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Li X, Wang Y, Liu Q, Zeng Q, Fu H, He J, Schmidt-Wolf IG, Sharma A, Liao F. A rare imaging presentation with multisystemic clinicopathological features of Langerhans cell histiocytosis: Case report and literature review. Medicine (Baltimore) 2023; 102:e34881. [PMID: 37657004 PMCID: PMC10476768 DOI: 10.1097/md.0000000000034881] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/02/2023] [Indexed: 09/03/2023] Open
Abstract
RATIONALE Langerhans cell histiocytosis (LCH) is a kind of rare disease in which dendritic cells proliferate abnormally. It often occurs in children and can involve any tissue and organ. The affected sites usually include bone, skin, pituitary gland, and lungs, while the thyroid gland and external auditory canal are rarely observed. The perineal and labial involvement of this disease has not been reported yet. PATIENT CONCERNS A 47-year-old female patient experienced a swelling of the anterior neck area without an obvious inducement. She noticed a quail egg-like mass on the left side, and the mass increased progressively within 3 months. The anterior neck area was found to be swollen, and some flaky red rashes were seen on the scalp and bilateral external auditory canals. DIAGNOSES Imaging examination showed enlarged thyroid and cervical lymph nodes, multiple low-density nodules in the liver, and reduced signal in the posterior pituitary gland. The biopsy pathological result of the increased left cervical lymph node indicated that LCH was detected. INTERVENTIONS VP regimen (vincristine, dexamethasone per os) and related supportive treatments were given as inducing chemotherapy for 6 weeks. OUTCOMES After the second chemotherapy, the rash on the scalp and external auditory canal improved, and the neck mass was significantly reduced. After the third chemotherapy, the rash was mostly disappeared, while the neck lumps increased during chemotherapy. Thus, clatribine chemotherapy was recommended as the follow-up. LESSONS Imaging examinations played an important role in the diagnosis and follow-up of the disease, especially 18F-FDG PET/CT, which could show multiple involving organs at the same time. When a patient suffering from diabetes insipidus, skin rash, or fever, has a high FDG uptake PET/CT result in multiple tissues and organs throughout the body, it is necessary to consider the possibility of LCH.
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Affiliation(s)
- Xiaofen Li
- Department of Medical Imaging, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Yulu Wang
- Department of Integrated Oncology, Center for Integrated Oncology (CIO), University Hospital Bonn, Germany
| | - Qian Liu
- Department of Pathology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Qingyun Zeng
- Department of Nuclear Medicine, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Huan Fu
- Hematology department, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Jianlin He
- Ping An Haoyi medical imaging center of Nanchang
| | - Ingo G.H. Schmidt-Wolf
- Department of Integrated Oncology, Center for Integrated Oncology (CIO), University Hospital Bonn, Germany
| | - Amit Sharma
- Department of Integrated Oncology, Center for Integrated Oncology (CIO), University Hospital Bonn, Germany
- Department of Neurosurgery, University Hospital Bonn, Germany
| | - Fengxiang Liao
- Department of Nuclear Medicine, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
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Banks SA, Sartori Valinotti JC, Go RS, Abeykoon JP, Goyal G, Young JR, Koster MJ, Vassallo R, Ryu JH, Davidge-Pitts CJ, Ravindran A, Bennani NN, Shah MV, Rech KL, Tobin WO. Neurological Manifestations of Histiocytic Disorders. Curr Neurol Neurosci Rep 2023; 23:277-286. [PMID: 37209319 DOI: 10.1007/s11910-023-01272-4] [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] [Accepted: 04/04/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE OF REVIEW Histiocytic disorders, including Erdheim-Chester disease (ECD), Langerhans cell histiocytosis (LCH), and Rosai-Dorfman disease (RDD), are rare neoplasms that may present with a spectrum of neurologic involvement. Diagnostic delay is common due to heterogeneity in presentation and challenging pathology. RECENT FINDINGS Recent advances in the treatment of these diseases targeted towards mutations in the MAP kinase pathway have led to an improved prognosis in these patients with neurologic involvement. It is critical for clinicians to have a high index of suspicion to allow for early targeted treatment and optimize neurologic outcomes. A systematic approach to diagnosis is presented in this article to allow for accurate diagnosis of these rare diseases.
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Affiliation(s)
- Samantha A Banks
- Department of Neurology, Mayo Clinic Rochester, 200 First St SW, Rochester, MN, 55905, USA
| | | | - Ronald S Go
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN, USA
| | | | - Gaurav Goyal
- Division of Hematology-Oncology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jason R Young
- Department of Radiology, Mayo Clinic in Jacksonville, Jacksonville, FL, USA
| | - Matthew J Koster
- Division of Rheumatology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Robert Vassallo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic Rochester, Rochester, MN, USA
| | - Jay H Ryu
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN, USA
| | | | - Aishwarya Ravindran
- Division of Laboratory Medicine-Hematopathology, Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - N Nora Bennani
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Mithun V Shah
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Karen L Rech
- Division of Hematopathology, Mayo Clinic Rochester, Rochester, MN, USA
| | - W Oliver Tobin
- Department of Neurology, Mayo Clinic Rochester, 200 First St SW, Rochester, MN, 55905, USA.
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3
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Ramji HF, Deng F. Langerhans Cell Histiocytosis Reactivation in a Teenager. J Pediatr 2022; 248:131-132. [PMID: 35667446 DOI: 10.1016/j.jpeds.2022.05.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/31/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Husayn F Ramji
- University of Oklahoma College of Medicine, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Francis Deng
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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4
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Tani M, Hiroshima S, Sato H, Sawano K, Ogawa Y, Imamura M, Oishi M, Nagasaki K. Infantile-Onset Isolated Neurohypophyseal Langerhans Cell Histiocytosis with Central Diabetes Insipidus: A Case Report. CHILDREN 2022; 9:children9050716. [PMID: 35626895 PMCID: PMC9139757 DOI: 10.3390/children9050716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/06/2022] [Accepted: 05/11/2022] [Indexed: 11/16/2022]
Abstract
Central diabetes insipidus (CDI) is a rare disease in children and has a variety of etiologies. The major causes of CDI with pituitary stalk thickening (PST) are germinoma, Langerhans cell histiocytosis (LCH), and Lymphocytic infundibulo-neurohypophysitis, which are difficult to differentiate by imaging and require pathological diagnosis. We report a case of infantile-onset isolated neurohypophyseal LCH diagnosed by pathological findings. A 2-year-old girl presented with polydipsia and polyuria. CDI was diagnosed and treatment with oral desmopressin was initiated. Magnetic resonance imaging (MRI) of the head showed PST and absence of high-signal intensity of posterior pituitary on T1-weighted images. Follow-up MRI scans showed that the tumor mass was gradually increasing and extending posteriorly toward the area near the mamillary body. Simultaneously, anterior pituitary dysfunction was observed. She underwent a biopsy of the PST and LCH was diagnosed by immunohistochemical analysis. DNA analysis showed no BRAF V600E mutation. Monotherapy with 2-Chlorodeoxyadenosine reduced the tumor size but did not improve pituitary function. Isolated neurohypophyseal LCH should be considered in infantile-onset cases of CDI with PST. 2-CdA treatment resulted in rapid PST shrinkage. Further cases are needed to determine whether early diagnosis and treatment can prevent anterior pituitary dysfunction.
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Affiliation(s)
- Mizuki Tani
- Department of Pediatrics, Niigata Prefectural Shibata Hospital, Niigata 957-8588, Japan; (M.T.); (H.S.)
| | - Shota Hiroshima
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan; (S.H.); (K.S.); (Y.O.); (M.I.)
| | - Hidetoshi Sato
- Department of Pediatrics, Niigata Prefectural Shibata Hospital, Niigata 957-8588, Japan; (M.T.); (H.S.)
| | - Kentaro Sawano
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan; (S.H.); (K.S.); (Y.O.); (M.I.)
| | - Yohei Ogawa
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan; (S.H.); (K.S.); (Y.O.); (M.I.)
| | - Masaru Imamura
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan; (S.H.); (K.S.); (Y.O.); (M.I.)
| | - Makoto Oishi
- Department of Neurosurgery, Brain Research Institute, University of Niigata, Niigata 951-8510, Japan;
| | - Keisuke Nagasaki
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan; (S.H.); (K.S.); (Y.O.); (M.I.)
- Correspondence: ; Tel.: +81-025-227-2222
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Oda Y, Amano K, Seki Y, Kimura S, Yamashita K, Masui K, Komori T, Ichihara A, Kawamata T. Clinical features and difficulty in diagnosis of Langerhans cell histiocytosis in the hypothalamic-pituitary region. Endocr J 2022; 69:441-449. [PMID: 34776469 DOI: 10.1507/endocrj.ej21-0341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a multi-organ disorder that rarely involves the hypothalamic-pituitary region (HPR). HPR-LCH presents with severe progressive pituitary dysfunction and its prognosis is poor. The definitive diagnosis of LCH is considerably difficult and complicated owing to the occurrence of several diseases with similar manifestations in the HPR and its location in the deepest portion of the anterior skull base, in close proximity to important normal structures, severely limiting the size of the biopsy specimen. Chemotherapy is the established treatment modality for LCH; hence, timely and accurate diagnosis of LCH is essential for early therapeutic intervention. We retrospectively reviewed clinical features and biopsy procedures in four patients with HPR-LCH (all female, 28-44 years old) from 2009 to 2020. Maximum diameter of supra-sellar lesions was 23-35 mm and 2 cases had skip lesions. All patients demonstrated central diabetes insipidus, hyper-prolactinemia, and severe anterior pituitary dysfunction. Two of the patients had progressive disease. Furthermore, four patients presented body weight gain, two visual disturbance, and two impaired consciousness. The duration from onset to diagnosis of LCH was 3 to 10 (average 7.25) years. In total, eight operations were performed until final diagnosis. The percentage of correct diagnosis by biopsy was 50% (4/8). Clinical features of HPR-LCH are very similar to those of other HPR diseases, and their symptoms are progressive and irreversible. Clinicians should consider repeated biopsy with a more aggressive approach if the lesion is refractory to steroid therapy, in order to ensure accurate diagnosis and appropriate treatment.
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Affiliation(s)
- Yuichi Oda
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Kosaku Amano
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Yasufumi Seki
- Department of Endocrinology and Hypertension, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Shihori Kimura
- Department of Endocrinology and Hypertension, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Kaoru Yamashita
- Department of Endocrinology and Hypertension, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Kenta Masui
- Department of Pathology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Takashi Komori
- Department of Laboratory Medicine and Pathology (Neuropathology), Tokyo Metropolitan Neurological Hospital, Tokyo 183-0042, Japan
| | - Atsuhiro Ichihara
- Department of Endocrinology and Hypertension, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo 162-8666, Japan
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6
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Goyal G, Tazi A, Go RS, Rech KL, Picarsic JL, Vassallo R, Young JR, Cox CW, Van Laar J, Hermiston ML, Cao XX, Makras P, Kaltsas G, Haroche J, Collin M, McClain KL, Diamond EL, Girschikofsky M. International expert consensus recommendations for the diagnosis and treatment of Langerhans cell histiocytosis in adults. Blood 2022; 139:2601-2621. [PMID: 35271698 PMCID: PMC11022927 DOI: 10.1182/blood.2021014343] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/24/2022] [Indexed: 11/20/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) can affect children and adults with a wide variety of clinical manifestations, including unifocal, single-system multifocal, single-system pulmonary (smoking-associated), or multisystem disease. The existing paradigms in the management of LCH in adults are mostly derived from the pediatric literature. Over the last decade, the discovery of clonality and MAPK-ERK pathway mutations in most cases led to the recognition of LCH as a hematopoietic neoplasm, opening the doors for treatment with targeted therapies. These advances have necessitated an update of the existing recommendations for the diagnosis and treatment of LCH in adults. This document presents consensus recommendations that resulted from the discussions at the annual Histiocyte Society meeting in 2019, encompassing clinical features, classification, diagnostic criteria, treatment algorithm, and response assessment for adults with LCH. The recommendations favor the use of 18F-Fluorodeoxyglucose positron emission tomography-based imaging for staging and response assessment in the majority of cases. Most adults with unifocal disease may be cured by local therapies, while the first-line treatment for single-system pulmonary LCH remains smoking cessation. Among patients not amenable or unresponsive to these treatments and/or have multifocal and multisystem disease, systemic treatments are recommended. Preferred systemic treatments in adults with LCH include cladribine or cytarabine, with the emerging role of targeted (BRAF and MEK inhibitor) therapies. Despite documented responses to treatments, many patients struggle with a high symptom burden from pain, fatigue, and mood disorders that should be acknowledged and managed appropriately.
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Affiliation(s)
- Gaurav Goyal
- Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Abdellatif Tazi
- Université de Paris, INSERM UMR 976, Saint Louis Research Institute, Paris, France
- French National Reference Center for Histiocytoses, Department of Pulmonology, Saint-Louis Teaching Hospital, Assistance Publique-Hôpiaux de Paris, Paris, France
| | | | - Karen L. Rech
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Jennifer L. Picarsic
- Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | | | | | - Jan Van Laar
- Department of Internal Medicine
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Michelle L. Hermiston
- Division of Pediatric Hematology-Oncology, University of California, San Francisco, San Francisco, CA
| | - Xin-Xin Cao
- 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
| | - Polyzois Makras
- LCH Adult Clinic
- Department of Endocrinology and Diabetes, 251 Hellenic Air Force and VA General Hospital, Athens, Greece
| | - Gregory Kaltsas
- 1st Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Greece
| | - Julien Haroche
- Service de médecine interne 2, Centre de Référence des Histiocytoses, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France
| | - Matthew Collin
- Newcastle University and Newcastle Upon Tyne Hospitals, Newcastle Upon Tyne, United Kingdom
| | - Kenneth L. McClain
- Texas Children's Cancer and Hematology Centers, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Eli L. Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael Girschikofsky
- Internal Medicine I (Hemostasis, Hematology and Stem, Cell Transplantation and Medical Oncology), Ordensklinikum Linz Elisabethinen, Linz, Austria
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7
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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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8
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Sbardella E, Puliani G, Feola T, Pofi R, Pirchio R, Sesti F, Verdecchia F, Gianfrilli D, Moffat D, Isidori AM, Grossman AB. A clinical approach to parasellar lesions in the transition age. J Neuroendocrinol 2021; 33:e12995. [PMID: 34138496 DOI: 10.1111/jne.12995] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/23/2021] [Accepted: 05/11/2021] [Indexed: 12/16/2022]
Abstract
Many reviews have summarised the pathology and management of the parasellar region in adult patients, although an analysis of these aspects in the transition years, from puberty onset to the age of peak bone mass, has been lacking. A comprehensive search of English-language original articles, published from 2000 to 2020, was conducted in the MEDLINE database (December 2019 to March 2020). We selected all studies regarding epidemiology, diagnosis and management of the following parasellar lesions: germinoma, craniopharyngioma, Langerhans cell histiocytosis, optic glioma, hypothalamic hamartoma, tuber cinereum hamartoma, cranial chordoma, Rathke cleft cyst, hypophysitis and hypothalamitis during the transition age from childhood to adulthood. In the present review, we provide an overview of the principal parasellar lesions occurring in the transition age. Symptoms are usually a result of the mass effect of the lesions on nearby structures, as well as anterior pituitary deficits. Diabetes insipidus occurs frequently in these patients. In this age group, pubertal developmental disorders may be more evident compared to other stages of life. Parasellar lesions in the transition age mostly include neoplastic lesions such as germinomas, hamartomas, optic gliomas, craniopharyngiomas Langerhans cell histiocytosis and chordomas, and rarely inflammatory lesions (hypophysitis, hypothalamitis). There are limited data on the management of parasellar lesions in the transition age. Endocrine evaluation is crucial for identifying conditions that require hormonal treatment so that they can be treated early to improve the quality of life of the individual patient in this complex age range. The clinical approach to parasellar lesions involves a multidisciplinary effort.
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Affiliation(s)
- Emilia Sbardella
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Giulia Puliani
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
- Oncological Endocrinology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Tiziana Feola
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
- Neuroendocrinology, Neuromed Institute, IRCCS, Pozzilli, Italy
| | - Riccardo Pofi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Rosa Pirchio
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - Franz Sesti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Federica Verdecchia
- Dipartimento Pediatrico Universitario Ospedaliero, Bambino Gesù Children Hospital, Rome, Italy
| | - Daniele Gianfrilli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Daniel Moffat
- Department of Neurosurgery, Barts and the London NHS Trust, London, UK
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Ashley B Grossman
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, University of Oxford, Oxford, UK
- Centre for Endocrinology, Barts and the London School of Medicine, London, UK
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Nellan A, Bodlak A, Mirsky DM, Mulcahy Levy J, Garrington TP, Foreman NK, Gilani A, Hayashi M. ddPCR Analysis Reveals BRAF V600E Mutations Are Infrequent in Isolated Pituitary Langerhans Cell Histiocytosis Patients. J Neuropathol Exp Neurol 2021; 79:1313-1319. [PMID: 32930721 DOI: 10.1093/jnen/nlaa091] [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: 11/13/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is an inflammatory myeloid neoplasia with a highly variable clinical presentation affecting people of all ages. Mutations in BRAF V600E are the most identifiable molecular alteration in LCH although its incidence in pediatric patients with isolated pituitary stalk involvement is not well described. Pediatric patients with LCH and isolated pituitary stalk involvement typically present with central diabetes insipidus. Diagnosis requires a transcranial biopsy which often yields scant tissue. We sought to determine the prevalence of BRAF V600E mutations in patients with isolated pituitary stalk LCH using digital droplet polymerase chain reaction because this method requires minimal tumor DNA. We identified 8 patients with isolated pituitary stalk thickening who underwent a biopsy at Children's Hospital Colorado from January 2001 to December 2019, as well as 6 patients with systemic LCH diagnosed by biopsy in the same period as a comparison. Only one out of the 8 patients with isolated thickened pituitary stalk was found to have a detectable BRAF V600E mutation. Five out of the 6 patients with systemic LCH had a detectable BRAF V600E mutation. In our series, BRAF V600E mutations are rare in pediatric patients with LCH and isolated pituitary stalk involvement.
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Affiliation(s)
- Anandani Nellan
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Center for Cancer and Blood Disorders, Children's Hospital Colorado.,Division of Pediatric Hematology / Oncology, Department of Pediatrics, University of Colorado Denver, Aurora, Colorado
| | - Avery Bodlak
- Division of Pediatric Hematology / Oncology, Department of Pediatrics, University of Colorado Denver, Aurora, Colorado
| | | | - Jean Mulcahy Levy
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Center for Cancer and Blood Disorders, Children's Hospital Colorado.,Division of Pediatric Hematology / Oncology, Department of Pediatrics, University of Colorado Denver, Aurora, Colorado
| | - Timothy P Garrington
- Division of Pediatric Hematology / Oncology, Department of Pediatrics, University of Colorado Denver, Aurora, Colorado
| | - Nicholas K Foreman
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Center for Cancer and Blood Disorders, Children's Hospital Colorado.,Division of Pediatric Hematology / Oncology, Department of Pediatrics, University of Colorado Denver, Aurora, Colorado
| | - Ahmed Gilani
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Center for Cancer and Blood Disorders, Children's Hospital Colorado.,Department of Pathology, University of Colorado Denver, Aurora, Colorado
| | - Masanori Hayashi
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Center for Cancer and Blood Disorders, Children's Hospital Colorado.,Division of Pediatric Hematology / Oncology, Department of Pediatrics, University of Colorado Denver, Aurora, Colorado
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10
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Wang BB, Ye JR, Li YL, Jin Y, Chen ZW, Li JM, Li YP. Multisystem involvement Langerhans cell histiocytosis in an adult: A case report. World J Clin Cases 2020; 8:4966-4974. [PMID: 33195668 PMCID: PMC7642549 DOI: 10.12998/wjcc.v8.i20.4966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/26/2020] [Accepted: 08/25/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a rare condition wherein Langerhans cells proliferate abnormally, adversely impacting organs including lymph nodes, bones, skin, lungs, and pituitary gland. The LCH disease course varies widely among patients from a self-limiting condition to one that progresses rapidly and culminates in death. It is uncommon for multisystem LCH to be observed in adults. Herein we describe a woman suffering from multi-system LCH involvement.
CASE SUMMARY A 37-year old Chinese woman was admitted to the hospital in June 2019 suffering from dyspnea that had progressed over the course of 5 years. Her medical history included: central diabetes insipidus (DI) that had been treated via radiotherapy, desmopressin acetate, and bromocriptine; bilateral pneumothorax with two surgeries having been performed to remove bullae; and autoimmune hepatitis that had been unsuccessfully treated using a combination of methylprednisolone and mycophenolate mofetil. A chest computed tomography (CT) scan revealed the presence of multiple pulmonary cysts of varying sizes. We re-analyzed right pulmonary bullae samples that had been removed in 2014, performed a systematic 18F-FDG PET/CT analysis, and convened a multidisciplinary medical team to diagnose and treat this patient. As a result, we were able to eventually diagnose this patient with LCH that was not associated with BRAF-V600E mutations.
CONCLUSION We hope to emphasize the importance of systemic evaluation and of cooperation between multidisciplinary physicians with the goal of improving awareness and detection of this orphan disease.
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Affiliation(s)
- Bei-Bei Wang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Jun-Ru Ye
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Yun-Lei Li
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Yi Jin
- Pathology Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Zhong-Wei Chen
- Radiology Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Jian-Min Li
- Pathology Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Yu-Ping Li
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
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11
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Serra Soler G, Antich Barceló C, García Fernández H. Diabetes insipidus and diabetes mellitus diagnosed at the same time in a male with Langerhans cell histiocytosis. Med Clin (Barc) 2020; 157:152-153. [PMID: 32651074 DOI: 10.1016/j.medcli.2020.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 04/25/2020] [Accepted: 04/28/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Guillermo Serra Soler
- Departamento de Endocrinología, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España.
| | - Carlos Antich Barceló
- Departamento de Endocrinología, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España
| | - Honorato García Fernández
- Departamento de Endocrinología, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España
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12
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Zhou W, Rao J, Li C. Isolated Langerhans cell histiocytosis in the hypothalamic-pituitary region: a case report. BMC Endocr Disord 2019; 19:143. [PMID: 31856773 PMCID: PMC6924050 DOI: 10.1186/s12902-019-0474-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 12/11/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a rare disease that mainly affects children, but this disease is significantly rarer in patients who are older than 15 years. In this disease, any organ can be involved. The skeleton, skin and lung are commonly affected, and isolated hypothalamic-pituitary (HP) involvement is relatively rare. Here we report a 17-year-old adolescent with isolated HP-LCH of enlarged pituitary stalk presented with central diabetes insipidus (CDI). CASE PRESENTATION A 17-year-old male adolescent with polydipsia and polyuria accompanied with elevated serum sodium level and low urine osmolality for 3 weeks was referred to our hospital. After admission, hormonal evaluation showed that his growth hormone (GH) was slightly elevated, and serum osmolality and glucose were normal. The fluid deprivation-vasopressin test demonstrated CDI. Imaging examination showed an obvious thickening of the pituitary stalk. Lymphocytic hypophysitis, sarcoidosis and granulation tissue lesions were suspected. After oral 1-deamino-8-Darginine vasopressin (DDAVP) and prednisone were administered for 2 months, symptoms were relieved, and he discontinued taking the drugs by himself. On reexamination, imaging revealed changes in the size and shape of the pituitary stalk, with thickened nodules. Then, a diagnostic biopsy of the pituitary stalk lesion was performed. Immunohistochemistry confirmed the definitive diagnosis of LCH. The clinical symptoms subsided with oral hormone replacements. CONCLUSION CDI is a rare symptom in children and adolescents. Most of the causes are idiopathic, while others are caused by central nervous system (CNS) disorders. Meanwhile, lymphocytic hypophysitis, germinoma, LCH and other CNS disorders can all present as thickening of the pituitary stalk, diffuse enlargement of the pituitary gland, and weakening of high signal intensity in the neurohypophysis on magnetic resonance imaging (MRI). The differential diagnosis among these diseases depends on immunohistochemistry evidence.
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Affiliation(s)
- Weibin Zhou
- Department of Endocrinology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003 Zhejiang China
| | - Jia Rao
- Department of Endocrinology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003 Zhejiang China
| | - Chengjiang Li
- Department of Endocrinology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003 Zhejiang China
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13
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Goyal G, Young JR, Koster MJ, Tobin WO, Vassallo R, Ryu JH, Davidge-Pitts CJ, Hurtado MD, Ravindran A, Sartori Valinotti JC, Bennani NN, Shah MV, Rech KL, Go RS. The Mayo Clinic Histiocytosis Working Group Consensus Statement for the Diagnosis and Evaluation of Adult Patients With Histiocytic Neoplasms: Erdheim-Chester Disease, Langerhans Cell Histiocytosis, and Rosai-Dorfman Disease. Mayo Clin Proc 2019; 94:2054-2071. [PMID: 31472931 DOI: 10.1016/j.mayocp.2019.02.023] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/14/2019] [Accepted: 02/22/2019] [Indexed: 12/25/2022]
Abstract
Histiocytic neoplasms, a rare and heterogeneous group of disorders, primarily include Erdheim-Chester disease, Langerhans cell histiocytosis, and Rosai-Dorfman disease. Due to their diverse clinical manifestations, the greatest challenge posed by these neoplasms is the establishment of a diagnosis, which often leads to a delay in institution of appropriate therapy. Recent insights into their genomic architecture demonstrating mitogen-activated protein kinase/extracellular signal-regulated kinase pathway mutations have now enabled potential treatment with targeted therapies in most patients. This consensus statement represents a joint document from a multidisciplinary group of physicians at Mayo Clinic who specialize in the management of adult histiocytic neoplasms. It consists of evidence- and consensus-based recommendations on when to suspect these neoplasms and what tests to order for the diagnosis and initial evaluation. In addition, it also describes the histopathologic and individual organ manifestations of these neoplasms to help the clinicians in identifying their key features. With uniform guidelines that aid in identifying these neoplasms, we hope to improve the awareness that may lead to their timely and correct diagnosis.
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Affiliation(s)
- Gaurav Goyal
- Division of Hematology, Mayo Clinic, Rochester, MN.
| | | | | | | | - Robert Vassallo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | | - Maria D Hurtado
- Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester, MN
| | | | | | | | | | - Karen L Rech
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN.
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14
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Tamura S, Kawamoto K, Miyoshi H, Suzuki T, Katagiri T, Kasami T, Nemoto H, Miyakoshi S, Kobayashi H, Shibasaki Y, Masuko M, Takeuchi K, Ohshima K, Sone H, Takizawa J. Cladribine treatment for Erdheim-Chester disease involving the central nervous system and concomitant polycythemia vera: A case report. J Clin Exp Hematop 2018; 58:161-165. [PMID: 30305475 PMCID: PMC6407475 DOI: 10.3960/jslrt.18015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Erdheim–Chester disease (ECD), a rare form of non-Langerhans cell histiocytosis, is
characterized by the infiltration of foamy CD68+ and CD1a-
histiocytes into multiple organ systems. Central nervous system (CNS) involvement has
recently been reported to be a poor prognostic factor when treating ECD with interferon
alpha. We report the case of a 66-year-old Japanese patient with ECD involving the CNS who
harbored the BRAF V600E mutation and also concomitantly developed
polycythemia vera with the JAK2 V617F mutation. We confirmed
2-chlorodeoxyadenosine (cladribine) therapy to be effective for the patient in this
case.
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15
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Montefusco L, Harari S, Elia D, Rossi A, Specchia C, Torre O, Adda G, Arosio M. Endocrine and metabolic assessment in adults with Langerhans cell histiocytosis. Eur J Intern Med 2018; 51:61-67. [PMID: 29198444 DOI: 10.1016/j.ejim.2017.11.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 11/26/2017] [Accepted: 11/27/2017] [Indexed: 12/22/2022]
Abstract
CONTEXT Diabetes insipidus (DI) is one of most common complications of Langerhans cell histiocytosis (LCH) but prevalence of anterior pituitary deficiencies and metabolic alterations have not been clearly defined yet. OBJECTIVES Evaluate prevalence of endocrine and metabolic manifestations in a cohort of patients affected by Pulmonary LCH. METHODS Observational cross-sectional study on 18 adults (7 M/11 F, 42±12years) studied for complete basal and dynamic endocrine lab tests and glucose metabolism. RESULTS Hypothalamic-pituitary endocrine alterations were found in 9 patients: 9 had DI, 5 Growth Hormone Deficiency (GHD), 5 central hypogonadism, 3 central hypothyroidism and 1 central hypoadrenalism. Hyperprolactinemia and hypothalamic syndrome were found in 2 patients each. All these central endocrine alterations were always associated to DI. Five of the 10 MRI performed showed abnormalities. Prevalence of obesity and glucose alterations (either DM or IFG/IGT) were respectively 39% and 33%, higher than expected basing on epidemiological data on general Italian population. Multi-system-LCH without risk-organ involvement (LCH MS-RO-) seems to have slightly higher prevalence of insulin resistance, glucose alterations and metabolic syndrome than LCH with isolated lung involvement (LCH SS lung+). A papillary BRAFV600E positive thyroid carcinoma was diagnosed in one patient. CONCLUSIONS The presence of anterior pituitary deficiencies should be systematically sought in all LCH patients with DI both at diagnosis and during the follow-up by basal and dynamic hormonal assessment. Patients with pulmonary LCH, particularly those with MS disease, have a worse metabolic profile than general population. Occurrence of papillary thyroid carcinoma has been reported.
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Affiliation(s)
- L Montefusco
- U.O. di Malattie Endocrine e Diabetologia, Ospedale San Giuseppe Multimedica, Milan, Italy; MultiMedica IRCCS, Milan, Italy
| | - S Harari
- MultiMedica IRCCS, Milan, Italy; U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria - Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe Multimedica, Milan, Italy.
| | - D Elia
- MultiMedica IRCCS, Milan, Italy; U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria - Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe Multimedica, Milan, Italy
| | - A Rossi
- U.O. di Malattie Endocrine e Diabetologia, Ospedale San Giuseppe Multimedica, Milan, Italy; MultiMedica IRCCS, Milan, Italy
| | - C Specchia
- MultiMedica IRCCS, Milan, Italy; Dipartimento di Medicina Molecolare e Traslazionale, Università di Brescia, Italy
| | - O Torre
- MultiMedica IRCCS, Milan, Italy; U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria - Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe Multimedica, Milan, Italy
| | - G Adda
- U.O. di Malattie Endocrine e Diabetologia, Ospedale San Giuseppe Multimedica, Milan, Italy; MultiMedica IRCCS, Milan, Italy
| | - M Arosio
- U.O. di Endocrinologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Milan, Italy
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16
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Papapanagiotou M, Griewank KG, Hillen U, Schimming TT, Moeller LC, Führer D, Zimmer L, Roesch A, Sucker A, Schadendorf D, Livingstone E, Schilling B. Trametinib-Induced Remission of an MEK1-Mutated Langerhans Cell Histiocytosis. JCO Precis Oncol 2017; 1:1-5. [DOI: 10.1200/po.16.00070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Matina Papapanagiotou
- Matina Papapanagiotou, Klaus G. Griewank, Uwe Hillen, Tobias T. Schimming, Lars C. Moeller, Dagmar Führer, Lisa Zimmer, Alexander Roesch, Antje Sucker, Dirk Schadendorf, Elisabeth Livingstone, and Bastian Schilling, University Hospital, University of Duisburg-Essen, Essen; and Bastian Schilling, University Hospital Würzburg, Würzburg, Germany
| | - Klaus G. Griewank
- Matina Papapanagiotou, Klaus G. Griewank, Uwe Hillen, Tobias T. Schimming, Lars C. Moeller, Dagmar Führer, Lisa Zimmer, Alexander Roesch, Antje Sucker, Dirk Schadendorf, Elisabeth Livingstone, and Bastian Schilling, University Hospital, University of Duisburg-Essen, Essen; and Bastian Schilling, University Hospital Würzburg, Würzburg, Germany
| | - Uwe Hillen
- Matina Papapanagiotou, Klaus G. Griewank, Uwe Hillen, Tobias T. Schimming, Lars C. Moeller, Dagmar Führer, Lisa Zimmer, Alexander Roesch, Antje Sucker, Dirk Schadendorf, Elisabeth Livingstone, and Bastian Schilling, University Hospital, University of Duisburg-Essen, Essen; and Bastian Schilling, University Hospital Würzburg, Würzburg, Germany
| | - Tobias T. Schimming
- Matina Papapanagiotou, Klaus G. Griewank, Uwe Hillen, Tobias T. Schimming, Lars C. Moeller, Dagmar Führer, Lisa Zimmer, Alexander Roesch, Antje Sucker, Dirk Schadendorf, Elisabeth Livingstone, and Bastian Schilling, University Hospital, University of Duisburg-Essen, Essen; and Bastian Schilling, University Hospital Würzburg, Würzburg, Germany
| | - Lars C. Moeller
- Matina Papapanagiotou, Klaus G. Griewank, Uwe Hillen, Tobias T. Schimming, Lars C. Moeller, Dagmar Führer, Lisa Zimmer, Alexander Roesch, Antje Sucker, Dirk Schadendorf, Elisabeth Livingstone, and Bastian Schilling, University Hospital, University of Duisburg-Essen, Essen; and Bastian Schilling, University Hospital Würzburg, Würzburg, Germany
| | - Dagmar Führer
- Matina Papapanagiotou, Klaus G. Griewank, Uwe Hillen, Tobias T. Schimming, Lars C. Moeller, Dagmar Führer, Lisa Zimmer, Alexander Roesch, Antje Sucker, Dirk Schadendorf, Elisabeth Livingstone, and Bastian Schilling, University Hospital, University of Duisburg-Essen, Essen; and Bastian Schilling, University Hospital Würzburg, Würzburg, Germany
| | - Lisa Zimmer
- Matina Papapanagiotou, Klaus G. Griewank, Uwe Hillen, Tobias T. Schimming, Lars C. Moeller, Dagmar Führer, Lisa Zimmer, Alexander Roesch, Antje Sucker, Dirk Schadendorf, Elisabeth Livingstone, and Bastian Schilling, University Hospital, University of Duisburg-Essen, Essen; and Bastian Schilling, University Hospital Würzburg, Würzburg, Germany
| | - Alexander Roesch
- Matina Papapanagiotou, Klaus G. Griewank, Uwe Hillen, Tobias T. Schimming, Lars C. Moeller, Dagmar Führer, Lisa Zimmer, Alexander Roesch, Antje Sucker, Dirk Schadendorf, Elisabeth Livingstone, and Bastian Schilling, University Hospital, University of Duisburg-Essen, Essen; and Bastian Schilling, University Hospital Würzburg, Würzburg, Germany
| | - Antje Sucker
- Matina Papapanagiotou, Klaus G. Griewank, Uwe Hillen, Tobias T. Schimming, Lars C. Moeller, Dagmar Führer, Lisa Zimmer, Alexander Roesch, Antje Sucker, Dirk Schadendorf, Elisabeth Livingstone, and Bastian Schilling, University Hospital, University of Duisburg-Essen, Essen; and Bastian Schilling, University Hospital Würzburg, Würzburg, Germany
| | - Dirk Schadendorf
- Matina Papapanagiotou, Klaus G. Griewank, Uwe Hillen, Tobias T. Schimming, Lars C. Moeller, Dagmar Führer, Lisa Zimmer, Alexander Roesch, Antje Sucker, Dirk Schadendorf, Elisabeth Livingstone, and Bastian Schilling, University Hospital, University of Duisburg-Essen, Essen; and Bastian Schilling, University Hospital Würzburg, Würzburg, Germany
| | - Elisabeth Livingstone
- Matina Papapanagiotou, Klaus G. Griewank, Uwe Hillen, Tobias T. Schimming, Lars C. Moeller, Dagmar Führer, Lisa Zimmer, Alexander Roesch, Antje Sucker, Dirk Schadendorf, Elisabeth Livingstone, and Bastian Schilling, University Hospital, University of Duisburg-Essen, Essen; and Bastian Schilling, University Hospital Würzburg, Würzburg, Germany
| | - Bastian Schilling
- Matina Papapanagiotou, Klaus G. Griewank, Uwe Hillen, Tobias T. Schimming, Lars C. Moeller, Dagmar Führer, Lisa Zimmer, Alexander Roesch, Antje Sucker, Dirk Schadendorf, Elisabeth Livingstone, and Bastian Schilling, University Hospital, University of Duisburg-Essen, Essen; and Bastian Schilling, University Hospital Würzburg, Würzburg, Germany
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17
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Huo Z, Lu T, Liang Z, Ping F, Shen J, Lu J, Ma W, Zhao D, Zhong D. Clinicopathological features and BRAF V600E mutations in patients with isolated hypothalamic-pituitary Langerhans cell histiocytosis. Diagn Pathol 2016; 11:100. [PMID: 27760550 PMCID: PMC5070363 DOI: 10.1186/s13000-016-0548-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 10/05/2016] [Indexed: 12/30/2022] Open
Abstract
Background Isolated hypothalamic-pituitary Langerhans cell histiocytosis (HPLCH) is very rare. We investigated the clinicopathological characteristics, endocrine function changes, BRAFV600E mutations and treatments of isolated HPLCH. Methods We identified seven patients with isolated HPLCH by reviewing the clinical and pathological files in our hospital from 2007 to 2015. The clinical characteristics of the seven patients were retrospectively reviewed, especially the endocrine function changes. Immunostaining and mutation profiling of BRAFV600E were performed. Results The seven HPLCH patients included three men and four women, aged 9–47 years. All patients presented with symptoms of central diabetes insipidus (CDI), and four displayed anterior pituitary hypofunction as well. Magnetic resonance imaging showed hypothalamic-pituitary axis involvement in all patients. There was no evidence for the involvement of other organs in all seven patients. Langerhans cell histiocytosis was confirmed by neuroendoscopic procedures, and immunohistochemical staining showed that all cases (7/7) were positive for CD68, CD1a, Langerin, and S-100. The BRAFV600E mutation was detected in three of the six cases (3/6). Six patients had follow-up information; all received desmopressin acetate and high-dose corticosteroid therapy, and two patients received radiotherapy. Conclusions Our study indicated that all patients with isolated HPLCH had CDI as the earliest symptom, and more than half of the patients had anterior pituitary deficiencies. The BRAFV600E mutation is a common genetic change in HPLCH patients. Treatment of HPLCH patients is difficult, and the progressive loss of endocrine function is irreversible in most cases.
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Affiliation(s)
- Zhen Huo
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Tao Lu
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Zhiyong Liang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Fan Ping
- Department of Endocrine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Jie Shen
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, BeiJing, 100730, China
| | - Jingjing Lu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Wenbing Ma
- Department of Cerebral Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, BeiJing, 100730, China
| | - Dachun Zhao
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Dingrong Zhong
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, China.
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18
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Fenstermaker R, Abad A. Imaging of Pituitary and Parasellar Disorders. Continuum (Minneap Minn) 2016; 22:1574-1594. [DOI: 10.1212/con.0000000000000380] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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19
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Kruljac I, Rinčić G, Pećina HI. Hyperosmolar coma in a patient with hypothalamic Langerhans cell histiocytosis. Endocrine 2016; 52:176-7. [PMID: 26148702 DOI: 10.1007/s12020-015-0675-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/23/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Ivan Kruljac
- Department of Endocrinology, Diabetes and Metabolic Diseases "Mladen Sekso", University Hospital Center "Sestre Milosrdnice", University of Zagreb Medical School, Vinogradska Cesta 29, 10000, Zagreb, Croatia.
| | - Goran Rinčić
- Department of Hematology, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | - Hrvoje Ivan Pećina
- Department of Radiology, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
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20
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Imaging of Nervous System Involvement in Hematologic Malignancies: What Radiologists Need to Know. AJR Am J Roentgenol 2015; 205:604-17. [DOI: 10.2214/ajr.14.14092] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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21
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Makras P, Kaltsas G. Langerhans cell histiocytosis and pituitary function. Endocrine 2015; 48:728-9. [PMID: 25552340 DOI: 10.1007/s12020-014-0497-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 11/26/2014] [Indexed: 12/26/2022]
Affiliation(s)
- Polyzois Makras
- Department of Endocrinology, 251 Hellenic Airforce, VA General Hospital, Athens, Greece
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