2
|
Langerhans Cell Histiocytosis in an Infant Mimicking a Lymphoma at Presentation. Case Rep Hematol 2015; 2015:670843. [PMID: 26587301 PMCID: PMC4637459 DOI: 10.1155/2015/670843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 10/09/2015] [Accepted: 10/13/2015] [Indexed: 11/17/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare disorder characterized by proliferation and accumulation of clonal dendritic cells with varied clinical presentation and an unpredictable course. We report a 5-month-old infant with LCH who presented with severe respiratory distress, a large mediastinal mass, significant generalized lymphadenopathy, and hepatosplenomegaly. Lymphoma, especially T cell lymphoblastic lymphoma, can present with superior mediastinal syndrome needing urgent empirical therapy without biopsy. However, lack of response prompted a biopsy which confirmed it to be a case of LCH and that leads to appropriate therapy and survival. There have been reports of LCH presenting with isolated mediastinal mass or with generalized lymphadenopathy, but the combined presentation of generalized lymphadenopathy with large mediastinal mass, hepatosplenomegaly, and fever in an infant has rarely been reported. Conclusion. LCH should also be considered in the differential diagnosis of an infant presenting with generalized lymphadenopathy, mediastinal mass, hepatosplenomegaly, and fever.
Collapse
|
3
|
Ramzan M, Yadav SP, Joshi R, Das D, Tamhankar P, Shaikh S, Agrawal A, Shrivastava J, Singh A, Choudhary S, Berwal PK, Khichar S, Baid P, Shruthi TK, Shuba S, Rajakumar PS, Chitrambalam S. Case Reports. Indian Pediatr 2014; 51:397-8. [DOI: 10.1007/s13312-014-0405-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
4
|
Ducassou S, Seyrig F, Thomas C, Lambilliotte A, Marec-Berard P, Berger C, Plat G, Brugiere L, Ouache M, Barkaoui M, Armari-Alla C, Lutz P, Leverger G, Rialland X, Mansuy L, Pacquement H, Jeziorski E, Gandemer V, Chalard F, Chateil JF, Tazi A, Emile JF, Donadieu J. Thymus and mediastinal node involvement in childhood Langerhans cell histiocytosis: long-term follow-up from the French national cohort. Pediatr Blood Cancer 2013; 60:1759-65. [PMID: 23813854 PMCID: PMC3824083 DOI: 10.1002/pbc.24603] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 04/29/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Mediastinal involvement (MI) in Langerhans cell histiocytosis (LCH) has been rarely reported. Here, we describe the clinical, radiological, and biological presentation, and the outcome of childhood LCH with MI. METHOD From the French LCH register, which includes 1,423 patients aged less than 18 years, we retrieved the medical charts of patients with mediastinal enlargement detected on chest X-rays. RESULTS Thirty-seven patients were retrieved, including 18 males; median age of diagnosis was 0.7 years, and median follow-up time was 6.2 years. The prevalence of MI varied with the age at diagnosis, ranging from 7% below 1 year old to less than 1% at >5 years. Thirteen cases (35%) were diagnosed because of MI-related symptoms, including respiratory distress (N = 4), superior venous cava syndrome (N = 2), and/or cough and polypnea (N = 10). CT scans performed in 32 cases at diagnosis showed tracheal compression (N = 5), cava thrombosis (N = 2), and/or calcification (N = 16). All patients presented multi-system disease at LCH diagnosis, and 35/37 were initially treated with vinblastine and corticosteroids. Death occurred in five cases, due to MI (N = 1) or hematological refractory involvement (N = 4). The overall 5-year survival was 87.1%, and immunodeficiency was not detected as a sequel. CONCLUSIONS MI in LCH mainly occurs in young children, and diagnosis was based on CT showing thymus enlargement and calcifications.
Collapse
Affiliation(s)
- Stephane Ducassou
- Service D'hémato Oncologie Pédiatrique, CHU de StrasbourgStrasbourg, France,Service D'hémato Oncologie Pédiatrique, CHU de BordeauxBordeaux, France,*Correspondence to: Stephane Ducassou, Service D'hémato Oncologie Pédiatrique, CHU de Bordeaux, Bordeaux, France., E-mail:
| | - Fanny Seyrig
- Service D'hémato Oncologie Pédiatrique, CHU de NantesNantes, France
| | - Caroline Thomas
- Service D'hémato Oncologie Pédiatrique, CHU de NantesNantes, France
| | - Anne Lambilliotte
- Service D'hématologie Oncologie Pédiatrique, Hôpital Jeanne de FlandresLille, France
| | | | - Claire Berger
- Service D'hémato Oncologie Pédiatrique, CHU de Saint EtienneFrance
| | - Genevieve Plat
- Service D'hémato Oncologie Pédiatrique Hopital Purpan, CHU de ToulouseFrance
| | - Laurence Brugiere
- Service D'oncologie Pédiatrique, Institut Gustave RoussyVillejuif, France
| | - Marie Ouache
- Service D'hématologie Pédiatrique, Hopital Robert DébréParis, France
| | - Mohamed Barkaoui
- Service D'hémato Oncologie Pédiatrique, Centre de référence des histiocytoses, registre des histiocytoses, APHP Hôpital A. TrousseauParis, France
| | - Corinne Armari-Alla
- Service de Pédiatrie, Unité D'hémato Oncologie Pédiatrique, CHU MichallonGrenoble, France
| | - Patrick Lutz
- Service D'hémato Oncologie Pédiatrique, CHU de StrasbourgStrasbourg, France
| | - Guy Leverger
- Service D'hémato Oncologie Pédiatrique, Centre de référence des histiocytoses, registre des histiocytoses, APHP Hôpital A. TrousseauParis, France
| | - Xavier Rialland
- Service de Pédiatrie, Unité d'hémato Oncologie Pédiatrique, CHU d'AngersAngers, France
| | - Ludovic Mansuy
- Service de Médecine Infantile II, CHU de Brabois, NancyFrance
| | | | - Eric Jeziorski
- Service de Médecine Infantile, Hopital Arnaud de Villeneuve, CHU de MontpellierMontpellier, France
| | - Virginie Gandemer
- Service D'hémato Oncologie Pédiatrique, Hopital Sud CHURennes, France
| | | | | | - Abdellatif Tazi
- Service de Pneumologie, Centre de référence des histiocytoses, APHP Hôpital Saint LouisParis, France
| | - Jean François Emile
- Laboratoire D'anatomie et Cytologie Pathologique, APHP Hopital A ParéBoulognes, France
| | - Jean Donadieu
- Service D'hémato Oncologie Pédiatrique, Centre de référence des histiocytoses, registre des histiocytoses, APHP Hôpital A. TrousseauParis, France
| | | |
Collapse
|
5
|
Babeto LT, de Oliveira BM, de Castro LPF, Campos MK, Valadares MTM, Viana MB. Langerhans cell histiocytosis: 37 cases in a single brazilian institution. Rev Bras Hematol Hemoter 2011; 33:353-7. [PMID: 23049339 PMCID: PMC3415777 DOI: 10.5581/1516-8484.20110098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 07/04/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To improve the level of 'definitive' diagnosis of Langerhans cell histiocytosis by immunohistochemical investigation of the CD1a surface antigen and to compare outcomes in respect to age, gender, stage of the disease, treatment response and level of diagnostic accuracy. METHODS A retrospective study was carried out of 37 children and adolescents with possible Langerhans cell histiocytosis between 1988 and 2008. The diagnoses were revisited using immunohistochemical investigations for CD1a, S-100 and CD68 in an attempt to reach definitive diagnoses for all cases. RESULTS Before the study, only 13 of 37 patients (35.1%) had a 'definitive' diagnosis; by the end of the study, this number rose to 25 patients (67.6%). All reviewed cases were positive for the CD1a antigen. Overall survival was 88.5%. Multisystem disease (Stage 2; n=19) and absence of response at the 6th week of therapy (n=5) were associated to significantly lower overall survival (p-value = 0.04 and 0.0001, respectively). All deaths occurred in patients with multisystem disease and organ dysfunction at diagnosis. Other potential prognostic factors were not significant. Reactivation episodes occurred in 75% of the patients with multisystem disease. Diabetes insipidus was the most common sequel (21.6%). CONCLUSION The level of diagnostic accuracy was increased through immunohistochemistry. The overall survival rate was similar to international multicentric studies. Multisystem disease and absence of response at six weeks of treatment were the most important unfavorable prognostic factors. The frequency of reactivation for patients with multisystem disease was higher than described in the literature, probably because maintenance chemotherapy was used only in two cases.
Collapse
Affiliation(s)
- Luciana Terra Babeto
- Hematology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, MG, Brazil
| | | | | | | | | | | |
Collapse
|
7
|
Chen J, Du YJ. Digestive system manifestations, diagnosis and treatment of Langerhans cell histiocytosis. Shijie Huaren Xiaohua Zazhi 2010; 18:531-535. [DOI: 10.11569/wcjd.v18.i6.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare disease characterized by an abnormal proliferation of histiocytes, known as Langerhans cells (LCs). At present, the pathogenesis of LCH remains unknown. LCH often involves the bone, skin, lung, bone marrow and lymph nodes. Besides, the liver, bile duct and gastrointestinal tract may also be affected. LCH has no specific clinical manifestations compared to other digestive system diseases. Once digestive system involvement is diagnosed in LCH patients, prompt treatment (even liver transplantation) should be given. In this paper, we will review the digestive system manifestations, diagnosis and treatment of LCH.
Collapse
|