1
|
Hirano T, Nakayama A, Yamaya G, Abe R, Kawai T, Takahashi M, Yagi M, Takeda Y, Yamada H. A case of adult-onset xanthogranuloma of the tongue. ORAL AND MAXILLOFACIAL SURGERY CASES 2023. [DOI: 10.1016/j.omsc.2023.100298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
|
2
|
Mota CP, Silva Cunha JL, Magalhães MCSV, Israel MS, Freire NDA, Dos Santos ERC, Canedo NHS, Agostini M, Abrahão AC, de Andrade BAB, Romañach MJ, de Sousa SF. Oral Juvenile Xanthogranuloma: A Clinicopathological, Immunohistochemical and BRAF V600E Study of Five New Cases, with Literature Review. Head Neck Pathol 2022; 16:407-415. [PMID: 34414559 PMCID: PMC9187812 DOI: 10.1007/s12105-021-01373-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/14/2021] [Indexed: 11/30/2022]
Abstract
Juvenile xanthogranuloma (JXG) is the most common form of non-Langerhans cell histiocytosis and oral mucosal involvement is exceedingly rare. Histiocytic disorders harbor activating mutations in MAPK pathway, including the report of BRAF V600E in JXG of extracutaneous site. However, no information is available for oral JXG. Herein, the clinicopathological and immunohistochemical features of five new oral JXG were evaluated in conjunction with literature review. Also, we assessed the BRAF V600E in oral samples. Five oral JXG were retrieved from pathology archives. Morphological and immunohistochemical analyses were performed. The BRAF V600E status was determined with TaqMan allele-specific qPCR. The series comprised of three female and two male patients, most of them adults, with a median age of 39 years (range 13-68 years). Clinically, the lesions appeared as asymptomatic solitary nodules, measuring until 2.5 cm, with more incident to the buccal mucosa. Morphologically, most of the cases presented classical histological features of JXG, with histiocytic cells consistent with the non-Langerhans cell immunophenotype. BRAF V600E was not detected in the cases tested. This is the first and largest published series of oral JXG affecting adults and a Brazilian population. The molecular pathogenesis of oral JXG remains unknown. Clinicians and pathologists must recognize JXG to avoid misdiagnoses with oral benign or malignant lesions.
Collapse
Affiliation(s)
- Carolina Peres Mota
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - John Lennon Silva Cunha
- Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas (FOP-UNICAMP), Piracicaba, Brazil
| | | | - Mônica Simões Israel
- Clinic of Stomatology, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Nathália de Almeida Freire
- Clinic of Stomatology, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | | | | | - Michelle Agostini
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Aline Corrêa Abrahão
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | - Mário José Romañach
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Sílvia Ferreira de Sousa
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil.
| |
Collapse
|
3
|
Gioco G, Rupe C, Basco A, Contaldo M, Gallenzi P, Lajolo C. Oral juvenile xanthogranuloma: An unusual presentation in an adult patient and a systematic analysis of published cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 133:42-49. [PMID: 34736900 DOI: 10.1016/j.oooo.2021.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/30/2021] [Accepted: 09/30/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The purpose of this study was to describe an unusual case of intraoral juvenile xanthogranuloma (JXG) and to perform a systematic review to investigate the available literature regarding oral JXGs. STUDY DESIGN We present a new case of oral JXG arising in a 36-year-old Italian woman and conducted a systematic literature review in PubMed, Web of Science, and Scopus, according to the PRISMA guidelines. RESULTS Our review of the English-language literature yielded 34 cases of oral JXG, which included our case report. CONCLUSIONS JXG is a non-Langerhans cell histiocytosis. Oral JXG has been reported, but it is a rare manifestation. Because of the rarity of oral lesions and possible variations in the clinical and histologic presentation, the correct diagnosis can be challenging, requiring a careful clinical and histopathologic evaluation with adjuvant immunohistochemical studies.
Collapse
Affiliation(s)
- Gioele Gioco
- Head and Neck Department, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cosimo Rupe
- Head and Neck Department, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Alessia Basco
- Head and Neck Department, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Contaldo
- University of Campania-Luigi Vanvitelli, Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, Naples, Italy
| | - Patrizia Gallenzi
- Head and Neck Department, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Lajolo
- Head and Neck Department, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
4
|
Sánchez-Romero C, Cuenca Arriaga AI, Paes de Almeida O, Gutiérrez Cortés E. Oral juvenile xanthogranuloma in a child: Clinical, histological and immunohistochemical profile of a rare entity. J Cutan Pathol 2018; 45:515-521. [DOI: 10.1111/cup.13152] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 03/25/2018] [Accepted: 03/31/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Celeste Sánchez-Romero
- Oral Pathology Section, Department of Oral Diagnosis; Piracicaba Dental School, University of Campinas (UNICAMP); Piracicaba Brazil
| | | | - Oslei Paes de Almeida
- Oral Pathology Section, Department of Oral Diagnosis; Piracicaba Dental School, University of Campinas (UNICAMP); Piracicaba Brazil
| | | |
Collapse
|
5
|
Chen CY, Sung CL, Hsieh MY, Wang WC, Lin LM, Chen YK. An adult juvenile xanthogranuloma in the buccal mucosa. J Dent Sci 2015. [DOI: 10.1016/j.jds.2013.02.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
6
|
Giant juvenile xanthogranuloma of the tongue presenting from birth in a 1-month-old infant. ANNALS OF PEDIATRIC SURGERY 2015. [DOI: 10.1097/01.xps.0000459977.75249.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
7
|
Collins L, Banks R, Robinson M. Juvenile xanthogranuloma: unusual intraoral finding. Br J Oral Maxillofac Surg 2015; 53:86-8. [PMID: 25300889 DOI: 10.1016/j.bjoms.2014.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 09/17/2014] [Indexed: 11/19/2022]
Abstract
Juvenile xanthogranuloma is a rare non-Langerhans cell histiocytosis that usually presents as a self-limiting dermatological condition in young children. Rarely, extracutaneous sites may also be involved. We report a case in a 3-year-old girl that presented intraorally as a solitary, well-defined, soft, purple palatal swelling. Patients with these rare intraoral lesions may present to dentists and subsequently to oral and maxillofacial surgeons. Diagnosis requires histopathological analysis and immunohistochemical staining. Further investigation from other specialties is required to rule out involvement of other organ systems.
Collapse
Affiliation(s)
- L Collins
- Department of Oral and Maxillofacial Surgery, Sunderland Royal Hospital, Kayll Road, Sunderland SR4 7TP, United Kingdom.
| | - R Banks
- Department of Oral and Maxillofacial Surgery, Sunderland Royal Hospital, Kayll Road, Sunderland SR4 7TP, United Kingdom
| | - M Robinson
- Centre for Oral Health Research, Newcastle University, Framlington Place, Newcastle Upon Tyne NE2 4BW, United Kingdom
| |
Collapse
|
8
|
Juvenile xanthogranuloma: a rare benign histiocytic disorder. Postepy Dermatol Alergol 2014; 31:197-200. [PMID: 25097495 PMCID: PMC4112258 DOI: 10.5114/pdia.2014.40918] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 05/15/2013] [Accepted: 05/23/2013] [Indexed: 11/17/2022] Open
Abstract
Juvenile xanthogranuloma (JXG) is a rare histiocytic disorder that typically affects children. The clinical presentation of this disease is characterized by single or, rarely, multiple yellow and brown skin nodules, most often found on the face and neck. Internal organ involvement has been sporadically observed in JXG and is associated with an increased risk of serious complications. We report two cases with a small and large nodular form of JXG.
Collapse
|
9
|
Lingual juvenile xanthogranuloma in a woman: a case report. J Med Case Rep 2011; 5:30. [PMID: 21261950 PMCID: PMC3033843 DOI: 10.1186/1752-1947-5-30] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Accepted: 01/24/2011] [Indexed: 11/13/2022] Open
Abstract
Introduction Juvenile xanthogranuloma is a rare non-Langerhans cell histiocytosis that usually occurs during infancy and early childhood. The presence of single or multiple raised cutaneous lesions characterize this self-healing disorder. Extracutaneous sites are rare. Case presentation We present a rare case of oral juvenile xanthogranuloma in a 49-year-old Caucasian woman. The histopathologic diagnosis of the lingual neoformation was histiocitary proliferation with the presence of giant cells, Touton type, compatible with juvenile xanthogranuloma. Conclusion To establish an accurate diagnosis, microscopic evaluation and immunohistochemical staining are necessary. Dentists, dermatologists and general practitioners may be the first to recognize this rare condition during the inspection of the oral cavity.
Collapse
|
10
|
Gingival juvenile xanthogranuloma in an adult patient: case report with immunohistochemical analysis and literature review. ACTA ACUST UNITED AC 2009; 107:246-52. [PMID: 19138643 DOI: 10.1016/j.tripleo.2008.09.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2008] [Revised: 09/16/2008] [Accepted: 09/29/2008] [Indexed: 11/22/2022]
Abstract
Juvenile xanthogranuloma (JXG) is a non-Langerhans cell histiocytosis (nonLCH). It is a benign and self-healing disorder that generally affects infants and children. Oral lesions in adult patients are rare, although the microscopic findings are similar to those observed in other locations. A 56-year-old white man presented with a chief complaint of a gingival mass that had appeared 6 months before and had grown slowly. An intraoral examination revealed the presence of a solitary, softened gingival mass affecting the mandibular lingual gingiva at the right central incisor area. A biopsy of the lesion showed multiple large macrophages and numerous giant cells of Touton type. The immunohistochemistry positivity for CD68, fascin, factor XIIIa, alpha-antitrypsin and negativity for S-100, beta-actin, CD1a, and desmin confirmed the diagnosis of JXG. The occurrence of adult oral JXG is extremely rare. It is a nonLCH that may present variable clinical and microscopic aspects, which leads to a diversity of clinical misdiagnoses. A precise diagnosis of these lesions requires an accurate evaluation of clinical, microscopic, and immunohistochemical features.
Collapse
|
11
|
Dehner LP. Juvenile xanthogranulomas in the first two decades of life: a clinicopathologic study of 174 cases with cutaneous and extracutaneous manifestations. Am J Surg Pathol 2003; 27:579-93. [PMID: 12717244 DOI: 10.1097/00000478-200305000-00003] [Citation(s) in RCA: 297] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Juvenile xanthogranulomas (JXG) is a histiocytic disorder, primarily but not exclusively seen throughout the first two decades of life and principally as a solitary cutaneous lesion. This study is a retrospective clinical and pathologic review of 174 cases documenting the cutaneous and extracutaneous manifestations in patients presenting from the neonatal period to 20 years of age (mean 3.3 years; median 1 year). There was a male predominance (99 male:75 female) in all categories of clinical presentation, but especially notable in the group with multiple cutaneous lesions (12 male:1 female). A solitary cutaneous lesion accounted for 67% of all cases, followed by a solitary subcutaneous or deep soft tissue mass (28 cases, 16%), multiple cutaneous lesions (13 cases, 7%), a solitary extracutaneous, nonsoft tissue lesion (9 cases, 5%), and multiple cutaneous and visceral-systemic lesions (8 cases, 5%). The recorded deaths due to disease included two neonates with systemic JXG who developed hepatic failure and thrombocytopenia and at autopsy had giant cell-neonatal hepatitis in addition to JXG in the liver and other visceral sites. A third death in a 3-month-old boy with a retroperitoneal-pelvic JXG occurred after failure to control severe hypercalcemia. The characteristic Touton giant cell in variable numbers was a consistent feature of the cutaneous lesions; however, these cells were either absent or present in reduced numbers in the various extracutaneous lesions when compared with JXG in the skin. Spindle cells intermingled among the mononuclear cells or forming short fascicles were seen in both cutaneous and extracutaneous lesions. Immunohistochemistry was performed on all extracutaneous lesions, and the constituent cells, regardless of their individual morphologic features, were uniformly positive for vimentin, CD68, and factor XIIIa and negative for S-100 protein and CD1a. It is widely held that JXG is a proliferative disorder of dendrocytes, possibly dermal dendrocytes; thus, its clinical and pathologic similarities to Langerhans cell histiocytosis are not entirely unexpected in light of the most recently proposed international classification of histiocytic disorders, which includes JXG and Langerhans cell histiocytosis together as "dendritic cell-related" histiocytoses.
Collapse
Affiliation(s)
- Louis P Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology, Barnes-Jewish and St. Louis Children's Hospitals, Washington University Medical Center, Missouri, 63110, USA.
| |
Collapse
|
12
|
Abstract
A 7-month-old girl presented with a single rapidly enlarging thickly crusted lesion on her frontal scalp. Histology was consistent with a juvenile xanthogranuloma (JXG) with ulceration and surface crust formation. Reports of ulcerating, crusted lesions of JXG are rare and the few reports have been confined to giant forms or those involving mucosal sites. This unusual presentation delayed diagnosis. Our report highlights the great variability in clinical presentation of JXG and is a reminder to consider this diagnosis in the differential of any lesion developing in an infant, particularly on the head, neck and upper trunk.
Collapse
Affiliation(s)
- Karen Behne
- Department of Dermatology, Royal Brisbane Hospital, Brisbane, Queensland, Australia.
| | | |
Collapse
|
13
|
Flaitz C, Allen C, Neville B, Hicks J. Juvenile xanthogranuloma of the oral cavity in children: a clinicopathologic study. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2002; 94:345-52. [PMID: 12324792 DOI: 10.1067/moe.2002.122340] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE This clinicopathologic study describes the histopathologic, immunocytochemical, and electron microscopic features of oral juvenile xanthogranuloma (JXG) in children. DESIGN The study population consisted of 5 children (5 months to 10 years of age) with biopsy-proven JXGs obtained for consultation. RESULTS Lesion sites were gingiva, buccal mucosa, and tongue and were described by the clinicians as (1). irritation fibroma; (2). granulation tissue; (3). pedunculated granular nodule; (4). papilloma-like lesion; and (5). brown-red umbilicated papule. Tissue was available for histopathologic (n = 5), immunocytochemical (n = 5), and ultrastructural (n = 3) studies. Three cases showed early JXG lesions possessing abundant histiocytes, but lacking Touton giant cells. The other 2 cases had classic JXG lesions with vacuolated histiocytes and Touton giant cells. Immunocytochemical findings were (1). CD68 (KP1, PGM1), moderate to diffuse; (2). fascin, moderate to diffuse; (3). factor XIIIa, focal to diffuse; (4). alpha-1-antitrypsin, moderate to diffuse; (5). S-100 protein, focal to diffuse; and (6). CD1a, negative in all cases. Ultrastructural examination displayed histiocytic and dendritic cells lacking pentalaminar structures (Birbeck granules). CONCLUSION JXGs of the oral cavity vary in their clinical and histopathologic appearances and necessitate that Langerhans' cell disease (LCD) be excluded. JXG and Langerhans' cell disease may occur concurrently, before or after each other, in some children.
Collapse
Affiliation(s)
- Catherine Flaitz
- Division of Oral and Maxillofacial Surgery and Pathology, University of Texas-Houston Health Science Center, Dental Branch, Houston, Tex 77030, USA.
| | | | | | | |
Collapse
|
14
|
Fabrizi G, Massi G. Mononuclear variant of juvenile xanthogranuloma in the oral cavity of an adult patient. Br J Dermatol 2001; 144:909-11. [PMID: 11298565 DOI: 10.1046/j.1365-2133.2001.04161.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
15
|
Shimoyama T, Horie N, Ide F. Juvenile xanthogranuloma of the lip: case report and literature review. J Oral Maxillofac Surg 2000; 58:677-9. [PMID: 10847293 DOI: 10.1016/s0278-2391(00)90167-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- T Shimoyama
- Department of Oral Surgery, Saitama Medical Center, Kawagoe, Japan
| | | | | |
Collapse
|
16
|
Chang MW. Update on juvenile xanthogranuloma: unusual cutaneous and systemic variants. SEMINARS IN CUTANEOUS MEDICINE AND SURGERY 1999; 18:195-205. [PMID: 10468039 DOI: 10.1016/s1085-5629(99)80017-0] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Juvenile xanthogranuloma (JXG) is a well-recognized benign disorder of infancy and early childhood characterized by yellowish cutaneous nodules that spontaneously regress over months to years. In the vast majority of children, JXG is limited to the skin and requires no treatment. Over the past two decades, unusual cutaneous and systemic forms of JXG have been increasingly reported. JXGs have been discovered, usually unexpectedly, in every organ system of the body. Correct diagnosis is crucial to prevent unnecessary invasive diagnostic and therapeutic procedures. Unusual clinical and histological variants of JXG often require immunohistochemical studies and/or electron microscopy to establish the diagnosis. Nonlipidized, giant, intramuscular, subcutaneous, and clustered JXG are but some of the variants that are discussed in this article. The immunohistochemistry of JXG, current nosology, and hypotheses regarding the origins of JXG are also reviewed.
Collapse
Affiliation(s)
- M W Chang
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, NY 10016, USA
| |
Collapse
|
17
|
Shapiro NL, Malis DJ, Charon CC, Billman GF, Kearns DB. Giant juvenile xanthogranuloma of the tongue. Am J Otolaryngol 1999; 20:241-4. [PMID: 10442777 DOI: 10.1016/s0196-0709(99)90007-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Juvenile xanthogranulomas (JXGs) are rare, benign, fibrohistiocytic lesions. They usually appear as one or more cutaneous papules on the head, neck, or trunk in infants. Twelve cases of oral JXGs have been reported, four of which involved the tongue. We present a 6-year-old girl with a large tongue mass diagnosed as JXG after an excisional biopsy. Histological and immunohistochemical staining results are presented. This is the first reported case of a giant oral JXG. A review of the literature on these unusual lesions is presented, along with discussion of their differential diagnosis and key aspects of the patient's evaluation, management, and pathological diagnosis.
Collapse
Affiliation(s)
- N L Shapiro
- Division of Head and Neck Surgery, UCLA School of Medicine, Los Angeles, CA 90095, USA
| | | | | | | | | |
Collapse
|
18
|
Abstract
Juvenile xanthogranuloma (JXG) is a benign, self-healing disorder characterized by solitary or multiple yellow-red nodules on the skin and, occasionally, in other organs. It is predominantly a disease of infancy or early childhood, although adults may also be affected. Histologically, JXG represents an accumulation of histiocytes lacking Birbeck granules (non-Langerhans cells), which can be differentiated from Langerhans cells by specific staining techniques. Affected persons have normal lipid metabolism. JXG is therefore classified as a normolipemic non-Langerhans cell histiocytosis. The patient's general health is not impaired and, in the absence of associated conditions, the prognosis is excellent. Diagnosis is readily made in typical cases, but may be more difficult in unusual variants.
Collapse
|