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Kemps PG, Kester L, Scheijde-Vermeulen MA, van Noesel CJM, Verdijk RM, Diepstra A, van Marion AMW, Dors N, van den Bos C, Bruggink AH, Hogendoorn PCW, van Halteren AGS. Demographics and additional haematologic cancers of patients with histiocytic/dendritic cell neoplasms. Histopathology 2024; 84:837-846. [PMID: 38213281 DOI: 10.1111/his.15127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/28/2023] [Accepted: 12/13/2023] [Indexed: 01/13/2024]
Abstract
AIMS The discovery of somatic genetic alterations established many histiocytic disorders as haematologic neoplasms. We aimed to investigate the demographic characteristics and additional haematologic cancers of patients diagnosed with histiocytic disorders in The Netherlands. METHODS AND RESULTS We retrieved data on histiocytosis patients from the Dutch Nationwide Pathology Databank (Palga). During 1993 to 2022, more than 4000 patients with a pathologist-assigned diagnosis of a histiocytic disorder were registered in Palga. Xanthogranulomas were the most common subtype, challenging the prevailing assumption that Langerhans cell histiocytosis (LCH) is the most common histiocytic disorder. LCH and juvenile xanthogranuloma (JXG) had a peak incidence in the first years of life; males were overrepresented among all histiocytosis subgroups. 118 patients had a histiocytic disorder and an additional haematologic malignancy, including 107 (91%) adults at the time of histiocytosis diagnosis. In 16/118 patients, both entities had been analysed for the same genetic alteration(s). In 11 of these 16 patients, identical genetic alterations had been detected in both haematologic neoplasms. This included two patients with PAX5 p.P80R mutated B cell acute lymphoblastic leukaemia and secondary histiocytic sarcoma, further supporting that PAX5 alterations may predispose (precursor) B cells to differentiate into the myeloid lineage. All 4/11 patients with myeloid neoplasms as their additional haematologic malignancy had shared N/KRAS mutations. CONCLUSIONS This population-based study highlights the frequency of xanthogranulomas. Furthermore, our data add to the growing evidence supporting clonal relationships between histiocytic/dendritic cell neoplasms and additional myeloid or lymphoid malignancies. Particularly adult histiocytosis patients should be carefully evaluated for the development of these associated haematologic cancers.
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Affiliation(s)
- Paul G Kemps
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Lennart Kester
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - Carel J M van Noesel
- Department of Pathology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Robert M Verdijk
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Pathology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Arjan Diepstra
- Department of Pathology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Natasja Dors
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Cor van den Bos
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | | | - Astrid G S van Halteren
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Internal Medicine, Section Clinical Immunology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
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Cong CV, Ly TT, Duc NM. Multisystem Langerhans cell histiocytosis: Literature review and case report. Radiol Case Rep 2022; 17:1407-1412. [PMID: 35251425 PMCID: PMC8891995 DOI: 10.1016/j.radcr.2022.02.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/03/2022] [Accepted: 02/05/2022] [Indexed: 11/16/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) refers to a group of diseases of unknown etiology, typically discovered in childhood, characterized by the accumulation of Langerhans cells (white blood cells with large cell nuclei that may contain cytoplasmic histiocytosis X bodies) involving one or more organ systems, including bones, lungs, pituitary gland, skin, lymph nodes, and liver. This disease is also known as histiocytosis X or eosinophilic granuloma. Pulmonary LCH is common (identified in 40% of LCH patients) and may be isolated to the lung or involve other organs. Although LCH is characterized by clonal cell proliferation, adult LCH is considered likely to represent the manifestation of an aberrant immune response to an unspecified antigenic stimulus rather than a manifestation of tumor proliferation. We report a very complicated clinical case of LCH, with multiple organ damage that received a variety of different diagnoses. An LCH diagnosis was confirmed based on postoperative spinal cord pathology results and immunohistochemistry examinations. This case report highlights the clinical, laboratory, and imaging signs observed in this case that should be noted to help doctors more quickly recognize, diagnose, and treat similar cases.
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Affiliation(s)
- Cung-Van Cong
- Department of Radiology, National Lung Hospital, Ha Noi, Vietnam
| | - Tran-Thi Ly
- Center of Training and Direction of Healthcare Activities, National Lung Hospital, Ha Noi, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh, Vietnam
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Le Louet S, Barkaoui MA, Miron J, Galambrun C, Aladjidi N, Chastagner P, Kebaili K, Armari-Alla C, Lambilliotte A, Lejeune J, Moshous D, Della Valle V, Sileo C, Ducou Le Pointe H, Chateil JF, Renolleau S, Piloquet JE, Portefaix A, Epaud R, Chiron R, Bugnet E, Lorillon G, Tazi A, Emile JF, Donadieu J, Héritier S. Childhood Langerhans cell histiocytosis with severe lung involvement: a nationwide cohort study. Orphanet J Rare Dis 2020; 15:241. [PMID: 32907615 PMCID: PMC7487928 DOI: 10.1186/s13023-020-01495-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/05/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Lung involvement in childhood Langerhans cell histiocytosis (LCH) is infrequent and rarely life threatening, but occasionally, severe presentations are observed. METHODS Among 1482 children (< 15 years) registered in the French LCH registry (1994-2018), 111 (7.4%) had lung involvement. This retrospective study included data for 17 (1.1%) patients that required one or more intensive care unit (ICU) admissions for respiratory failure. RESULTS The median age was 1.3 years at the first ICU hospitalization. Of the 17 patients, 14 presented with lung involvement at the LCH diagnosis, and 7 patients (41%) had concomitant involvement of risk-organ (hematologic, spleen, or liver). Thirty-five ICU hospitalizations were analysed. Among these, 22 (63%) were secondary to a pneumothorax, 5 (14%) were associated with important cystic lesions without pneumothorax, and 8 (23%) included a diffuse micronodular lung infiltration in the context of multisystem disease. First-line vinblastine-corticosteroid combination therapy was administered to 16 patients; 12 patients required a second-line therapy (cladribine: n = 7; etoposide-aracytine: n = 3; targeted therapy n = 2). A total of 6 children (35%) died (repeated pneumothorax: n = 3; diffuse micronodular lung infiltration in the context of multisystem disease: n = 2; following lung transplantation: n = 1). For survivors, the median follow-up after ICU was 11.2 years. Among these, 9 patients remain asymptomatic despite abnormal chest imaging. CONCLUSIONS Severe lung involvement is unusual in childhood LCH, but it is associated with high mortality. Treatment guidelines should be improved for this group of patients: viral infection prophylaxis and early administration of a new LCH therapy, such as targeted therapy.
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Affiliation(s)
- Solenne Le Louet
- French Reference Center for Langerhans Cell Histiocytosis, Trousseau Hospital, 26 avenue du Dr Netter, 75012, Paris, France.
| | - Mohamed-Aziz Barkaoui
- French Reference Center for Langerhans Cell Histiocytosis, Trousseau Hospital, 26 avenue du Dr Netter, 75012, Paris, France
| | - Jean Miron
- French Reference Center for Langerhans Cell Histiocytosis, Trousseau Hospital, 26 avenue du Dr Netter, 75012, Paris, France
| | - Claire Galambrun
- Department of Pediatric Hematology and Oncology, Hôpital de la Timone, Marseille, France
| | - Nathalie Aladjidi
- Department of Pediatric Hematology and Oncology, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France
| | - Pascal Chastagner
- Department of Pediatric Hematology and Oncology, Brabois-Enfants Hospital, Centre Hospitalo-Universitaire de Nancy, Vandœuvre-lès-Nancy, France
| | - Kamila Kebaili
- Department of Paediatric Oncology, Institut d'Hémato-Oncologie Pediatrique, Lyon, France
| | - Corinne Armari-Alla
- Department of Pediatric Hematology and Oncology, Centre Hospitalo-Universitaire de Grenoble, La Tronche, France
| | - Anne Lambilliotte
- Department of Pediatric Hematology and Oncology, Centre Hospitalo-Universitaire de Lille, Lille, France
| | - Julien Lejeune
- Department of Pediatric Hematology and Oncology, Centre Hospitalo-Universitaire de Tours, Tours, France
| | - Despina Moshous
- Department of Pediatric Immunology, Hematology and Rheumatology, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Institut Imagine, Sorbonne University, Paris, France
| | - Valeria Della Valle
- Department of Radiology, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Chiara Sileo
- Department of Radiology, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hubert Ducou Le Pointe
- Department of Radiology, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-François Chateil
- Department of Radiology, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France
| | - Sylvain Renolleau
- Intensive care unit, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Eudes Piloquet
- Intensive care unit, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Ralph Epaud
- Service de Pédiatrie générale, CHIC, Créteil, France
| | - Raphaël Chiron
- Service de Pneumologie, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Emmanuelle Bugnet
- Service de Pneumologie Centre de référence des histiocytoses Hôpital Saint Louis, Paris, France
| | - Gwenaël Lorillon
- Service de Pneumologie Centre de référence des histiocytoses Hôpital Saint Louis, Paris, France
| | - Abdelatif Tazi
- Service de Pneumologie Centre de référence des histiocytoses Hôpital Saint Louis, Paris, France
- Paris University, INSERM U976, Paris, France
| | | | - Jean Donadieu
- French Reference Center for Langerhans Cell Histiocytosis, Trousseau Hospital, 26 avenue du Dr Netter, 75012, Paris, France
- Départment of Pediatric Hematology and Oncology, Sorbonne University, Paris, France
| | - Sébastien Héritier
- French Reference Center for Langerhans Cell Histiocytosis, Trousseau Hospital, 26 avenue du Dr Netter, 75012, Paris, France
- EA4340, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
- Départment of Pediatric Hematology and Oncology, Sorbonne University, Paris, France
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