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Rajabi MT, Amoli FA, Koochakzadeh L, Rafizadeh SM, Rajabi MB, Hosseini SS, Aghajani AH, Pezeshgi S, Aghdam MA, Farrokhpour H, Abla O, Sadeghi R. Orbital histiocytosis and fibrohistiocytosis: the clinicopathological characteristics of 117 patients, over a decade of experience. Int Ophthalmol 2023; 43:4997-5009. [PMID: 37840073 DOI: 10.1007/s10792-023-02903-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 09/27/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE To describe the clinicopathological features of a large cohort of patients with orbital histiocytoses and fibrohistiocytosis, such as Langerhans cell histiocytosis (LCH) and non-LCH disorders, and correlate patients' clinical characteristics with their pathological diagnosis. METHODS In this retrospective study, medical records of patients presenting to Farabi Eye Hospital, a tertiary eye care center in Tehran, Iran, from 2010 until 2022, were reviewed. Patients' demographics, chief complaint, location and laterality of the tumor, best-corrected visual acuity, presence of bone erosion on imaging, and their pathological diagnosis were retrieved. Excisional biopsy was performed and evaluated through light microscopy and immunohistochemistry study for their respective markers, including CD1a, CD68, CD207, and S100. RESULTS A total of 117 patients with 11 pathological subtypes of histiocytoses and fibrohistiocyosis were identified, with 56.4% male and 43.6% female patients. The mean age at presentation was 23.4 years (range 1.5 months-73 years). Swelling and palpable mass were the most common chief complaints. LCH was the most common pathology (32.5%), followed by juvenile xanthogranuloma (26.5%) and adult xanthogranuloma (21.4%). Age, lesion location, and bone erosion had a statistically significant difference among the various diagnosed subtypes. CONCLUSIONS Histiocytoses and fibrohistiocytosis are diverse and rare disorders potentially involving multiple organ systems. Ophthalmic manifestations of these diseases are even more uncommon. We reviewed their orbital presentation along with their respective histopathological findings. Our results also suggested that an orbital CT scan can be of diagnostic value to discriminate LCH from other histiocytic pathologies.
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Affiliation(s)
- Mohammad Taher Rajabi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
| | - Fahimeh Asadi Amoli
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
| | - Leili Koochakzadeh
- Department of Pediatric Hematology and Oncology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohsen Rafizadeh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
| | - Mohammad Bagher Rajabi
- Eye Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Amir Hossein Aghajani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
| | - Saharnaz Pezeshgi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Abdolahzadeh Aghdam
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
| | - Hossein Farrokhpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Oussama Abla
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Reza Sadeghi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran.
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Hild V, Mellert K, Möller P, Barth TFE. Giant Cells of Various Lesions Are Characterised by Different Expression Patterns of HLA-Molecules and Molecules Involved in the Cell Cycle, Bone Metabolism, and Lineage Affiliation: An Immunohistochemical Study with a Review of the Literature. Cancers (Basel) 2023; 15:3702. [PMID: 37509363 PMCID: PMC10377796 DOI: 10.3390/cancers15143702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Giant cells (GCs) are thought to originate from the fusion of monocytic lineage cells and arise amid multiple backgrounds. To compare GCs of different origins, we immunohistochemically characterised the GCs of reactive and neoplastic lesions (n = 47). We studied the expression of 15 molecules including HLA class II molecules those relevant to the cell cycle, bone metabolism and lineage affiliation. HLA-DR was detectable in the GCs of sarcoidosis, sarcoid-like lesions, tuberculosis, and foreign body granuloma. Cyclin D1 was expressed by the GCs of neoplastic lesions as well as the GCs of bony callus, fibroid epulis, and brown tumours. While cyclin E was detected in the GCs of all lesions, p16 and p21 showed a heterogeneous expression pattern. RANK was expressed by the GCs of all lesions except sarcoid-like lesions and xanthogranuloma. All GCs were RANK-L-negative, and the GCs of all lesions were osteoprotegerin-positive. Osteonectin was limited to the GCs of chondroblastoma. Osteopontin and TRAP were detected in the GCs of all lesions except xanthogranuloma. RUNX2 was heterogeneously expressed in the reactive and neoplastic cohort. The GCs of all lesions except foreign body granuloma expressed CD68, and all GCs were CD163- and langerin-negative. This profiling points to a functional diversity of GCs despite their similar morphology.
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Affiliation(s)
- Vivien Hild
- Institute of Pathology, University Hospital Ulm, 89081 Ulm, Germany
| | - Kevin Mellert
- Institute of Pathology, University Hospital Ulm, 89081 Ulm, Germany
| | - Peter Möller
- Institute of Pathology, University Hospital Ulm, 89081 Ulm, Germany
| | - Thomas F E Barth
- Institute of Pathology, University Hospital Ulm, 89081 Ulm, Germany
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Detection of Immune Microenvironment Changes and Immune-Related Regulators in Langerhans Cell Histiocytosis Bone Metastasis. BIOMED RESEARCH INTERNATIONAL 2023; 2023:1447435. [PMID: 36714021 PMCID: PMC9879691 DOI: 10.1155/2023/1447435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 12/18/2022] [Accepted: 01/03/2023] [Indexed: 01/21/2023]
Abstract
The inflammation/immune response pathway is considered a key contributor to the development of Langerhans cell histiocytosis (LCH) bone metastasis. However, the dynamic changes in the immune microenvironment of LCH bone metastasis and critical regulators are still unclear. Expression profiling by arrays of GSE16395, GSE35340, and GSE122476 was applied to detect the immune microenvironment changes in the development of LCH bone metastasis. The single-cell high-throughput sequencing of GSE133704, involved in LCH bone lesions, was analyzed. The online database Metascape and gene set variation analysis (GSVA) algorithms were used to detect the gene function of Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG). The protein-protein interaction (PPI) network of hub regulators was constructed by the STRING database. In these results, key immune cells, such as Tem cells, NK T cells, CD8(+) T cells, and Th1 cells, were identified in LCH bone metastasis. These genes, which include LAG3, TSPAN5, LPAR5, VEGFA, CXCL16, CD74, and MARCKS, may significantly correlate with the cellular infiltration of B cells, aDCs, pDCs, cytotoxic cells, T cells, CD8+ T cells, T helper cells, and Tcm cells. In conclusion, our study constructed an atlas of the immune microenvironment of LCH bone metastasis. Genes including LAG3, TSPAN5, LPAR5, VEGFA, CXCL16, CD74, and MARCKS may be involved in the development of LCH bone metastasis. The hub gene-immune cell interactive map may be a potential prognostic biomarker for the progression of LCH bone metastasis and synergetic targets for immunotherapy in LCH patients.
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Alzahem T, Alkatan HM, Maktabi AM, Alsulaiman N, Cruz AAV. Ophthalmic histiocytic lesions (diseases of the L group): A multicenter clinicopathological study of 18 cases and review of literature. Eur J Ophthalmol 2023; 33:556-566. [PMID: 35816372 DOI: 10.1177/11206721221113431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Langerhans cell histiocytosis (LCH) and Erdheim-Chester disease (ECD) are rare histiocytic disorders in the L (Langerhans) group diseases. They range from self-limited benign diseases to lethal disseminated forms. METHODS This retrospective study was conducted in 3 tertiary hospitals in Saudi Arabia and Brazil. Histopathological records were searched for all patients diagnosed with ocular and periocular histiocytic disorders from January 1993 to December 2018. Histopathological slides and medical files were reviewed for data collection and simple analysis of demographics, clinical manifestations, and management. The relevant literature is reviewed. RESULTS Twenty-two eyes of 18 patients with biopsy-proven histiocytic disorders in the L group were included. Female-to-male ratio was 1.25:1. Average age at presentation was 14 years (range, 1-54). LCH was diagnosed in 14 eyes, while eight eyes had ECD. All LCH cases were unilateral and confined to the bone as cases of eosinophilic granuloma (EG), while patients with ECD were bilateral. Commonest presentations in EG and ECD were eyelid swelling (85.7%) and periocular xanthomas (75%), respectively. Orbit was involved in 100% of EG cases, with bony erosion in 54.5%. Relevant systemic involvement was found in 100% of ECD and 21% of EG cases. Surgical intervention was needed in 16 of the 22 eyes (72.7%). All EG and 25% of patients with ECD required surgical excision. CONCLUSIONS Histiocytic disorders are a rare group of diseases, including the L group. Relevant systemic associations require specific and selective therapy. A high clinical index and multidisciplinary collaboration are essential for the proper evaluation and management of these patients.
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Affiliation(s)
- Tariq Alzahem
- Ophthalmology Department, College of Medicine, 37850King Saud University, Riyadh, Saudi Arabia.,King Saud University Medical City, 37850King Saud University, Riyadh, Saudi Arabia.,Vitreoretinal Division, 46670King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Hind M Alkatan
- Ophthalmology Department, College of Medicine, 37850King Saud University, Riyadh, Saudi Arabia.,King Saud University Medical City, 37850King Saud University, Riyadh, Saudi Arabia.,Pathology and Laboratory Medicine Department, College of Medicine, 37850King Saud University, Riyadh, Saudi Arabia
| | - Azza My Maktabi
- Pathology and Laboratory Medicine Department, 46670King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Naif Alsulaiman
- Oculoplastics Division, 46670King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Antonio Augusto V Cruz
- Ophthalmology Department, 42496School of Medicine of Ribeirão-Preto, University of São Paulo, São Paulo, Brazil
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Fang J, Chen J, Deng C, Li J, Huang T, Li Y, Xie Y, Wang M. Langerhans Cell Histiocytosis in a Pediatric Patient with Simultaneous Gastrointestinal and Skin Involvement: A Case Report and Literature Review. Fetal Pediatr Pathol 2022; 42:483-487. [PMID: 36331524 DOI: 10.1080/15513815.2022.2142488] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: Langerhans cell histiocytosis (LCH) has heterogeneous presentations involving single or multiple systems, but simultaneous isolated skin and gastrointestinal involvement is not common. Case report: A female infant with intermittent bloody diarrhea was unresponsive for treatment of food allergy. Histology of gastric and colonic tissues demonstrated Langerhan's cell histiocytosis. The infant also had red rashes that were histologically proven Langerhan's cell histiocytosis. Chemotherapy utilized vincristine, cytarabine and prednisone. The bloody diarrhea and rash completely resolved with no recurrence in the 11 months of follow-up. Conclusion: Langerhan cell histiocytosis may present with simultaneous gastrointestinal and skin involvement.
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Affiliation(s)
- Jiahui Fang
- Department of Gastroenterology, Kunming Children's Hospital, Kunming, China
| | - Jun Chen
- Department of Gastroenterology, Kunming Children's Hospital, Kunming, China
| | - Chengjun Deng
- Department of Gastroenterology, Kunming Children's Hospital, Kunming, China
| | - Jiwei Li
- Department of Pathology, Kunming Children's Hospital, Kunming, China
| | - Tilong Huang
- Department of Hematology, Kunming Children's Hospital, Kunming, China
| | - Ying Li
- Department of Gastroenterology, Kunming Children's Hospital, Kunming, China
| | - Yucheng Xie
- Department of Pathology, Kunming Children's Hospital, Kunming, China
| | - Mingying Wang
- Department of Gastroenterology, Kunming Children's Hospital, Kunming, China
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Milman T, Eiger-Moscovich M, Henry RK, Ida CM, Ruben M, Shields CL, Lally SE, Penne RB, Stefanyszyn MA, Bilyk JR, Rapuano CJ, Rabinowitz M, Eagle RC. Cyclin D1 expression and molecular genetic findings in periocular histiocytoses and neoplasms of macrophage-dendritic cell lineage. Am J Ophthalmol 2022; 242:36-51. [PMID: 35594918 DOI: 10.1016/j.ajo.2022.05.009] [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: 02/15/2022] [Revised: 05/06/2022] [Accepted: 05/13/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Frequent activating mutations in the mitogen-activated protein kinase (MAPK) pathway genes have been identified in histiocytoses. MAPK signaling consistently upregulates Cyclin D1. The goal of this study was to determine whether Cyclin D1 expression by immunohistochemistry is a useful diagnostic marker for periocular histiocytoses and to further characterize their genetic basis. DESIGN Retrospective observational case series. METHODS Pathology records were searched for all patients with histiocytoses diagnosed between 1995-2020. Eleven histiocyte-rich inflammatory lesions and 10 xanthelasma served as controls. Cyclin D1 immunohistochemistry was performed on all tissues. A subset of histiocytoses was evaluated by next-generation sequencing (NGS) and droplet digital PCR (ddPCR). RESULTS There were 36 patients, 15 (42%) males and 21 (58%) females, with histiocytoses: 9 (25%) juvenile xanthogranuloma, 8 (22%) adult-onset asthma and periocular xanthogranuloma, 7 (19%) Langerhans cell histiocytosis, 5 (14%) Rosai-Dorfman disease, 5 (14%) xanthogranuloma not otherwise specified, 1 (3%) Erdheim-Chester disease, and 1 (3%) histiocytic sarcoma. Moderate-to-strong nuclear Cyclin D1 expression was present in ≥50% of lesional cells in histiocytoses (23/36, 64%), significantly more when compared to histiocyte-rich inflammatory lesions (0/11, 0%, P<.001) and xanthelasma (0/10, 0%, P<.001). Cyclin D1 was expressed in <10% of lesional cells in all 11 histiocyte-rich inflammatory lesions (P<.001) and all 10 xanthelasma lesions (P<.001). MAPK pathway gene mutations were detected in 12 of 14 (86%) histiocytoses successfully assayed by NGS and/or ddPCR. CONCLUSIONS Our study confirms that the Cyclin D1 immunohistochemical stain is a useful diagnostic marker for periocular histiocytoses, correlating with underlying mutations in MAPK pathway genes.
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Affiliation(s)
- Tatyana Milman
- From the Department of Pathology (T.M., M.E.-M., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Ophthalmology (T.M., C.L.S., S.E.L., R.B.P., M.A.S., J.R.B., C.J.R., M.Ra., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Maya Eiger-Moscovich
- From the Department of Pathology (T.M., M.E.-M., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Maya Eiger-Moscovich is currently practicing at Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel. Meghan Ruben is currently practicing at Department of Ophthalmology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Roger K Henry
- Institute of Ophthalmology and Visual Science, Rutgers-New Jersey Medical School at Rutgers University (R.K.H.), Newark, New Jersey
| | - Cristiane M Ida
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Mayo Clinic College of Medicine and Science (C.M.I.), Rochester, Minnesota; USA
| | - Megan Ruben
- Ocular Oncology Service (M.Ru., C.L.S., S.E.L., R.B.P.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Carol L Shields
- Department of Ophthalmology (T.M., C.L.S., S.E.L., R.B.P., M.A.S., J.R.B., C.J.R., M.Ra., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Ocular Oncology Service (M.Ru., C.L.S., S.E.L., R.B.P.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sara E Lally
- Department of Ophthalmology (T.M., C.L.S., S.E.L., R.B.P., M.A.S., J.R.B., C.J.R., M.Ra., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Ocular Oncology Service (M.Ru., C.L.S., S.E.L., R.B.P.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Robert B Penne
- Department of Ophthalmology (T.M., C.L.S., S.E.L., R.B.P., M.A.S., J.R.B., C.J.R., M.Ra., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Ocular Oncology Service (M.Ru., C.L.S., S.E.L., R.B.P.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mary A Stefanyszyn
- Department of Ophthalmology (T.M., C.L.S., S.E.L., R.B.P., M.A.S., J.R.B., C.J.R., M.Ra., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Oculoplastic and Orbital Surgery (M.A.S., J.R.B., M.Ra.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jurij R Bilyk
- Department of Ophthalmology (T.M., C.L.S., S.E.L., R.B.P., M.A.S., J.R.B., C.J.R., M.Ra., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Oculoplastic and Orbital Surgery (M.A.S., J.R.B., M.Ra.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Christopher J Rapuano
- Department of Ophthalmology (T.M., C.L.S., S.E.L., R.B.P., M.A.S., J.R.B., C.J.R., M.Ra., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Cornea Service (C.J.R.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael Rabinowitz
- Department of Ophthalmology (T.M., C.L.S., S.E.L., R.B.P., M.A.S., J.R.B., C.J.R., M.Ra., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Oculoplastic and Orbital Surgery (M.A.S., J.R.B., M.Ra.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ralph C Eagle
- From the Department of Pathology (T.M., M.E.-M., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Ophthalmology (T.M., C.L.S., S.E.L., R.B.P., M.A.S., J.R.B., C.J.R., M.Ra., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
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Plemel DJA, Benson MD, Tong CM, Mahmood MN, Pollock TJ. Nonosseous Periocular Manifestations of Langerhans Cell Histiocytosis: A Case Report and Systematic Review. Ophthalmic Plast Reconstr Surg 2021; 37:408-413. [PMID: 33315841 DOI: 10.1097/iop.0000000000001906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Langerhans cell histiocytosis (LCH) is a disorder of dendritic cell proliferation that typically involves bone. It can be diagnostically challenging when LCH presents without bony involvement, leading to delays in diagnosis and treatment. In this study, the periocular manifestations of LCH in cases where the underlying orbital bones are not involved are described through a systematic review. METHODS A systematic review of the literature was performed to capture all cases of LCH that involved the periocular region but not the underlying orbital bones. These included LCH cases that involved the periocular skin, the ocular surface, and the orbital tissue. The authors also highlight an additional case where LCH presented with periocular edema and multifocal, nodular conjunctival lesions. RESULT This review illustrates that LCH rarely presents with periocular infiltration without orbital bone involvement. In these atypical cases, LCH can present as an eyelid mass, a chalazion-like lesion, generalized periocular swelling, ocular surface lesions, or infiltration of any orbital structure. Ocular surface LCH has a higher rate of recurrence than other periocular LCH. Orbital LCH can involve any tissue including extraocular muscles, the lacrimal gland, or indistinct areas within the orbit. CONCLUSIONS LCH is a clinicopathologic diagnosis. Although most cases involve the bone, any soft tissue can be involved. Biopsy is required to confirm the diagnosis of this heterogeneous disease.
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Affiliation(s)
| | | | - C Maya Tong
- Department of Ophthalmology and Visual Sciences
| | - Muhammad N Mahmood
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
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Pegoraro F, Brambilla A, Coniglio ML, Caputo R, Perrone A, Buccoliero AM, Favre C, Sieni E. Severe ocular involvement in a newborn with Langerhans Cell Histiocytosis. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2021. [DOI: 10.1016/j.phoj.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Langerhans Cell Histiocytosis of the Orbit: Spectrum of Clinical and Imaging Findings. J Pediatr 2021; 230:174-181.e1. [PMID: 33157073 DOI: 10.1016/j.jpeds.2020.10.056] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/03/2020] [Accepted: 10/22/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the clinical and imaging characteristics of orbital lesions of pediatric Langerhans cell histiocytosis (LCH). STUDY DESIGN A retrospective analysis of clinical data and central review of magnetic resonance imaging scans in patients with LCH, enrolled into one of the consecutive international trials LCH I-III, or submitted for a second opinion between 1994 and 2015. RESULTS Data from 31 children (34 involved orbits) were analyzed. Orbital LCH was the only disease manifestation in 15, part of a multifocal skeletal in 5, or a multisystem LCH in 11 patients. Orbital LCH was part of the initial disease presentation in 23 or developed at relapse in 8 cases. Orbital involvement was unilateral in 28 and bilateral in 3 patients (34 affected orbits). Proptosis was present in 9 patients. Frontal and zygomatic bone were most commonly affected. All orbital lesions were extraconal. Associated extraorbital imaging findings were dural tail sign in 19, neurodegeneration in 8, and hypothalamic-pituitary mass in 3 patients. Sixteen patients (52%) had at least 1 documented disease relapse. Permanent consequences were prominent proptosis in 1, diabetes insipidus in 8, growth hormone deficiency in 2, radiologic neurodegeneration in 8, and clinical neurodegeneration in 3 patients. CONCLUSIONS Predominantly unilateral orbital LCH can be the only disease manifestation or part of a disseminated disease. Orbital lesions in LCH are exclusively extraconal, typically located at the roof and the lateral wall of the orbit. The optimal treatment approach of unifocal LCH of the orbit remains controversial and warrants a prospective evaluation.
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Koka K, Alam MS, Subramanian N, Subramanian K, Biswas J, Mukherjee B. Clinical spectrum and management outcomes of Langerhans cell histiocytosis of the orbit. Indian J Ophthalmol 2020; 68:1604-1608. [PMID: 32709787 PMCID: PMC7640849 DOI: 10.4103/ijo.ijo_1375_19] [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] [Indexed: 01/05/2023] Open
Abstract
Purpose To describe the clinical spectrum and management outcomes of Langerhans cell histiocytosis (LCH) involving the orbit. Methods Retrospective review of patients with orbital LCH presenting at the Sankara Nethralaya, Chennai, India, over the past 15 years. Demographic details, presenting features, radiology, histopathology, immunohistochemistry, and management outcomes were analyzed. Results Nine patients were reviewed. The mean age of presentation was 10.12 ± 14.31 years (range: 6 weeks to 35 years). Eyelid swelling was the most common presenting feature (4, 44.4%), followed by proptosis (3, 33.3%). The mean duration of the presentation was 2.21 ± 2.77 months. Radiological investigations revealed orbital roof osteolytic defects in six (66.6%) patients. Six patients underwent near-complete excision of the mass while three underwent incisional biopsy. Histopathology revealed histiocytes with nuclear grooving and numerous eosinophils characteristic of LCH. The cells were positive for CD1a and S 100 antigens. None of the patients had any systemic involvement. Three received systemic steroids and four received systemic chemotherapy. At a mean follow-up of 17.85 ± 23.46 months, all had complete remission without any signs of recurrence. One patient was lost to follow-up after near-complete excision while one adult patient with a mass in the intraconal space had no recurrence after near-complete excision. Conclusion LCH is a rare disorder of the orbit that commonly occurs in children and should be considered a differential for osteolytic lesions involving the orbit. All patients should undergo a systemic evaluation to rule out multifocal disease. The treatment depends upon disease extent and risk factors.
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Affiliation(s)
- Kirthi Koka
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Md Shahid Alam
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
| | - Nirmala Subramanian
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Krishnakumar Subramanian
- Larson and Turbo Department of Ocular Pahthology, Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Jyotirmoy Biswas
- Larson and Turbo Department of Ocular Pahthology, Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Bipasha Mukherjee
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
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The combination of methotrexate and cytosine arabinoside in newly diagnosed adult Langerhans cell histiocytosis: a prospective phase II interventional clinical trial. BMC Cancer 2020; 20:433. [PMID: 32423455 PMCID: PMC7236107 DOI: 10.1186/s12885-020-06872-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 04/15/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Langerhans Cell Histiocytosis (LCH) is a rare disease puzzling both children and adults, however outcome of adult patients is unfavorable. This prospective interventional trial aims to test the efficacy and safety of the combination of methotrexate and cytosine arabinoside in adult LCH patients. METHOD A total of 36 patients enrolled diagnosed with LCH and treated in our center from 1st Jan, 2014 to 30th Jun, 2016. RESULT Nineteen patients underwent the detection of BRAF mutation, with a positive rate of 21.1%. The overall response rate was 100%, only 16.7% achieved complete response. The overall regression rate of osseous lesions was 100%. Regression of central nervous system involvement was also favorable. After a median follow-up of 44 months, the estimated event-free survival was 48.9 months, the overall survival rate was 97.2%. The risk organ involvement showed strong prognostic value, EFS was 34.1 or 54.6 months (p = 0.001) in groups with/without risk organ involvement respectively. Neutropenia and thrombocytopenia were the most common adverse effects. CONCLUSION The regimen of methotrexate and cytosine arabinoside (MA) is effective and safe in treating adult LCH patients, and timely preventions may be considered for the high incidence of hematological adverse effects. TRIAL REGISTRATION Trial No. NCT02389400 on Clinicaltrials.gov, registered on 10th Mar. 2015.
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Kostyra K, Kostkiewicz B. Langerhans cell histiocytosis of the orbit and frontal sinus of the adult woman: A first case report in Poland. Surg Neurol Int 2019; 10:234. [PMID: 31893135 PMCID: PMC6911676 DOI: 10.25259/sni_140_2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 09/02/2019] [Indexed: 12/26/2022] Open
Abstract
Background: Langerhans cell histiocytosis (LCH) is a term describing a clonal proliferation of pathologic Langerhans cells (histiocytes), which may manifest as unisystem (unifocal or multifocal) or multisystem disease. LCH is a rare cause of the orbital tumor with the predilection to its lateral wall which is particularly common in children. Case Description: We report an unusual case of a 33-year-old woman, 6 months after childbirth, who presented with the edema of the right orbit and upper eyelid with headaches. On physical examination, the patient had a right superior and lateral swelling of the eyelid and the orbit and right enophthalmos, without blurred vision. Magnetic resonance imaging showed well-defined, expansile, intensely homogeneously enhancing mass lesion in the right superolateral orbital rim with the destruction of the upper wall of the orbit, growing into the frontal sinus and frontal part of the cranium with the bold of the dura mater in this region. Radical excision of the tumor was achieved through a right fronto-temporo-orbito-zygomatic craniotomy. Histopathological examination had confirmed the diagnosis of the LCH. The patient was discharged home with a modified Rankin Scale score of 0. Conclusion: The main purpose of this case report is that LCH should be considered as one of the possible causes of quickly appearing tumor of the orbit in adults.
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Affiliation(s)
- Kacper Kostyra
- Department of Neurosurgery, Central Clinical Hospital of the Ministry of Internal Affairs and Administration, Warsaw, Wołoska, Poland
| | - Bogusław Kostkiewicz
- Department of Neurosurgery, Central Clinical Hospital of the Ministry of Internal Affairs and Administration, Warsaw, Wołoska, Poland
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Luo E, Shi B, Chen QM, Zhou XD. [Dental-craniofacial manifestation and treatment of rare diseases in China]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2019; 37:130-142. [PMID: 31168978 PMCID: PMC7030144 DOI: 10.7518/hxkq.2019.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/16/2019] [Indexed: 02/05/2023]
Abstract
Rare diseases are genetic, chronic, and incurable disorders with relatively low prevalence. Thus, diagnosis and management strategies for such diseases are currently limited. This situation is exacerbated by insufficient medical sources for these diseases. The National Health and Health Committee of China recently first provided a clear definition of 121 rare diseases in the Chinese population. In this study, we summarize several dental-craniofacial manifestations associated with some rare diseases to provide a reference for dentists and oral maxillofacial surgeons aiming at fast-tracking diagnosis for the management of these rare diseases.
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Affiliation(s)
- En Luo
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Bing Shi
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Qian-Ming Chen
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Xue-Dong Zhou
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Luo E, Liu H, Zhao Q, Shi B, Chen Q. Dental-craniofacial manifestation and treatment of rare diseases. Int J Oral Sci 2019; 11:9. [PMID: 30783081 PMCID: PMC6381182 DOI: 10.1038/s41368-018-0041-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/22/2018] [Accepted: 10/28/2018] [Indexed: 02/05/2023] Open
Abstract
Rare diseases are usually genetic, chronic and incurable disorders with a relatively low incidence. Developments in the diagnosis and management of rare diseases have been relatively slow due to a lack of sufficient profit motivation and market to attract research by companies. However, due to the attention of government and society as well as economic development, rare diseases have been gradually become an increasing concern. As several dental-craniofacial manifestations are associated with rare diseases, we summarize them in this study to help dentists and oral maxillofacial surgeons provide an early diagnosis and subsequent management for patients with these rare diseases.
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Affiliation(s)
- En Luo
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hanghang Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Qiucheng Zhao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Bing Shi
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - Qianming Chen
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Richards NQ, Young M, Pierson K, Le J, Rong Y. Atypical presentation of isolated orbital Langerhans cell histiocytosis. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2019; 36:167-171. [PMID: 32476950 DOI: 10.36141/svdld.v36i2.7639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 11/05/2018] [Indexed: 11/02/2022]
Abstract
Background A 9-year old female presented with one month of waxing and waning upper eyelid swelling. An excisional biopsy via anterior orbitotomy was performed. Objective To describe a patient presenting atypically with symptoms concerning for orbital cellulitis who was diagnosed with Langerhans cell histiocytosis (LCH). Methods Description of case report. Results We report a case of a 9-year old female with one month of periorbital edema and erythema suspected to be orbital cellulitis. A complete ophthalmological exam, subsequent imaging, and an excisional biopsy revealed the diagnosis of LCH. With a confirmed diagnosis, the patient started chemotherapy indicated by the Histiocyte Society Evaluation and Treatment Guidelines. Conclusion Langerhans cell histiocytosis (LCH) embodies a spectrum of diseases with the primary pathologic process being the abnormal proliferation of polyclonal Langerhans cells. In children with isolated bony involvement, the most common presenting symptom is pain. Rarely is orbital involvement with associated periorbital edema and erythema the primary presentation.
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Affiliation(s)
- Nikisha Q Richards
- Department of Ophthalmology, Virginia Commonwealth University, Richmond, VA
| | - Matthew Young
- Department of Ophthalmology, Virginia Commonwealth University, Richmond, VA
| | - Kasey Pierson
- Department of Ophthalmology, Virginia Commonwealth University, Richmond, VA
| | - John Le
- Department of Ophthalmology, Virginia Commonwealth University, Richmond, VA
| | - Yuan Rong
- Department of Pathology, Virginia Commonwealth University, Richmond, VA
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Langerhans cell histiocytosis in an 18-month-old child presenting as periorbital cellulitis. Saudi J Ophthalmol 2018; 32:52-55. [PMID: 29755272 PMCID: PMC5944001 DOI: 10.1016/j.sjopt.2018.02.006] [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: 11/27/2017] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 12/20/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare multi-system disease. It presents infrequently as a childhood orbital tumor, and can mimic more common inflammatory orbital disease processes. We report the clinical, histopathological, and electron microscopic findings of orbital LCH in an 18-month-old child, along with a review of the recent literature regarding molecular pathogenetic analysis of LCH. The child presented with a two-week history of progressive left periorbital edema and redness. He was initially diagnosed and treated empirically for bacterial periorbital cellulitis, but subsequently underwent ophthalmological consultation after he failed to improve. Histopathological examination of an orbital biopsy specimen revealed numerous Langerhans-type cells, which stain positive for CD1A and CD207 (langerin). Electron microscopic examination demonstrated characteristic Birbeck granules within the Langerhans-type cells. Three year follow-up did not demonstrate recurrence or disease progression.
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17
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Frade AP, Godinho MM, Batalha ABW, Bueno APS. Congenital Langerhans cell histiocytosis: a good prognosis disease? An Bras Dermatol 2018; 92:40-42. [PMID: 29267442 PMCID: PMC5726673 DOI: 10.1590/abd1806-4841.20175308] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 05/01/2016] [Indexed: 11/29/2022] Open
Abstract
Langerhans cell histiocytosis is rare and more frequent in children. The skin is
affected in 50% of the cases and is the only site in 10%. Its course varies from
self-limited and localized forms to severe multisystemic forms. Congenital cases
are usually exclusively cutaneous and self-limited, with spontaneous remission
in months. This study presents a rare congenital case, initially restricted to
the skin, with subsequent dissemination and fatal outcome. A male newborn
presented congenital disseminated erythematous scaly lesions. The biopsy was
conclusive for Langerhans cell histiocytosis. The patient evolved into the
multisystemic form in weeks, when chemotherapy was started, according to the
LCH-2009 protocol; however, the patient was refractory to treatment and
died.
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Affiliation(s)
- Ana Paula Frade
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro (RJ), Brazil
| | | | - Anna Beatriz Willemes Batalha
- Department of Hematology, Instituto de Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro (IPPMG-UFRJ) - Rio de Janeiro (RJ), Brazil
| | - Ana Paula Silva Bueno
- Department of Hematology, Instituto de Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro (IPPMG-UFRJ) - Rio de Janeiro (RJ), Brazil
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18
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Sitaula RK, Khatri A. Langerhans cell histiocytosis with hemorrhagic uveitis and exudative retinal detachment. Int Med Case Rep J 2018; 11:65-68. [PMID: 29618940 PMCID: PMC5875406 DOI: 10.2147/imcrj.s162038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Bilateral intraocular involvement in Langerhans cell histiocytosis (LCH) is uncommon. A 15-year-old boy presented with painless decreased vision in right and painful left red eye of 2 weeks duration. Visual acuity was 20/500 and 20/200, respectively. A fixed dilated pupil with exudative retinal detachment was present in the right eye and hemorrhagic iris nodules with hyphema and hypopyon were seen in the left eye. Intraocular pressure was 12 and 31 mmHg, respectively, in each eye. Ocular symptoms were preceded by fever with multiple skin rashes, subcutaneous nodules, and lymph node enlargement. The histopathological examination of skin and lymph node showed histiocytes positive for histiocytic S 100. He was treated with topical steroids and antiglaucoma eye drops along with intravenous vinblastine 6 mg and oral prednisolone (1 mg/kg). Hyphema and hypopyon were resolved, vision improved to 20/320 and 20/80, and intraocular pressure was under control. However, as multisystemic LCH has a poor prognosis, we were unable to save him. Hence, fatal conditions like LCH should also be considered in the differential diagnosis of any hemorrhagic uveitis.
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Affiliation(s)
- Ranju Kharel Sitaula
- Uveitis Department, B.P. Koirala Lions Center for Ophthalmic Studies, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Anadi Khatri
- Fellow of Vitreo-Retina Surgery, Lumbini Eye Institute, Siddharthanagar, Nepal
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Langerhans cell histiocytosis in children - a disease with many faces. Recent advances in pathogenesis, diagnostic examinations and treatment. Postepy Dermatol Alergol 2018; 35:6-17. [PMID: 29599667 PMCID: PMC5872238 DOI: 10.5114/pdia.2017.67095] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/16/2017] [Indexed: 02/06/2023] Open
Abstract
Langerhans cell histiocytosis is a rare clonal disease characterized by the proliferation of CD1a-positive immature dendritic cells. The purpose of this article was to present an updated review of recent advances in the pathogenesis, clinical features, imaging and treatment of this disease. The discovery of oncogenic BRAF mutations and the presence of proinflammatory cytokines and chemokines confirmed the unusual characteristics of this disease. Currently, children with organ involvement who do not have a good response to chemotherapy and have neurodegeneration or diabetes insipidus are the most problematic patients. Further research is needed to improve the results of treatment.
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Addenan M, May CM, Hooi TK, Ismail F, Kamalden TA. A rare case of solitary unifocal Langerhans cell histiocytosis with orbital extension: Diagnostic dilemma. Oman J Ophthalmol 2018; 11:284-287. [PMID: 30505126 PMCID: PMC6219334 DOI: 10.4103/ojo.ojo_149_2017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is rarely encountered in ophthalmology practice. It is a spectrum of disorder characterized by accumulation of histiocytes in various tissues. Diagnosis is challenging as it may simulate periorbital hematoma, rhabdomyosarcoma, and neuroblastoma. We report a case of unifocal LCH with orbital extension. Diagnosis was obtained from incisional biopsy, and histopathological examination showed numerous histiocytes with eosinophilic infiltrations. The presence of Langerhans cells was confirmed by the presence of protein S-100, CD1a, and/or Langerin (CD207). Treatment depends on the degree of organ involvement. She responded well to cytotoxic drugs and steroids. This emphasized that prompt tissue diagnosis is crucial for early management.
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Affiliation(s)
- Maftuhim Addenan
- Department of Ophthalmology, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Choo May May
- Department of Ophthalmology, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Teoh Kean Hooi
- Department of Pathology, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Fazliana Ismail
- Department of Ophthalmology, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Tengku Ain Kamalden
- Department of Ophthalmology, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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Langerhans Cell Histiocytosis of the Orbit: Spectrum of Disease and Risk of Central Nervous System Sequelae in Unifocal Cases. Ophthalmic Plast Reconstr Surg 2016; 32:28-34. [PMID: 25689784 DOI: 10.1097/iop.0000000000000402] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE To describe the spectrum of disease extent and clinical response in Langerhans cell histiocytosis (LCH) presenting with orbital involvement and to determine if unifocal orbital disease increases the risk for central nervous system sequelae (CNS-LCH). METHODS Retrospective chart review of patients with orbital LCH representing a range of severity treated at the Children's Hospital of Wisconsin from 2003 to 2011; analysis of current international treatment protocols; literature review. RESULTS Six patients presenting with orbital LCH are described: 1 with unifocal orbital disease completely responsive to local measures; 1 with multifocal bone disease completely responsive to local intervention; 1 with unifocal orbital disease incompletely responsive to surgical intervention, and requiring systemic chemotherapy; and 3 with multisystem disease at presentation. Literature review identified 806 cases of CNS-LCH. Orbital involvement could be determined in 11 cases. Of these, 6 had multisystem disease and 3 had multifocal bone disease; 1 presented with unifocal orbital disease but progressed to multifocal bone involvement; 1 had insufficient clinical information to distinguish unifocal from multisite presentation. No cases of CNS-LCH directly resulted from isolated unifocal orbital disease. CONCLUSIONS Initial treatment of orbital LCH should depend on disease extent at diagnosis. Unifocal cases that completely respond to biopsy, curettage, and/or corticosteroid instillation may be managed with initial oncologic staging and careful long-term observation, with default to chemotherapy for local recurrence or multisite progression. There is currently little evidence that unifocal orbital disease increases the risk for CNS-LCH and therefore warrants prophylactic systemic chemotherapy in all patients.
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Ramos-Gutiérrez E, Alejo-González F, Ruiz-Rodríguez S, Garrocho-Rangel JA, Pozos-Guillén A. Langerhans cell histiocytosis: Current concepts in dentistry and case report. J Clin Exp Dent 2016; 8:e102-8. [PMID: 26855698 PMCID: PMC4739360 DOI: 10.4317/jced.52498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 08/13/2015] [Indexed: 11/23/2022] Open
Abstract
Langerhans cell histiocytosis (LCH), which is a rare granulomatous pediatric disease of unknown etiology, is characterized by the idiopathic proliferation and accumulation of abnormal and clonal Langerhans cells or their marrow precursors, resulting in localized, solitary or multiple destructive lesions. These lesions are most commonly eosinophilic granuloma, which are found in craniofacial bone structures such as the skull and mandible, skin and other organs. In children, the disease has a variable initial presentation, and the clinical course, prognosis and survival are unpredictable. The aims of this report were to present an LCH case in a girl aged 2 years, 8 months and her clinicopathological features, to describe the bucodental management provided, and to discuss special dental considerations of this disease.
Key words:Children, dental management, histiocytosis, Langerhans cells.
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Affiliation(s)
- Efraín Ramos-Gutiérrez
- DDS, Resident, Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, San Luis Potosi University, SLP, Mexico
| | - Francisco Alejo-González
- MD, MS, Associate Professor, Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, San Luis Potosi University, SLP, Mexico
| | - Socorro Ruiz-Rodríguez
- DDS, MS, Chairman, Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, San Luis Potosi University, SLP, Mexico
| | - José-Arturo Garrocho-Rangel
- DDS, MS, PhD, Associate Professor, Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, San Luis Potosi University, SLP, Mexico
| | - Amaury Pozos-Guillén
- DDS, MS, PhD, Associate Professor, Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, San Luis Potosi University, SLP, Mexico
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Thongtharb A, Uchida K, Chambers JK, Kagawa Y, Nakayama H. Histological and immunohistochemical studies on primary intracranial canine histiocytic sarcomas. J Vet Med Sci 2015; 78:593-9. [PMID: 26668164 PMCID: PMC4873849 DOI: 10.1292/jvms.15-0627] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Histiocytic sarcoma is a progressive and fatal malignant neoplasm that mainly occurs in
middle- to old-aged dogs. This study describes clinicopathological, histological and
immunohistochemical characteristics of intracranial histiocytic sarcomas in 23 dogs.
Magnetic resonance imaging and/or computed tomography of the brains revealed that the
tumors mainly located in the cerebrum, particularly the frontal lobe. Seizure was a
predominant clinical sign in most of the cases. Histologically, the tumor cells were
morphologically classified into round/polygonal- and spindle-shaped cell types. There was
a significant association between tumor cell types and hemophagocytic activity
(P<0.05). However, there was no significant
difference in other clinicopathological parameters and mitotic index between the 2 types.
Immunohistochemically, tumor cells were strongly positive for HLA-DR, Iba-1 and CD204 in
all the 23 cases, for iNOS in 20, for CD163 in 17, for CD208 (DC-LAMP) in 9, for lysozyme
in 8 and for S100 in 5 cases. In addition, the Ki67-proliferative index showed range of
0.50–64.33% (Average 26.60 ± 3.81%). These observations suggest that canine primary
intracranial histiocytic sarcomas tend to exhibit both dendritic cell and macrophage
phenotypes of histiocytic differentiation.
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Affiliation(s)
- Atigan Thongtharb
- Department of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
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Emmanouil D, Birpou E, Chatzidimitriou K, Matsioula C, Christopoulos P, Tosios K. Hand-Schüler-Christian disease presenting with recurrent, bilateral, symmetrical mandibular lesions in an 8-year-old boy: report of a case. SPECIAL CARE IN DENTISTRY 2015; 35:316-21. [PMID: 26243405 DOI: 10.1111/scd.12126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Hand-Schüller-Christian disease (HSC) is the unisystem multifocal form of Langerhans Cell Histiocytosis (LCH) and is primarily seen in infants and children. CASE REPORT An 8-year-old boy was referred for acute mandibular pain. His medical history included otic LCH and diabetes insipidus at age of 11 months. Intraorally, a pressure sensitive swelling, and radiographically, extensive bone loss were revealed on the area of lower second primary molars. The primary molars were extracted and histological examination confirmed the final diagnosis of HSC. The patient was treated with chemotherapy and the lesions decreased considerably. Two years later, a new swelling was recorded in the same area bilaterally. Biopsy confirmed recurrent HSC disease and the patient entered an alternative chemotherapy protocol. Six months later, improvement of the lesions was revealed. CONCLUSIONS Dentists can contribute to a timely and valid identification of HSC disease by correctly differentially diagnosing lesions of head and neck.
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Affiliation(s)
- Dimitris Emmanouil
- Assistant Professor of Paediatric Dentistry, School of Dentistry, University of Athens, Athens, Greece
| | - Eleftheria Birpou
- Postgraduate student of Oral Biology, School of Dentistry, University of Athens, Athens, Greece
| | | | | | - Panos Christopoulos
- Assistant Professor of Oral and Maxillofacial Surgery, School of Dentistry, University of Athens, Athens, Greece
| | - Konstantinos Tosios
- Assistant Professor of Oral Medicine and Pathology, School of Dentistry, University of Athens, Athens, Greece
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Byragani D, Baradhi K, Schendrick I, Koya S. Langerhan Cell Histiocytosis: A Rare Disorder With a Rare Presentation. World J Oncol 2015; 6:335-337. [PMID: 29147428 PMCID: PMC5649723 DOI: 10.14740/wjon880w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2015] [Indexed: 11/11/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare disorder most commonly seen in Caucasians of Northern European decent, male, children. The most common presentation is osteolytic bone lesions. A 44-year-old native American presents with diffuse erythematous, scaling lesions. The patient also had pruritus and lymphadenopathy. These lesions were positive for S-100 and CD1a. The patient was started on chemotherapy which improved her symptoms immensely. This was a rare disease with a rare presentation.
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Affiliation(s)
- Divya Byragani
- University of Oklahoma School of Community Medicine, Tulsa, OK 74135, USA
| | - Krishna Baradhi
- Division of Nephrology and Hypertension, University of Oklahoma School of Community Medicine, Tulsa, OK 74135, USA
| | - Igor Schendrick
- University of Oklahoma, Regional Medical Laboratory, 4142 South Mingo Rd., Tulsa, OK 74146, USA
| | - Supriya Koya
- Utica Park Clinic Oncology, 1245 S Utica Ave Ste 240, Tulsa, OK 74104, USA
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Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a variable disorder involving either single bone or multiorgan systems. The most effective treatment of unifocal osseous lesions is debated in the literature. This study describes the treatment approaches for LCH and demonstrates the effectiveness of biopsy in providing symptom resolution. METHODS Records of 61 patients diagnosed with LCH at a single institution over an 11-year period were reviewed. Thirty-nine patients with biopsy-confirmed diagnoses of unifocal osseous LCH were included in the analysis. At this institution, lesions are surgically treated by incisional biopsy, trocar biopsy, or curettage and grafting. Patients receive chemotherapy on a case-by-case basis, depending on the lesion location and size. A Kaplan-Meier analysis was used to compare time with symptom resolution across treatment groups. RESULTS In the 39 patients with unifocal osseous LCH, treatment approaches included incisional biopsy (n = 18, 46.15%), trocar biopsy (n = 8, 20.51%), incisional biopsy and chemotherapy (n = 8, 20.51%), and biopsy with bone grafting (n = 5, 12.82%). The median time from biopsy to symptom resolution was 5.43 weeks, with an average length of follow-up of 1.59 years. The median time to symptom resolution was 3.86 weeks with incisional biopsy, 5.43 weeks with biopsy and grafting, 5.64 weeks with trocar biopsy, and 16.57 weeks with biopsy and chemotherapy. Overall, there was a significant difference (P = 0.0262) in the time to symptom resolution across the different treatment approaches. Time to symptom resolution was significantly different between incisional biopsy and chemotherapy treatment compared with the incisional biopsy treatment (P = 0.0027), as well as biopsy with grafting treatment (P = 0.0264). CONCLUSIONS Symptom resolution occurred rapidly after biopsy and did not significantly differ among patients who received incisional biopsy, trocar biopsy, or biopsy with grafting. Unifocal osseous LCH likely does not require aggressive surgical or medical management. Biopsy alone both confirms the diagnosis and precedes a predictable resolution of symptoms. LEVEL OF EVIDENCE Level III, retrospective comparative therapeutic study.
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Abstract
PURPOSE The management of Langerhans cell histiocytosis is controversial. This study evaluated our clinical experience and therapeutic results in orbital Langerhans cell histiocytosis. METHODS This is a retrospective, noncomparative interventional case series involving 17 consecutive patients with biopsy-proven orbital Langerhans cell histiocytosis. Response to surgery and chemotherapy and development of diabetes insipidus were the main outcome measures. RESULTS Thirteen (76.5%) of the patients were male and the mean age at diagnosis was 10.7 years (range 2-39 years). The most frequent presenting sign was proptosis (8 patients) and upper eyelid edema (4 patients). Pain was present in 5 cases and periocular redness in 6. No patient reported a history of trauma. The frontal bone was involved in 16 patients followed by the zygomatic in 9 cases. Five patients also had lesions in the calvarium, femur, facial, temporal, and parietal bones. No patients had systemic disease. Ten patients were managed with vinblastine (0.2 mg/kg, 6-12 months) chemotherapy because of major residual tumor burden (5 cases) and multi-bone involvement (5 cases). Four patients were observed following macroscopically complete tumor removal. Three patients with limited anterior orbital soft tissue tumors and single bone involvement received systemic corticosteroids (40 mg/m2/d, 6-10 weeks). No patients developed diabetes insipidus after a median follow-up of 46 months. CONCLUSIONS Macroscopically complete excision of the unifocal tumors may not necessitate any further treatment. Vinblastine chemotherapy following incomplete tumor removal and in patients with multifocal bone disease resulted in recurrence-free survival at 3 years in 90% of patients.
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Miscellaneous Uveal Tumors. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00154-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Herwig MC, Wojno T, Zhang Q, Grossniklaus HE. Langerhans cell histiocytosis of the orbit: five clinicopathologic cases and review of the literature. Surv Ophthalmol 2012; 58:330-40. [PMID: 23246282 DOI: 10.1016/j.survophthal.2012.09.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Revised: 09/14/2012] [Accepted: 09/18/2012] [Indexed: 01/01/2023]
Abstract
Langerhans cell histiocytosis (LCH) is a proliferation of Langerhans cells intermixed with inflammatory cells, in particular eosinophils, that may manifest as unisystem (unifocal or multifocal) or multisystem disease. Orbital involvement typically manifests as a solitary lesion that carries a favorable prognosis. We describe the clinical and histologic spectrum of LCH of the orbit in our five cases. One patient exhibited multifocal unisystem disease; the other four had a localized process. Typical histologic features included numerous histiocytes with varying degrees of giant cell formation and scattered eosinophilic granulocytes. The presence of Langerhans cells was confirmed by CD1a and S100 immunohistochemistry. Transmission electron microscopy demonstrated characteristic intracytoplasmic Birbeck granules. We review the different ophthalmic manifestations of LCH and treatment strategies. As LCH may solely involve the orbit, treatment is based on the degree of organ involvement. LCH should included in the differential diagnosis in tumors of the ocular adnexae, especially in young children.
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Affiliation(s)
- Martina C Herwig
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia 30322, USA
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Iyeyasu JN, Vaz ACM, Reis F, Altemani J, Queiroz LDS, Carvalho KMD. Histiocitose de células de Langerhans diagnosticada em um paciente de idade avançada. Radiol Bras 2012. [DOI: 10.1590/s0100-39842012000400014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A histiocitose de células de Langerhans é uma doença rara caracterizada proliferação de células de Langerhans. Neste artigo descrevemos um caso de histiocitose de células de Langerhans em um paciente de 63 anos, com uma lesão expansiva periorbital como primeiro sintoma e cuja tomografia computadorizada revelou acometimento pulmonar característico da doença. A condução do caso, os achados radiológicos e os resultados são apresentados.
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Lindahl LM, Fenger-Grøn M, Iversen L. Topical nitrogen mustard therapy in patients with Langerhans cell histiocytosis. Br J Dermatol 2012; 166:642-5. [PMID: 21967132 DOI: 10.1111/j.1365-2133.2011.10673.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is characterized by abnormal proliferation and infiltration of Langerhans cells in different organs. The skin is frequently involved either as unisystem or multisystem disease. OBJECTIVES To review the clinical response and side-effects of nitrogen mustard therapy in LCH in children and adults with unisystem or multisystem disease. PATIENTS AND METHODS This retrospective study includes 10 children and four adults with LCH, treated with nitrogen mustard from 1975 to 2010. The median extent of skin involvement was 46% (range 5-100%). RESULTS Overall, 13 patients had complete or partial response. Although eight patients achieved a complete response with a median time of 12·3months (range 36 days to 1·9 years), six of these patients ultimately relapsed. One patient, who had unisystem disease limited to the skin, initially showed progression of her cutaneous lesions with nitrogen mustard treatment. Although subsequently the cutaneous lesions completely regressed, concomitant systemic involvement was noted. Four other patients similarly experienced improvement of their skin lesions with treatment, but also exhibited progression of the LCH systemically. The patients were treated with other therapies prior and adjunctive to nitrogen mustard. However, five patients had progression to other organs, despite regression of skin lesions, which supports that the treatment effect in the skin is related to topical nitrogen mustard. Six patients developed contact dermatitis to nitrogen mustard. CONCLUSIONS Topical nitrogen mustard can be an effective and safe therapy in both children and adults with cutaneous LCH, although relapses are common.
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Affiliation(s)
- L M Lindahl
- Department of Dermatology, Aarhus University Hospital, Aarhus Sygehus, P.P. Oerumsgade 11, 8000 Aarhus C, Denmark.
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Jeunon T, Sousa MAJ, Santos-Rodrigues N, Lopes R. Langerhans cell histiocytosis - a case report. Dermatol Pract Concept 2012. [PMID: 24765546 DOI: 10.5826/dpc.0201a04.] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2022] Open
Abstract
A 17-year-old male presented for dermatologic consultation with slightly elevated reddish papules covered by yellowish scales in the scalp for the last two years and reddish and indurated ulcers in the perineum lasting six months. Additional complaints included polyuria, polydipsia, delay in the development of secondary sexual characteristics and hearing loss of the right ear secondary to a medium otitis. Lesions from scalp and perineum were sampled for histopathologic examination and revealed a dense cellular infiltrate made up of mononuclear cells with conspicuous eosinophilic cytoplasm and large cleaved vesicular nucleus, some of them with shapes resembling the format of a kidney and others reminiscent of coffee beans. Numerous intermingling eosinophils were present. The diagnosis of Langerhans cell histiocytosis was then rendered and confirmed by positive immunostaining of neo-plastic cells for anti-CD1a and anti-S100 protein antibodies. The work-up revealed diabetes insipidus, hypogonadotropic hypogonadism, hiperprolactenemia, growing-hormone deficiency and thickness of the pituitary stalk. The patient was treated with prednisone and vinblastin based chemotherapy regimen for six months with complete remission, but presented recurrence of some lesions in the scalp, which were handled with topical mustard and corticosteroids. After chemotherapy, the endocrinologic disturbances were corrected with hormonal replacement therapy. The patient is currently in good health with a follow-up of five years.
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Affiliation(s)
- Thiago Jeunon
- Departments of Dermatology and Pathology, Hospital Federal de Bonsucesso and ID-Investigação em Dermatologia, Rio de Janeiro, Brazil
| | | | | | - Raquel Lopes
- Department of Dermatology, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil
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Presence of Erdheim-Chester Disease and Langerhans Cell Histiocytosis in the Same Patient: A Report of 2 Cases. J Neuroophthalmol 2011; 31:217-23. [DOI: 10.1097/wno.0b013e31820a204e] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hervey-Jumper SL, Ghori A, Ziewacz JE, McKeever PE, Chandler WF. Langerhans cell histiocytosis of the optic chiasm: case report. Neurosurgery 2011; 68:E556-61. [PMID: 21135729 DOI: 10.1227/neu.0b013e31820206c7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Langerhans cell histiocytosis (LCH) is an uncommon disease, usually affecting the cranium and peripheral bones. We present a rare case of isolated optic chiasm involvement by LCH to highlight the importance of considering LCH in the differential diagnosis of optic chiasm lesions. CLINICAL PRESENTATION A 71-year-old woman presented with a 6-week history of worsening peripheral vision, headaches, weakness, cold sensitivity, and fatigue. She was found to have dense bitemporal hemianopsia. Magnetic resonance imaging revealed a 2-cm lesion, contrast enhancing on T1 and bright on T2 signal, involving the optic chiasm but not the pituitary gland. Preoperative considerations included optic nerve glioma, choristoma of the stalk, sarcoid, hypothalamic glioma, and Langerhans cell histiocytosis. The patient underwent a right subfrontal craniotomy for biopsy of the lesion. The optic chiasm was grossly enlarged with no tissue external to the chiasm. A midline incision was made in the lamina terminalis, and multiple biopsies were taken of firm fibrous material. Histologically, the tumor was characteristic for LCH and included a mixture of histiocytes with features of Langerhans cells, eosinophils, small lymphocytes, macrophages, neutrophils, and plasma cells. CONCLUSION LCH is a rare disease, generally affecting bone, skin, lymph nodes, and in more severe cases, visceral organs. LCH involving the optic pathways is a rare condition that should be included in the differential for adults with mass lesions involving the orbit, eye, optic nerve, or chiasm. Future clinical and basic science research is needed to better understand LCH, its molecular origin, and its growth pattern.
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Affiliation(s)
- Shawn L Hervey-Jumper
- Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA
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Shields CL, Hogarty MD, Kligman BE, Christian C, Ehya H, Shields JA. Langerhans cell histiocytosis of the uvea with neovascular glaucoma: diagnosis by fine-needle aspiration biopsy and management with intraocular bevacizumab and brachytherapy. J AAPOS 2010; 14:534-7. [PMID: 21168078 DOI: 10.1016/j.jaapos.2010.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 09/16/2010] [Accepted: 10/01/2010] [Indexed: 10/18/2022]
Abstract
A 6-year-old boy with known multisystem Langerhans cell histiocytosis developed photophobia, conjunctival injection, iris neovascularization, and an iridociliochoroidal mass. Fine-needle aspiration biopsy revealed mononucleated and multinucleate histiocytes that demonstrated positive immunostaining for CD68 and S100 consistent with Langerhans cell histiocytosis. Management with intracameral bevacizumab (1.25 mg/0.05 mL) resolved the iris neovascularization, and plaque radiotherapy (brachytherapy) resolved the mass rapidly and completely, preserving the patient's visual acuity and preventing glaucoma during the 10-month follow-up.
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Affiliation(s)
- Carol L Shields
- Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
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Li Z, Yanqiu L, Yan W, Xiaoying Q, Hamze F, Siyuan C, Hongxiang C, Jiawen L, Chunsen W, Yating T, Changzheng H. Two case report studies of Langerhans cell histiocytosis with an analysis of 918 patients of Langerhans cell histiocytosis in literatures published in China†. Int J Dermatol 2010; 49:1169-74. [DOI: 10.1111/j.1365-4632.2009.04360.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wang Y, Hammes F, De Roy K, Verstraete W, Boon N. Past, present and future applications of flow cytometry in aquatic microbiology. Trends Biotechnol 2010; 28:416-24. [DOI: 10.1016/j.tibtech.2010.04.006] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 04/26/2010] [Accepted: 04/29/2010] [Indexed: 10/19/2022]
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Wang J, Wu X, Xi ZJ. Langerhans cell histiocytosis of bone in children: a clinicopathologic study of 108 cases. World J Pediatr 2010; 6:255-9. [PMID: 20549416 DOI: 10.1007/s12519-010-0205-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2009] [Accepted: 07/06/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a rare disease that is characterized by abnormal proliferation of pathological Langerhans cells (LCs). In this study, a total of 108 pediatric patients with LCH of bone were evaluated retrospectively for illustrating the clinicopathologic features of this disease, with a goal of improving the diagnosis, treatment, and prognosis. METHODS A retrospective study was based on the clinical records and pathological data of 108 patients (13 days to 12 years of age) with LCH of bone from a single hospital. Hematoxylin-eosin stain and immunohistochemical stain were applied. The follow-up was conducted to June 2008. RESULTS The peak age of the patients ranged between 3 years and 6 years (80.6%, 87/108), and male gender predominated. The most common clinical presentation was local pain, and the imaging findings commonly showed an isolated lytic lesion in the bone. Of the 108 patients, 79 (73.1%) had single bone involvement, 27 (25.0%) had multi-bone involvement (with or without related skin involvement), and 2 (1.8%) had multisystem involvement. Histologically, all the lesions revealed abnormal proliferation of pathological Langerhans cells along with an admixture of eosinophils, lymphocytes, and other inflammatory cells. The LCs have similar shape and are positive for cluster of differentiation 1a (CD1a) (100.0%, 60/60), S100 (90.0%, 54/60), CD68 (41.7%, 25/60), lysozyme (Lys) (40.0%, 24/60), and macrophage antigen compound (MAC) 387 (30.0%, 18/60); cytokeratin (CK) and epithelial membrane antigen (EMA) were negative. The overall survival rate was 98.0% at a median follow-up of 5 years. CONCLUSIONS LCH of bone in children is predominant in males and usually shows as an isolated lytic lesion. Histologically, the lesions reveal abnormal proliferation of pathological Langerhans cells, admixed with various types of inflammatory cells. The patients have a good prognosis, except those with multi-system involvement.
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Affiliation(s)
- Jia Wang
- Department of Pathology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
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Chen J, Du YJ. Digestive system manifestations, diagnosis and treatment of Langerhans cell histiocytosis. Shijie Huaren Xiaohua Zazhi 2010; 18:531-535. [DOI: 10.11569/wcjd.v18.i6.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare disease characterized by an abnormal proliferation of histiocytes, known as Langerhans cells (LCs). At present, the pathogenesis of LCH remains unknown. LCH often involves the bone, skin, lung, bone marrow and lymph nodes. Besides, the liver, bile duct and gastrointestinal tract may also be affected. LCH has no specific clinical manifestations compared to other digestive system diseases. Once digestive system involvement is diagnosed in LCH patients, prompt treatment (even liver transplantation) should be given. In this paper, we will review the digestive system manifestations, diagnosis and treatment of LCH.
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[Orbital langerhans cell histiocytosis: a multidisciplinary approach]. An Pediatr (Barc) 2010; 72:160-1. [PMID: 20116354 DOI: 10.1016/j.anpedi.2009.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2009] [Revised: 11/03/2009] [Accepted: 11/04/2009] [Indexed: 10/19/2022] Open
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