1
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Song L, Li Q, Yin R, Wang D. Unusual site of Langerhans cell histiocytosis: cervical and vaginal involvement. J OBSTET GYNAECOL 2019; 39:576-578. [PMID: 30634883 DOI: 10.1080/01443615.2018.1535578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Liang Song
- a Department of Obstetrics and Gynecology , West China Second University Hospital, Sichuan University , Chengdu , China.,b Ministry of Education , Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) , Chengdu , China
| | - Qingli Li
- a Department of Obstetrics and Gynecology , West China Second University Hospital, Sichuan University , Chengdu , China.,b Ministry of Education , Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) , Chengdu , China
| | - Rutie Yin
- a Department of Obstetrics and Gynecology , West China Second University Hospital, Sichuan University , Chengdu , China.,b Ministry of Education , Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) , Chengdu , China
| | - Danqing Wang
- a Department of Obstetrics and Gynecology , West China Second University Hospital, Sichuan University , Chengdu , China.,b Ministry of Education , Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) , Chengdu , China
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2
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Jorgensen EM, Chen PP, Rutter S, Cron JA. Vulvar Lesions in an 8-Year-Old Girl: Cutaneous Manifestations of Multisystem Langerhans Cell Histiocytosis. J Pediatr Adolesc Gynecol 2018; 31:153-155. [PMID: 28993226 DOI: 10.1016/j.jpag.2017.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/31/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a rare localized or systemic disease characterized by proliferation of myeloid-derived dendritic cells. Vulvar lesions might be the herald symptom of LCH and might mimic other cutaneous lesions. Prognosis varies widely on the basis of the extent and spread of disease. CASE An 8-year-old girl with a 4-month history of vulvar lesions resistant to topical steroids was referred by her pediatrician. Vulvar biopsy was diagnostic for LCH. Imaging studies revealed a left hip lesion consistent with LCH. The patient was subsequently treated for multisystem LCH with vinblastine and prednisone. SUMMARY AND CONCLUSION Although rare, LCH might be diagnosed by gynecologic providers and should be included in the differential diagnosis of genital lesions. We recommend having a low threshold for performing biopsy of vulvar lesions.
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Affiliation(s)
- Elisa M Jorgensen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut.
| | - Peter P Chen
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Sarah Rutter
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Julia A Cron
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
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3
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Capucha T, Koren N, Nassar M, Heyman O, Nir T, Levy M, Zilberman-Schapira G, Zelentova K, Eli-Berchoer L, Zenke M, Hieronymus T, Wilensky A, Bercovier H, Elinav E, Clausen BE, Hovav AH. Sequential BMP7/TGF-β1 signaling and microbiota instruct mucosal Langerhans cell differentiation. J Exp Med 2018; 215:481-500. [PMID: 29343501 PMCID: PMC5789418 DOI: 10.1084/jem.20171508] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/09/2017] [Accepted: 12/08/2017] [Indexed: 01/29/2023] Open
Abstract
Capucha et al. demonstrate that mucosal Langerhans cell (LC) differentiation from pre–dendritic cells and monocytes involves consecutive BMP7 and TGF-β1 signaling in separate anatomical locations. Moreover, mucosal microbiota regulates the development of LCs that in turn shape microbial and immunological homeostasis. Mucosal Langerhans cells (LCs) originate from pre–dendritic cells and monocytes. However, the mechanisms involved in their in situ development remain unclear. Here, we demonstrate that the differentiation of murine mucosal LCs is a two-step process. In the lamina propria, signaling via BMP7-ALK3 promotes translocation of LC precursors to the epithelium. Within the epithelium, TGF-β1 finalizes LC differentiation, and ALK5 is crucial to this process. Moreover, the local microbiota has a major impact on the development of mucosal LCs, whereas LCs in turn maintain mucosal homeostasis and prevent tissue destruction. These results reveal the differential and sequential role of TGF-β1 and BMP7 in LC differentiation and highlight the intimate interplay of LCs with the microbiota.
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Affiliation(s)
- Tal Capucha
- The Institute of Dental Sciences, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Noam Koren
- The Institute of Dental Sciences, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Maria Nassar
- The Institute of Dental Sciences, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Oded Heyman
- Department of Periodontology, Faculty of Dental Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Tsipora Nir
- The Institute of Dental Sciences, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Maayan Levy
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | | | - Katya Zelentova
- The Institute of Dental Sciences, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Luba Eli-Berchoer
- The Institute of Dental Sciences, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Martin Zenke
- Institute for Biomedical Engineering, Department of Cell Biology, Medical Faculty and Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Thomas Hieronymus
- Institute for Biomedical Engineering, Department of Cell Biology, Medical Faculty and Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Asaf Wilensky
- Department of Periodontology, Faculty of Dental Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Herve Bercovier
- Department of Microbiology and Molecular Genetics, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Eran Elinav
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Björn E Clausen
- Institute for Molecular Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Avi-Hai Hovav
- The Institute of Dental Sciences, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
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4
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Diagnosis of primary langerhans cell histiocytosis of the vulva in a postmenopausal woman. Case Rep Obstet Gynecol 2013; 2013:962670. [PMID: 24109536 PMCID: PMC3787643 DOI: 10.1155/2013/962670] [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: 07/26/2013] [Accepted: 08/18/2013] [Indexed: 11/17/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a very rare disease of female genital tract, most commonly seen in vulva and unusual in postmenopausal period. Herein, we report the 8th case of pure vulvar LCH in a postmenopausal woman. We pay attention to the differential diagnosis in postmenopausal state, features of pathologic diagnosis, and treatment options.
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5
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Edelbroek JR, Vermeer MH, Jansen PM, Stoof TJ, van der Linden MMD, Horváth B, van Baarlen J, Willemze R. Langerhans cell histiocytosis first presenting in the skin in adults: frequent association with a second haematological malignancy. Br J Dermatol 2013; 167:1287-94. [PMID: 22835048 DOI: 10.1111/j.1365-2133.2012.11169.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) in adults first presenting in the skin is rare. Guidelines for staging, treatment and follow-up are lacking. OBJECTIVES To better define staging procedures, treatment results and clinical course in adult patients with LCH first presenting in the skin. METHODS Eighteen adult patients with LCH first presenting in the skin were collected from five centres collaborating in the Dutch Cutaneous Lymphoma Group. Clinical records and (skin) biopsy specimens were reviewed and follow-up data were obtained. A literature search on adult patients with LCH presenting in the skin was performed. RESULTS Staging procedures showed extracutaneous disease in three of 16 patients who were adequately staged. One patient had a histologically confirmed lytic LCH bone lesion, while two patients had a myelodysplastic syndrome. During follow-up two of 18 patients developed extracutaneous localizations of LCH. Five patients developed a second haematological malignancy, including (myelo)monocytic leukaemia (two cases), histiocytic sarcoma (one case), diffuse large B-cell lymphoma (one case) and peripheral T-cell lymphoma (one case). Review of the literature revealed six other adult patients with a second haematological malignancy preceding or following a diagnosis of LCH. CONCLUSIONS The results of the present study suggest an increased risk of a second haematological malignancy in adult patients with LCH presenting in the skin. Extensive staging at presentation and long-term follow-up are therefore warranted in such patients.
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Affiliation(s)
- J R Edelbroek
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
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6
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Chang JC, Blake DG, Leung BV, Plaza JA. Langerhans cell histiocytosis associated with lichen sclerosus of the vulva: case report and review of the literature. J Cutan Pathol 2012; 40:279-83. [DOI: 10.1111/cup.12051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 08/28/2012] [Accepted: 10/12/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Jason C. Chang
- Department of Pathology; Medical College of Wisconsin; Milwaukee; WI; USA
| | - David G. Blake
- Department of Hematology/Oncology; Aurora St. Luke's Medical Center; Milwaukee; WI; USA
| | - Belinda V. Leung
- Department of Obstetrics and Gynecology; Aurora St. Luke's Medical Center; Milwaukee; WI; USA
| | - Jose A. Plaza
- Department of Pathology; Medical College of Wisconsin; Milwaukee; WI; USA
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7
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El-Safadi S, Dreyer T, Oehmke F, Muenstedt K. Management of adult primary vulvar Langerhans cell histiocytosis: review of the literature and a case history. Eur J Obstet Gynecol Reprod Biol 2012; 163:123-8. [PMID: 22464205 DOI: 10.1016/j.ejogrb.2012.03.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 02/10/2012] [Accepted: 03/08/2012] [Indexed: 01/27/2023]
Abstract
Primary vulvar Langerhans cell histiocytosis (LCH) is extremely rare and there are no standard treatment options. This review of the published literature with a case report aimed to clarify the optimal treatment for patients with this condition. Medline and PubMed were searched and all cases of primary vulvar LCH reported as single case reports or small case series were reviewed. A patient with vulvar LCH treated in this department is also reported. Twenty-seven cases, including the reported case, were reviewed. First-line treatments included surgery, radiotherapy, chemotherapy, thalidomide and local treatment. The mean follow-up time was 21.1±17.7 months. Although no patient died from the disease, recurrence rates were high (62%) and the mean time to relapse was 10.9±11.8 months (range 1-36 months). Treatment with thalidomide was successful, resulting in long-lasting remission. Disease recurrence is likely after surgery and or radiotherapy, and these treatments together with chemotherapy affect the patient's wellbeing adversely. Although definitive conclusions await further work, thalidomide has minimal adverse effects, is easy to administer and should be considered as a first-line treatment or as maintenance therapy in some patients.
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Affiliation(s)
- Samer El-Safadi
- Department of Gynaecology and Obstetrics, University Hospital Giessen and Marburg GmbH, Giessen, Klinikstrasse 33, D-35392 Giessen, Germany.
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8
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Krasteva A, Obreshkova E, Michaylova H, Aleksiev E, Kisselova A, Krastev Z. Oral Cavity and Systemic Diseases—Langerhans Cell Histiocytosis. BIOTECHNOL BIOTEC EQ 2012. [DOI: 10.5504/bbeq.2012.0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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9
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Jiang W, Li L, He YM, Yang KX. Langerhans cell histiocytosis of the female genital tract: a literature review with additional three case studies in China. Arch Gynecol Obstet 2011; 285:99-103. [DOI: 10.1007/s00404-011-2113-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 10/06/2011] [Indexed: 11/24/2022]
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10
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Foley S, Panting K, Bell H, Leonard N, Franks A. Rapid resolution of primary vulval adult Langerhans cell histiocytosis with very potent topical corticosteroids. Australas J Dermatol 2011; 52:e8-e14. [DOI: 10.1111/j.1440-0960.2009.00585.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Simons M, Van De Nieuwenhof HP, Van Der Avoort IA, Bulten J, De Hullu JA. A patient with lichen sclerosus, Langerhans cell histiocytosis, and invasive squamous cell carcinoma of the vulva. Am J Obstet Gynecol 2010; 203:e7-10. [PMID: 20541173 DOI: 10.1016/j.ajog.2010.04.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 03/03/2010] [Accepted: 04/12/2010] [Indexed: 11/26/2022]
Abstract
We report a patient with vulvar lichen sclerosus, Langerhans cell histiocytosis (LCH), and later vulvar cancer. In LCH, high amounts of non functional Langerhans cells are present in the affected tissue, making it possible that LCH may have contributed to vulvar cancer development in this patient.
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12
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Naresh KN, Zokaie S, Madhavan KS, Chu A. The Hammersmith Hospital hematopathology case of the month: Myeloid sarcoma with Langerhans cell proliferation. Leuk Lymphoma 2010; 51:1128-34. [DOI: 10.3109/10428191003777989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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13
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Bongiorno MR, Pistone G, de Giorgi V, Aricò M. Clinical and immunohistochemical evaluation of the vulvar Langerhans cell histiocytosis. Dermatol Ther 2009; 21 Suppl 3:S15-20. [PMID: 19076626 DOI: 10.1111/j.1529-8019.2008.00236.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We present the case of a woman with diabetes insipidus with subsequent genital and multiorgan Langerhans cell histiocytosis (LCH). A monolateral and slightly infiltrated erythematous plaque of the vulva was observed. Hematoxylin and eosin and immunophenotypic studies were performed. The primary antibodies used were monoclonal antibody to S100, CD1a, CD34, HLA-DR, PCNA, CD45Ro, CD40, and langerin. The histology of the infiltrates revealed a granulomatous reaction pattern, with extensive aggregates of histiocyte proliferation. The histiocytes, morphologically characterized by a pale staining of cytoplasm surrounding a grooved reniform nucleus, sometimes contained small distinct nucleoli. Lymphocytes, eosinophils, macrophages, and both plasma cells and giant cells typically infiltrated the lesions. Cells CD1a+ and S100+ infiltrated the epidermic and were dispersed over the infiltrates as well as in clusters, and around the vessels. A considerable number of CD40-expressing cells were restricted to CD1a+ LCH cells. The specimen contained a high percentage of langerin+ cells in both the dermis and the epidermis. The clinical manifestations of LCH affecting the genital area can be diverse, and in most patients take the form of ulcers or erythematous plaques. Histopathologic examination of the lesion evidences a mixture of Langerhans cell histiocytes (CD1a+, S100+, HLADr+, CD207+, CD 40+), lymphocytes (predominantly helper [CD4] CD 45 Ro+), eosinophils, and macrophages. Each of the cell types produces a "cytokine storm." Many of the cytokines favor recruitment of Langerhans cell progenitors and rescue the Langerhans cell histiocytes from apoptosis.
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Affiliation(s)
- Maria Rita Bongiorno
- Department of Dermatology, Policlinico Universitario, Via del Vespro 131, 90127, Palermo, Italy.
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14
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Isolated Langerhans cell histiocytosis of the vulva: a case report and review of the literature. ACTA ACUST UNITED AC 2007. [DOI: 10.1007/s10397-007-0351-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Mottl H, Rob L, Stary J, Kodet R, Drahokoupilova E. Langerhans cell histiocytosis of vulva in adolescent. Int J Gynecol Cancer 2007; 17:520-4. [PMID: 17362323 DOI: 10.1111/j.1525-1438.2007.00791.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) affecting child vulva alone is a very rare disease. Only 13 cases of primary vulvar LCH have been previously reported in the medical literature. We describe an additional case in which the LCH was confined to the vulva, with review of the literature. A 16.5-year-old girl presented with papulous and ulcerative lesions on her labia majora and minora. The biopsy revealed a typical histopathologic finding consistent with LCH. A metastatic work-up did not reveal any evidence of the disease except on the vulva. Treatment was carried out according to LCH II protocol. The patient was diagnosed with a recurrent disorder in the vulva 8 months after the completion of primary chemotherapy. For this reason, she underwent second line treatment with 2-chlorodeoxyadenosine. Eighteen months after the second line chemotherapy, the patient has no signs of a local or systemic recurrence. Primary LCH of vulva is very unusual, but we have to keep in mind this possibility when an adolescent girl presents with an atypical chronic lesion on the vulva. This patient appears to be the first case of adolescent 16.5 year old having a solely cutaneous lesion of the vulva
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Affiliation(s)
- H Mottl
- Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University, Motol, Prague, Czech Republic.
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16
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Venizelos ID, Mandala E, Tatsiou ZA, Acholos V, Goutzioulis M. Primary Langerhans Cell Histiocytosis of the Vulva. Int J Gynecol Pathol 2006; 25:48-51. [PMID: 16306784 DOI: 10.1097/01.pgp.0000172085.84631.37] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Langerhans cell histiocytosis (LCH) of the female genital tract is very rare. A review of the literature revealed that only 12 cases of primary vulvar LCH have previously been published. We describe an additional case of LCH in which the disease was confined to the vulva. A 64-year-old woman was admitted to our hospital with a nodular mass on her left labium minus, and complete surgical excision was performed. On histological and immunohistochemical examination, the tumor fulfilled the criteria of LCH. A metastatic workup did not reveal any evidence of disease beyond the vulva. The patient received local radiotherapy, and 22 months later she is in excellent condition without local recurrence or metastatic disease.
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Affiliation(s)
- Ioannis D Venizelos
- Department of Pathology, Hippokration General Hospital, Thessaloniki, Greece.
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17
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Padula A, Medeiros LJ, Silva EG, Deavers MT. Isolated vulvar Langerhans cell histiocytosis: report of two cases. Int J Gynecol Pathol 2005; 23:278-83. [PMID: 15213605 DOI: 10.1097/01.pgp.0000130042.31203.b0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Two cases of Langerhans cell histiocytosis involving the vulva are reported. The clinical features of Case 1 have been previously reported. The patients, aged 31 (Case 1) and 52 (Case 2) years, had disease limited to the vulva at the time of diagnosis. In both cases, the vulvar lesions were composed of Langerhans cells with twisted nuclei and nuclear grooves, associated with eosinophils and other inflammatory cells. Immunohistochemical studies using fixed, paraffin-embedded tissue sections showed that the Langerhans cells were positive for CD1A and S-100 protein in both cases, supporting the morphologic diagnosis. The first patient had multiple local recurrences during 3 years despite radiation therapy and vulvectomy, but is currently in remission and being treated with thalidomide. The second patient experienced disseminated disease involving multiple bony sites and the mouth despite radiation therapy. Including the present two cases, 6 of 18 (33%) cases of isolated vulvar LCH subsequently disseminated, most commonly to bone; other patients had local recurrences. Thus isolated vulvar LCH has the potential for aggressive clinical behavior, either as local recurrence or disseminated disease. New treatment modalities are needed for this disease.
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Affiliation(s)
- Anthony Padula
- Department of Hematopathology, The University of Texas-M. D. Anderson Cancer Center, Houston, Texas 77030-4095, USA
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18
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Dietrich JE, Edwards C, Laucirica R, Kaufman RH. Langerhans Cell Histiocytosis of the Vulva: Two Case Reports. J Low Genit Tract Dis 2004; 8:147-9. [PMID: 15874853 DOI: 10.1097/00128360-200404000-00011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This report describes the histopathologic results of Langerhans cell histiocytosis of the vulva and options for treatment. We present two new cases demonstrating vulvar manifestations of disease and their course of treatment with a review of the literature. Langerhans cell histiocytosis of the female genital tract is rare. The disease cannot be diagnosed without biopsy of cutaneous lesions. Langerhans cell histiocytosis of the vulva is a rare disorder with few options for treatment.
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Affiliation(s)
- Jennifer E Dietrich
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, USA.
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Singh A, Prieto VG, Czelusta A, McClain KL, Duvic M. Adult Langerhans cell histiocytosis limited to the skin. Dermatology 2004; 207:157-61. [PMID: 12920365 DOI: 10.1159/000071786] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2002] [Accepted: 01/10/2003] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The incidence of Langerhans cell histiocytosis (LCH) is 4-5 per million in children with only 30% of this number having an adult onset. While dermatological manifestations occur in as many as 50% of cases, disease limited to the skin is uncommon among reported cases of adult LCH. OBJECTIVES AND METHODS To present 3 new cases of adult LCH and a review of the literature of isolated cutaneous LCH in adults. RESULTS Three adults with scalp, vulvar and generalized LCH lesions had refractory responses to treatment. CONCLUSIONS LCH may present with unusual cutaneous manifestations limited to the skin in adults. Optimal treatment has not yet been determined.
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Affiliation(s)
- Asha Singh
- Department of Dermatology, University of Texas M.D. Anderson Cancer Center, Houston, Tex. 77030, USA.
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20
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Santillan A, Montero AJ, Kavanagh JJ, Liu J, Ramirez PT. Vulvar Langerhans cell histiocytosis: a case report and review of the literature. Gynecol Oncol 2003; 91:241-6. [PMID: 14529688 DOI: 10.1016/s0090-8258(03)00370-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) of the female genital tract is rare. Only, seven cases of primary vulvar LCH have been previously reported in the medical literature. We describe an additional case of LCH in which the disease was confined to the vulva. CASE A 33-year-old gravida 0, para 0 Ethiopian woman presented with a nodular lesion on her left vulva. The lesion was biopsied, and the results were consistent with LCH. A metastatic workup did not reveal any evidence of disease beyond the vulva. The patient was initially treated with radiotherapy to the vulva. She was diagnosed with recurrent disease in the vulva 21 months after the completion of radiotherapy. At that time, she underwent a wide local excision. Five months later, we found a lesion on her right labium majus that was consistent with a recurrence. The patient's vulva was treated with a higher dose of radiotherapy than it had been the first time. Six months later the patient again experienced a local recurrence. She underwent a wide radical vulvar excision of diffuse bilateral lesions and was free of disease for approximately 3 months, after which she experienced another recurrence and underwent treatment with thalidomide. Within 2 months of starting thalidomide therapy, the patient experienced resolution of her symptoms and of her vulvar lesions. CONCLUSIONS Primary LCH of the vulva is very rare. Its etiology and pathophysiology, as well as the most effective modes of therapy, remain elusive. We propose that thalidomide is a useful alternative for patients with this disease.
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Affiliation(s)
- Antonio Santillan
- Department of Gynecology and Obstetrics, The University of Oklahoma, Tulsa, OK 74129, USA
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21
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Montero AJ, Díaz-Montero CM, Malpica A, Ramirez PT, Kavanagh JJ. Langerhans cell histiocytosis of the female genital tract: a literature review. Int J Gynecol Cancer 2003; 13:381-8. [PMID: 12801274 DOI: 10.1046/j.1525-1438.2003.13204.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare malignant disease involving the accumulation of a monoclonal proliferation of cells in various organs, that phenotypically resemble Langerhans cells (LC). LCH is not merely a hyperplasia of LC, as it typically affects organs that are outside of their normal physiologic distribution. Normal Langerhans cells are bone marrow-derived dendritic cells that populate the epidermis and are distinguished by the presence of Birbeck granules and cell surface protein CD1a. LC act as sentinels; they recognize, internalize, and process antigens encountered in the skin. Upon encountering an antigen, LC become activated with subsequent maturation and induction of their migratory capacity. Langerhans cells in patients with LCH are aberrant and profoundly differ from normal LC. The clinical spectrum of LCH is quite diverse; multiple organs can be affected. "Pure" genital Langerhans cell histiocytosis is a rare presentation, with only 12 previously reported cases. Due to the rarity of this disease, treatment of genital LCH is still very diverse. No modality is proven to be superior in improving patient outcome, and relapses frequently occur after surgery. Dramatic responses of cutaneous and ano-genital lesions to thalidomide and interferons have been reported. We advocate the use of immuno-modulating agents in LCH of the female genital tract first, rather than surgery.
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Affiliation(s)
- A J Montero
- Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030-4009, USA
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