1
|
Goyal G, Parikh R, Richman J, Abeykoon JP, Morlote D, Go RS, Bhatia S. Spectrum of second primary malignancies and cause-specific mortality in pediatric and adult langerhans cell histiocytosis. Leuk Res 2023; 126:107032. [PMID: 36758375 DOI: 10.1016/j.leukres.2023.107032] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/11/2023] [Accepted: 02/01/2023] [Indexed: 02/09/2023]
Abstract
With the advent of targeted therapeutics in Langerhans cell histiocytosis (LCH), there is a growing survivor population that might be at risk for late mortality from non-LCH causes, including second primary malignancies (SPMs). We undertook a large study using the Surveillance, Epidemiology, and End Results (SEER) database to evaluate the patterns of SPMs and cause-specific mortality among individuals with LCH (2000-2016) from the US. We found an increased risk of SPMs in the cohort (standardized incidence ratio [SIR] 2.07). The pediatric group was at a high risk of developing Hodgkin lymphoma (SIR 60.93) and non-Hodgkin lymphoma (SIR 60.88). People with adult-onset LCH were found to have a high risk of developing miscellaneous malignant cancers (SIR 11.43), which primarily included myelodysplastic syndrome. Adults were also at a high risk of developing carcinoma in-situ of vulva at 2-11 months [SIR 62.72] and B-ALL at 60-119 months [SIR 66.29] after LCH diagnosis. Additionally, 5% and 1% of the patients developed prior or concomitant malignancies with LCH, respectively. The 5 yr overall survival (OS) was 96.6% for pediatric and 88.5% for adult LCH cohorts. Most common cause of death was infections in pediatric and SPMs in adult LCH. Our study highlights that despite advances in treatments, people with LCH have an increased mortality risk from non-LCH causes when compared with the general population, including a high risk of SPMs.
Collapse
Affiliation(s)
- Gaurav Goyal
- Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Richa Parikh
- Department of Hematology/Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan, USA
| | - Joshua Richman
- Department of Surgery, University of Alabama School of Medicine, Birmingham, AL, USA
| | | | - Diana Morlote
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
2
|
St Claire K, Bunney R, Ashack KA, Bain M, Braniecki M, Tsoukas MM. Langerhans cell histiocytosis: A great imitator. Clin Dermatol 2019; 38:223-234. [PMID: 32513402 DOI: 10.1016/j.clindermatol.2019.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Langerhans cell histiocytosis (LCH) is an uncommon but serious inflammatory neoplasia that affects many organs, including the skin. Though uncommon, it should remain high on a clinician's differential diagnosis in treatment-resistant cases of conditions, such as seborrheic dermatitis, diaper dermatitis, arthropod bites, and many more. A thorough history nd physical examination for each patient can aid in the diagnosis; however, if clinically suspicious for LCH, a punch biopsy should be performed. Histologic evaluation of LCH is often enough to differentiate it from the many clinical mimickers. Characteristic findings include a histiocytic infiltrate with "coffee bean"-cleaved nuclei, rounded shape, and eosinophilic cytoplasm. Immunohistochemical stains, including CD1a, S100, and CD207 (langerin) are often needed for a definitive diagnosis. Electron microscopy also demonstrates the ultrastructural presence of Birbeck granules, but this is no longer needed due to immunohistochemical staining. Treatment is often necessary for LCH, if systemic involvement exists.
Collapse
Affiliation(s)
- Kayla St Claire
- Department of Dermatology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Ryan Bunney
- Department of Dermatology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Kurt A Ashack
- Department of Dermatology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Michelle Bain
- Department of Dermatology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Marylee Braniecki
- Department of Pathology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Maria M Tsoukas
- Department of Dermatology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA.
| |
Collapse
|
3
|
Langerhans Cell Histiocytosis Associated With Underlying Hematolymphoid Disorders in Adults: Report of 2 Cases and Review of the Literature. Am J Dermatopathol 2018; 40:588-593. [PMID: 30035752 DOI: 10.1097/dad.0000000000001072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Langerhans cell histiocytosis (LCH) is an uncommon disorder characterized by proliferation of abnormal LCs usually affecting children and adolescents. LCH in adults first presenting in the skin is rare. Although LCH and even LCH with a second malignancy may be more common in children, cutaneous LCH with a second hematologic malignancy has been more commonly identified in adults. The authors report 2 new cases of LCH in adult patients with underlying myelodysplasia and follicular lymphoma. The specimens were examined by routine microscopy and immunohistochemical stains for S100 protein and CD1a. Patients were elderly men with established diagnoses of follicular lymphoma and myelodysplasia, presented with follicular lesions and erythematous plaques involving intertriginous areas. Histologic examination revealed collections of mononuclear cells in upper dermis, which demonstrated strong positivity for S100 and CD1a, confirming their identity as LCs. BRAF analysis returned negative for detection of BRAF V600E mutation in both patients. The authors have recently encountered 2 cases of adult patients with skin-limited LCH predated by other lymphoproliferative disorders. The association between LCH and hematopoietic disorders may be explained by a common bone marrow precursor that is differentiating along different cell lines. Cutaneous LCH may be associated with underlying lymphoproliferative disorders and should be considered in the differential diagnosis of cutaneous eruptions in patients with hematopoietic disorders. Clinical follow-up evaluation of patients diagnosed with LCH for peripheral blood abnormalities and lymphadenopathy or "B symptoms" may be prudent in patients not already carrying a diagnosis of an underlying hematologic disorder.
Collapse
|
4
|
Pina-Oviedo S, Torres-Cabala CA, Miranda RN, Tetzlaff MT, Singh S, Rapini RP, Prieto VG, Aung PP. Concomitant Cutaneous Langerhans Cell Hystiocytosis and Leukemia Cutis. Am J Dermatopathol 2017; 39:388-392. [DOI: 10.1097/dad.0000000000000775] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
5
|
Maia RC, de Rezende LMM, Robaina M, Apa A, Klumb CE. Langerhans cell histiocytosis: Differences and similarities in long-term outcome of paediatric and adult patients at a single institutional centre. Hematology 2014; 20:83-92. [DOI: 10.1179/1607845414y.0000000173] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Raquel Ciuvalschi Maia
- Programa de Pesquisa em Hemato-Oncologia MolecularInstituto Nacional de Câncer (INCA), Rio de Janeiro (RJ), Brazil
- Serviço de Hematologia, Hospital do Câncer-I, INCA, RJ, Brazil
| | | | - Marcela Robaina
- Programa de Pesquisa em Hemato-Oncologia MolecularInstituto Nacional de Câncer (INCA), Rio de Janeiro (RJ), Brazil
| | - Alexandre Apa
- Serviço de Hematologia, Hospital do Câncer-I, INCA, RJ, Brazil
| | - Claudete Esteves Klumb
- Programa de Pesquisa em Hemato-Oncologia MolecularInstituto Nacional de Câncer (INCA), Rio de Janeiro (RJ), Brazil
- Serviço de Hematologia, Hospital do Câncer-I, INCA, RJ, Brazil
| |
Collapse
|
6
|
Chang NY, Wang J, Wen MC, Lee FY. Langerhans Cell Sarcoma in a Chronic Myelogenous Leukemia Patient Undergoing Imatinib Mesylate Therapy. Int J Surg Pathol 2013; 22:456-63. [DOI: 10.1177/1066896913501382] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Langerhans cell sarcoma (LCS) is a rare malignancy requiring differential diagnosis from other high-grade nonhematologic and hematologic tumors. The pathogenesis of LCS remains unknown. Notably, LCS and its benign counterpart, Langerhans cell histiocytosis (LCH), are frequently associated with other malignancies. To the best of our knowledge, we describe the first case of LCS in a chronic myelogenous leukemia (CML) patient undergoing imatinib mesylate therapy. We performed molecular cytogenetic analyses for investigating the association between LCS and CML. In our case, molecular cytogenetic analysis did not reveal BCR-ABL1 fusion and BRAF V600E mutation, suggesting that LCS may be coincident in this patient. However, recurrent BRAF V600E mutation has been found in LCH. Published reports have revealed the clonal relationship between LCH/LCS and other hematologic malignancies, especially lymphoid neoplasms. However, there are only 2 reports demonstrating the clonal relationship between LCH and myeloid neoplasms. The association of LCH/LCS with myeloid neoplasms and the role of BRAF V600E mutation in LCS are discussed.
Collapse
Affiliation(s)
- Nien-Yi Chang
- Da Chien General Hospital, Miaoli, Taiwan
- Taichung Veterans General Hospital, Tachiung, Taiwan
| | - John Wang
- Taichung Veterans General Hospital, Tachiung, Taiwan
| | - Mei-Chin Wen
- Taichung Veterans General Hospital, Tachiung, Taiwan
| | - Fang-Yi Lee
- Taichung Veterans General Hospital, Tachiung, Taiwan
| |
Collapse
|
7
|
Edelbroek JR, Vermeer MH, Jansen PM, Stoof TJ, van der Linden MMD, Horváth B, van Baarlen J, Willemze R. Langerhans cell histiocytosis first presenting in the skin in adults: frequent association with a second haematological malignancy. Br J Dermatol 2013; 167:1287-94. [PMID: 22835048 DOI: 10.1111/j.1365-2133.2012.11169.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) in adults first presenting in the skin is rare. Guidelines for staging, treatment and follow-up are lacking. OBJECTIVES To better define staging procedures, treatment results and clinical course in adult patients with LCH first presenting in the skin. METHODS Eighteen adult patients with LCH first presenting in the skin were collected from five centres collaborating in the Dutch Cutaneous Lymphoma Group. Clinical records and (skin) biopsy specimens were reviewed and follow-up data were obtained. A literature search on adult patients with LCH presenting in the skin was performed. RESULTS Staging procedures showed extracutaneous disease in three of 16 patients who were adequately staged. One patient had a histologically confirmed lytic LCH bone lesion, while two patients had a myelodysplastic syndrome. During follow-up two of 18 patients developed extracutaneous localizations of LCH. Five patients developed a second haematological malignancy, including (myelo)monocytic leukaemia (two cases), histiocytic sarcoma (one case), diffuse large B-cell lymphoma (one case) and peripheral T-cell lymphoma (one case). Review of the literature revealed six other adult patients with a second haematological malignancy preceding or following a diagnosis of LCH. CONCLUSIONS The results of the present study suggest an increased risk of a second haematological malignancy in adult patients with LCH presenting in the skin. Extensive staging at presentation and long-term follow-up are therefore warranted in such patients.
Collapse
Affiliation(s)
- J R Edelbroek
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Bohn OL, Feldman JL, Heaney ML, Teruya-Feldstein J. Acute Myeloid Leukemia With t(9;11) (p22;q23) and Synchronous Langerhans Cell Histiocytosis. Int J Surg Pathol 2013; 22:172-6. [DOI: 10.1177/1066896913487985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We present here the first report of an adult patient with simultaneous LCH and AML with t(9;11).5
Collapse
Affiliation(s)
- Olga L. Bohn
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Mark L. Heaney
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | |
Collapse
|
9
|
|
10
|
Baikaidi M, Chung SS, Tallman MS, Damon LE, Walker AR, Marcucci G, Sholi AM, Morris GJ. A 75-year-old woman with thoracic spinal cord compression and chloroma (granulocytic sarcoma). Semin Oncol 2013. [PMID: 23206848 DOI: 10.1053/j.seminoncol.2012.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
11
|
Jeong TD, Jang S, Park CJ, Chi HS, Lee JH. A case of Langerhans cell histiocytosis following acute basophilic leukemia. Ann Hematol 2012; 92:137-9. [DOI: 10.1007/s00277-012-1542-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 07/25/2012] [Indexed: 10/28/2022]
|
12
|
Song HL, Huang WY, Chen YP, Chang KC. Tumorous proliferations of plasmacytoid dendritic cells and Langerhans cells associated with acute myeloid leukaemia. Histopathology 2012; 61:974-83. [PMID: 22804228 DOI: 10.1111/j.1365-2559.2012.04282.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS Proliferation of plasmacytoid dendritic cells (PDCs) occurs in both reactive lymphoid hyperplasia and myeloproliferative disorders, especially chronic myelomonocytic leukaemia. PDCs in the former appear reactive, but in the latter are reported to be clonally related to the underlying myeloid neoplasm. Langerhans cells (LCs), another type of dendritic cell, also proliferate in both reactive dermatoses and, rarely, myeloproliferative disorders, such as acute leukaemia. METHODS AND RESULTS We report a rare case of tumorous proliferation of PDCs and LCs in the systemic lymph nodes in a 55-year-old man with acute myeloid leukaemia. A microsatellite instability assay showed identical patterns of short tandem repeats in both microdissected PDC and LC components, along with blood blasts. CONCLUSIONS We hypothesize that the combined proliferations of PDCs and LCs derive from the same haematopoietic stem cells, but that they differentiate divergently under the effect of different microenvironments.
Collapse
Affiliation(s)
- Hsiang-Lin Song
- Department of Pathology, National Cheng Kung University and Hospital, Tainan, Taiwan
| | | | | | | |
Collapse
|