis. J Am Acad Dermatol 2018; 78:1035-1044. [PMID: 29754885 DOI: 10.1016/j.jaad.2017.05.059] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/15/2017] [Accepted: 05/31/2017] [Indexed: 12/16/2022]
Abstract
Langerhans cell histiocytosis (LCH) is an inflammatory neoplasia of myeloid precursor cells driven by mutations in the mitogen-activated protein kinase pathway. When disease involves the skin, LCH most commonly presents as a seborrheic dermatitis or eczematous eruption on the scalp and trunk. Evaluation for involvement of other organ systems is essential, because 9 of 10 patients presenting with cutaneous disease also have multisystem involvement. Clinical manifestations range from isolated disease with spontaneous resolution to life-threatening multisystem disease. Prognosis depends on involvement of risk organs (liver, spleen, and bone marrow) at diagnosis, particularly on presence of organ dysfunction, and response to initial therapy. Systemic treatment incorporating steroids and cytostatic drugs for at least one year has improved prognosis of multisystem LCH and represents the current standard of care.
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Mogensen H, Modig K, Tettamanti G, Erdmann F, Heyman M, Feychting M. Survival After Childhood Cancer-Social Inequalities in High-Income Countries. Front Oncol 2018; 8:485. [PMID: 30474007 PMCID: PMC6238081 DOI: 10.3389/fonc.2018.00485] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/09/2018] [Indexed: 11/21/2022] Open
Abstract
Despite substantial improvements in survival from childhood cancer during the last decades, there are indications that survival rates for several cancer types are no longer improving. Moreover, evidence accumulates suggesting that socioeconomic and sociodemographic factors may have an impact on survival also in high-income countries. The aim of this review is to summarize the findings from studies on social factors and survival in childhood cancer. Several types of cancer and social factors are included in order to shed light on potential mechanisms and identify particularly affected groups. A literature search conducted in PubMed identified 333 articles published from December 2012 until June 2018, of which 24 fulfilled the inclusion criteria. The findings are diverse; some studies found no associations but several indicated a social gradient with higher mortality among children from families of lower socioeconomic status (SES). There were no clear suggestions of particularly vulnerable subgroups, but hematological malignancies were most commonly investigated. A wide range of social factors have been examined and seem to be of different importance and varying between studies. However, potential underlying mechanisms linking a specific social factor to childhood cancer survival was seldom described. This review provides some support for a relationship between lower parental SES and worse survival after childhood cancer, which is a finding that needs further attention. Studies investigating predefined hypotheses involving specific social factors within homogenous cancer types are lacking and would increase the understanding of mechanisms involved, and allow targeted interventions to reduce health inequalities.
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Affiliation(s)
- Hanna Mogensen
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karin Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Giorgio Tettamanti
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Friederike Erdmann
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Mats Heyman
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Schwentner R, Jug G, Kauer MO, Schnöller T, Waidhofer-Söllner P, Holter W, Hutter C. JAG2 signaling induces differentiation of CD14 + monocytes into Langerhans cell histiocytosis-like cells. J Leukoc Biol 2018; 105:101-111. [PMID: 30296338 DOI: 10.1002/jlb.1a0318-098r] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 08/12/2018] [Accepted: 09/17/2018] [Indexed: 12/26/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a MAPK pathway-driven disease characterized by the accumulation of CD1a+ langerin+ cells of unknown origin. We have previously reported that the Notch signaling pathway is active in LCH lesions and that the Notch ligand Jagged2 (JAG2) induces CD1a and langerin expression in monocytes in vitro. Here we show that Notch signaling induces monocytes to acquire an LCH gene signature and that Notch inhibition suppresses the LCH phenotype. In contrast, while also CD1c+ dendritic cells or IL-4-stimulated CD14+ monocytes acquire CD1a and langerin positivity in culture, their gene expression profiles and surface phenotypes are more different from primary LCH cells. We propose a model where CD14+ monocytes serve as LCH cell precursor and JAG2-mediated activation of the Notch signaling pathway initiates a differentiation of monocytes toward LCH cells in selected niches and thereby contributes to LCH pathogenesis.
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Affiliation(s)
- Raphaela Schwentner
- Children´s Cancer Research Institute, St. Anna Kinderkrebsforschung, Vienna, Austria
| | - Gunhild Jug
- Children´s Cancer Research Institute, St. Anna Kinderkrebsforschung, Vienna, Austria
| | - Maximilian O Kauer
- Children´s Cancer Research Institute, St. Anna Kinderkrebsforschung, Vienna, Austria
| | - Thomas Schnöller
- Children´s Cancer Research Institute, St. Anna Kinderkrebsforschung, Vienna, Austria
| | | | - Wolfgang Holter
- Children´s Cancer Research Institute, St. Anna Kinderkrebsforschung, Vienna, Austria.,St. Anna Children's Hospital, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Caroline Hutter
- Children´s Cancer Research Institute, St. Anna Kinderkrebsforschung, Vienna, Austria.,St. Anna Children's Hospital, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
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34
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Affiliation(s)
- Carl E Allen
- From the Texas Children's Cancer Center and the Department of Pediatrics, Baylor College of Medicine, Houston (C.E.A., K.L.M.); and the Department of Oncological Sciences, the Precision Immunology Institute, and the Tisch Cancer Institute, Icahn School of Medicine, New York (M.M.)
| | - Miriam Merad
- From the Texas Children's Cancer Center and the Department of Pediatrics, Baylor College of Medicine, Houston (C.E.A., K.L.M.); and the Department of Oncological Sciences, the Precision Immunology Institute, and the Tisch Cancer Institute, Icahn School of Medicine, New York (M.M.)
| | - Kenneth L McClain
- From the Texas Children's Cancer Center and the Department of Pediatrics, Baylor College of Medicine, Houston (C.E.A., K.L.M.); and the Department of Oncological Sciences, the Precision Immunology Institute, and the Tisch Cancer Institute, Icahn School of Medicine, New York (M.M.)
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35
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Goyal G, Shah MV, Hook CC, Wolanskyj AP, Call TG, Rech KL, Go RS. Adult disseminated Langerhans cell histiocytosis: incidence, racial disparities and long-term outcomes. Br J Haematol 2018; 182:579-581. [PMID: 28653448 DOI: 10.1111/bjh.14818] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Gaurav Goyal
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Mithun V Shah
- Division of Hematology, MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | - Karen L Rech
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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Peckham-Gregory EC, McClain KL, Allen CE, Scheurer ME, Lupo PJ. The role of parental and perinatal characteristics on Langerhans cell histiocytosis: characterizing increased risk among Hispanics. Ann Epidemiol 2018; 28:521-528. [PMID: 29724524 PMCID: PMC6054892 DOI: 10.1016/j.annepidem.2018.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/23/2018] [Accepted: 04/10/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE Potential roles of inherited and environmental risk factors in pathogenesis of Langerhans cell histiocytosis (LCH), a myeloid neoplastic disorder, are undefined. We therefore evaluated the role of parental and perinatal factors on the risk of this childhood cancer. METHODS Information on LCH cases (n = 162) for the period 1995-2011 was obtained from the Texas Cancer Registry. Birth certificate controls were frequency-matched on year of birth at a ratio of 10:1 for the same period. Variables evaluated included parental age, race/ethnicity, size for gestational age, and birth order. Logistic regression was used to generate an adjusted odds ratio (aOR) and 95% confidence interval (CI) testing the association between each factor and LCH. RESULTS Few perinatal or parental factors were associated with LCH risk, with the exception of race/ethnicity. Mothers of Hispanic ethnicity were more likely to have children who developed LCH compared to non-Hispanic whites (aOR: 1.51; 95% CI: 1.02-2.25). This risk increased when both parents were Hispanic (aOR: 1.80; 95% CI: 1.13-2.87). Non-Hispanic black mothers were suggested as less likely to give birth to offspring who developed LCH compared to non-Hispanic whites (aOR: 0.50; 95% CI: 0.24-1.02). CONCLUSIONS LCH is characterized by somatic mutations in MAPK pathway genes in myeloid precursors. Increased risk for LCH in children of Hispanic parents suggests potential impact of inherited factors on LCH pathogenesis.
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Affiliation(s)
- Erin C Peckham-Gregory
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, TX; Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, TX
| | - Kenneth L McClain
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, TX; Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, TX
| | - Carl E Allen
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, TX; Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, TX; Program in Translational Biology and Molecular Medicine, Baylor College of Medicine, Houston, TX
| | - Michael E Scheurer
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, TX; Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, TX
| | - Philip J Lupo
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, TX; Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, TX.
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A genome-wide association study of LCH identifies a variant in SMAD6 associated with susceptibility. Blood 2017; 130:2229-2232. [PMID: 28935696 DOI: 10.1182/blood-2017-08-800565] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Abstract
STUDY DESIGN Retrospective clinical cohort study. OBJECTIVE To determine if certain risk factors (age, curve magnitude, skeletal maturity, gender, and curve pattern) traditionally associated with curve progression and surgical intervention in the general population apply equally to African Americans. SUMMARY OF BACKGROUND DATA Currently, information is limited on the role that a patient's race plays in the risk of curve progression of adolescent idiopathic scoliosis (AIS), and existing studies have conflicting results. METHODS Retrospective search of records identified patients who were African American, had been diagnosed with AIS, had a major curve Cobb angle of 10 degrees or more, and had at least two clinical visits with spinal radiographs at least 90 days apart to determine the risk factors for surgical treatment, and 2 years apart to determine the risk factors for curve progression. Patients with a medical condition likely to cause scoliosis were excluded. RESULTS Of 738 African American patients with AIS, 223 were assessed for surgical risk factors, and 72 were assessed for curve progression risk factors. Fifty-six (29.17%) had progression of the major coronal curve, and 38 (17.04%) underwent surgery. Age at presentation and curve magnitude at presentation were significant risk factors for surgical intervention. Curve magnitude at presentation was a significant risk factor for curve progression. No significant relationships were found for gender or curve type as they relate to surgical intervention or curve progression. CONCLUSION Age and curve magnitude at presentation were significantly associated with surgery, as is true in other scoliosis populations. Curve magnitude at presentation was associated with curve progression. In contrast to studies in other populations, however, no significant association was observed between curve progression and age at presentation, curve type, or gender, or between surgery and curve type or gender. LEVEL OF EVIDENCE Level III, prognostic cohort study.
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Rivera-Luna R, Zapata-Tarres M, Shalkow-Klincovstein J, Velasco-Hidalgo L, Olaya-Vargas A, Finkelstein-Mizrahi N, Cárdenas-Cardós R, Aguilar-Ortiz MR. The burden of childhood cancer in Mexico: Implications for low- and middle-income countries. Pediatr Blood Cancer 2017; 64. [PMID: 27905680 DOI: 10.1002/pbc.26366] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 10/03/2016] [Accepted: 10/28/2016] [Indexed: 12/29/2022]
Abstract
In Mexico, childhood cancer incidence and mortality have increased in the last decade. Through government actions since 2005, the Popular Medical Insurance (PMI) program for childhood cancer was created. The objective of PMI was to offer early cancer diagnosis, standardized treatment regimens, and numerous pediatric oncology residency programs. It has also accredited 55 national hospitals for the care of these children. Current problems still present under the PMI include shortage of pediatric oncologists and nurses and high rate of abandonment of treatment. Our aim is to describe the current scenario of childhood cancer care in Mexico, especially from the perspective of the PMI and how it has impacted human resources, infrastructure, and medical education.
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Affiliation(s)
- Roberto Rivera-Luna
- Division of Pediatric Hem/Oncology, National Institute of Pediatrics (NIP), Mexico City, Mexico.,Program of the National Council for the Prevention and Treatment of Childhood Cancer, CENSIA, Mexico City, Mexico
| | - Marta Zapata-Tarres
- Department of Pediatric Oncology, National Institute of Pediatrics (NIP), Mexico City, Mexico
| | - Jaime Shalkow-Klincovstein
- Program of the National Council for the Prevention and Treatment of Childhood Cancer, CENSIA, Mexico City, Mexico
| | - Liliana Velasco-Hidalgo
- Department of Pediatric Oncology, National Institute of Pediatrics (NIP), Mexico City, Mexico
| | - Alberto Olaya-Vargas
- Bone Marrow Transplant Unit, National Institute of Pediatrics (NIP), Mexico City, Mexico
| | - Nicole Finkelstein-Mizrahi
- General Direction of Development of Health Services, Office of the Fund for Protection Against Catastrophic Expenses for Childhood Cancer from the Popular Medical Insurance, Mexico City, Mexico
| | - Rocío Cárdenas-Cardós
- Department of Pediatric Oncology, National Institute of Pediatrics (NIP), Mexico City, Mexico
| | - Marco R Aguilar-Ortiz
- Department of Pediatric Oncology, National Institute of Pediatrics (NIP), Mexico City, Mexico
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40
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Karimzada MM, Matthews MN, French SW, DeUgarte D, Kim DY. Langerhans cell histiocytosis masquerading as acute appendicitis: Case report and review. World J Gastrointest Endosc 2017; 9:139-144. [PMID: 28360976 PMCID: PMC5355761 DOI: 10.4253/wjge.v9.i3.139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/15/2016] [Accepted: 12/28/2016] [Indexed: 02/06/2023] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare syndrome characterized by unifocal, multifocal unisystem, or disseminated/multi-system disease that commonly involves the bone, skin, lymph nodes, pituitary, or sometimes lung (almost exclusively in smokers) causing a variety of symptoms from rashes and bone lesions to diabetes insipidus or pulmonary infiltrates. We present a previously unreported case of gastrointestinal LCH as well as a novel characteristic lesion affecting the colon of a young woman who presented with signs and symptoms mimicking acute on chronic appendicitis. Immunohistochemical analysis of appendectomy specimen and nodular specimens on colonoscopy demonstrated S-100, CD1a, and langerin reactivity. The patient underwent systemic chemotherapy with cytarabine and demonstrated excellent response to therapy.
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Affiliation(s)
- Julia E Noel
- 1 Stanford University School of Medicine, Stanford, CA, USA
| | - Anna H Messner
- 1 Stanford University School of Medicine, Stanford, CA, USA
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Rivera-Luna R, Velasco-Hidalgo L, Zapata-Tarrés M, Cárdenas-Cardos R, Aguilar-Ortiz MR. Current outlook of childhood cancer epidemiology in a middle-income country under a public health insurance program. Pediatr Hematol Oncol 2017; 34:43-50. [PMID: 28287336 DOI: 10.1080/08880018.2016.1276236] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In Mexico, childhood cancer (0-18 years) is treated in a multidisciplinary way while providing care for more than half of the affected children through a public medical insurance. This insurance is given to all children who do not have any health care coverage in Mexico. This program is offered to the poorest of all Mexicans. All the children with this disease are submitted to pathology diagnosis and treatment according to national treatment protocols from 57 accredited medical institutions. From 2007 to 2015, a total of 24,039 children with cancer have been registered; the male gender predominates by 55%. The highest incidence was in the group aged between 0 and 4 years. Every year, there has been an increment in registration. In 2015, there were 3,433 new patients with an incidence of 150.1/million. In the same year, the incidence for all types of leukemia increased to 89.5/million. But for acute lymphoblastic leukemia, the incidence was found to be 79.8/million, which is extremely high. The mortality rate for all these patients in 2015 was 5.3/100,000. However, with regard to children aged between 15 and 18 years, the mortality rate was 8.5/100,000. Abandonment rate was 10%, and there were nine state institutions that had a mortality rate between 25% and 50% among their patients. Coincidentally, as per the Human Development Index, the parameters for education, health, and income were low for those nine institutions. The purpose of this work is to show the epidemiology and the burden we are facing due to this disease.
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Affiliation(s)
- Roberto Rivera-Luna
- a Technical Committee of the National Council for the Prevention and Treatment of Childhood Cancer/Department of Pediatric Oncology , UNAM/Division of Pediatric Hematology/Oncology, National Institute of Pediatrics (NIP) , Mexico City , Mexico
| | - Liliana Velasco-Hidalgo
- b Department of Pediatric Oncology , National Institute of Pediatrics (NIP) , Mexico City , Mexico
| | - Marta Zapata-Tarrés
- b Department of Pediatric Oncology , National Institute of Pediatrics (NIP) , Mexico City , Mexico
| | - Rocío Cárdenas-Cardos
- c Department of Pediatric Oncology, UNAM/Department of Oncology , National Institute of Pediatrics (NIP)/Program of the National Council for the Prevention and Treatment of Childhood Cancer , Mexico City , Mexico
| | - Marco R Aguilar-Ortiz
- b Department of Pediatric Oncology , National Institute of Pediatrics (NIP) , Mexico City , Mexico
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Monsereenusorn C, Minkov M, Rodriguez-Galindo C. Current treatment of Langerhans cell histiocytosis. Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2016.1230058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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44
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Rigaud C, Barkaoui MA, Thomas C, Bertrand Y, Lambilliotte A, Miron J, Aladjidi N, Plat G, Jeziorski E, Galambrun C, Mansuy L, Lutz P, Deville A, Armari-Alla C, Reguerre Y, Fraitag S, Coulomb A, Gandemer V, Leboulanger N, Moshous D, Hoang-Xuan K, Tazi A, Heritier S, Emile JF, Donadieu J. Langerhans cell histiocytosis: therapeutic strategy and outcome in a 30-year nationwide cohort of 1478 patients under 18 years of age. Br J Haematol 2016; 174:887-98. [PMID: 27273725 DOI: 10.1111/bjh.14140] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/20/2016] [Indexed: 10/21/2022]
Abstract
The French national cohort of children with Langerhans cell histiocytosis (LCH) has included 1478 patients since it was established in 1983. LCH therapeutic strategies substantially changed in 1998, so we have divided the cohort into two 15-year periods. Starting in 1998, therapy duration increased from 6 to 12 months, repeated induction therapy was performed in cases showing a poor response to the first induction with vinblastine and steroids, and refractory disease in a risk organ (RO+) was treated with cladribine and cytarabine. A total of 483 (33%) patients were enrolled before 1998, and 995 (67%) after 1998. Five-year survival was 96·6% (95% confidence interval: 95·4-97·5%) overall, improving from 92% pre-1998 to 99% post-1998 (P < 0·001 adjusted to disease extent). This change was supported by an increase in 5-year survival from 60% to 92% in the RO+ group. Survival was particularly associated with cladribine and cytarabine among refractory RO+ patients. Disease reactivation was slightly less frequent after 1998, due to better enrolment of single-system patients, extended therapy duration, and more efficient second-line therapy. The crude rates of endocrine and neurological sequelae (the most frequent sequelae) appeared to improve over time, but this difference was not observed when the analysis was stratified by disease extent.
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Affiliation(s)
- Charlotte Rigaud
- Registre français des histiocytoses, Service d'Hémato-oncologie Pédiatrique Hôpital Trousseau, AP-HP, Paris, France.,Service de Pédiatrie Institut Gustave Roussy, IGR, Villejuif
| | - Mohamed A Barkaoui
- Registre français des histiocytoses, Service d'Hémato-oncologie Pédiatrique Hôpital Trousseau, AP-HP, Paris, France
| | - Caroline Thomas
- Service d'hémato-oncologie pédiatrique, Centre Hospitalo-Universitaire de Nantes, Nantes, France
| | - Yves Bertrand
- Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France
| | - Anne Lambilliotte
- Unité d'Hémato-oncologie Pédiatrique, Centre Hospitalo-Universitaire de Lille, Lille, France
| | - Jean Miron
- Registre français des histiocytoses, Service d'Hémato-oncologie Pédiatrique Hôpital Trousseau, AP-HP, Paris, France
| | - Nathalie Aladjidi
- CIC 1401, Inserm CICP, Hopital Pellegrin-enfant, CEREVANCE, CHU de Bordeaux, Bordeaux, France
| | - Geneviève Plat
- Service d'hémato-oncologie pédiatrique, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Eric Jeziorski
- Service d'hémato et d'oncologie pédiatrique, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France
| | - Claire Galambrun
- Service d'Hématologie Oncologie pédiatrique, Centre Hospitalo-Universitaire de Marseille, Marseille, France
| | - Ludovic Mansuy
- Medecine Infantile 2, Centre Hospitalo-Universitaire de Nancy, Nancy, France
| | - Patrick Lutz
- Service d'hémato-oncologie pédiatrique, Centre Hospitalo-Universitaire de Strasbourg, Strasbourg, France
| | - Anne Deville
- Service d'hémato-oncologie pédiatrique, Centre Hospitalo-Universitaire de Nice, Nice, France
| | - Corinne Armari-Alla
- Service d'hémato-oncologie pédiatrique, Centre Hospitalo-Universitaire de Grenoble, La Tronche, France
| | - Yves Reguerre
- Service d'hémato-oncologie pédiatrique, Centre Hospitalo-Universitaire de la Réunion Hôpital Felix Guyon, Saint denis, La Réunion, France
| | - Sylvie Fraitag
- Service d'Anatomopathologie, Hôpital Necker Enfants, AP-HP, Paris, France
| | - Aurore Coulomb
- Service d'Anatomopathologie, Hopital Trousseau, Paris, France
| | - Virginie Gandemer
- Service d'Hématologie pédiatrique, Centre Hospitalo-Universitaire de Rennes, Rennes, France
| | - Nicolas Leboulanger
- Service d'Otorhinolaryngologie et Chirurgie Cervicofaciale, Hôpital Necker Enfants Malades, AP-HP, Paris, France
| | - Despina Moshous
- Unité d'Immuno-hématologie pédiatrique, Hôpital Necker Enfants Malades, AP-HP, Paris, France
| | - Khe Hoang-Xuan
- Service de Neurologie, Groupe hospitalier Pitié Salpêtrière-Charles Foix, AP-HP, Sorbonne Universités - UPMC, Paris, France
| | - Abdellatif Tazi
- APHP Service de Pneumologie Centre de référence des histiocytoses Hôpital Saint Louis, Paris, France
| | - Sébastien Heritier
- Registre français des histiocytoses, Service d'Hémato-oncologie Pédiatrique Hôpital Trousseau, AP-HP, Paris, France
| | - Jean-François Emile
- Service de pathologie, Hôpital Ambroise Paré, UVSQ, Université Paris-Saclay, AP-HP, Boulogne, France
| | - Jean Donadieu
- Registre français des histiocytoses, Service d'Hémato-oncologie Pédiatrique Hôpital Trousseau, AP-HP, Paris, France
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Gholami N. Pericardial Effusion in Langerhans Cell Histiocytosis: A Case Report. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e25604. [PMID: 27621925 PMCID: PMC5004507 DOI: 10.5812/ircmj.25604] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 11/15/2015] [Accepted: 01/02/2016] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Langerhans cell histiocytosis (LCH) is a proliferative disorder of histiocytes in multiple organs. Langerhans cell histiocytosis involves bones, skin, lung and other organs. CASE PRESENTATION This study describes a seven-month-old Iranian girl who presented with skin rash and cervical lymphadenopathy. Langerhans cell histiocytosis was suspected when it was associated with anemia, splenomegaly and lytic bone lesions. A skin biopsy confirmed the diagnosis of Langerhans cell histiocytosis. During hospitalization, the patient looked ill with respiratory distress. A chest X-ray showed a ground glass view, and echocardiography showed moderate pericardial effusion. CONCLUSIONS Pericardial effusion was a rare finding in this case of Langerhans cell histiocytosis. Pericardial effusion in Langerhans cell histiocytosis, which is an unusual presentation, should be considered when the patient experiences respiratory distress.
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Affiliation(s)
- Narges Gholami
- Assistant Professor of Pediatrics, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Narges Gholami, Assistant Professor of Pediatrics, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2155419005, Fax: +98-2155417547, E-mail:
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Lozano Masdemont B, Gómez-Recuero Muñoz L, Villanueva Álvarez-Santullano A, Parra Blanco V, Campos Domínguez M. Langerhans cell histiocytosis mimicking lichen nitidus with bone involvement. Australas J Dermatol 2016; 58:231-233. [PMID: 26990538 DOI: 10.1111/ajd.12467] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 02/04/2016] [Indexed: 12/18/2022]
Abstract
We report the case of a 6-month-old Hispanic boy with a 4-month history of widespread pruritic hypopigmented papules mimicking lichen nitidus. The final diagnosis was multisystem non-risk-organ Langerhans cell histiocytosis (LCH), with cutaneous and multiple bone involvement. With this patient and others previously reported in the literature, we suggest an early biopsy of the hypopigmented rash in children.
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Affiliation(s)
- Belén Lozano Masdemont
- Department of Dermatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Verónica Parra Blanco
- Department of Pathology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Minia Campos Domínguez
- Department of Dermatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Monsereenusorn C, Rodriguez-Galindo C. Clinical Characteristics and Treatment of Langerhans Cell Histiocytosis. Hematol Oncol Clin North Am 2015; 29:853-73. [PMID: 26461147 DOI: 10.1016/j.hoc.2015.06.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a disease caused by clonal proliferation of CD1a+/CD207+ cells that is characterized by a spectrum of varying degrees of organ involvement and dysfunction. Treatment of LCH is risk adapted; patients with single lesions may respond well to local treatment, whereas patients with multi-system disease and risk-organ involvement require more intensive therapy. Although survival for patients without organ dysfunction is excellent, mortality rates for patients with organ dysfunction may reach 30% to 40%. For patients with low-risk disease, although cure is almost universal, disease reactivation rates are in excess of 30%.
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Affiliation(s)
- Chalinee Monsereenusorn
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, 450 Brookline Avenue D3-133, Boston, MA 02215, USA
| | - Carlos Rodriguez-Galindo
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, 450 Brookline Avenue D3-133, Boston, MA 02215, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
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