1
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Fourmond S, Pham-Ledard A, Vergier B, Peyrot I, Beylot-Barry M, Ducharme O. Extrafacial necrobiotic xanthogranuloma and a disseminated marginal zone B lymphoma: a unique tissue collision. Int J Dermatol 2024; 63:113-114. [PMID: 37830310 DOI: 10.1111/ijd.16879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/12/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023]
Affiliation(s)
| | - Anne Pham-Ledard
- Dermatology Department, CHU de Bordeaux, Bordeaux, France
- Translational Research on Oncodermatology and Rare Skin Diseases, INSERM U1312, Bordeaux Institute of Oncology, Bordeaux University, Bordeaux, France
| | - Beatrice Vergier
- Translational Research on Oncodermatology and Rare Skin Diseases, INSERM U1312, Bordeaux Institute of Oncology, Bordeaux University, Bordeaux, France
- Pathology Department, CHU Bordeaux, Bordeaux, France
| | - Itzia Peyrot
- Dermatology Department, CHU de Bordeaux, Bordeaux, France
| | - Marie Beylot-Barry
- Dermatology Department, CHU de Bordeaux, Bordeaux, France
- Translational Research on Oncodermatology and Rare Skin Diseases, INSERM U1312, Bordeaux Institute of Oncology, Bordeaux University, Bordeaux, France
| | - Océane Ducharme
- Dermatology Department, CHU de Bordeaux, Bordeaux, France
- Translational Research on Oncodermatology and Rare Skin Diseases, INSERM U1312, Bordeaux Institute of Oncology, Bordeaux University, Bordeaux, France
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2
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Oganesyan A, Gregory A, Malard F, Ghahramanyan N, Mohty M, Kazandjian D, Mekinian A, Hakobyan Y. Monoclonal gammopathies of clinical significance (MGCS): In pursuit of optimal treatment. Front Immunol 2022; 13:1045002. [PMID: 36505449 PMCID: PMC9728929 DOI: 10.3389/fimmu.2022.1045002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022] Open
Abstract
Monoclonal gammopathy of clinical significance (MGCS) represents a new clinical entity referring to a myriad of pathological conditions associated with the monoclonal gammopathy of undetermined significance (MGUS). The establishment of MGCS expands our current understanding of the pathophysiology of a range of diseases, in which the M protein is often found. Aside from the kidney, the three main organ systems most affected by monoclonal gammopathy include the peripheral nervous system, skin, and eye. The optimal management of these MGUS-related conditions is not known yet due to the paucity of clinical data, the rarity of some syndromes, and limited awareness among healthcare professionals. Currently, two main treatment approaches exist. The first one resembles the now-established therapeutic strategy for monoclonal gammopathy of renal significance (MGRS), in which chemotherapy with anti-myeloma agents is used to target clonal lesion that is thought to be the culprit of the complex clinical presentation. The second approach includes various systemic immunomodulatory or immunosuppressive options, including intravenous immunoglobulins, corticosteroids, or biological agents. Although some conditions of the MGCS spectrum can be effectively managed with therapies aiming at the etiology or pathogenesis of the disease, evidence regarding other pathologies is severely limited to individual patient data from case reports or series. Future research should pursue filling the gap in knowledge and finding the optimal treatment for this novel clinical category.
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Affiliation(s)
- Artem Oganesyan
- Department of Hematology and Transfusion Medicine, National Institute of Health, Yerevan, Armenia,Department Of Adult Hematology, Hematology Center after Prof. R. Yeolyan, Yerevan, Armenia,*Correspondence: Artem Oganesyan,
| | - Andrew Gregory
- Wayne State University School of Medicine, Detroit, MI, United States
| | - Florent Malard
- Department of Clinical Hematology and Cellular Therapy, INSERM, Saint-Antoine Research Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Paris, France
| | - Nerses Ghahramanyan
- Department Of Adult Hematology, Hematology Center after Prof. R. Yeolyan, Yerevan, Armenia
| | - Mohamad Mohty
- Department of Clinical Hematology and Cellular Therapy, INSERM, Saint-Antoine Research Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Paris, France
| | - Dickran Kazandjian
- Myeloma Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
| | - Arsène Mekinian
- Department of Internal Medicine (DMU i3), Sorbonne University, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Paris, France,French-Armenian Clinical Research Center, National Institute of Health, Yerevan, Armenia
| | - Yervand Hakobyan
- Department of Hematology and Transfusion Medicine, National Institute of Health, Yerevan, Armenia,Department Of Adult Hematology, Hematology Center after Prof. R. Yeolyan, Yerevan, Armenia
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3
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Steinhelfer L, Kühnel T, Jägle H, Mayer S, Karrer S, Haubner F, Schreml S. Systemic therapy of necrobiotic xanthogranuloma: a systematic review. Orphanet J Rare Dis 2022; 17:132. [PMID: 35331271 PMCID: PMC8944121 DOI: 10.1186/s13023-022-02291-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Even though a plethora of systemic therapies have been proposed for necrobiotic xanthogranuloma (NXG), there is no systematic review on this topic in literature. OBJECTIVE To review all existing literature on the systemic therapy of NXG in order to identify the most effective therapies. METHODS All reported papers in the literature were screened for systemic treatments of NXG. Papers without proper description of the therapies, papers describing topical therapy, and articles without assessment of effectiveness were excluded. Subsequently, we analyzed 79 papers and a total of 175 cases. RESULTS The most effective treatments for NXG are intravenous immunoglobulins (IVIG), corticosteroids, and combination therapies including corticosteroids. CONCLUSIONS Corticosteroids and IVIG should therefore be considered first-line treatments in patients with NXG.
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Affiliation(s)
- Lisa Steinhelfer
- Department of Dermatology, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.,Department of Nuclear Medicine, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany.,Department of Radiology, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Thomas Kühnel
- Department of Otorhinolaryngology, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Herbert Jägle
- Department of Ophthalmology, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Stephanie Mayer
- Department of Internal Medicine III, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Sigrid Karrer
- Department of Dermatology, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Frank Haubner
- Department of Otorhinolaryngology, Ludwig Maximilians University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Stephan Schreml
- Department of Dermatology, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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4
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Means A, Marvin EK, Anderson KR, Lehman JS, Hertel D. Necrobiotic xanthogranuloma with type 1 cryoglobulinemia mimicking necrobiosis lipoidica in a young woman with myeloma. JAAD Case Rep 2022; 21:195-197. [PMID: 35252521 PMCID: PMC8894138 DOI: 10.1016/j.jdcr.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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5
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First case report of pre-mortem biopsy-proven kidney involvement by necrobiotic xanthogranuloma with monoclonal gammopathy. J Nephrol 2021; 35:1753-1757. [PMID: 34739712 DOI: 10.1007/s40620-021-01186-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
Necrobiotic xanthogranuloma (NXG) is a rare non-Langerhans cell histiocytosis with characteristic cutaneous features and rare visceral involvement. More than 80% of individuals with this disease have a detectable paraprotein but the precise pathogenesis remains obscure. A 68-year-old man with known cutaneous necrobiotic xanthogranuloma presented with acute kidney injury and imaging suggestive of bilateral perinephric infiltration. Renal biopsy showed a prominent histiocytic infiltration of renal capsule and cortex with necrobiosis and characteristic 'Touton-type' giant cells suggestive of necrobiotic xanthogranuloma involvement. Kidney function returned to normal and cutaneous lesions improved with a combination of corticosteroid, chlorambucil and rituximab. This case represents only the second reported incidence of kidney involvement by necrobiotic xanthogranuloma and the first with acute kidney injury and pre-mortem histopathology. This report adds to a small body of literature on the diagnosis and management of visceral involvement by this rare disease.
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6
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Liang D, Liu J, Liang S, Xu F, Cheng Z, Huang X, Zeng C, Liu Z. Types of M protein and clinicopathological profiles in patients with monoclonal gammopathy of renal significance. J Nephrol 2020; 34:1137-1146. [PMID: 32725498 DOI: 10.1007/s40620-020-00817-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/22/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The development of renal disease in patients with monoclonal gammopathy of renal significance (MGRS) depends on the pathogenicity of the secreted monoclonal protein (M protein). However, the correlation between the types of M proteins and clinical and renal pathological features is still unclear. METHODS A total of 148 patients with detectable serum M protein and biopsy-proven MGRS were recruited. The patients were categorized according to the heavy and light chain types of M protein in the serum. RESULTS Among 148 patients, the most common M protein was IgGλ, followed by IgAλ and IgGκ. According to the type of heavy chain, patients with IgM-MGRS were more likely to have renal dysfunction, anemia and hypocomplementemia than patients with IgG-MGRS and IgA-MGRS. The λ light chain was predominant in patients with IgG-MGRS and IgA-MGRS, whereas the κ light chain was predominant in patients with IgM-MGRS. The most common renal lesion was amyloidosis in patients with IgG-MGRS and IgA-MGRS, while it was cryoglobulinemic glomerulonephritis in patients with IgM-MGRS. According to the type of light chain, patients with κ light chain were more likely to be male and to have renal dysfunction, anemia and hypocomplementemia than those with λ light chain. The types of heavy chain and light chain of M protein were not associated with patient or renal survival. CONCLUSION The clinicopathological features were distinct in patients with different types of M protein. Integration of the types of M protein and renal pathologic findings may shed light on individual management of patients with MGRS.
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Affiliation(s)
- Dandan Liang
- National Clinical Research Center of Kidney Diseases, Jinling Clinical Medical College of Nanjing Medical University, 305 East Zhongshan Road, Nanjing, China
| | - Jing Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Shaoshan Liang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Feng Xu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Zhen Cheng
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Xianghua Huang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Caihong Zeng
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Zhihong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Clinical Medical College of Nanjing Medical University, 305 East Zhongshan Road, Nanjing, China. .,National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
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7
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Henning C, Meyers S, Swift R, Eades B, Bussell L, Spektor TM, Berenson JR. Efficacy of Topical Use Crisaborole 2% Ointment for Treatment of Necrobiotic Xanthogranuloma Associated With Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e492-e495. [PMID: 32389673 DOI: 10.1016/j.clml.2020.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 03/31/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | - Letantia Bussell
- Letantia Bussell, MD, Beverly Hills, CA; Bussell Skin Care, Beverly Hills, CA; Beverly Hills Dermatology Consultants, Beverly Hills, CA; Beverly Hills Dermatology Surgery Center, Beverly Hills, CA
| | | | - James R Berenson
- James R. Berenson MD, Inc, West Hollywood, CA; Oncotherapeutics, West Hollywood, CA; Institute for Myeloma and Bone Cancer Research, West Hollywood, CA.
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8
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Monoclonal Gammopathy of Undetermined Significance: Current Concepts and Future Prospects. Curr Hematol Malig Rep 2020; 15:45-55. [DOI: 10.1007/s11899-020-00569-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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9
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Nelson CA, Zhong CS, Hashemi DA, Ashchyan HJ, Brown-Joel Z, Noe MH, Imadojemu S, Micheletti RG, Vleugels RA, Wanat KA, Rosenbach M, Mostaghimi A. A Multicenter Cross-Sectional Study and Systematic Review of Necrobiotic Xanthogranuloma With Proposed Diagnostic Criteria. JAMA Dermatol 2020; 156:270-279. [PMID: 31940000 PMCID: PMC6990734 DOI: 10.1001/jamadermatol.2019.4221] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 11/07/2019] [Indexed: 11/14/2022]
Abstract
Importance Necrobiotic xanthogranuloma (NXG) is a non-Langerhans cell histiocytosis classically associated with paraproteinemia attributable to plasma-cell dyscrasias or lymphoproliferative disorders. Despite the morbidity of NXG, the literature is limited to case reports and small studies, and diagnostic criteria are lacking. Objective To evaluate the characteristics of NXG and propose diagnostic criteria. Design, Setting, and Participants This multicenter cross-sectional study was conducted at tertiary academic referral centers and followed by a systematic review and a consensus exercise. The multicenter cohort included patients with NXG diagnosed at the Brigham and Women's and Massachusetts General Hospitals (2000-2018), the University of Iowa Hospitals and Clinics (2000-2018), and the University of Pennsylvania Health System (2008-2018). The systematic review was conducted in 2018 and included patients with NXG identified in the Cochrane, Ovid EMBASE, PubMed, and Web of Science databases. The consensus exercise was conducted by 8 board-certified dermatologists to identify diagnostic criteria. Main Outcomes and Measures Demographic factors, comorbidities, clinical features, and treatment response. Results Of 235 included patients with NXG (34 from the multicenter cohort and 201 from the systematic review results), the mean (SD) age at presentation was 61.6 (14.2) years; 147 (62.6%) were female. Paraproteinemia was detected in 193 patients (82.1%), most often IgG-κ (117 patients [50.0%]). A malignant condition was detected in 59 patients (25.1%), most often multiple myeloma (33 patients [14.0%]). The overall rate of paraproteinemia and/or a malignant condition was 83.8% (197 patients). In the multicenter cohort, evolution of paraproteinemia into multiple myeloma was observed up to 5.7 years (median [range], 2.4 [0.1-5.7] years) after NXG presentation. Cutaneous lesions consisted of papules, plaques, and/or nodules, typically yellow or orange in color (113 of 187 [60.4%]) with a periorbital distribution (130 of 219 [59.3%]). The eye was the leading site of extracutaneous involvement (34 of 235 [14.5%]). In the multicenter cohort, intravenous immunoglobulin had the best treatment response rate (9 of 9 patients [100%]), followed by antimalarial drugs (4 of 5 patients [80%]), intralesional triamcinolone (6 of 8 patients [75%]), surgery (3 of 4 patients [75%]), chemotherapy (8 of 12 patients [67%]), and lenalidomide or thalidomide (5 of 8 patients [63%]). The consensus exercise yielded 2 major criteria, which were (1) clinical and (2) histopathological features consistent with NXG, and 2 minor criteria, consisting of (1) paraproteinemia, plasma-cell dyscrasia, and/or other associated lymphoproliferative disorder and (2) periorbital distribution of cutaneous lesions. In the absence of foreign body, infection, or another identifiable cause, fulfillment of both major and at least 1 minor criterion were proposed to establish the diagnosis of NXG. Conclusions and Relevance Necrobiotic xanthogranuloma is a multisystem disorder associated with paraproteinemia and malignant conditions. The proposed diagnostic criteria may advance clinical research and should be validated.
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Affiliation(s)
- Caroline A. Nelson
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - David A. Hashemi
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Hovik J. Ashchyan
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Zoe Brown-Joel
- University of Iowa Carver College of Medicine, Iowa City
| | - Megan H. Noe
- Perelman School of Medicine at the University of Pennsylvania, Department of Dermatology, Philadelphia
| | - Sotonye Imadojemu
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert G. Micheletti
- Perelman School of Medicine at the University of Pennsylvania, Department of Dermatology, Philadelphia
- Perelman School of Medicine at the University of Pennsylvania, Department of Medicine, Philadelphia
| | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Karolyn A. Wanat
- Department of Dermatology, University of Iowa Carver College of Medicine, Iowa City
| | - Misha Rosenbach
- Perelman School of Medicine at the University of Pennsylvania, Department of Dermatology, Philadelphia
- Perelman School of Medicine at the University of Pennsylvania, Department of Medicine, Philadelphia
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Wetzel M, Owen CE, Callen JP. Paraneoplastic Syndromes for the Inpatient Dermatologist. CURRENT DERMATOLOGY REPORTS 2019. [DOI: 10.1007/s13671-019-00277-y] [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]
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11
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Eason CR, Stovall C, Corley SB. Ulcerated indurated plaques on the upper extremities. JAAD Case Rep 2019; 5:749-751. [PMID: 31516986 PMCID: PMC6728607 DOI: 10.1016/j.jdcr.2019.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Caitlin Riley Eason
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Caroline Stovall
- Department of Dermatology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | - Sarah Beth Corley
- Department of Dermatology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
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12
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de Mello RB, do Vale ECS. Necrobiotic xanthogranuloma associated with smoldering multiple myeloma: satisfactory response to cyclophosphamide, dexamethasone, and thalidomide. An Bras Dermatol 2019; 94:337-340. [PMID: 31365665 PMCID: PMC6668937 DOI: 10.1590/abd1806-4841.20198500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 11/22/2018] [Indexed: 11/25/2022] Open
Abstract
Necrobiotic xanthogranuloma is a rare chronic condition, belonging to the group C non-Langerhans cell histiocytoses, which is relevant due to the possibility of extracutaneous involvement and association with systemic diseases, particularly hematologic malignancies. The case reported here was only diagnosed after nine years of evolution and was associated with plasma cell dyscrasia. After treatment with cyclophosphamide, dexamethasone, and thalidomide, there was a reduction of cutaneous lesions and serum levels of monoclonal protein.
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Affiliation(s)
- Renan Bernardes de Mello
- Dermatology Service, Hospital das Clínicas, Universidade
Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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13
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Legrand A, Jullie ML, Ly S, Beylot-Barry M, Viallard JF, Calonje J, Bureau-Lenoir C, Doutre MS. Extrafacial necrobiotic xanthogranuloma and monoclonal gammopathy: two cases. Int J Dermatol 2019; 58:e112-e114. [PMID: 30883695 DOI: 10.1111/ijd.14416] [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: 09/17/2018] [Revised: 01/23/2019] [Accepted: 02/05/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Adeline Legrand
- Dermatology Department, University Hospital of Bordeaux, Bordeaux, France
| | | | - Sandra Ly
- Dermatology Department, University Hospital of Bordeaux, Bordeaux, France
| | - Marie Beylot-Barry
- Dermatology Department, University Hospital of Bordeaux, Bordeaux, France
| | | | - Jaime Calonje
- Dermatopathology Laboratory, St John's Institute of Dermatology, St Thomas' Hospital, London, UK
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14
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Miola AC, Marques MEA, Miot HA. Necrobiotic xanthogranuloma (without paraproteinemia) in a patient with Pelger-Huët anomaly. Int J Dermatol 2018; 58:E93-E94. [PMID: 30588610 DOI: 10.1111/ijd.14365] [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: 11/24/2018] [Revised: 11/29/2018] [Accepted: 12/05/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Anna C Miola
- Department of Dermatology and Radiotherapy, FMB-UNESP, Botucatu, São Paulo, Brazil
| | | | - Helio A Miot
- Department of Dermatology and Radiotherapy, FMB-UNESP, Botucatu, São Paulo, Brazil
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15
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Monoclonal gammopathy of clinical significance: a novel concept with therapeutic implications. Blood 2018; 132:1478-1485. [DOI: 10.1182/blood-2018-04-839480] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 06/22/2018] [Indexed: 12/12/2022] Open
Abstract
Abstract
Monoclonal gammopathy is a common condition, particularly in the elderly. It can indicate symptomatic multiple myeloma or another overt malignant lymphoid disorder requiring immediate chemotherapy. More frequently, it results from a small and/or quiescent secreting B-cell clone, is completely asymptomatic, and requires regular monitoring only, defining a monoclonal gammopathy of unknown significance (MGUS). Sometimes, although quiescent and not requiring any treatment per se, the clone is associated with potentially severe organ damage due to the toxicity of the monoclonal immunoglobulin or to other mechanisms. The latter situation is increasingly observed but still poorly recognized and frequently undertreated, although it often requires rapid specific intervention to preserve involved organ function. To improve early recognition and management of these small B-cell clone–related disorders, we propose to introduce the concept of monoclonal gammopathy of clinical significance (MGCS). This report identifies the spectrum of MGCSs that are classified according to mechanisms of tissue injury. It highlights the diversity of these disorders for which diagnosis and treatment are often challenging in clinical practice and require a multidisciplinary approach. Principles of management, including main diagnostic and therapeutic procedures, are also described. Importantly, efficient control of the underlying B-cell clone usually results in organ improvement. Currently, it relies mainly on chemotherapy and other anti–B-cell/plasma cell agents, which should aim at rapidly producing the best hematological response.
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16
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Fink C, Schneiderbauer R, Hartschuh W, Enk A, Toberer F. Necrobiotic xanthogranuloma associated with chronic lymphocytic leukemia. Int J Dermatol 2018; 57:719-720. [PMID: 29485184 DOI: 10.1111/ijd.13951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 12/05/2017] [Accepted: 01/28/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Christine Fink
- Department of Dermatology, Venerology, and Allergology, University Medical Center, Ruprecht-Karl University, Heidelberg, Germany
| | - Roland Schneiderbauer
- Department of Dermatology, Venerology, and Allergology, University Medical Center, Ruprecht-Karl University, Heidelberg, Germany
| | - Wolfgang Hartschuh
- Department of Dermatology, Venerology, and Allergology, University Medical Center, Ruprecht-Karl University, Heidelberg, Germany
| | - Alexander Enk
- Department of Dermatology, Venerology, and Allergology, University Medical Center, Ruprecht-Karl University, Heidelberg, Germany
| | - Ferdinand Toberer
- Department of Dermatology, Venerology, and Allergology, University Medical Center, Ruprecht-Karl University, Heidelberg, Germany
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Go RS, Rajkumar SV. How I manage monoclonal gammopathy of undetermined significance. Blood 2018; 131:163-173. [PMID: 29183887 PMCID: PMC5757684 DOI: 10.1182/blood-2017-09-807560] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/19/2017] [Indexed: 12/16/2022] Open
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) is, in many ways, a unique hematologic entity. Unlike most hematologic conditions in which the diagnosis is intentional and credited to hematologists, the discovery of MGUS is most often incidental and made by nonhematologists. MGUS is considered an obligate precursor to several lymphoplasmacytic malignancies, including immunoglobulin light-chain amyloidosis, multiple myeloma, and Waldenström macroglobulinemia. Therefore, long-term follow-up is generally recommended. Despite its high prevalence, there is surprisingly limited evidence to inform best clinical practice both at the time of diagnosis and during follow-up. We present 7 vignettes to illustrate common clinical management questions that arise during the course of MGUS. Where evidence is present, we provide a concise summary of the literature and clear recommendations on management. Where evidence is lacking, we describe how we practice and provide a rationale for our approach. We also discuss the potential harms associated with MGUS diagnosis, a topic that is rarely, if ever, broached between patients and providers, or even considered in academic debate.
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Affiliation(s)
- Ronald S Go
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - S Vincent Rajkumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
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Gonzales JA, Haemel A, Gross AJ, Acharya NR. Management of Uveitis and Scleritis in Necrobiotic Xanthogranuloma. J Ocul Pharmacol Ther 2017; 33:325-333. [PMID: 28394239 DOI: 10.1089/jop.2016.0135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Necrobiotic xanthogranuloma (NXG) is a chronic, progressive non-Langerhans histiocytic granulomatous disease. While case reports describing periorbital involvement of NXG are frequent, only a few case reports describing ocular involvement, such as scleritis and uveitis, exist. Herein, we present a case presenting initially as bilateral anterior and posterior scleritis, as well as a chronic bilateral granulomatous panuveitis, and discuss the immunosuppressant options that should be considered for this disease with protean manifestations.
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Affiliation(s)
- John A Gonzales
- 1 F.I. Proctor Foundation, University of California , San Francisco, San Francisco, California.,2 Department of Ophthalmology, University of California , San Francisco, San Francisco, California
| | - Anna Haemel
- 3 Department of Dermatology, University of California , San Francisco, San Francisco, California
| | - Andrew J Gross
- 4 Department of Rheumatology, University of California , San Francisco, San Francisco, California
| | - Nisha R Acharya
- 1 F.I. Proctor Foundation, University of California , San Francisco, San Francisco, California.,2 Department of Ophthalmology, University of California , San Francisco, San Francisco, California
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