1
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Ortonne N. [Endogenous skin overloads]. Ann Pathol 2024:S0242-6498(24)00194-9. [PMID: 39368935 DOI: 10.1016/j.annpat.2024.09.006] [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: 09/09/2024] [Accepted: 09/14/2024] [Indexed: 10/07/2024]
Abstract
As in other organs, the diagnosis of endogenous cutaneous overload diseases is based on histopathological analysis of the lesions using special stainings, even if the clinical appearance is sometimes very suggestive. The lesions are sometimes very subtle and can be included in the group of "invisible" dermatoses, such as primary macular cutaneous amyloidosis or calciphylaxis. Superficial dermal melanosis or pigmentary incontinence generally reflects the post-inflammatory stage of a chronic or recurrent interface dermatitis. Section levels should be systematically performed to look for active lesions of diagnostic interest: Alcian blue staining to identify dermal mucinosis (connectivitis) and pan-T markers (fixed pigmented erythema, lichenoid mycosis fungoides, and vitiligo). Some pathologies have a prognostic impact, either because they reflect an underlying disease, monoclonal gammopathies, in particular myeloma, being one of the most common conditions in this context (AL amyloidosis, xanthoma and xanthogranuloma, scleromyxedema), or because they can be associated with visceral damage (AL amyloidosis, scleromyxedema). The clinical-pathological comparison is mandatory to rule out differential diagnoses, especially for life-threatening diseases: nodular amyloidosis and primary cutaneous amyloidosis versus systemic AL amyloidosis, papular mucinosis versus scleromyxedema and calcific panniculitis versus calciphylaxis.
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Affiliation(s)
- Nicolas Ortonne
- Département de Pathologie, université Paris Est Créteil (UPEC), hôpital Henri-Mondor, AP-HP, 1, rue Gustave Eiffel, 94000 Créteil, France.
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2
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Mandić JJ, Bakula M, Šklebar LK, Jakovčević A, Mandić K, Petrović Jurčević J, Padjen I. Histiocytosis and adult-onset orbital xanthogranuloma in 2023: a review of the literature and mini case series. Int Ophthalmol 2024; 44:301. [PMID: 38951425 DOI: 10.1007/s10792-024-03181-y] [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] [Received: 02/13/2024] [Accepted: 06/15/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE Within the large umbrella of histiocytosis are a few similar yet heterogenous entities involving the orbit and periocular tissues with or without systemic infiltration, termed adult onset xanthogranuloma or orbital xanthogranuloma. Due to rarity of these conditions, different classifications in use, diverse clinical presentations and still unknown etiology, the aim of this paper was to provide an up-to-date literature review of the actual understanding of histiocytosis and its subgroups involving the orbit and periocular area, diagnostic strategies and therapeutic modalities. METHODS We present a review of literature and small case series comprising four patients diagnosed and treated in the period from 2001 until 2023 in our hospital. Clinical files of 4 patients with adult-onset xanthogranulomatous disease of the orbit and ocular adnexa (AOXGD) were reviewed retrospectively. Clinical, laboratory, radiological, histopathological, and immunohistochemical findings were reexamined. RESULTS Reviewing medical records of our patients with AOXGD, we found significant overlap between histiocytosis and different immune disorders. A broad workup should be considered in these patients as they can harbour severe immune disfunctions and hematologic disorders. Preferred treatment modality depends on a histopathologic type of AOXGD, clinical presentation and systemic involvement and should be conducted multidisciplinary. CONCLUSION The diagnosis is often delayed because of its rarity and diverse clinical findings. Development of molecular genetic tests, detection of BRAF V600E mutation and different types of kinase mutations, mutations in transcriptional regulatory genes as well as tyrosine kinase receptors have shed a new light on the etiopathogenesis and potential targeted treatment of histiocytosis.
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Affiliation(s)
- Jelena Juri Mandić
- School of Medicine, University of Zagreb, Šalata 3B, Zagreb, Croatia.
- Department of Ophthalmology, University Hospital Center Zagreb, Kišpatićeva 12, Zagreb, Croatia.
| | - Maja Bakula
- School of Medicine, University of Zagreb, Šalata 3B, Zagreb, Croatia
- Department of Ophthalmology, University Hospital Center Zagreb, Kišpatićeva 12, Zagreb, Croatia
| | - Lorena Karla Šklebar
- School of Medicine, University of Zagreb, Šalata 3B, Zagreb, Croatia
- Department of Ophthalmology, University Hospital Center Zagreb, Kišpatićeva 12, Zagreb, Croatia
| | - Antonia Jakovčević
- Department of Pathology, University Hospital Center Zagreb, Kišpatićeva 12, Zagreb, Croatia
| | - Krešimir Mandić
- School of Medicine, University of Zagreb, Šalata 3B, Zagreb, Croatia
- Department of Ophthalmology, University Hospital Center Zagreb, Kišpatićeva 12, Zagreb, Croatia
| | | | - Ivan Padjen
- School of Medicine, University of Zagreb, Šalata 3B, Zagreb, Croatia
- Division of Clinical Immunology and Rheumatology, Referral Centre for Systemic Lupus Erythematosus and Related Disorders, Department of Internal Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb, Croatia
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3
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Song X, Zhang D, Zhao Z, Wang A. Multiple Red-brown Papules and Plaques on the Trunk and Extremities: A Quiz. Acta Derm Venereol 2023; 103:adv12419. [PMID: 37721357 PMCID: PMC10512967 DOI: 10.2340/actadv.v103.12419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/11/2023] [Indexed: 09/19/2023] Open
Abstract
Abstract is missing (Quiz)
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Affiliation(s)
- Xiaoting Song
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing 100034, China
| | - Daoning Zhang
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing 100034, China
| | - Zuotao Zhao
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing 100034, China
| | - Aiping Wang
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing 100034, China.
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4
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Chen L, Feng L, E L. Oral Juvenile Xanthogranuloma: a case report of gingival hyperplasia and osteolysis in male adult patient. BMC Oral Health 2022; 22:618. [PMID: 36529720 PMCID: PMC9761958 DOI: 10.1186/s12903-022-02643-y] [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: 07/23/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Juvenile Xanthogranuloma (JXG) is a non-hereditary, self-limiting disease which is usually presented in infancy or early childhood and in males over females. CASE PRESENTATION We report a rare case of oral Juvenile Xanthogranuloma with recurrent progressive gingival hyperplasia and concomitant presentation of osteolysis in a 21-year-old adult male with no significant medical history. Patient presented with generalized gingival hyperplasia, osteolysis of the maxilla and mandible, and a round, firm, nodular mass with clear circumference on the left shoulder. Results of gingival tissue biopsy, karyotype, bone marrow biopsy and immunohistochemistry were suggestive of a diagnosis of Juvenile Xanthogranuloma with no association to hematologic malignancy. Unfortunately, patient declined treatment and elected to be transferred back to local hospital for future evaluation. CONCLUSIONS Juvenile Xanthogranuloma in adults can have atypical manifestations including generalized gingival hyperplasia and osteolysis of the maxilla and mandible. It should be differentiated between Langerhans cell histiocytosis, Papillon-Lefevre Syndrome, and Pyogenic Granulomas. Despite uncommon incidence, it should be included in differential diagnoses in cases of similar clinical presentations.
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Affiliation(s)
- Long Chen
- Department of Stomatology, People’s Hospital of Mancheng District, Baoding, 072150 Hebei China ,grid.414252.40000 0004 1761 8894Department of Oral and Maxillofacial Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, 100853 China
| | - Lin Feng
- grid.414252.40000 0004 1761 8894Department of Oral and Maxillofacial Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, 100853 China
| | - Lingling E
- grid.414252.40000 0004 1761 8894Institute of Stomatology and Oral Maxilla Facial Key Laboratory, First Medical Center of Chinese PLA General Hospital, Beijing, 100853 China
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5
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Trauma-induced Adult Xanthogranuloma Mimicking Keloid on the Left Nasal Ala. ACTAS DERMO-SIFILIOGRAFICAS 2022:S0001-7310(22)00888-2. [PMID: 36265679 DOI: 10.1016/j.ad.2022.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 11/26/2021] [Accepted: 01/07/2022] [Indexed: 12/13/2022] Open
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6
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Wada S, Namiki T, Miura K. Mononuclear variant of adult xanthogranuloma associated with B-cell acute lymphocytic leukemia. J Dermatol 2022; 49:e161-e162. [PMID: 34978093 DOI: 10.1111/1346-8138.16296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/15/2021] [Accepted: 12/21/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Shogo Wada
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeshi Namiki
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiko Miura
- Department of Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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7
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Progressive Nodular Histiocytosis: Report of a Case and Review of the Literature. Case Rep Pathol 2021; 2021:5531820. [PMID: 34567817 PMCID: PMC8463211 DOI: 10.1155/2021/5531820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022] Open
Abstract
Progressive nodular histiocytosis (PNH) is a rare condition characterized by progressive eruption of multiple yellowish-brown papules and nodules on the skin and mucous membranes. We present the case of a 37-year-old Caucasian man with gradually increased appearance of nodular lesions on the forehead and right temple. These lesions were initially diagnosed as xanthomas and did not respond to intralesional injections of triamcinolone. Additional biopsy revealed an intense dermal infiltrate of foamy mononuclear epithelioid cells with a minor admixture of plasma cells, lymphocytes, and scattered multinucleated giant cells. On immunohistochemical staining, the lesional cells were positive for CD163 and CD68 and negative for CD1a, thus confirming a mononuclear-macrophage lineage. The clinical presentation and the histological impression lead to the diagnosis of PNH. This condition could be challenging, mimicking microscopically similar lesions of the non-Langerhans cell histiocytosis group. Although uncommon, PNH stands out due to its clinical and microscopic features and should be taken into consideration in the differential diagnosis of cutaneous histiocytoses.
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8
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Bergqvist C, Bernigaud C, Ingen-Housz-Oro S, Sujobert P, Hotz C, Lebre C, Ortonne N, Chosidow O. Intravenous immunoglobulins: an eye opener on the successful treatment of severe adult-onset paraprotein-associated xanthogranulomatosis. Clin Exp Dermatol 2021; 46:1346-1348. [PMID: 33969535 DOI: 10.1111/ced.14727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 11/26/2022]
Affiliation(s)
- C Bergqvist
- Departments of, Department of, Dermatology, AP-HP, Henri Mondor Jospital, Créteil, France.,Université Paris-Est Créteil, Créteil, France
| | - C Bernigaud
- Departments of, Department of, Dermatology, AP-HP, Henri Mondor Jospital, Créteil, France.,Université Paris-Est Créteil, Créteil, France
| | - S Ingen-Housz-Oro
- Departments of, Department of, Dermatology, AP-HP, Henri Mondor Jospital, Créteil, France
| | - P Sujobert
- Department of Biological Haematology, Hôpital Lyon-sud, Pierre-Bénite, France
| | - C Hotz
- Departments of, Department of, Dermatology, AP-HP, Henri Mondor Jospital, Créteil, France
| | - C Lebre
- Departments of, Department of, Dermatology, AP-HP, Henri Mondor Jospital, Créteil, France
| | - N Ortonne
- Department of, Pathology, AP-HP, Henri Mondor Jospital, Créteil, France.,Université Paris-Est Créteil, Créteil, France
| | - O Chosidow
- Departments of, Department of, Dermatology, AP-HP, Henri Mondor Jospital, Créteil, France.,Université Paris-Est Créteil, Créteil, France
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9
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Multiple Xanthogranulomas in an Adult Patient with Myelodysplastic Syndrome. Case Rep Dermatol Med 2021; 2020:8826715. [PMID: 33489387 PMCID: PMC7803178 DOI: 10.1155/2020/8826715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/25/2020] [Indexed: 11/17/2022] Open
Abstract
Adult multiple xanthogranuloma (XG) is a rare late-onset variant of juvenile XG. It is characterized by the appearance of papules or nodules located preferably on the trunk. A case of a 54-year-old man with myelodysplastic syndrome is presented as a history of interest, who consulted due to the appearance of multiple brownish papules distributed mainly in the trunk. So far, there are only 22 cases of this clinical form reported in the literature, 9 of them associated with malignant hematological processes. We highlight the importance of this entity as a possible cutaneous marker of blood dyscrasias.
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10
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Bátai B, Krizsán S, Gángó A, Hegyi L, Csóka M, Erdélyi DJ, Csomor J, Kállay K, Bödör C. Juvenile myelomonocytic leukaemia presentation after preceding juvenile xanthogranuloma harbouring an identical somatic PTPN11 mutation. Pediatr Blood Cancer 2020; 67:e28368. [PMID: 32558336 DOI: 10.1002/pbc.28368] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/09/2020] [Accepted: 04/11/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Bence Bátai
- First Department of Pathology and Experimental Cancer Research, Hungarian Academy of Sciences-Semmelweis University Momentum Molecular Oncohematology Research Group, Semmelweis University, Budapest, Hungary
| | - Szilvia Krizsán
- First Department of Pathology and Experimental Cancer Research, Hungarian Academy of Sciences-Semmelweis University Momentum Molecular Oncohematology Research Group, Semmelweis University, Budapest, Hungary
| | - Ambrus Gángó
- First Department of Pathology and Experimental Cancer Research, Hungarian Academy of Sciences-Semmelweis University Momentum Molecular Oncohematology Research Group, Semmelweis University, Budapest, Hungary
| | - Lajos Hegyi
- First Department of Pathology and Experimental Cancer Research, Hungarian Academy of Sciences-Semmelweis University Momentum Molecular Oncohematology Research Group, Semmelweis University, Budapest, Hungary
| | - Monika Csóka
- Second Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | | | - Judit Csomor
- First Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Krisztián Kállay
- Department of Pediatric Hematology and Stem Cell Transplantation, Central Hospital of Southern Pest, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Csaba Bödör
- First Department of Pathology and Experimental Cancer Research, Hungarian Academy of Sciences-Semmelweis University Momentum Molecular Oncohematology Research Group, Semmelweis University, Budapest, Hungary
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11
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Pawińska-Wa Sikowska K, Cwiklinska M, Wyrobek E, Balwierz W, Bukowska-Strakova K, Dluzniewska A, Gozdzik J, Drabik G, Rygielska M, Stepien K, Skoczen S. Disseminated Juvenile Xanthogranuloma and Hemophagocytic Lymphohistiocytosis Developed During Treatment of Acute Lymphoblastic Leukemia: Case Report. Front Oncol 2020; 10:921. [PMID: 32719740 PMCID: PMC7350519 DOI: 10.3389/fonc.2020.00921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/11/2020] [Indexed: 12/02/2022] Open
Abstract
The association between acute lymphoblastic leukemia (ALL), non-Langerhans cell histiocytosis (non-LCH), and hemophagocytic lymphohistiocytosis (HLH), to the best of our knowledge, has not been published to date. Juvenile xanthogranuloma (JXG), as a type of non-LCH, is usually a benign disease limited to the skin. Systemic involvement is rarely reported. The present case report describes a 15-year-old boy diagnosed with disseminated JXG involving skin and bone marrow concurrent with severe symptoms of HLH during ALL therapy. Examination of immunoglobulin heavy chain genes in B-cell precursor leukemic blasts and histiocytes in the skin and bone marrow revealed identical rearrangements, confirming clonal relationship between both diseases. Implementation of corticosteroids, vinblastine, etoposide, cyclosporine, and tocilizumab resulted in partial skin lesion resolution with no improvement of bone marrow function; therefore, hematopoietic stem cell transplantation (HSCT) was eventually performed. The patient's hematological and general status has improved gradually; however, remarkable recovery of skin lesions was observed after empirical antitubercular therapy. Mycobacterium spp. infection should be considered as a possible secondary HLH trigger. Triple association of ALL, non-LCH, and HLH highlights heterogeneity of histiocytic disorders and possible common origin of dendritic and lymphoid cells.
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Affiliation(s)
- Katarzyna Pawińska-Wa Sikowska
- Department of Pediatric Oncology and Hematology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland.,Department of Oncology and Hematology, University Children's Hospital of Krakow, Krakow, Poland
| | - Magdalena Cwiklinska
- Department of Pediatric Oncology and Hematology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland.,Department of Oncology and Hematology, University Children's Hospital of Krakow, Krakow, Poland
| | - Elzbieta Wyrobek
- Department of Oncology and Hematology, University Children's Hospital of Krakow, Krakow, Poland
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland.,Department of Oncology and Hematology, University Children's Hospital of Krakow, Krakow, Poland
| | - Karolina Bukowska-Strakova
- Department of Clinical Immunology and Transplantation, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Dluzniewska
- Department of Clinical Immunology and Transplantology, Stem Cell Transplant Center, University Children's Hospital of Krakow, Jagiellonian University Medical College, Krakow, Poland
| | - Jolanta Gozdzik
- Department of Clinical Immunology and Transplantology, Stem Cell Transplant Center, University Children's Hospital of Krakow, Jagiellonian University Medical College, Krakow, Poland
| | - Grazyna Drabik
- Department of Pathology, University Children's Hospital of Krakow, Krakow, Poland
| | - Monika Rygielska
- Department of Biochemistry, University Children's Hospital of Krakow, Krakow, Poland
| | - Konrad Stepien
- Student Scientific Group of Pediatric Oncology and Hematology, Jagiellonian University Medical College, Krakow, Poland
| | - Szymon Skoczen
- Department of Pediatric Oncology and Hematology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland.,Department of Oncology and Hematology, University Children's Hospital of Krakow, Krakow, Poland
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12
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Ruiz-Villaverde R, Espelt-Otero JL, Linares-Gonzalez L. Multiple xanthogranuloma in an adult: Succesful response to UVA-1 therapy. Dermatol Ther 2020; 33:e13892. [PMID: 32584446 DOI: 10.1111/dth.13892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/20/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Ricardo Ruiz-Villaverde
- Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, Spain.,Instituto biosanitatio ibs Granada, Granada, Spain
| | - Jorge L Espelt-Otero
- Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, Spain.,Instituto biosanitatio ibs Granada, Granada, Spain
| | - Laura Linares-Gonzalez
- Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, Spain.,Instituto biosanitatio ibs Granada, Granada, Spain
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13
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Debois D, Marot L, Andre M, Dachelet C. Thalidomide as an effective treatment for adult multiple xanthogranuloma. JAAD Case Rep 2018; 4:896-898. [PMID: 30306122 PMCID: PMC6172436 DOI: 10.1016/j.jdcr.2018.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Deborah Debois
- Department of Dermatology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Liliane Marot
- Department of Dermatology, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Department of Dermatopathology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Marc Andre
- Department of Hematology, CHU UCL-Namur, Therasse, Yvoir, Belgium
| | - Claire Dachelet
- Department of Dermatology, CHU UCL-Namur, Therasse, Yvoir, Belgium
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14
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Cheon E, Yang S, Han JH, Lee KC, Park JE. Systemic Juvenile Xanthogranuloma Involving the Bone Marrow, Multiple Bones, and the Skin That Developed During Treatment of Acute Lymphoblastic Leukemia in Remission State. Pediatr Dev Pathol 2018; 21:489-493. [PMID: 28836893 DOI: 10.1177/1093526617721775] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Juvenile xanthogranuloma (JXG) is a rare benign disorder classified as non-Langerhans cell histiocytosis, with unclear etiology and pathogenesis. JXG is generally characterized by solitary or multiple cutaneous nodules that resolve spontaneously over a few years. JXG rarely presents as extracutaneous lesions that progress to a symptomatic systemic disorder through multiple organ involvement. We encountered a systemic JXG case involving the bone marrow, multiple bones, and the skin during acute lymphoblastic leukemia (ALL) treatment. A 16-year-old boy undergoing ALL treatment experienced unexplained prolonged fever and scalp, hip joint, and right knee joint pain for 2 weeks during interim maintenance chemotherapy. Bone marrow pathologic findings revealed no evidence of leukemia relapse but showed diffuse infiltration of histiocytes with several Touton-type giant cells; the stains were positive for CD68 and negative for CD1a and S100 protein. Bone and skin biopsies confirmed the findings. Symptoms have resolved since maintenance chemotherapy, which included vincristine, dexamethasone, 6-mercaptopurine, and methotrexate. Bone marrow involvement of JXG is very rare, occurring only in patients less than 1 year of age; however, this case was reported in an adolescent during ALL treatment.
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Affiliation(s)
- Eunjae Cheon
- 1 Department of Pediatrics, School of Medicine, Ajou University, Suwon, Korea
| | - Saemi Yang
- 1 Department of Pediatrics, School of Medicine, Ajou University, Suwon, Korea
| | - Jae Ho Han
- 1 Department of Pediatrics, School of Medicine, Ajou University, Suwon, Korea
| | - Kwang Chul Lee
- 2 Department of Pediatrics, College of Medicine, Korea University, Korea
| | - Jun Eun Park
- 1 Department of Pediatrics, School of Medicine, Ajou University, Suwon, Korea
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15
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Sanchez-Petitto G, Duke TC, Swaby M, Aisenberg GM. Juvenile xanthogranuloma: A herald to the diagnosis of Erdheim-Chester disease in an adult with acute leukemia. J Cutan Pathol 2018; 45:914-917. [PMID: 30117175 DOI: 10.1111/cup.13340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 06/30/2018] [Accepted: 07/24/2018] [Indexed: 12/23/2022]
Abstract
A 21-year-old man with B-cell acute lymphoblastic leukemia developed an eruption of multiple flesh-colored nodules and persistent fevers. A lesional biopsy showed diffuse dermal infiltrates of histiocytes, foam cells, and Touton giant cells consistent with juvenile xanthogranulomatosis. Upon further investigation, the patient's constellation of findings fit criteria for Erdheim-Chester disease.
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Affiliation(s)
- Gabriela Sanchez-Petitto
- Department of Internal Medicine, The University of Texas, McGovern School of Medicine, Houston, Texas
| | - Taylor C Duke
- Department of Internal Medicine, The University of Texas, McGovern School of Medicine, Houston, Texas
| | - Michael Swaby
- Department of Pathology, The University of Texas, McGovern School of Medicine, Houston, Texas
| | - Gabriel M Aisenberg
- Department of Internal Medicine, The University of Texas, McGovern School of Medicine, Houston, Texas
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16
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Baykal C, Polat Ekinci A, Yazganoglu KD, Buyukbabani N. The clinical spectrum of xanthomatous lesions of the eyelids. Int J Dermatol 2017; 56:981-992. [PMID: 28500693 DOI: 10.1111/ijd.13637] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 03/10/2017] [Accepted: 03/21/2017] [Indexed: 12/11/2022]
Abstract
Yellowish papules, nodules, or plaques, namely "xanthomatous" lesions, may be seen on the eyelids in the course of various disorders. The prototype is "xanthelasma palpebrarum" (XP) that is localized only to the eyelids and may be associated with hyperlipidemia. On the other hand, different types of normolipemic disorders may also cause xanthomatous eyelid lesions. Among these, Langerhans cell histiocytosis, diffuse normolipemic xanthoma, and non-Langerhans cell histiocytoses (papular xanthoma, juvenile xanthogranuloma, xanthoma disseminatum, adult-onset xanthogranuloma, adult-onset asthma and periocular xanthogranuloma, necrobiotic xanthogranuloma, Erdheim-Chester disease, Rosai-Dorfman disease, and reticulohistiocytosis) can be listed. The eyelid findings of this heterogeneous group of disorders are challenging to differentiate from each other due to common clinical aspects that may even sometimes mimic XP. Nodularity, induration, ulceration, diffuse eyelid involvement, and extension from eyelids to the neighboring skin may represent the clinical features of xanthomatous lesions other than XP. It is necessary to obtain a thorough history and exclude XP and then perform detailed dermatological and systemic examination, biopsy for histopathologic confirmation, and appropriate specific imaging screens. As some of the conditions may be associated with other systemic disorders, especially malignancies, the differentiation of xanthomatous eyelid lesions has a critical importance, and clinical signs can be guiding.
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Affiliation(s)
- Can Baykal
- Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Algun Polat Ekinci
- Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Kurtulus D Yazganoglu
- Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Nesimi Buyukbabani
- Pathology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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17
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Ederle A, Kim KH, Gardner JM. Eruptive xanthogranuloma in a healthy adult male. J Cutan Pathol 2016; 44:385-387. [PMID: 28000234 DOI: 10.1111/cup.12877] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/10/2016] [Accepted: 12/15/2016] [Indexed: 11/29/2022]
Abstract
Xanthogranuloma is a benign, non-Langerhans cell histiocytosis primarily diagnosed in infants and children, although a subset occurs in adults. Multifocal eruptive presentation of xanthogranuloma is very rare with only 4 previous cases reported in the literature to our knowledge. We describe a case of eruptive xanthogranuloma in a 49-year-old man who presented with sudden onset of numerous asymptomatic, red-yellow to orange papules on the face, scalp, axilla, flank and scrotum. Histologic features were consistent with xanthogranuloma with diffuse mixed infiltrate of foamy histiocytes, Touton giant cells and lymphocytes. Other than temporarily elevated non-fasting triglycerides, lab values have been unremarkable including serum plasma electrophoresis; however, the patient will continue to be monitored for ocular and other extracutaneous involvement and hematologic malignancies.
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Affiliation(s)
- Ashley Ederle
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Kevin H Kim
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jerad M Gardner
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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18
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Singer L, Calkins SM, Horvai AE, Ryan WR, Yom SS. Xanthogranuloma in the heavily irradiated low neck in a patient with head and neck cancer. J Otolaryngol Head Neck Surg 2016; 45:20. [PMID: 27009318 PMCID: PMC4806421 DOI: 10.1186/s40463-016-0134-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 03/21/2016] [Indexed: 11/18/2022] Open
Abstract
Background Head and neck cancer is often managed with a combination of surgery, radiation therapy, and chemotherapy, and skin toxicity is not uncommon. Xanthogranuloma is a pathological finding resulting from an inflammatory reaction that has not been previously reported following head and neck radiation therapy. Case presentation A patient with squamous cell carcinoma of the oropharynx, treated with definitive chemoradiation and hyperthermia, presented at eight-month follow-up with an in-field cutaneous lesion in the low neck, initially concerning for recurrent tumor. Biopsy showed xanthogranuloma and the patient underwent complete resection with congruent surgical pathology. The patient remained free of malignancy but continued to experience wound healing difficulties at the resection site which resolved with specialized wound care and hyperbaric oxygen. Conclusions Skin toxicity is not uncommon in patients with head and neck cancer treated with radiation therapy. Awareness of unusual pathologic sequelae, such as xanthogranuloma, is needed to provide patient counseling while continuing appropriate surveillance for recurrent malignancy.
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Affiliation(s)
- Lisa Singer
- Department of Radiation Oncology, University of California, San Francisco, 1600 Divisadero St, Suite H-1031, San Francisco, CA, 94143 - 1708, USA
| | - Sarah M Calkins
- Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
| | - Andrew E Horvai
- Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
| | - William R Ryan
- Department of Otolaryngology, University of California, San Francisco, 1600 Divisadero St, Suite H-1031, San Francisco, CA, 94143 - 1708, USA
| | - Sue S Yom
- Department of Radiation Oncology, University of California, San Francisco, 1600 Divisadero St, Suite H-1031, San Francisco, CA, 94143 - 1708, USA. .,Department of Otolaryngology, University of California, San Francisco, 1600 Divisadero St, Suite H-1031, San Francisco, CA, 94143 - 1708, USA.
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19
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Vadeboncoeur S, Provost N. Multiple Xanthogranulomas in an Adult: Known Entity, New Association. J Cutan Med Surg 2016; 20:474-7. [PMID: 27006313 DOI: 10.1177/1203475416640795] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Multiple xanthogranulomas (XGs) in adults are rare, although an increasing number of case reports are being published. The most frequent association is hematologic malignancies, but the majority of cases remain idiopathic, with occasional spontaneous resolution. OBJECTIVE The aims of this report are to describe a case of eruptive XG in a woman with a solid neoplasia who was receiving imatinib and to review the literature. METHODS AND RESULTS This 33-year-old woman had a gastrointestinal stromal tumor. After undergoing surgical removal and being on imatinib for 1 year, the patient developed multiple slightly erythematous papules with an orange hue on the axillary region, trunk, abdomen, and thighs. A biopsy confirmed the diagnosis of XG. CONCLUSION This is to the investigators' knowledge the first case of eruptive XG in the setting of a solid neoplasia. The possibility of drug-induced XG lesions due to imatinib cannot be excluded. This presentation could be added to the list of associations of adult XG.
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Affiliation(s)
| | - Nathalie Provost
- Division of Dermatology, Université de Montréal, Montreal, QC, Canada
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20
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Blattner CM, Gilliam AC, Murase JE. Thin yellow papules and plaques on the eyelids, cheeks, and neck. Int J Dermatol 2015; 54:1129-31. [PMID: 26148243 DOI: 10.1111/ijd.12818] [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: 03/08/2014] [Revised: 07/13/2014] [Accepted: 07/22/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Collin M Blattner
- Department of Dermatology, Des Moines University, Des Moines, IA, USA
| | - Anita C Gilliam
- Department of Dermatology, Palo Alto Foundation Medical Group, Palo Alto, Mountain View, CA, USA
| | - Jenny E Murase
- Department of Dermatology, Palo Alto Foundation Medical Group, Palo Alto, Mountain View, CA, USA.,Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
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21
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Adult Xanthogranuloma, Reticulohistiocytosis, and Rosai-Dorfman Disease. Dermatol Clin 2015; 33:465-72; discussion 473. [DOI: 10.1016/j.det.2015.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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22
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Stinco G, Patriarca M, Di Loreto C, Patrone P. A histiocytic disorder that does not easily fit into the classification of the juvenile xanthogranuloma family. Int J Dermatol 2015; 52:849-55. [PMID: 23789603 DOI: 10.1111/j.1365-4632.2011.05358.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Giuseppe Stinco
- Department of Experimental Medical and Clinical Sciences, DISM, Institute of Dermatology, University of Udine, Udine, Italy.
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23
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Orbital Xanthogranuloma in an Adult Patient With Xanthelasma Palpebrarum and Hypercholesterolemia. Ophthalmic Plast Reconstr Surg 2014; 30:e6-8. [DOI: 10.1097/iop.0b013e3182873d13] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Shon W, Peters MS, Reed KB, Ketterling RP, Dogan A, Gibson LE. Atypical generalized eruptive histiocytosis clonally related to chronic myelomonocytic leukemia with loss of Y chromosome. J Cutan Pathol 2013; 40:725-9. [DOI: 10.1111/cup.12168] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 04/23/2012] [Accepted: 05/28/2012] [Indexed: 12/31/2022]
Affiliation(s)
| | | | - Kurtis B. Reed
- Department of Dermatology; Mayo Clinic; Rochester; MN; USA
| | | | - Ahmet Dogan
- Laboratory Medicine and Pathology; Mayo Clinic; Rochester; MN; USA
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25
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26
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Disseminated Juvenile Xanthogranuloma Associated With Follicular Lymphoma in an Adult: Successful Treatment With Chemotherapy and Rituximab. A Review of the Literature. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.adengl.2012.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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27
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Narváez-Moreno B, Pulpillo-Ruiz Á, De Zulueta-Dorado T, Conejo-Mir J. Disseminated juvenile xanthogranuloma associated with follicular lymphoma in an adult: successful treatment with chemotherapy and rituximab. A review of the literature. ACTAS DERMO-SIFILIOGRAFICAS 2012; 104:242-6. [PMID: 22681714 DOI: 10.1016/j.ad.2012.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Revised: 02/01/2012] [Accepted: 02/10/2012] [Indexed: 11/25/2022] Open
Abstract
Juvenile xanthogranuloma is a non-Langerhans cell histiocytosis that typically affects children, but several cases have been reported in adults, some in connection with hematologic malignancies. We present the case of a 61-year-old woman with multiple xanthogranulomas who developed a follicular lymphoma after 4 years of follow-up. After 6 months of treatment with chemotherapy and rituximab, the cutaneous lesions disappeared and the patient achieved remission from lymphoma. We highlight this case because xanthogranuloma is a rare disorder that is difficult to diagnose in adults and also because this is the first report of an association between xanthogranuloma and follicular lymphoma. Excellent response was achieved with chemotherapy and rituximab. Finally, given the possible association between xanthogranulomas and hematologic diseases, these lesions may be a cutaneous manifestation of an occult malignancy.
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Affiliation(s)
- B Narváez-Moreno
- Servicio de Gestión Clínica Dermatología, Hospitales Universitarios Virgen del Rocío, Sevilla, Spain.
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28
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Abstract
The triple association between juvenile xanthogranuloma (JXG), juvenile myelomonocytic leukemia and neurofibromatosis was described in literature in about 20 cases. In this paper, the case of an 11-month-old infant boy with a disseminated JXG with unusual cytogenetic representation in the bone marrow was reported. Neurofibromatosis and juvenile myelomonocytic leukemia were excluded, just the same as other leukemias. Bone marrow and peripheral blood cytogenetic analysis revealed a karyotype with many rearrangements 46,XY,-6,der(12)t(6;12)(p21;p13),del(7)(p13p22),+9 once described in the literature as a B-acute lymphoblastic leukemia case. On the contrary, in our patient immunologic testing demonstrated a high activity of T lymphocytes, however, inflammation was excluded. To the best of our knowledge this is the first described case of systemic JXG with determined karyotype representing unusual chromosomal aberrations.
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29
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Perez-Becker R, Szczepanowski M, Leuschner I, Janka G, Gokel M, Imschweiler T, Völpel S, Niehues T, Klapper W. An aggressive systemic juvenile xanthogranuloma clonally related to a preceding T-cell acute lymphoblastic leukemia. Pediatr Blood Cancer 2011; 56:859-62. [PMID: 20848640 DOI: 10.1002/pbc.22756] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 06/28/2010] [Indexed: 11/12/2022]
Abstract
Juvenile xanthogranuloma (JXG) is a disorder of disputed origin thought to be related to the dermal/interstitial macrophage. A 5-year-old female presented with an aggressive systemic JXG that developed 5 months after the diagnosis of T-cell acute lymphoblastic leukemia (T-ALL). Examination of the T-cell receptor gamma (TCR-γ) rearrangement in T-ALL blasts, JXG infiltrated lymph node biopsies and micro-dissected JXG histiocytes revealed an identical bi-allelic TCR-γ rearrangement in all samples, thus providing evidence for a clonal relationship between T-ALL and JXG in this case.
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Affiliation(s)
- Ruy Perez-Becker
- HELIOS Klinikum Krefeld, Zentrum für Kinder- und Jugendmedizin, Lutherplatz 40, 47805 Krefeld, Germany
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30
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Castro ECC, Blazquez C, Boyd J, Correa H, de Chadarevian JP, Felgar RE, Graf N, Levy N, Lowe EJ, Manning JT, Proytcheva MA, Senger C, Shayan K, Sterba J, Werner A, Surti U, Jaffe R. Clinicopathologic features of histiocytic lesions following ALL, with a review of the literature. Pediatr Dev Pathol 2010; 13:225-37. [PMID: 19642834 DOI: 10.2350/09-03-0622-oa.1] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We describe the clinicopathologic features of 15 patients who had histiocytic lesions that followed acute lymphoblastic leukemia (ALL). Twenty-one separate histiocytic lesions were evaluated that covered a wide spectrum, some conforming to the usual categories of juvenile xanthogranulomas (5), Langerhans' cell histiocytosis (1), Langerhans' cell sarcoma (4), Rosai-Dorfman disease (1), and histiocytic sarcoma (4). Most were atypical for the category by histology, phenotype, or abnormally high turnover rate. Seven low-grade lesions defied easy categorization and were characterized only as "atypical histiocytic lesion" following ALL. For those evaluated, the molecular signature of the prior leukemia was present in the histiocytic lesion. In 3 of 15 patients, the leukemia and histiocytic lesion shared immunoglobulin H or monoclonal TCR gene rearrangements and, in 4 of 15 patients, clonal identity was documented by fluorescence in situ hybridization. Four patients died of progressive disease, 3 of whom had histiocytic sarcoma and 1 who had an atypical lesion. One patient died of recurrent ALL. The other 10 patients are alive, 7 after recurrences and treatment with surgery and/or chemotherapy. The post-ALL lesions are more aggressive than their native counterparts, but despite the demonstration of the presence of the leukemia signature in 7 of 15 patients, the prognosis is generally favorable, except for patients with histiocytic sarcoma. It remains unclear whether the histiocytic lesions arise as a line from the original ALL or whether transdifferentiation is involved.
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Affiliation(s)
- Eumenia C C Castro
- Department of Pathology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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31
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Cohen PR, Prieto VG. Radiation port xanthogranuloma: solitary xanthogranuloma occurring within the irradiated skin of a breast cancer patient-report and review of cutaneous neoplasms developing at the site of radiotherapy. J Cutan Pathol 2010; 37:891-4. [DOI: 10.1111/j.1600-0560.2010.01524.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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