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Shi X, Sun G, Li T, Xu M, Liu Y, Wang Z, Hou Y. Erdheim‑Chester disease of multisystem involvement with delayed diagnosis: A case report and literature review. Exp Ther Med 2024; 27:159. [PMID: 38476885 PMCID: PMC10928972 DOI: 10.3892/etm.2024.12447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 01/30/2024] [Indexed: 03/14/2024] Open
Abstract
Erdheim-Chester disease (ECD) is a rare tumor of histiocytic origin, characterized by foamy or lipid-laden histiocytes mixed or surrounded by fibrosis that infiltrate multiple organs. Misdiagnosis is common due to the diversity of clinical presentations. The present study reported a case of ECD with the involvements of bone, cardiac, aorta and retroperitoneum. The patient had no obvious clinical symptoms and no noteworthy foamy histiocytes or Touton giant cells were found on pathological examination, delaying the diagnosis. The patient was a young male found to have pericardial effusion on physical examination, and computed tomography (CT) revealed soft tissue infiltrates in the retroperitoneum and around the aorta. A mediastinal biopsy revealed fibrous connective tissue with small-vessel hyperplasia and acute-chronic inflammatory cell infiltration. The initial diagnosis was retroperitoneal fibrosis (RPF), and hormonal and tamoxifen treatments were administered. The patient presented with oliguria, eyelid edema and fever four years later. A repeat CT revealed an increase in the extent of tissue infiltration and pericardial effusion compared with the previous CT. Subsequent cardiac magnetic resonance imaging revealed massive thickening in the form of fibrotic tissue infiltrating the heart and surrounding thoracic and abdominal aorta. Single photon emission CT revealed multiple areas of increased bone metabolism, particularly symmetrical involvement of the long bones of both lower extremities. A biopsy of the perirenal tissue revealed fibrous tissue and a small number of lymphocytes and macrophages [typical foamy histiocytes observed via x200 magnification and hematoxylin-eosin (HE) staining, no presence of xanthogranuloma or Touton giant cells]. After a comprehensive evaluation and ruling out other diseases, the diagnosis of ECD was determined. The prognosis of this disease is poor; early diagnosis is critical and requires accurate judgment by clinicians. Biopsies of all involved sites and refinement of genetic tests to guide treatment, if possible, are both necessary.
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Affiliation(s)
- Xiaotong Shi
- School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong 261053, P.R. China
| | - Guangzhi Sun
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, Shandong 250000, P.R. China
| | - Tongguan Li
- The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, School of Clinical Medicine, Shandong First Medical University, Jinan, Shandong 250117, P.R. China
| | - Mengjiao Xu
- The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, School of Clinical Medicine, Shandong First Medical University, Jinan, Shandong 250117, P.R. China
| | - Yixuan Liu
- School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong 261053, P.R. China
| | - Zhankui Wang
- Department of Rheumatology and Autoimmunology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Medicine and Health Key Laboratory of Rheumatism, Jinan, Shandong 250000, P.R. China
| | - Yanfeng Hou
- Department of Rheumatology and Autoimmunology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Medicine and Health Key Laboratory of Rheumatism, Jinan, Shandong 250000, P.R. China
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Yuen CA, Bao S, Aung MS, Shishodia R, Kong XT. Dabrafenib and steroids for the treatment of Erdheim-Chester disease with extensive CNS involvement: a case report. Per Med 2024; 21:71-78. [PMID: 38275171 DOI: 10.2217/pme-2023-0137] [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: 11/23/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024]
Abstract
Erdheim-Chester disease (ECD) is an exceedingly rare non-Langerhans cell CD68+ CD1a- S100- histiocytic multi-organ disease. Diagnosis of ECD is often delayed due to non-specific radiographic findings and heterogeneous lesional tissue. Increasingly, the role of genomic alterations is being recognized for both diagnosis and treatment of ECD. More than half of ECD patients harbor the BRAFV600E mutation. Evaluation for this mutation be can falsely negative on immunohistochemical staining and confirmation with molecular analyses is recommended. We present a case of the 44 year-old male with BRAFV600E-positive ECD treated successfully with steroids followed by single-agent dabrafenib.
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Affiliation(s)
- Carlen A Yuen
- Department of Neuro-Oncology, University of California, Irvine, CA 92868-3201, USA
| | - Silin Bao
- Department of Internal Medicine. Community Regional Medical Center, Fresno, CA 93721, USA
| | - Mya Sandi Aung
- California Health Sciences University, College of Osteopathic Medicine, Clovis, CA 93611, USA
| | - Rhea Shishodia
- California Health Sciences University, College of Osteopathic Medicine, Clovis, CA 93611, USA
| | - Xiao-Tang Kong
- Department of Neuro-Oncology, University of California, Irvine, CA 92868-3201, USA
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3
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Banks SA, Bhatti MT, Go RS, Abeykoon JP, Acosta-Medina AA, Hazim AZ, Goyal G, Young JR, Koster MJ, Vassallo R, Ryu JH, Davidge-Pitts CJ, Ravindran A, Sartori Valinotti JC, Bennani NN, Shah MV, Rech KL, Garrity JA, Tobin WO. Ophthalmologic Involvement in Adults with Histiocytic Disorders: Clinical Presentation and Treatment Outcomes. Ophthalmology 2023; 130:77-86. [PMID: 35932838 DOI: 10.1016/j.ophtha.2022.07.031] [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: 04/07/2022] [Revised: 07/08/2022] [Accepted: 07/28/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To evaluate the clinical presentation, treatment, and outcomes in adult patients with histiocytic disorders with ocular, orbital, optic nerve, or cavernous sinus involvement. DESIGN Observational, retrospective chart review. PARTICIPANTS Adult patients (age ≥ 18 years) at Mayo Clinic from January 1, 1996, to July 1, 2021, with histiocytic disorders. Inclusion criteria were (1) histiocytic disorder by biopsy and appropriate clinical phenotype; (2) available medical records; and (3) ocular, orbital, optic nerve, or cavernous sinus involvement. METHODS Retrospective chart review. MAIN OUTCOME MEASURES Response to therapy, measured in clinical and radiographic impact. RESULTS Thirty-two patients were identified: 7 with Langerhans cell histiocytosis (LCH); 15 with Erdheim-Chester disease (ECD); 1 with mixed LCH/ECD phenotype; 8 with Rosai-Dorfman disease (RDD); and 1 with mixed RDD/ECD phenotype. Ophthalmologic involvement was part of the initial presentation in 69% of patients (22/32). Eyelid edema (13/32, 41%) and proptosis (12/32, 38%) were the most frequent presentations. Isolated orbital or cavernous sinus involvement was present in 3 of 7 patients with LCH and 1 of 8 patients with RDD. Optic nerve sheath involvement was present in 2 of 7 LCH patients, 14 of 15 ECD patients, and 1 RDD/ECD patient. Diffuse (> 75%) orbital involvement was seen in 12 of 15 ECD patients and 1 of 7 LCH patients. Ocular involvement was seen in 1 of 15 ECD patients, 6 of 8 RDD patients, and 1 of 1 mixed RDD/ECD patient. The cavernous sinuses were involved in 1 of 7 LCH patients, 5 of 15 ECD patients, and both mixed phenotype patients. Visual acuity was affected in 14 patients (14/24, 58%) with a median logarithm of the minimum angle of resolution visual acuity of 0.1 (range, -0.12 to 3). BRAF V600E mutations were found in 75% (3/4) of LCH patients and 91% (10/11) of ECD patients. Patients received a variety of treatment, and response was variable across disease types. CONCLUSIONS Orbital involvement was more commonly seen in LCH and ECD, whereas ocular involvement was more common in RDD. Visual acuity may be impacted from ocular involvement or compression of the optic nerve with diffuse orbital involvement.
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Affiliation(s)
- Samantha A Banks
- Division of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - M Tariq Bhatti
- Division of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota; Division of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Ronald S Go
- Division of Hematology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Jithma P Abeykoon
- Division of Hematology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Aldo A Acosta-Medina
- Division of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Antonious Z Hazim
- Division of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Gaurav Goyal
- Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jason R Young
- Division of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Matthew J Koster
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Robert Vassallo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Caroline J Davidge-Pitts
- Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Aishwarya Ravindran
- Division of Hematopathology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | | | - N Nora Bennani
- Division of Hematology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Mithun V Shah
- Division of Hematology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Karen L Rech
- Division of Hematopathology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - James A Garrity
- Division of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - W Oliver Tobin
- Division of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota.
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Prasad RN, Kobalka PJ, Perlow HK, Prevedello DM, Blakaj DM, Raval RR, Palmer JD. Craniospinal irradiation for respiratory failure secondary to central nervous system Erdheim-Chester disease. Radiat Oncol J 2022; 40:162-168. [PMID: 35796119 PMCID: PMC9262703 DOI: 10.3857/roj.2021.01074] [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: 12/08/2021] [Accepted: 03/17/2022] [Indexed: 12/01/2022] Open
Abstract
Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis typically featuring lower extremity osteosclerosis (96%) from Langerin-negative histiocytes with fibrosis. Central nervous system (CNS)-only disease is extremely rare, and particularly difficult to diagnose and manage. Neurologic complaints may be refractory to systemic therapy (ST), and the role of radiation therapy (RT) is undefined. We present a patient with ECD of the medulla complicated by respiratory failure and strength deficits with disseminated leptomeningeal disease (LMD) but not systemic disease, representing the first report of CNS-limited ECD with LMD. He received upfront craniospinal irradiation (CSI), representing a rare account of CSI for ESD, with marked clinical improvement resulting in extubation and improved strength. CSI facilitated excellent preservation of quality of life, and no treatment-related toxicity was observed prior to eventual, unrelated cardiopulmonary arrest. Thus, palliative CSI may augment ST by safely offering improved local control and symptomatic relief for CNS ECD.
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Affiliation(s)
- Rahul N. Prasad
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Peter J. Kobalka
- Department of Neuropathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Haley K. Perlow
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Daniel M. Prevedello
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Dukagjin M. Blakaj
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Raju R. Raval
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Joshua D. Palmer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Correspondence: Joshua D. Palmer Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W 10th Ave, Columbus, OH 43210, USA. Tel: +1-614-685-9707 E-mail:
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5
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Kanakis M, Petrou P, Lourida G, Georgalas I. Erdheim-Chester disease: a comprehensive review from the ophthalmologic perspective. Surv Ophthalmol 2021; 67:388-410. [PMID: 34081930 DOI: 10.1016/j.survophthal.2021.05.013] [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: 07/26/2020] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 01/18/2023]
Abstract
Erdheim-Chester disease (ECD) is a rare clonal histiocytic neoplasm with less than 1200 documented cases to date. The disease is life-threatening and difficult to recognize, although increasing awareness as well as the integration of clinical, imaging, pathology information , and genetic studies have led to a recent exponential increase in new reported cases. ECD affects multiple organs and systems, including skeletal, neurologic, and cardiovascular. Pulmonary, retroperitoneal, and cutaneous lesions have also been reported in various combinations. Until the discovery that more than half of ECD patients harbor the BRAF-V600E mutation or other mutations in the mitogen-activated protein kinase (MAPK) and RAS pathways, Interferon-a was the first-line treatment. Nowadays BRAF and MEK-inhibitors targeted therapies are the mainstay of treatment. Ophthalmologic involvement occurs in 25% -30% of ECD cases, usually in the form of orbital involvement presenting with exophthalmos and ophthalmoplegia. Other ophthalmologic manifestations include palpebral xanthelasmas, anterior uveitis and vitritis, optic disk edema, choroidal infiltration, recurrent serous retinal detachment, retinal drusen-like deposits and retinal pigment epithelial changes. ECD patients can also present with ocular symptoms as a result of adverse effects of the treatment regimens. In some cases with smoldering or protean symptoms, the emergence of eye manifestations triggered the diagnosis. Ophthalmologists have to be aware of the disease, recognize the constellation of ECD symptoms, and contribute to the diagnosis, treatment, and follow-up of ECD patients.
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Affiliation(s)
| | - Petros Petrou
- G. Genimatas General Hospital, National and Kapodistrian University of Athens, 1st University Eye Clinic, Athens, Greece
| | - Giota Lourida
- Department of Internal Medicine and Infectious Disease, Sotiria Hospital, Athens, Greece
| | - Ilias Georgalas
- G. Genimatas General Hospital, National and Kapodistrian University of Athens, 1st University Eye Clinic, Athens, Greece.
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6
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Erdheim-Chester disease: consensus recommendations for evaluation, diagnosis, and treatment in the molecular era. Blood 2021; 135:1929-1945. [PMID: 32187362 DOI: 10.1182/blood.2019003507] [Citation(s) in RCA: 170] [Impact Index Per Article: 56.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/04/2020] [Indexed: 01/18/2023] Open
Abstract
Erdheim-Chester disease (ECD) is a rare histiocytosis that was recently recognized as a neoplastic disorder owing to the discovery of recurrent activating MAPK (RAS-RAF-MEK-ERK) pathway mutations. Typical findings of ECD include central diabetes insipidus, restrictive pericarditis, perinephric fibrosis, and sclerotic bone lesions. The histopathologic diagnosis of ECD is often challenging due to nonspecific inflammatory and fibrotic findings on histopathologic review of tissue specimens. Additionally, the association of ECD with unusual tissue tropism and an insidious onset often results in diagnostic errors and delays. Most patients with ECD require treatment, except for a minority of patients with minimally symptomatic single-organ disease. The first ECD consensus guidelines were published in 2014 on behalf of the physicians and researchers within the Erdheim-Chester Disease Global Alliance. With the recent molecular discoveries and the approval of the first targeted therapy (vemurafenib) for BRAF-V600-mutant ECD, there is a need for updated clinical practice guidelines to optimize the diagnosis and treatment of this disease. This document presents consensus recommendations that resulted from the International Medical Symposia on ECD in 2017 and 2019. Herein, we include the guidelines for the clinical, laboratory, histologic, and radiographic evaluation of ECD patients along with treatment recommendations based on our clinical experience and review of literature in the molecular era.
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7
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Malhotra A, Seifert K, Fisayo AA. Rare Case of Bilateral Orbital Masses. JAMA Ophthalmol 2019; 137:1074-1075. [DOI: 10.1001/jamaophthalmol.2019.1053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| | - Kimberly Seifert
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| | - Adeniyi A. Fisayo
- Departments of Neurology and Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
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A Rare Case of Erdheim-Chester Disease (Non-Langerhans Cell Histiocytosis) with Concurrent Langerhans Cell Histiocytosis: A Diagnostic and Therapeutic Challenge. Case Rep Hematol 2018; 2018:7865325. [PMID: 29888013 PMCID: PMC5977054 DOI: 10.1155/2018/7865325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 01/08/2018] [Accepted: 01/28/2018] [Indexed: 01/09/2023] Open
Abstract
Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocyte disorder most commonly characterized by multifocal osteosclerotic lesions of the long bones demonstrating sheets of foamy histiocyte infiltrates on biopsy with or without histiocytic infiltration of extraskeletal tissues. ECD can be difficult to diagnose since it is a very rare disease that can affect many organ systems. Diagnosis is based on the pathologic evaluation of involved tissue interpreted within the clinical context. Patients who have the BRAF V600E mutation are treated first line with vemurafenib. For those without the mutation with symptomatic ECD, conventional or PEGylated interferon alpha is recommended. For patients who are either intolerant or nonresponsive to interferon alpha, systemic chemotherapy with or without corticosteroids can be used. We present a rare case of Erdheim-Chester disease with concurrent Langerhans cell histiocytosis which occurs in only one fifth of the cases and often presents as a diagnostic and therapeutic challenge.
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Franco P, Filippi AR, Ciammella P, Botticella A, Namysl-Kaletka A, Ricardi U. Polyostotic Sclerosing Histiocytosis (Erdheim-Chester Disease) Treated with Combined Vertebroplasty and Radiation Therapy. TUMORI JOURNAL 2018; 96:633-6. [DOI: 10.1177/030089161009600421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Erdheim-Chester disease is an uncommon form of non-Langherans-cell histiocytosis, with a heterogeneous range of systemic manifestations and a pattern of typical clinico-pathological and radiological features. Symmetric sclerotic radiological alterations of the long bones are peculiar, such as the infiltration of several organs by lipid-laden histiocytes. Radiation therapy has been anecdotally employed in a palliative setting in order to relieve symptoms mainly due to cerebral, retro-orbital and skeletal localizations. Exclusive osseous involvement is rarely described in the medical literature. Moreover, the role, timing and schedule of radiotherapy in this subset of patients remain controversial. We herein report on a case of osseous-only Erdheim-Chester disease treated with a combined modality approach including transoral vertebroplasty and external beam radiation therapy, which gave an analgesic effect that lasted 1 year, with no treatment-related side effects.
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Affiliation(s)
- Pierfrancesco Franco
- Department of Medical and Surgical Sciences, Radiation Oncology Unit, University of Torino, Ospedale S. Giovanni Battista, Turin, Italy
| | - Andrea Riccardo Filippi
- Department of Medical and Surgical Sciences, Radiation Oncology Unit, University of Torino, Ospedale S. Giovanni Battista, Turin, Italy
| | - Patrizia Ciammella
- Department of Medical and Surgical Sciences, Radiation Oncology Unit, University of Torino, Ospedale S. Giovanni Battista, Turin, Italy
| | - Angela Botticella
- Department of Medical and Surgical Sciences, Radiation Oncology Unit, University of Torino, Ospedale S. Giovanni Battista, Turin, Italy
| | - Agnieszka Namysl-Kaletka
- Department of Medical and Surgical Sciences, Radiation Oncology Unit, University of Torino, Ospedale S. Giovanni Battista, Turin, Italy
- Department of Radiotherapy, Center of Oncology, Maria-Sklodowska-Curie Memorial Institute, Gliwice, Poland
| | - Umberto Ricardi
- Department of Medical and Surgical Sciences, Radiation Oncology Unit, University of Torino, Ospedale S. Giovanni Battista, Turin, Italy
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Wagner KM, Mandel JJ, Goodman JC, Gopinath S, Patel AJ. Intracranial Erdheim-Chester Disease Mimicking Parafalcine Meningioma: Report of Two Cases and Review of the Literature. World Neurosurg 2017; 110:365-370. [PMID: 29191545 DOI: 10.1016/j.wneu.2017.11.074] [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] [Received: 07/29/2017] [Revised: 11/14/2017] [Accepted: 11/16/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Erdheim-Chester disease (ECD) is a rare, non-Langerhans cell histiocytosis that typically occurs in middle-aged patients. It is usually characterized by multifocal osteosclerotic lesions of the long-bones, however many cases have extraskeletal involvement. Central nervous system (CNS) involvement is common, but isolated CNS involvement at presentation has rarely been reported. CASE DESCRIPTION Here we report two cases of dural-based ECD mimicking meningioma on imaging with no other identified sites of disease. CONCLUSION ECD is a rare disease, with isolated CNS involvement reported only a few times in the literature. The significance of this presentation requires additional study and long-term follow up.
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Affiliation(s)
- Kathryn M Wagner
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Jacob J Mandel
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - J Clay Goodman
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Shankar Gopinath
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
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Calandra CR, Bustos A, Falcon F, Arakaki N. Erdheim-Chester disease: atypical presentation of a rare disease. BMJ Case Rep 2017; 2017:bcr-2017-220827. [PMID: 29025773 DOI: 10.1136/bcr-2017-220827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
We report the clinical case of an adult patient referred to our hospital because of trismus due to a tumour in the right infratemporal and pterygomaxillary fossa. He referred hyporexia, weight loss and right trigeminal neuralgia. On physical examination, he had trismus and diplopia. On neuroimaging, the tumour invaded the central nervous system affecting the right temporal lobe and orbit, and the sellar region. Tumour biopsy revealed foamy histiocytes and isolated giant multinuclear cells immunoreactive to CD68 and negative to CD1a and S100. A diagnosis of Erdheim-Chester disease was made. Non-evidence of large bone involvement was found in neither plain radiographs nor Technetium 99 m bone scintigraphy. BRAFV600E mutation analysis was negative. Because of raised intracranial pressure, a debulking surgery of the intracranial histiocytic process was performed. The patient improved his symptoms and remains clinically stable after 12 months of treatment with pegylated interferon-α-2a 180 µg/weekly.
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Affiliation(s)
- Cristian Ricardo Calandra
- Department of Neurology, Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina.,Neurology, Hospital El Cruce de Alta Complejidad, Florencio Varela, Buenos Aires, Argentina
| | - Ariel Bustos
- Department of Neurology, Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina
| | - Florencia Falcon
- Department of Pathology, Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina
| | - Naomi Arakaki
- Department of Neuropathology, Institute for Neurological Research, FLENI, Buenos Aires, Argentina
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Merritt H, Pfeiffer ML, Richani K, Phillips ME. Erdheim-Chester disease with orbital involvement: Case report and ophthalmic literature review. Orbit 2016; 35:221-226. [PMID: 27322549 DOI: 10.1080/01676830.2016.1176211] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Erdheim-Chester disease (ECD) is a rare xanthogranulomatous disease in which orbital involvement can have devastating outcomes. Through a case report and review of the ophthalmic literature, we explore orbital findings, disease progression, and treatment options. Cases of orbital involvement in Erdheim-Chester disease were identified in the ophthalmic literature with a PubMed query and review of cited references. A total of 14 publications reporting 19 separate cases that included ophthalmic examination data were identified. Patient ages ranged from 26-77 years with a mean age of 50 years. Seventy-four percent (14/19) were men. Vision progression to no light perception was found in 32% (6/19) of the patients. Reviewed cases reported a variety of medical and surgical treatment approaches, however, only 53% reported cases (10/19) demonstrated disease improvement or stabilization. Erdheim-Chester disease with orbital involvement is a devastating disease with a poor prognosis. Awareness of this entity by the ophthalmologist is important as orbital signs and symptoms may manifest early, and orbital biopsy is often crucial to the definitive diagnosis.
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Affiliation(s)
- Helen Merritt
- a Ruiz Department of Ophthalmology and Visual Science , The University of Texas Health Science Center at Houston , Houston , Texas , USA
| | - Margaret L Pfeiffer
- a Ruiz Department of Ophthalmology and Visual Science , The University of Texas Health Science Center at Houston , Houston , Texas , USA
| | - Karina Richani
- a Ruiz Department of Ophthalmology and Visual Science , The University of Texas Health Science Center at Houston , Houston , Texas , USA
- b Robert Cizik Eye Clinic , Houston , Texas , USA
| | - Margaret E Phillips
- a Ruiz Department of Ophthalmology and Visual Science , The University of Texas Health Science Center at Houston , Houston , Texas , USA
- b Robert Cizik Eye Clinic , Houston , Texas , USA
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Chicas Sett R, Pons Llanas O, Celada Álvarez F, Pacheco Usmayo A, Roldán S, Collado E, Cuervo Madrid E, Solves Aleman A, Pérez Calatayud J, Tormo Micó A. A case report of recurrent adult-onset xanthogranuloma: is the radiotherapy a treatment option? Int Cancer Conf J 2015; 5:77-81. [PMID: 31149431 DOI: 10.1007/s13691-015-0232-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/25/2015] [Indexed: 11/24/2022] Open
Abstract
Adult-onset xanthogranuloma (AOX) is one of the four uncommon syndromes called adult xanthogranulomatous disease (AXD), which is diagnosed by characteristic histopathology. AXD is rare and heterogeneous group of entities that can affect multiple organ systems. Orbital involvement is included in the xanthogranulomatous disease although less prevalent. This work focuses on the use of external beam radiotherapy in the control of local symptoms of periocular manifestation of AOX as case report and literature review.
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Affiliation(s)
- R Chicas Sett
- 1Department of Radiation Oncology, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell No 106, CP 46013 Valencia, Spain
| | - O Pons Llanas
- 1Department of Radiation Oncology, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell No 106, CP 46013 Valencia, Spain
| | - F Celada Álvarez
- 1Department of Radiation Oncology, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell No 106, CP 46013 Valencia, Spain
| | - A Pacheco Usmayo
- 3Department of Radiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - S Roldán
- 1Department of Radiation Oncology, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell No 106, CP 46013 Valencia, Spain
| | - E Collado
- 1Department of Radiation Oncology, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell No 106, CP 46013 Valencia, Spain
| | - E Cuervo Madrid
- 1Department of Radiation Oncology, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell No 106, CP 46013 Valencia, Spain
| | - A Solves Aleman
- 2Department of Ophthalmology, Hospital Universitario Dr. Peset, Valencia, Spain
| | - J Pérez Calatayud
- 1Department of Radiation Oncology, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell No 106, CP 46013 Valencia, Spain
| | - A Tormo Micó
- 1Department of Radiation Oncology, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell No 106, CP 46013 Valencia, Spain
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Alimohamadi M, Hartmann C, Paterno V, Samii M. Erdheim-Chester disease mimicking an intracranial trigeminal schwannoma: case report. J Neurosurg Pediatr 2015; 15:493-8. [PMID: 25723722 DOI: 10.3171/2014.10.peds14441] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Erdheim-Chester disease (ECD) is non-Langerhans histiocytosis that can affect multiple organ systems. It usually affects middle-aged patients, and only a few reports of ECD in children appear in the literature. Central nervous system involvement is a common feature that usually occurs as infiltration of the hypothalamus-pituitary axis, cerebellum, and/or brainstem. Meningeal involvement occurs less commonly. In this article, the authors discuss a rare pediatric case of ECD presenting as an infiltrative mass of the trigeminal nerve and resembling the clinical and imaging features of a trigeminal schwannoma.
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Blomstrand L, Thor A, Hagberg H. Erdheim-Chester disease presenting as periodontal disease: Experience of treatment with cladribine, interferon-a, local radiotherapy and anakinra. Acta Oncol 2015; 55:248-50. [PMID: 25902723 DOI: 10.3109/0284186x.2015.1023463] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Lena Blomstrand
- a Department of Surgical Sciences , Oral and Maxillofacial Surgery, Uppsala University , Uppsala , Sweden
| | - Andreas Thor
- b Department of Surgical Sciences , Oral and Maxillofacial Surgery, Uppsala University , Uppsala , Sweden
| | - Hans Hagberg
- c Department of Radiology , Oncology and Radiation Science, Oncology, Uppsala University , Uppsala , Sweden
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Nazar R, Ortega G, Miranda G, Naser A. Enfermedad de Erdheim-Chester de localización nasosinusal. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015; 66:e4-6. [DOI: 10.1016/j.otorri.2013.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 11/03/2013] [Accepted: 11/08/2013] [Indexed: 10/25/2022]
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Erdheim–Chester Disease in a Sinonasal Location. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015. [DOI: 10.1016/j.otoeng.2013.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Clinical considerations and key issues in the management of patients with Erdheim-Chester Disease: a seven case series. BMC Med 2014; 12:221. [PMID: 25434739 PMCID: PMC4248471 DOI: 10.1186/s12916-014-0221-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 11/03/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Erdheim-Chester Disease (ECD), a non Langerhans' cell histiocytosis of orphan nature and propensity for multi-systemic presentations, comprises an intricate medical challenge in terms of diagnosis, treatment and complication management. OBJECTIVES The objectives are to report the clinical, radiological and pathological characteristics, as well as cardinal therapeutic approaches to ECD patients and to provide clinical analyses of the medical chronicles of these complex patients. METHODS Patients with biopsy proven ECD were audited by a multi-disciplinary team of specialists who formed a coherent timeline of all the substantial clinical events in the evolution of their patients' illness. RESULTS Seven patients (five men, two women) were recruited to the study. The median age at presentation was 53 years (range: 39 to 62 years). The median follow-up time was 36 months (range: 1 to 72 months). Notable ECD involvement sites included the skeleton (seven), pituitary gland (seven), retroperitoneum (five), central nervous system (four), skin (four), lungs and pleura (four), orbits (three), heart and great vessels (three) and retinae (one). Prominent signs and symptoms were fever (seven), polyuria and polydipsia (six), ataxia and dysarthria (four), bone pain (four), exophthalmos (three), renovascular hypertension (one) and dyspnea (one). The V600E BRAF mutation was verified in three of six patients tested. Interferon-α treatment was beneficial in three of six patients treated. Vemurafenib yielded dramatic neurological improvement in a BRAF mutated patient. Infliximab facilitated pericardial effusion volume reduction. Cladribine improved cerebral blood flow originally compromised by perivenous lesions. CONCLUSIONS ECD is a complex, multi-systemic, clonal entity coalescing both neoplastic and inflammatory elements and strongly dependent on impaired RAS/RAF/MEK/ERK signaling.
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Midtvedt Ø, Gran JT, Solheim H, Kirkhus E, Spetalen S. [A man in his forties with swelling in both orbits]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2014; 134:1472-6. [PMID: 25138406 DOI: 10.4045/tidsskr.13.0115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
UNLABELLED Erdheim-Chester disease. A multi-disiplinary challenge. The histiocytoses are a diverse, but rare group of disorders with symptoms affecting many organs, varying from self-limiting, localised lesions to disseminated multi-organ disease. The diagnostic challenges are illustrated and discussed in the following case. CASE REPORT A man in his forties was admitted to hospital due to pain in his right eye and visual disturbances. MRI imaging detected a mass in his right orbit and a minor mass in his left orbit. The histological results of the mass in his right orbit revealed an inflammatory process with lymphocytes and macrophages and no sign of vasculitis, infection or malignancy. The diagnosis pseudotumor orbita was made and treatment with corticosteroids was initiated. He did not respond to corticosteroids or radiotherapy and increasing symptoms necessitated rehospitalisation. Further tests disclosed a multisystem disease which affected the aorta, skeleton, lung, heart and kidney. The biopsy was reconsidered and the disease was classified as a histiocytosis with CD68 positive and CD1a negative cells. The diagnosis Erdheim-Chester was given, about 14 months after the initial hospitalisation. Treatment with interferon α was started.
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Affiliation(s)
- Øyvind Midtvedt
- Revmatologisk avdeling Oslo universitetssykehus, Rikshospitalet
| | - Jan Tore Gran
- Revmatologisk avdeling Oslo universitetssykehus, Rikshospitalet
| | - Hanne Solheim
- Avdeling for radiologi og nukleærmedisin Oslo universitetssykehus, Rikshospitalet
| | - Eva Kirkhus
- Avdeling for radiologi og nukleærmedisin Oslo universitetssykehus, Rikshospitalet
| | - Signe Spetalen
- Avdeling for patologi Oslo universitetssykehus, Radiumhospitalet
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Mirimanoff RO, Ozsahin M, Thariat J, Ozyar E, Schick U, Pehlivan B, Krengli M, Pellanda AF, Vees H, Cai L, Scandolaro L, Belkacemi Y, Villà S, Igdem S, Lutsyk M, Miller RC. History of the rare cancer network and past research. Rare Tumors 2014; 6:5462. [PMID: 25276325 PMCID: PMC4178278 DOI: 10.4081/rt.2014.5462] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 04/27/2014] [Indexed: 02/03/2023] Open
Abstract
Approximately, twenty years ago, the Rare Cancer Network (RCN) was formed in Lausanne, Switzerland, to support the study of rare malignancies. The RCN has grown over the years and now includes 130 investigators from twenty-four nations on six continents. The network held its first international symposium in Nice, France, on March 21-22, 2014. The proceedings of that meeting are presented in two companion papers. This manuscript reviews the history of the growth of the RCN and contains the abstracts of fourteen oral presentations made at the meeting of prior RCN studies. From 1993 to 2014, 74 RCN studies have been initiated, of which 54 were completed, 10 are in progress or under analysis, and 9 were stopped due to poor accrual. Forty-four peer reviewed publications have been written on behalf of the RCN.
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Affiliation(s)
- René-Olivier Mirimanoff
- Department of Radiation Oncology, University of Lausanne Medical Center , Lausanne, Switzerland
| | - Mahmut Ozsahin
- Department of Radiation Oncology, University of Lausanne Medical Center , Lausanne, Switzerland
| | - Juliette Thariat
- Department of Radiation Oncology, Centre Lacassagne , Nice, France
| | - Enis Ozyar
- Department of Radiation Oncology, Acibadem University , Istanbul, Turkey
| | - Ulrike Schick
- Department of Radiation Oncology, University Hospital , Geneva, Switzerland
| | - Berrin Pehlivan
- Department of Radiation Oncology, Medstar Antalya Hospital , Antalya, Turkey
| | - Marco Krengli
- Division of Radiotherapy, University of Piemonte Orientale , Novara, Italy
| | | | - Hansjörg Vees
- Department of Radiation Oncology, University Hospital , Geneva, Switzerland
| | - Ling Cai
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center , Guangzhou, China
| | | | - Yazid Belkacemi
- Department of Radiation Therapy and Breast Center, Henri Mondor University Hospital, Université Paris Est Créteil (UPEC) , Créteil, France
| | - Salvador Villà
- Radiation Oncology, Institut Català d'Oncologia , Badalona, Barcelona, Catalonia, Spain
| | - Sefik Igdem
- Department of Radiation Oncology, Istanbul Bilim University , Istanbul, Turkey
| | - Myroslav Lutsyk
- Department of Radiation Oncology, Ram Bam Medical Center , Haifa, Israel
| | - Robert C Miller
- Department of Radiation Oncology, Mayo Clinic , Rochester, MN, USA
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Abstract
Erdheim-Chester disease (ECD) is a rare, non-Langerhans histiocytosis. Recent findings suggest that ECD is a clonal disorder, marked by recurrent BRAFV600E mutations in >50% of patients, in which chronic uncontrolled inflammation is an important mediator of disease pathogenesis. Although ∼500 to 550 cases have been described in the literature to date, increased physician awareness has driven a dramatic increase in ECD diagnoses over the last decade. ECD frequently involves multiple organ systems and has historically lacked effective therapies. Given the protean clinical manifestations and the lack of a consensus-derived approach for the management of ECD, we provide here the first multidisciplinary consensus guidelines for the clinical management of ECD. These recommendations were outlined at the First International Medical Symposium for ECD, comprised of a comprehensive group of international academicians with expertise in the pathophysiology and therapy of ECD. Detailed recommendations on the initial clinical, laboratory, and radiographic assessment of ECD patients are presented in addition to treatment recommendations based on critical appraisal of the literature and clinical experience. These formalized consensus descriptions will hopefully facilitate ongoing and future research efforts in this disorder.
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Darstein F, Kirschey S, Heckl S, Rahman F, Schwarting A, Schuchmann M, Galle PR, Zimmermann T. Successful treatment of Erdheim-Chester disease with combination of interleukin-1-targeting drugs and high-dose glucocorticoids. Intern Med J 2014; 44:90-2. [DOI: 10.1111/imj.12329] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 07/07/2013] [Indexed: 12/28/2022]
Affiliation(s)
- F. Darstein
- I. Medizinische Klinik; Universitätsmedizin Mainz; Bad Kreuznach Germany
| | - S. Kirschey
- III. Medizinische Klinik; Universitätsmedizin Mainz; Bad Kreuznach Germany
| | - S. Heckl
- I. Medizinische Klinik; Universitätsmedizin Mainz; Bad Kreuznach Germany
| | - F. Rahman
- I. Medizinische Klinik; Universitätsmedizin Mainz; Bad Kreuznach Germany
| | - A. Schwarting
- I. Medizinische Klinik; Universitätsmedizin Mainz; Bad Kreuznach Germany
- Rheumazentrum; Bad Kreuznach Germany
| | - M. Schuchmann
- Zentrum für Innere Medizin; Klinikum Konstanz Konstanz Germany
| | - P. R. Galle
- I. Medizinische Klinik; Universitätsmedizin Mainz; Bad Kreuznach Germany
| | - T. Zimmermann
- I. Medizinische Klinik; Universitätsmedizin Mainz; Bad Kreuznach Germany
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Mazor RD, Manevich-Mazor M, Shoenfeld Y. Strategies and treatment alternatives in the management of Erdheim–Chester disease. Expert Opin Orphan Drugs 2013. [DOI: 10.1517/21678707.2013.847785] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Patel A, Ozsahin M, Mirimanoff RO, Bhatia S, Chang K, Miller RC. The Rare Cancer Network: achievements from 1993 to 2012. Rare Tumors 2012; 4:e35. [PMID: 23087791 PMCID: PMC3475942 DOI: 10.4081/rt.2012.e35] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 03/09/2012] [Accepted: 03/21/2012] [Indexed: 02/03/2023] Open
Abstract
The Rare Cancer Network (RCN), founded in 1993, performs research involving rare tumors that are not common enough to be the focus of prospective study. Over 55 studies have either been completed or are in progress. The aim of the paper is to present an overview of the 30 studies done through the RCN to date, organized by disease site. Five studies focus on breast pathology, including sarcoma, lymphoma, phyllodes tumor, adenoid cystic carcinoma, and ductal carcinoma in situ in young women. Three studies on prostate cancer address prostatic small cell carcinoma and adenocarcinoma of young and elderly patients. Six studies on head and neck cancers include orbital and intraocular lymphoma, mucosal melanoma, pediatric nasopharyngeal carcinoma, olfactory neuroblastoma, and mucosa-associated lymphoid tissue lymphoma of the salivary glands. There were 4 central nervous system studies on patients with cerebellar glioblastoma multiforme, atypical and malignant meningioma, spinal epidural lymphoma and myxopapillary ependymoma. Outside of these disease sites, there is a wide variety of other studies on tumors ranging from uterine leiomyosarcoma to giant cell tumors of the bone. The studies done by the RCN represent a wide range of rare pathologies that were previously only studied in small series or case reports. With further growth of the RCN and collaboration between members our ability to analyze rare tumors will increase and result in better understanding of their behavior and ultimately help direct research that may improve patient outcomes.
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Affiliation(s)
- Ajaykumar Patel
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
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Erdheim-Chester disease: The role of video-assisted thoracoscopic surgery in diagnosing and treating cardiac involvement. Int J Surg Case Rep 2011; 3:107-10. [PMID: 22288060 DOI: 10.1016/j.ijscr.2011.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 11/24/2011] [Accepted: 12/01/2011] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Erdheim-Chester disease is a rare, non-Langerhans histiocytosis in which pericardial involvement is diagnosed with increasing frequency and is associated with high mortality rates. PRESENTATION OF CASE A 53-year-old woman presented with progressive exertional dyspnea and pericardial effusion was discovered. Further investigations revealed the presence of a diffuse, infiltrating process and a diagnosis of Erdheim-Chester disease was made. An emergent pericardiocentesis by subxiphoid approach was completed but recurrent drainage obviated removal of the pigtail catheter. A pleuro-pericardial window was placed using video-assisted thoracoscopic surgery (VATS) and analysis of the resected specimen confirmed pericardial involvement. DISCUSSION In this case, high pericardial fluid output demanded definitive treatment of the pericardial effusion. Traditionally this would be completed via thoracotomy. VATS is a minimally invasive alternative which permits exploration of the thoracic cavity and the creation of a pleuropericardial window. CONCLUSION We describe, for the first time, the successful use of VATS for both diagnostic confirmation and therapeutic relief of recurrent pericardial fluid drainage due to pericardial involvement by Erdheim-Chester disease.
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Manousaridis K, Casper J, Schittkowski MP, Nizze H, Guthoff RF. [Erdheim-Chester disease of the orbit with compressive optic neuropathy]. Ophthalmologe 2010; 107:266-9. [PMID: 19777245 DOI: 10.1007/s00347-009-2041-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 60-year-old man presented with left exophthalmos and deterioration in visual acuity of slow evolution. Bilateral orbital Erdheim-Chester disease was diagnosed. Systemic evaluation revealed a retroperitoneal fibrosis. Treatment with interferon-alpha followed, but bilateral compressive optic neuropathy with visual acuity deterioration and visual field defects evolved. Bilateral orbital decompression was performed.
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Affiliation(s)
- K Manousaridis
- Klinik und Poliklinik für Augenheilkunde, Universität Rostock, Deutschland.
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Furlanetto TW, Fischer J, Polanczyk CA, Vasconcelos MV. A multiplication problem. Am J Med 2009; 122:32-4. [PMID: 19114169 DOI: 10.1016/j.amjmed.2008.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Revised: 09/09/2008] [Accepted: 09/10/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Tania W Furlanetto
- Division of Internal Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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