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Wongpattaraworakul W, Krongbaramee T, Lanzel EA, Hellstein JW, Teixeira FB. Hematolymphoid neoplasm mimicking endodontic lesions: case series and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2024:S2212-4403(24)00406-1. [PMID: 39179451 DOI: 10.1016/j.oooo.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/16/2024] [Accepted: 07/20/2024] [Indexed: 08/26/2024]
Abstract
Hematolymphoid neoplasms originating in the periapical region of a tooth are rare occurrences. Their signs, symptoms, and radiographic findings can also mimic lesions of endodontic origin. History-taking and clinical examination provide clues to determine the possibility of a non-endodontic lesion, although the definitive diagnosis can only be rendered based on histologic examination. In our case series, we present four cases of hematolymphoid neoplasms that radiographically mimicked endodontic lesions. All the cases initially underwent endodontic treatment, but the lesions failed to resolve. In one case, the clinician suspected a diagnosis of lymphoma based on the patient's history. In the other cases, the clinicians' impression was that the lesions originated from endodontic issues. We present two cases of diffuse large B-cell lymphoma, a case of a plasma cell neoplasm, and a case of Langerhans cell histiocytosis, along with a literature review of three entities when found in the oral cavity as well as review of hematolymphoid neoplasm mimicking endodontic lesion previously reported in literature.
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Affiliation(s)
- Wattawan Wongpattaraworakul
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA; Division of Oral Diagnostic Sciences, Faculty of Dentistry, Thammasat University, Pathumthani, Thailand
| | - Tadkamol Krongbaramee
- Division of Endodontics, Department of Restorative Dentistry & Periodontology, Chiang Mai University, Chiang Mai, Thailand
| | - Emily A Lanzel
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA
| | - John W Hellstein
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA
| | - Fabricio B Teixeira
- Department of Endodontics, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA.
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2
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Alsharif MT, Badr F, Mair Y, Komo H, Alkeheli M, Binmadi N. Spontaneous pathological mandibular fracture in a 48-year-old patient. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:566-572. [PMID: 38508905 DOI: 10.1016/j.oooo.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/18/2024] [Accepted: 02/26/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Maha T Alsharif
- Department of Oral Diagnostic Sciences, King Abdulaziz University Faculty of Dentistry, Jeddah, Saudi Arabia.
| | - Fatma Badr
- Department of Oral Diagnostic Sciences, King Abdulaziz University Faculty of Dentistry, Jeddah, Saudi Arabia
| | - Yasmin Mair
- Department of Oral Diagnostic Sciences, King Abdulaziz University Faculty of Dentistry, Jeddah, Saudi Arabia
| | - Hisham Komo
- Department of Oral and Maxillofacial Surgery, King Abdulaziz University Faculty of Dentistry, Jeddah, Saudi Arabia
| | - Madawi Alkeheli
- Department of Oral Diagnostic Sciences, King Abdulaziz University Faculty of Dentistry, Jeddah, Saudi Arabia
| | - Nada Binmadi
- Department of Oral Diagnostic Sciences, King Abdulaziz University Faculty of Dentistry, Jeddah, Saudi Arabia
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3
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Georgiev A, Genova S, Uchikov P, Kraev K, Kraeva M, Chakarov D, Uchikov A. Solitary primary intraosseous xanthoma of the mandible in a 15-year-old boy: a case report. J Med Case Rep 2024; 18:225. [PMID: 38711147 PMCID: PMC11075217 DOI: 10.1186/s13256-024-04534-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/01/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND A xanthoma is a rare bone condition consisting of a predominant collection of lipid-rich, foamy histiocytes. The central xanthoma of the jaws is a unique benign tumor. CASE REPORT A 15-year-old Caucasian male has been presented to our department. He had radiological changes in the area of the left mandibular angle, with an area of diffuse osteolysis of 3.0 cm by 2.0 cm. Computed tomography reveals an area of diffuse osteolysis that starts from the distal root of the lower second molar and reaches the ascending process. A bone biopsy was performed, which revealed a benign proliferative process composed of histiocytic cells involving and infiltrating trabecular bone in a background of loose fibrous connective tissue devoid of any other significant inflammatory infiltrate. The size of the formation was 2.9 cm by 2.0 cm. Immunohistochemical staining for CD68 was strongly positive and negative for S-100 and CD1a. From routine blood tests, cholesterol, triglycerides, and blood sugar are within normal values, which excludes systemic metabolic disease. Subsequent to the surgical intervention, the patient underwent postoperative assessments at intervals of 14, 30, 60 days, and a year later, revealing the absence of any discernible complications during the aforementioned observation periods. CONCLUSION The diagnosis of primary xanthoma of the mandible is rare and can often be confused with other histiocytic lesions. A differential diagnosis should be made with nonossifying fibroma and Langerhans cell histiocytosis, as in our case. In these cases, immunohistochemistry with CD 68, S-100, and CD1a, as well as blood parameters, are crucial for the diagnosis.
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Affiliation(s)
- A Georgiev
- Department of Maxillo Facial Surgery, Multiprofile Hospital for Active Medical Treatment "Sv. Panteleimon" Plovdiv, Plovdiv, Bulgaria
| | - S Genova
- Department of General and Clinical Pathology, Medical Faculty, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - P Uchikov
- Department of Special Surgery, Medical Faculty, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Krasimir Kraev
- Department of Propedeutics of Internal Diseases, Medical Faculty, Medical University of Plovdiv, 15A Vasil Aprilov Boulevard, Plovdiv, 4000, Bulgaria.
| | - M Kraeva
- Department of Otorhinolaryngology, Medical Faculty, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - D Chakarov
- Department of Propaedeutics of Surgical Diseases, Section of General Surgery, Faculty of Medicine, Medical University of Plovdiv, 4002, Plovdiv, Bulgaria
| | - A Uchikov
- Department of Special Surgery, Medical Faculty, Medical University of Plovdiv, Plovdiv, Bulgaria
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4
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Sekar R, Raja K. Langerhans Cell Histiocytosis of the Nose and Maxilla: A Rare Presentation. Indian J Otolaryngol Head Neck Surg 2023; 75:4106-4109. [PMID: 37974832 PMCID: PMC10646049 DOI: 10.1007/s12070-023-04075-8] [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: 07/02/2023] [Accepted: 07/10/2023] [Indexed: 11/19/2023] Open
Abstract
Langerhans cell histiocytosis (LCH) is a disease characterized by localized and generalized proliferation of the histiocytes. It is a locally aggressive condition. The clinical presentation is highly variable and can range from isolated, self-healing skin or bone lesions to life-threatening multisystem disease. It can present as a unifocal or multifocal disease. The majority are present in the head and neck region, but the involvement of Paranasal sinuses is rare. Here we describe a 64-years-old female who presented with a slow-growing left nasal mass for 1 year. Evaluation of the patient was suggestive of malignancy, but the biopsy report turned out to be Langerhans cell histiocytosis; subsequently left, total maxillectomy was done. We hereby present a unique case of LCH with isolated nose and paranasal sinus involvement.
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Affiliation(s)
- Raghul Sekar
- Department of Otorhinolaryngology , Saveetha Medical College and Hospital , Chennai, India
| | - Kalaiarasi Raja
- Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research(JIPMER), Puducherry, 605006 India
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5
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Shakya R, Koirala B, Dongol A, Maharjan IK, Keshwar S, Jain N, Shrestha A. Langerhans cell histiocytosis in a pediatric patient: A typical presentation with oral manifestations. Clin Case Rep 2023; 11:e7645. [PMID: 37426687 PMCID: PMC10323083 DOI: 10.1002/ccr3.7645] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/05/2023] [Accepted: 06/15/2023] [Indexed: 07/11/2023] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare hematological disorder characterized by abnormal proliferation of Langerhans cells. Head and neck region is commonly involved with oral manifestations appearing first in many instances. A thorough knowledge of the disorder and an interdisciplinary approach warrant for the better outcome of the condition.
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Affiliation(s)
- Royasa Shakya
- Department of Pedodontics and Preventive DentistryB.P. Koirala Institute of Health SciencesDharanNepal
| | - Bandana Koirala
- Department of Pedodontics and Preventive DentistryB.P. Koirala Institute of Health SciencesDharanNepal
| | - Ashok Dongol
- Department of Oral and Maxillofacial SurgeryB.P. Koirala Institute of Health SciencesDharanNepal
| | - Iccha Kumar Maharjan
- Department of Oral Medicine and RadiologyB.P. Koirala Institute of Health SciencesDharanNepal
| | - Shashi Keshwar
- Department of Oral PathologyB.P. Koirala Institute of Health SciencesDharanNepal
| | - Neetu Jain
- Department of Oral PathologyB.P. Koirala Institute of Health SciencesDharanNepal
| | - Ashish Shrestha
- Department of Oral PathologyB.P. Koirala Institute of Health SciencesDharanNepal
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Schwartz TR, Elliott LA, Fenley H, Ramdas J, Scott Greene J. Langerhans Cell Histiocytosis of the Head and Neck: Experience at a Rural Tertiary Referral Center. Ann Otol Rhinol Laryngol 2023; 132:431-439. [PMID: 35656804 DOI: 10.1177/00034894221098466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Retrospectively analyze head and neck Langerhans Cell Histiocytosis at a rural tertiary referral center and compare results with previously published data. METHODS Electronic health record review was performed from 2003 to 2019. Patients with biopsy proven LCH with primary head and neck involvement were included. Demographics, presentation, imaging characteristics, treatment modality, delay in diagnosis (DD, ≥60 days), and outcomes were analyzed and reported. RESULTS Twenty-four patients were included. The most common presenting symptoms were otorrhea (n = 6) and scalp pain or swelling (n = 6). All patients had bony involvement. The most common site was facial or skull lesions (n = 20). Most skull lesions (75%) demonstrated CNS risk. Six patients were treated with primary surgery, 15 with primary chemotherapy, and 3 with surgery plus adjuvant chemotherapy. Nine patients experienced relapse of disease with median time to documented relapse of 11.4 months; all were treated with salvage chemotherapy to achieve complete remission (median follow-up: 72 months). Patients most likely to relapse were those with multisystem disease (5/7, 71.4%), temporal bone lesions (4/7, 57.1%), and DD (7/12, 58.3%). Of the 9 total patients who experienced relapse, 78% had a delay in diagnosis. CONCLUSIONS LCH is a complex disease process in which diagnosis can be delayed if not considered in the differential. Within the head and neck, the skull, including isolated temporal bone involvement, is the most common site of involvement. Treatment modality does not appear to have an influence on relapse rates. Relapse was more likely to occur in the first year after treatment and close monitoring is required.
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Affiliation(s)
- Tyler R Schwartz
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Leighton A Elliott
- Division of Hematology/Oncology, University of Florida Department of Medicine, Gainesville, FL, USA
| | - Heather Fenley
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Jagadeesh Ramdas
- Department of Pediatric Hematology and Oncology, Janet Weis Children's Hospital, Geisinger Medical Center, Danville, PA, USA
| | - Joseph Scott Greene
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, PA, USA
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7
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Phan DAT, Phung GB, Duong TT, Hoang AV, Ngo QD, Trinh DTN, Tran TT. The Value of BRAF VE1 Immunoexpression in Pediatric Langerhans Cell Histiocytosis. Fetal Pediatr Pathol 2022; 41:558-567. [PMID: 33295826 DOI: 10.1080/15513815.2020.1857483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
IntroductionVE1 is a monoclonal antibody detecting mutant BRAF V600E protein by immunohistochemistry (IHC) with a high concordance rate with molecular analysis in many cancers. Materials and methods: BRAF V600E mutation was assessed on 94 pediatric LCH patients using sequencing analysis and VE1 immunohistochemistry with stringent and lenient-scoring criteria. Results: BRAF V600E mutation exon 15 was detected by sequencing in 47.9% of LCH cases. BRAF V600E mutation rate in multiple-system LCH was 65.2%, significantly higher than in single-system LCH (p = .001). VE1 assays showed 35.6% sensitivity, 75.5% specificity (Stringent criteria), and 91.1% sensitivity, 35.7% specificity (Lenient criteria). Conclusions: The proportion of BRAF V600E mutational status was relatively high and related to high-risk LCH. Molecular assays for BRAF mutation detection are preferred in LCH lesions. VE1 is not ready as an alternative option for LCH BRAF testing.
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Affiliation(s)
- Dang Anh Thu Phan
- Pathology Department, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam
| | - Gia Bao Phung
- Pathology Department, City Children Hospital- Ho Chi Minh City, Viet Nam
| | - Thanh Tu Duong
- Pathology Department, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam
| | - Anh Vu Hoang
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam
| | - Quoc Dat Ngo
- Pathology Department, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam
| | | | - Thanh Tung Tran
- Pathology Department, Children's Hospital 1- Ho Chi Minh City, Viet Nam
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8
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Manifestation of Langerhans cell histiocytosis in the oral cavity: The authors’ experience. POSTEP HIG MED DOSW 2022. [DOI: 10.2478/ahem-2021-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background. Langerhans cell histiocytosis is a rare reactive proliferative disorder marked by excess proliferation and accumulation of mononuclear phagocytes in tissues and organs. Usually, organs and systems where Langerhans cells are normally found are involved. Lesions may be limited to one system and be single- or multisite, or many systems may be involved. The etiology is not fully known. According to one of the hypotheses, immune dysfunction due to exuberant response to an unknown antigen may be the cause. The most common clinical symptoms include skin lesions, bone pain, exophthalmos, and enlarged lymph nodes, affecting the liver and spleen. Gingivitis, pocket granulation tissue, ulceration of the gingival papilla, alveolar bone atrophy leading to loosening and loss of teeth are observed in the oral cavity. The aim of the study was to determine the type and incidence of oral manifestations in patients diagnosed with Langerhans cell histiocytosis.
Methods. We evaluated patients’ medical records to obtain data on the children’s age at diagnosis, sex, the form of Langerhans cell histiocytosis, clinical picture (systemic and local oral symptoms), and radiological findings. Dental examinations (clinical and radiological) were performed to assess oral mucosa and periodontal tissues, and medical records were analyzed for the course and treatment of histiocytosis.
Results. The analysis included the medical records of 43 patients with Langerhans cell histiocytosis. Oral lesions in the form of gingivitis, pathological tooth mobility, and expansion of alveolar mandibular bone were observed in 7 patients. Conclusions. Langerhans cell histiocytosis may be accompanied by maxillary, gingival, and mucosal lesions.
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9
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Faustino ISP, Fernandes PM, Pontes HAR, Mosqueda-Taylor A, Santos-Silva AR, Vargas PA, Lopes MA. Langerhans cell histiocytosis in the oral and maxillofacial region: An update. J Oral Pathol Med 2021; 50:565-571. [PMID: 34091963 DOI: 10.1111/jop.13207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a rare disorder characterized by abnormal proliferation and infiltration of histiocytic cells. METHODS This review focused on the main aspects associated with LCH. RESULTS LCH can involve single or multiple organs and systems, with bone and skin being the most commonly affected sites. Regarding skeletal manifestations, the jawbones are involved in about 20%-30% of all cases. Such lesions may present as unilocular or multilocular images mainly affecting the posterior mandible. Oral soft tissue lesions may also occur, with the gingiva and hard palate being the most frequently affected sites. CONCLUSION The diagnosis and management of LCH are challenging, requiring a multidisciplinary approach, with dentists playing a central role since oral manifestations can be the first sign of the condition.
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Affiliation(s)
| | - Patrícia Maria Fernandes
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | | | | | - Alan Roger Santos-Silva
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Pablo Agustin Vargas
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Marcio Ajudarte Lopes
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
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10
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Ono K, Okui T, Kunisada Y, Obata K, Masui M, Ryumon S, Ibaragi S, Nakamura T, Sasaki A. A case of langerhans cell histiocytosis of the mandible that spontaneously regressed after biopsy in a child. Clin Case Rep 2021; 9:e04321. [PMID: 34194804 PMCID: PMC8223692 DOI: 10.1002/ccr3.4321] [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: 02/15/2021] [Revised: 04/20/2021] [Accepted: 04/26/2021] [Indexed: 12/24/2022] Open
Abstract
In younger patients of LCH, we should consider that the effectiveness of follow-up without aggressive treatment for SS-type LCH in the oral and maxillofacial bone. However, there are very rare case in which an SS-type LCH recurred after showing a healing tendency. Regular follow-up must be performed even after healing.
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Affiliation(s)
- Kisho Ono
- Department of Oral and Maxillofacial SurgeryDentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
| | - Tatsuo Okui
- Department of Oral and Maxillofacial SurgeryDentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
- Department of Oral and Maxillofacial SurgeryFaculty of MedicineShimane UniversityShimaneJapan
| | - Yuki Kunisada
- Department of Oral and Maxillofacial SurgeryDentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
| | - Kyoichi Obata
- Department of Oral and Maxillofacial SurgeryDentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
| | - Masanori Masui
- Department of Oral and Maxillofacial SurgeryDentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
| | - Shoji Ryumon
- Department of Oral and Maxillofacial SurgeryDentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
| | - Soichiro Ibaragi
- Department of Oral and Maxillofacial SurgeryDentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
| | - Tomoya Nakamura
- Department of Oral and Maxillofacial SurgeryDentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
| | - Akira Sasaki
- Department of Oral and Maxillofacial SurgeryDentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
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11
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Xie X, Wang J, Ding Y. Recurrent eosinophilic granuloma involving maxilla and mandible in an adult male: an unusual case report. Aust Dent J 2021; 66 Suppl 1:S88-S92. [PMID: 34043826 DOI: 10.1111/adj.12861] [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: 04/15/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 02/05/2023]
Abstract
Langerhans' cell histiocytosis (LCH) is a disease spectrum characterized by the intense infiltration/accumulation of Langerhans' cells in the affected tissues. Eosinophilic granuloma is the mildest form of LCH which mainly affects the skull, mandible, ribs and femur in children and young adults but rarely occurs in the maxilla. Here, we describe an unusual case of eosinophilic granuloma affecting the tissues adjacent to tooth #25 and tooth #46 (FDI numbering system) in a 35-year-old male. Although lesions underwent clinical remission after local radiotherapy, a new lesion appeared 11 months after initial therapy in tooth #18, indicating recurrence of eosinophilic granuloma. Subsequently, the patient was treated with corticosteroid therapy, achieved remission and is disease free after 3 years of follow-up.
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Affiliation(s)
- X Xie
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - J Wang
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Y Ding
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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12
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Cherian LM, Sasikumar D, Sathyan P, Varghese BE. Langerhans cell histiocytosis: A diagnostic enigma in the oral cavity. J Oral Maxillofac Pathol 2021; 25:S27-S31. [PMID: 34083966 PMCID: PMC8123262 DOI: 10.4103/jomfp.jomfp_296_20] [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: 07/15/2020] [Revised: 12/15/2020] [Accepted: 01/29/2021] [Indexed: 11/04/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare reactive and proliferative disease of histiocytes. The disease occurs predominantly in children and rarely in adults. This disease of unknown etiology exhibits extreme clinical heterogeneity. Even though LCH manifests initially in the oral cavity in most of the cases, owing to the relative rarity of the condition, it remains a disease in which the diagnosis is often delayed, missed or misdiagnosed. This is a case of LCH in a child which presented with swelling in the mandibular region.
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Affiliation(s)
- Latha Mary Cherian
- Department of Oral Pathology and Microbiology, Government Dental College, Kottayam, Kerala, India
| | - Dhanya Sasikumar
- Department of Oral Pathology and Microbiology, Government Dental College, Kottayam, Kerala, India
| | - Pradeesh Sathyan
- Department of Oral Pathology and Microbiology, Government Dental College, Kottayam, Kerala, India
| | - Binuja Elsa Varghese
- Department of Oral Pathology and Microbiology, Government Dental College, Kottayam, Kerala, India
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13
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Solitary Hard Palate Langerhans Cell Histiocytosis Demonstrated on PET/CT Scan in an Adult. Clin Nucl Med 2020; 45:811-812. [PMID: 32804762 DOI: 10.1097/rlu.0000000000003248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Langerhans cell histiocytosis (LCH) is rare in adults. Oral and maxillofacial LCH commonly affects the bones of the skull and jaws. Here we report a case of a 57-year-old man with a painless oral mass evaluated by F-FDG PET/CT. PET/CT showed a solitary F-FDG-avid tumor in his left hard palate. LCH was confirmed after surgery. This case reminds us that LCH should be considered in an adult with hypermetabolic hard palate lesion on F-FDG PET/CT.
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14
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Prathap A, Areekkal RR, Thomas E, Pratap N, Udayakumar V. Eosinophilic Granuloma of the Mandible. Ann Maxillofac Surg 2020; 10:254-257. [PMID: 32855953 PMCID: PMC7433976 DOI: 10.4103/ams.ams_139_17] [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: 08/05/2017] [Revised: 09/05/2019] [Accepted: 01/13/2020] [Indexed: 12/05/2022] Open
Abstract
Eosinophilic granuloma (EG) is a rare histiocytic disorder resulting from clonal proliferation of Langerhans cells. Eosinophilic granuloma, the most benign of the three entities of Langerhans cell histiocytosis, may be multiple or solitary. This lesion can affect any bones but commonly involves the mandible when the jaws are affected. It is difficult to make a correct diagnosis on it without proof of a pathological diagnosis, which correlates with the diverse clinical and radiographic presentations of EG in the jaws. This report describes a case of unifocal EG of the mandible occurring in a 6-year-old boy whose initial presentation led to confusion of any solitary bony lesion. A final diagnosis of EG was established after histopathological examination of the biopsy specimen.
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Affiliation(s)
- Akhilesh Prathap
- Department of Oral and Maxillofacial Surgery, Pushpagiri College of Dental Sciences, Thiruvalla, Kerala, India
| | - Ravi Rajan Areekkal
- Department of Oral and Maxillofacial Surgery, Pushpagiri College of Dental Sciences, Thiruvalla, Kerala, India
| | - Eapen Thomas
- Department of Oral and Maxillofacial Surgery, Pushpagiri College of Dental Sciences, Thiruvalla, Kerala, India
| | - Nithin Pratap
- Department of Oral and Maxillofacial Surgery, Pushpagiri College of Dental Sciences, Thiruvalla, Kerala, India
| | - Vinesh Udayakumar
- Department of Oral and Maxillofacial Surgery, Pushpagiri College of Dental Sciences, Thiruvalla, Kerala, India
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15
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Abstract
Signs and symptoms representative of a systemic condition can manifest in the oral cavity and orofacial region. Such conditions may be previously diagnosed, or the orofacial manifestation may be the presenting sign of an acute or chronic systemic condition not previously diagnosed. Pathologic processes in the mouth, jaws, and contiguous structures could have a direct and indirect impact on the patient's overall systemic condition. Moreover, systemic conditions may result in compromised function of the orofacial region or impact patients' oral health profile. This article reviews selected systemic conditions that present or impact on the oral cavity and orofacial region.
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Affiliation(s)
- Joel J Napeñas
- Department of Oral Medicine, Atrium Health's Carolinas Medical Center, PO Box 32861, Charlotte, NC 28232, USA.
| | - Michael T Brennan
- Department of Oral Medicine, Atrium Health's Carolinas Medical Center, PO Box 32861, Charlotte, NC 28232, USA
| | - Sharon Elad
- Division of Oral Medicine, Hospital Dentistry, Eastman Institute for Oral Health, University of Rochester Medical Center, 625 Elmwood Avenue, Rochester, NY 14620, USA
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Zhang C, Gao J, He J, Liu C, Lv X, Yin X, Deng Y, Lu Z, Tian Z. Regulatory T-cell expansion in oral and maxillofacial Langerhans cell histiocytosis. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:547-556. [PMID: 32988807 DOI: 10.1016/j.oooo.2020.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 06/22/2020] [Accepted: 08/02/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Langerhans cell histiocytosis (LCH) is a rare myeloid-origin neoplasm characterized by the expansion and dissemination of CD1 a+/CD207+ dendritic cells (LCH cells), but the rarity of its occurrence has long impeded progress in understanding its pathology. We focus on the potentially important role that regulatory T cells (T-reg) play in the oral and maxillofacial LCH tumor microenvironment (TME). STUDY DESIGN Nine cases of oral and maxillofacial LCH, diagnosed from 2009 to 2019, were collected retrospectively from the affiliated hospitals of Southern Medical University. Immunohistochemistry was conducted characterizing T cells and T-reg phenotype. Data were evaluated by 1-sample Wilcoxon's test. RESULTS Significantly increased frequency and abnormal distributions of T-reg were identified in all the LCH lesion sections. Proliferating T-reg account for a mean average of 11.5% of the total T-cell subsets, with significant difference (Wilcoxon's test; P < .05). CONCLUSIONS T-reg expansion in the localized inflammatory TME leads to a failure of immune regulation by suppressing antitumor response, which can be a latent and significant factor contributing to LCH progression. However, T-reg may also acquire the capability for aiding in initiating T-cell responses under the "cytokine storm" at the beginning of LCH onset. T-reg might contribute to the augmentation of tissue repair by transforming growth factor-β (TGF-β), explaining the self-limiting character of LCH.
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Affiliation(s)
- Chuhan Zhang
- Department of Stomatology, School of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Jingyi Gao
- Department of Stomatology, School of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Jianghai He
- Department of Stomatology, School of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Chundong Liu
- Department of Stomatology, School of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Xiaozhi Lv
- Department of Stomatology, School of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Xuemin Yin
- Department of Stomatology, School of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Yongjian Deng
- Department of Pathology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Zhiyun Lu
- Department of Stomatology, School of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China.
| | - Zhihui Tian
- Department of Stomatology, School of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China.
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Sabrine M, Marouen BR, Riahi I, Karima Z, Nadia Z, Issam Z. A pathologic mandibular fracture revealing a bifocal location of Langerhans cell histiocytosis. Ann Med Surg (Lond) 2020; 56:128-132. [PMID: 32637087 PMCID: PMC7327002 DOI: 10.1016/j.amsu.2020.06.019] [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: 05/04/2020] [Revised: 06/14/2020] [Accepted: 06/14/2020] [Indexed: 11/02/2022] Open
Abstract
Introduction Langerhans cell histiocytosis is a rare disease. When it occurs in the cranium/facial bones, the mandibular location is the most frequent. Presentation of case A 31 years-old man was referred to our department for a mandibular chronic discomfort during an acute exacerbation, spontaneous teeth mobility and an alteration of the dental occlusion revealing a pathologic mandibular fracture.The diagnosis was confirmed by a subsequent CT scan.The surgical procedure was performed under general anesthesia by a maxillo-facial senior surgeon. The therapeutic plan combined teeth extractions, enucleation of both the left maxillary and right mandibular cystic lesions and osteosynthesis of the pathologic mandibular fracture with a miniplate.Histological and immunohistochemistry analysis of the maxillary and mandibular cystic lesions pointed the diagnosis of a bifocal Langerhans cell histiocytosis of the oral cavity.Several investigations were done in order to find another location, showing no abnormalities. Discussion This is a case of rare single system LCH at two distinct locations: one at the mandibular bone and the other at the upper left maxilla. Both were uncovered by an acute exacerbation of a chronic discomfort secondary to a mandibular pathologic fracture. This should draw attention to the issues of the diagnosis. Conclusion An early LCH diagnosis and a multidisciplinary treatment plan allow the improvement of the patient 's prognosis and quality of life.
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Affiliation(s)
- Maamouri Sabrine
- Department of Maxillo Facial and Aesthetic Surgery of Charles Nicole's Hospital, Tunis, Tunisia
| | - Ben Rejeb Marouen
- Department of Maxillo Facial and Aesthetic Surgery of Charles Nicole's Hospital, Tunis, Tunisia
| | - Ines Riahi
- Department of ORL of Charles Nicole's Hospital, Tunis, Tunisia
| | - Zitouni Karima
- Department of Maxillo Facial and Aesthetic Surgery of Charles Nicole's Hospital, Tunis, Tunisia
| | - Zanidi Nadia
- Department of Anatomopathology of Charles Nicole's Hospital, Tunis, Tunisia
| | - Zairi Issam
- Department of Maxillo Facial and Aesthetic Surgery of Charles Nicole's Hospital, Tunis, Tunisia
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19
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Almuzayyen A, Elhassan W, Alabbadi M. Intralesional Triamcinolone for Treating Mandibular Langerhans Cell Histiocytosis: A Case Report and Literature Review. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2019; 7:47-50. [PMID: 30787858 PMCID: PMC6381848 DOI: 10.4103/sjmms.sjmms_84_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Langerhans cell histiocytosis is a rare condition ranging in manifestation from a focal boney lesion to multisystem involvement. Several treatment modalities have been proposed including curettage, low-dose radiotherapy, chemotherapy and intralesional injection of corticosteroids. These treatment options can be used as a single or combined approach. Prognosis depends on the extent of systemic involvement, and solitary lesions respond favorable to treatment. Here, the authors report a case of a 10-year-old male patient with Langerhans cell histiocytosis affecting his right posterior mandible that was successfully treated with intralesional injection of triamcinolone in multiple sessions. Complete recovery was confirmed clinically and radiographically in 18 months from the time of diagnosis.
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Affiliation(s)
- Ahmed Almuzayyen
- Department of Surgery, Dental and Maxillofacial Surgery Unit, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Wahbi Elhassan
- Department of Surgery, Dental and Maxillofacial Surgery Unit, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Mousa Alabbadi
- Department of Surgery, Dental and Maxillofacial Surgery Unit, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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20
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Langerhans cell histiocytosis in children: History, classification, pathobiology, clinical manifestations, and prognosis. J Am Acad Dermatol 2018; 78:1035-1044. [PMID: 29754885 DOI: 10.1016/j.jaad.2017.05.059] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/15/2017] [Accepted: 05/31/2017] [Indexed: 12/16/2022]
Abstract
Langerhans cell histiocytosis (LCH) is an inflammatory neoplasia of myeloid precursor cells driven by mutations in the mitogen-activated protein kinase pathway. When disease involves the skin, LCH most commonly presents as a seborrheic dermatitis or eczematous eruption on the scalp and trunk. Evaluation for involvement of other organ systems is essential, because 9 of 10 patients presenting with cutaneous disease also have multisystem involvement. Clinical manifestations range from isolated disease with spontaneous resolution to life-threatening multisystem disease. Prognosis depends on involvement of risk organs (liver, spleen, and bone marrow) at diagnosis, particularly on presence of organ dysfunction, and response to initial therapy. Systemic treatment incorporating steroids and cytostatic drugs for at least one year has improved prognosis of multisystem LCH and represents the current standard of care.
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21
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Neves-Silva R, Fernandes DT, Fonseca FP, Rebelo Pontes HA, Brasileiro BF, Santos-Silva AR, Vargas PA, Lopes MA. Oral manifestations of Langerhans cell histiocytosis: A case series. SPECIAL CARE IN DENTISTRY 2018; 38:426-433. [DOI: 10.1111/scd.12330] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/13/2018] [Accepted: 07/30/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Rodrigo Neves-Silva
- Oral Diagnosis Department; Piracicaba Dental School; University of Campinas (UNICAMP); Piracicaba São Paulo Brazil
| | - Diego Tetzner Fernandes
- Oral Diagnosis Department; Piracicaba Dental School; University of Campinas (UNICAMP); Piracicaba São Paulo Brazil
| | - Felipe Paiva Fonseca
- Oral Diagnosis Department; Piracicaba Dental School; University of Campinas (UNICAMP); Piracicaba São Paulo Brazil
| | | | | | - Alan Roger Santos-Silva
- Oral Diagnosis Department; Piracicaba Dental School; University of Campinas (UNICAMP); Piracicaba São Paulo Brazil
| | - Pablo Agustin Vargas
- Oral Diagnosis Department; Piracicaba Dental School; University of Campinas (UNICAMP); Piracicaba São Paulo Brazil
| | - Marcio Ajudarte Lopes
- Oral Diagnosis Department; Piracicaba Dental School; University of Campinas (UNICAMP); Piracicaba São Paulo Brazil
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22
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Abstract
Giant cell rich lesions of the temporal bone encompass a wide spectrum of disease that includes infectious, reactive, and neoplastic processes. When dealing with any lesion that can potentially involve bone, it is important to understand both the clinical presentation and to correlate the histologic findings with the radiologic imaging. This review discusses the clinical, the pathologic features including the differential diagnosis, and the treatment of some of the more commonly encountered giant cell rich entities in this region.
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23
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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: 58] [Impact Index Per Article: 9.7] [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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24
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Tamura R, Maeda S, Terashi H. Reconstruction of a severe mandibular pathological fracture caused by Langerhans cell histiocytosis using a free fibula osteocutaneous flap:a case report. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2018; 5:9-13. [PMID: 29372175 PMCID: PMC5769776 DOI: 10.1080/23320885.2017.1421468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 12/20/2017] [Indexed: 12/27/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a rare disease in which Langerhans cells, which are bone marrow-derived antigen-presenting cells, proliferate in single or multiple organs. We successfully treated a patient with unifocal LCH of the mandible with malocclusion due to a severe pathological fracture, using reconstruction with a vascularised free bone.
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Affiliation(s)
- Ryosuke Tamura
- Department of Plastic Surgery, Hyogo Prefectural Awaji Medical CenterSumotoHyogoJapan.,Department of Plastic Surgery, Kobe University Graduate School of MedicineKobeHyogoJapan
| | - Sho Maeda
- Department of Plastic Surgery, Hyogo Prefectural Awaji Medical CenterSumotoHyogoJapan
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of MedicineKobeHyogoJapan
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25
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Bedran NR, Carlos R, de Andrade BAB, Bueno APS, Romañach MJ, Milito CB. Clinicopathological and Immunohistochemical Study of Head and Neck Langerhans Cell Histiocytosis from Latin America. Head Neck Pathol 2017; 12:431-439. [PMID: 29164473 PMCID: PMC6232207 DOI: 10.1007/s12105-017-0867-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 11/13/2017] [Indexed: 01/23/2023]
Abstract
Langerhans cell histiocytosis (LCH) is an inflammatory myeloid neoplastic proliferation with variable clinical behavior caused by the accumulation of CD1a+/CD207+ histiocytes, associated with a variable number of eosinophils, lymphocytes, plasma cells and multinucleated giant cells, most commonly observed in male children. LCH is uncommon in the head and neck region, occurring as ulcerated and reddened plaques or nodules that cause destruction of adjacent soft tissues and bone. The exact etiology of LCH is still unknown and controversial, with possible etiologic role of viruses, including Epstein-Barr virus (EBV). The aim of this study was to describe the clinicopathologic and immunohistochemical features of patients with LCH of the head and neck region. Clinical data from 19 patients with LCH were obtained from the archives of the Federal University of Rio de Janeiro and the Clinical Head and Neck Center of Guatemala. All cases were submitted to morphological, immunohistochemical analysis with CD1a, CD207, CD3, CD20, CD68, S-100 and Ki-67 and in situ hybridization for EBV. Ten cases were female and 9 male, with mean age of 11.5 years. Fourteen cases were located in the oral cavity, three cases in lymph nodes, and two cases in the scalp. In regard to the oral lesions, 13 cases were intra-osseous with six cases in anterior mandible, five cases in posterior mandible, and two cases in posterior maxilla while one case was located exclusively in the gingiva. The inflammatory pattern showed variation in the number of plasma cells, eosinophils and lymphocytes, while tumor cells were positive for CD1a, S-100 and CD68 in all cases, and positive for CD207 in 18 cases. In situ hybridization for EBV were negative in all cases.
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Affiliation(s)
- Natália Rocha Bedran
- Department of Pathology, School of Medicine, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Román Carlos
- Pathology Section, Centro Clínico de Cabeza y Cuello/Hospital Herrera Llerandi, Guatemala City, Guatemala
| | - Bruno Augusto Benevenuto de Andrade
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (FO-UFRJ), Av. Carlos Chagas Filho 373, Prédio do CCS Bloco K, 2° andar Sala 56. Ilha da Cidade Universitária, Rio de Janeiro, 21941-902 Brazil
| | - Ana Paula Silva Bueno
- Pediatric Hematology Section, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mário José Romañach
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (FO-UFRJ), Av. Carlos Chagas Filho 373, Prédio do CCS Bloco K, 2° andar Sala 56. Ilha da Cidade Universitária, Rio de Janeiro, 21941-902 Brazil
| | - Cristiane Bedran Milito
- Department of Pathology, School of Medicine, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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26
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Peters SM, Pastagia J, Yoon AJ, Philipone EM. Langerhans Cell Histiocytosis Mimicking Periapical Pathology in a 39-year-old Man. J Endod 2017; 43:1909-1914. [DOI: 10.1016/j.joen.2017.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/22/2017] [Accepted: 05/30/2017] [Indexed: 12/23/2022]
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27
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Khan A, Peters SM, Han C, Yoon AJ, Philipone EM. A 23-year-old female with a painless left mandibular swelling. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:519-524. [PMID: 28964765 DOI: 10.1016/j.oooo.2017.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/04/2017] [Accepted: 08/18/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Alia Khan
- Columbia University College of Dental Medicine, New York, NY, USA
| | - Scott M Peters
- Division of Oral and Maxillofacial Pathology, Columbia University College of Dental Medicine, New York, NY, USA
| | - Chang Han
- Private Practice, Hackensack, NJ, USA
| | - Angela J Yoon
- Division of Oral and Maxillofacial Pathology, Columbia University College of Dental Medicine, New York, NY, USA
| | - Elizabeth M Philipone
- Division of Oral and Maxillofacial Pathology, Columbia University College of Dental Medicine, New York, NY, USA.
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28
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Affiliation(s)
- Christina McCord
- Division of Oral Pathology, Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, HSA 418A, London, Ontario N6A 5C1, Canada.
| | - Lisa Johnson
- Department of Oral and Maxillofacial Sciences, Faculty of Dentistry, Dalhousie University, 5981 University Avenue, Room 5124, PO Box 15000, Halifax, Nova Scotia B3H 4R2, Canada
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29
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Facciolo MT, Riva F, Gallenzi P, Patini R, Gaglioti D. A rare case of oral multisystem Langerhans cell histiocytosis. J Clin Exp Dent 2017. [PMID: 28638562 PMCID: PMC5474341 DOI: 10.4317/jced.53774] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare disorder characterized by high proliferation of Langerhans dendritic cells. LCH is a solitary or multifocal disease that primarily involves bone tissue and often affects children and young men. A 29 years-old Caucasian man was referred to the Oral Surgery Unit of George Eastman Hospital - Umberto I teaching hospital, with third degree mobility of teeth belonging to second, third and fourth quadrant. Panoramic radiograph showed multiple radiolucent areas with well demarcated borders on the right and left site of the mandible and on the left site of the maxilla. Extractions of compromised teeth and biopsy of the osteolytic tissue were performed. The final diagnosis of multisystem Langerhans cell histiocytosis of the soft and hard tissues of the oral cavity was made. The patient was sent to the Hematology department of Umberto I Teaching Hospital of “Sapienza” – University of Rome for the proper treatment. The present case of rare multisystem LCH involving oral hard and soft tissues shows the strong importance of better investigate, with appropriate additional exams, initial shifty symptoms that could lead to a misdiagnosis.
Key words:Differential diagnosis, microscopic diagnosis, Langerhans cell histiocytosis.
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Affiliation(s)
- Maria-Teresa Facciolo
- Oral Surgery Unit of George Eastman Hospital, Umberto I Teaching Hospital, Rome, Italy
| | - Francesco Riva
- Oral Surgery Unit of George Eastman Hospital, Umberto I Teaching Hospital, Rome, Italy
| | - Patrizia Gallenzi
- Clinical Dentistry Institute of Head and Neck Clinical Area. School of dentistry, Catholic University of Sacred Heart. Largo A. Gemelli, 1 - 00168 Rome, Italy
| | - Romeo Patini
- Clinical Dentistry Institute of Head and Neck Clinical Area. School of dentistry, Catholic University of Sacred Heart. Largo A. Gemelli, 1 - 00168 Rome, Italy
| | - Domenico Gaglioti
- Oral Surgery Unit of George Eastman Hospital, Umberto I Teaching Hospital, Rome, Italy
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30
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Ballester LY, Cantu MD, Lim KPH, Sarabia SF, Ferguson LS, Renee Webb C, Allen CE, McClain KL, Mohila CA, Punia JN, Roy A, López-Terrada DH, John Hicks M, Fisher KE. The use of BRAF V600E mutation-specific immunohistochemistry in pediatric Langerhans cell histiocytosis. Hematol Oncol 2017; 36:307-315. [PMID: 28219109 PMCID: PMC6886693 DOI: 10.1002/hon.2388] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/09/2017] [Accepted: 01/10/2017] [Indexed: 01/01/2023]
Abstract
BRAF p.V600E mutations are detected in greater than 50% of pediatric Langerhans cell histiocytosis (LCH) lesions. However, the use of mutation-specific BRAF V600E immunohistochemistry (IHC) as a surrogate for molecular testing in pediatric LCH is unknown. We tested the mutation-specific BRAF V600E monoclonal antibody (clone VE1) in formalin-fixed, paraffin-embedded LCH samples from 26 pediatric patients (14 males and 12 females, ages 7 mo-17 y) using allele-specific real-time polymerase chain reaction (PCR) with a limit of detection of 0.5% as the comparative gold standard. BRAF VE1 staining was scored for both intensity (0-3+) and percentage of immunoreactive tumor cells (0%-100%). BRAF VE1 immunoreactivity was determined using both lenient (≥1+, ≥1%) and stringent (≥2+, ≥10%) scoring criteria. Using lenient-scoring criteria, we found that the sensitivity and specificity of IHC compared with allele-specific real-time PCR were 100.0% and 18.2%, respectively. The poor specificity of lenient IHC analysis was attributable to weak, 1+ staining in both BRAF-mutated and wild-type LCH. Using stringent-scoring criteria, we found that specificity improved to 100.0% at the expense of sensitivity that decreased to 80.0%. Stringent scoring generated 3 false-negative results, but in all cases, neoplastic tissue comprised less than 5% of the stained section and/or the specimen was decalcified. In conclusion, highly sensitive molecular assays remain the gold standard for BRAF mutation analysis in LCH paraffin-embedded lesions. To avoid false-positive results, unequivocal VE1 staining of 2+ intensity in greater than or equal to 10% neoplastic histiocytes is required. However, negative VE1 results require additional studies to exclude false-negatives, and stringent-scoring criteria may not be optimal for scant or decalcified specimens.
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Affiliation(s)
- Leomar Y Ballester
- Department of Pathology, Texas Children's Hospital, Houston, TX, USA.,Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
| | - Miguel D Cantu
- Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA.,Division of Hematology and Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Karen P H Lim
- Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA.,Division of Hematology and Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Stephen F Sarabia
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
| | | | - C Renee Webb
- Department of Pathology, Texas Children's Hospital, Houston, TX, USA
| | - Carl E Allen
- Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA.,Division of Hematology and Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Kenneth L McClain
- Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA.,Division of Hematology and Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Carrie A Mohila
- Department of Pathology, Texas Children's Hospital, Houston, TX, USA.,Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
| | - Jyotinder N Punia
- Department of Pathology, Texas Children's Hospital, Houston, TX, USA.,Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
| | - Angshumoy Roy
- Department of Pathology, Texas Children's Hospital, Houston, TX, USA.,Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA.,Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - Dolores H López-Terrada
- Department of Pathology, Texas Children's Hospital, Houston, TX, USA.,Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA.,Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - M John Hicks
- Department of Pathology, Texas Children's Hospital, Houston, TX, USA.,Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA.,Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - Kevin E Fisher
- Department of Pathology, Texas Children's Hospital, Houston, TX, USA.,Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
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31
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Raviraj J, Venkata S, Shaik S, Kodadala A, Kakarla P. Multifocal Eosinophilic Granuloma of Jaws and Skull with Classical and Unusual Radiographic/Imaging Findings. J Clin Diagn Res 2017; 11:ZD09-ZD11. [PMID: 28274065 DOI: 10.7860/jcdr/2017/23732.9154] [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] [Received: 08/24/2016] [Accepted: 10/19/2016] [Indexed: 12/23/2022]
Abstract
Eosinophilic granuloma is basically a disorder of reticuloendothelial system and is one of the variants of langerhans cell histiocytosis. Multifocal eosinophilic granuloma affecting jaws and skull is relatively a rare disorder. We hereby report a case of multifocal eosinophilic granuloma involving mandible, maxilla and several skull bones. The present case has mixture of classical floating teeth appearance and an unusual radiographic/imaging finding of periosteal remodeling, which is rarely seen in adult patients of eosinophilic granuloma and pseudo-multilocular appearance in anterior mandibular region in coronal sections and moth-eaten appearance of skull was appreciated in axial slices of Computed Tomography (CT).
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Affiliation(s)
- Jayam Raviraj
- Professor, Department of Oral Medicine and Radiology, CKS Teja Institute of Dental Sciences and Research , Tirupati, Andhra Pradesh, India
| | - Suman Venkata
- Reader, Department of Oral Medicine and Radiology, CKS Teja Institute of Dental Sciences and Research , Tirupati, Andhra Pradesh, India
| | - Sameulla Shaik
- Senior Lecturer, Department of Oral Medicine and Radiology, CKS Teja Institute of Dental Sciences and Research , Tirupati, Andhra Pradesh, India
| | - Amrutha Kodadala
- Ex-Postgraduate Student, Department of Oral Medicine and Radiology, CKS Teja Institute of Dental Sciences and Research , Tirupati, Andhra Pradesh, India
| | - Prashanti Kakarla
- Senior Lecturer, Department of Oral Medicine and Radiology, CKS Teja Institute of Dental Sciences and Research , Tirupati-Andhra Pradesh, India
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Abstract
Extragnathic xanthomas are seen in the bones or as soft tissue masses. They are often associated with hyperlipidemia and are considered as reactive or metabolic lesions. Only 19 cases of xanthomas of the jaws have been reported so far in the English literature. A total of ten cases of central xanthoma of the jaw bones were identified from the Oral and Maxillofacial Pathology biopsy services of the University of Washington and the Tufts University School of Dental Medicine, between the years 2000-2016. The demographic and clinical information on these cases was tabulated logically on the basis of age, gender, location and presence or absence of symptoms, extragnathic lesions and serum hyperlipidemia. Radiographic and histopathological features were also examined. The findings in these cases were correlated with those available from the previously reported cases. Majority of cases are seen in the second and third decades of life. There is no gender predilection. Jaw lesions presented as solitary radiolucencies with a predilection for the posterior mandible. Unlike maxillary lesions, pain and expansion are inconsistent findings in mandibular lesions. Jaw lesions are not associated with extragnathic bone or soft tissue involvement or a hyperlipidemia. The central xanthoma of the jaws is a unique benign tumor. Histopathologically, many other jaw lesions contain variable numbers of foamy histiocytes. Therefore, a diagnosis of a central xanthoma of the jaws must be made after excluding all other such histiocyte containing lesions. This requires correlation of histopathological findings with clinical and radiographic features.
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Chemotherapy in Children with Head and Neck Cancers: Perspectives and Review of Current Therapies. Oral Maxillofac Surg Clin North Am 2016; 28:127-38. [PMID: 26614705 DOI: 10.1016/j.coms.2015.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cancers of the head and neck in children represent a heterogeneous group of malignancies requiring a variety of treatment modalities. In many instances of childhood head and neck cancers, chemotherapy will be required for treatment, often in conjunction with surgery and/or radiation therapy. Chemotherapy in children with head and neck cancers poses unique challenges in terms of immediate as well as long-term toxicities. This article focuses on the common chemotherapeutic agents, with a particular focus on early and late effects, used in the treatment of children with head and neck cancers.
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Gambirazi L, Libório T, Nunes F, Sugaya N, Migliari D. Diagnosis and Intralesional Corticotherapy in Oral Ulcers Occurring as the Sole Manifestation of Langerhans Cell Histiocytosis. A Case Report. Open Dent J 2016; 10:330-7. [PMID: 27398106 PMCID: PMC4920974 DOI: 10.2174/1874210601610010330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 05/04/2016] [Accepted: 05/09/2016] [Indexed: 12/26/2022] Open
Abstract
This article reports a case of oral mucosa lesions as the sole manifestation in Langerhans cell histiocytosis (LCH). This is a very uncommon manifestation of LCH since this disease preferably affects the bones with frequent involvement of the jaws. LCH may also involve other organs, particularly the lungs, liver, lymph nodes, and skin. The highlights of this report are the differential diagnosis, immunohistochemical analysis and, mostly, the therapeutic approach.
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Affiliation(s)
- Liane Gambirazi
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Tatiana Libório
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Fábio Nunes
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Norberto Sugaya
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Dante Migliari
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Vargas A, Ramírez H, Ramírez P, Foncea C, Venegas B, Astorga P. Spontaneous remission of eosinophilic granuloma of the maxilla after incisional biopsy: a case report. Head Face Med 2016; 12:21. [PMID: 27251410 PMCID: PMC4890254 DOI: 10.1186/s13005-016-0118-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 05/24/2016] [Indexed: 12/11/2022] Open
Abstract
Background Langerhans cell histiocytosis (LCH), previously known as Histiocytosis X, is an infrequent disease that congregates a wide spectrum of clinical presentations with variable systemic involvement. Unification of these diseases under only one category is based on the almost identical histopathologic features of the lesions, but the etiology and proper approach for each presentation remains controversial. The localized alternative of Langerhans cell histiocytosis (LLCH), known as Eosinophilic Granuloma (EG) of bone, is the predominant clinical presentation of LCH. The maxilla is involved in 1 % of the head and neck region cases, representing an uncommon condition in this area. Case Presentation In this clinical case report, it is described a case of a 16-year-old male patient with an asymptomatic osteolytic lesion at first upper left molar apical level, a finding detected on control radiographic images was reported as “Monostotic Eosinophilic granuloma of the maxillary bone”, which was later confirmed through an incisional biopsy. A surgical excision was initially planned, but finally it was not performed due to a spontaneous healing of the lesion after the incisional biopsy. Conclusions The presented case supports a conservative approach in the management of solitary EG of maxillary and mandibular bone lesions and even supports an expectant attitude in the course of treatment given the possibility of a spontaneous regression after the biopsy, especially in small lesions.
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Affiliation(s)
- Alex Vargas
- DDS. Associated Professor of the Oncology and Maxillofacial Surgery Department, Medicine Faculty, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Hernán Ramírez
- DDS. Associated Professor of the Oncology and Maxillofacial Surgery Department, Medicine Faculty, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Ramírez
- Assistant Professor of Hematology Department, Medicine Faculty, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Camila Foncea
- Resident of Oral and Maxillofacial Surgery Program, Medicine Faculty, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Bernardo Venegas
- Oral Pathologist at the University of Talca and Carlos Van Buren Hospital of Valparaíso, Valparaíso, Chile
| | - Paula Astorga
- Observer of the Oncology and Maxillofacial Surgery Department, Medicine Faculty, Pontificia Universidad Católica de Chile, Santiago, Chile
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Leveson J, Bourque JM, Lukovic J, Dar AR. Radiotherapy for Langerhans Cell Histiocytosis of Bilateral Eyelids. Cureus 2016; 8:e474. [PMID: 27004151 PMCID: PMC4779081 DOI: 10.7759/cureus.474] [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: 10/07/2015] [Accepted: 02/02/2016] [Indexed: 11/30/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare disorder with numerous clinicopathological variants with differing clinical courses, treatment methods, and prognoses. We report one patient with atypical LCH of the bilateral lower eyelids and subsequent successful treatment with local radiation therapy.
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Affiliation(s)
| | | | - Jelena Lukovic
- Department of Radiation Oncology, London Regional Cancer Program
| | - A Rashid Dar
- Department of Radiation Oncology, London Regional Cancer Program
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Gonçalves CF, Morais MO, de Cássia Gonçalves Alencar R, Batista AC, Mendonça EF. Solitary Langerhans cell histiocytosis in an adult: case report and literature review. BMC Res Notes 2016; 9:19. [PMID: 26749317 PMCID: PMC4706661 DOI: 10.1186/s13104-015-1799-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 12/14/2015] [Indexed: 12/23/2022] Open
Abstract
Background Langerhans cell histiocytosis (LCH) is a disease that often affects children, but can also occur in adults and smokers. Oral manifestations are unusual and are characterized by bone pain, tooth mobility, necrotic ulcers and local edema. The aim of this paper is to describe a clinical case of LCH in an oral cavity that mimicked oral squamous cell carcinoma. Case presentation A male, 63 years old, complaining about a “wound in the mouth” for 6 months, without any pain or spontaneous bleeding. His medical history was free of disease. The patient was a smoker for 33 years. Intraoral examination revealed a destructive ulcerative lesion around the upper left first and second molars that resembled an oral squamous cell carcinoma. Biopsy of the ulcerative lesion was performed and the microscopic features showed an inflammatory infiltrate rich in plasma cells. Based on this microscopical finding, the final diagnosis was periodontal disease associated with a proliferative non-neoplastic lesion. The patient was referred to a specialized dental surgeon and underwent periodontal therapy including surgical procedures. After that, according to follow-up with the patient, there were no signs of disease remission. The lesion increased in size, although the patient did not complain of any symptoms. A second biopsy was performed and the microscopic features again showed a rich inflammatory infiltrate with mononuclear cells and histiocytic cells, characterized by pale histiocytes with lobed nuclei, resembling a bean. A varying number of eosinophils also were observed, without any evidence of atypical cells present in this infiltrate. An immunohistochemical staining panel was done to determine the nature of this inflammatory infiltrate by using antibodies S-100, CD1a, CD-68 and CD45RO that were positive. These immunohistochemical findings were fundamental for the final diagnosis of LCH. The treatment included surgical extraction of all superior teeth, radiation and systemic corticoid therapies. After 8 years of treatment, the patient is free of disease. Conclusion Although LCH is an unusual lesion in an oral cavity, it can be present. Biopsy and a histological exam are essential to establish the diagnosis. Immunohistochemicals were fundamental to exclude malignant lesion and to confirm the diagnosis of LCH.
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Affiliation(s)
- Cíntia Ferreira Gonçalves
- Avenida Teotônio Segurado, Cj. 01, Lt. 01, Sl 508, Plano Diretor Sul, Palmas, Tocantins, CEP 77061-002, Brazil.
| | - Marília Oliveira Morais
- Faculdade de Odontologia, Praça Universitária S/N, Setor Universitário, Universidade Federal de Goiás, Goiânia, Goiás, CEP 74605-220, Brazil.
| | | | - Aline Carvalho Batista
- Faculdade de Odontologia, Praça Universitária S/N, Setor Universitário, Universidade Federal de Goiás, Goiânia, Goiás, CEP 74605-220, Brazil.
| | - Elismauro Francisco Mendonça
- Faculdade de Odontologia, Praça Universitária S/N, Setor Universitário, Universidade Federal de Goiás, Goiânia, Goiás, CEP 74605-220, Brazil.
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Plona GA, Wiltz M, Kelsch R. Spontaneous resolution of an eosinophilic granuloma of the mandible following open biopsy. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 122:e60-3. [PMID: 27033671 DOI: 10.1016/j.oooo.2015.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 11/10/2015] [Accepted: 11/15/2015] [Indexed: 12/15/2022]
Abstract
Langerhans cell histiocytosis X is a clonal proliferation of dendritic cells of the immune system, which can affect multiple organ systems and range in behavior from a benign inflammatory process to a much more aggressive process. Only few isolated cases have been reported in the jaws. This case represents an example of Langerhans cell histiocytosis X in the mandible, which resolved following incisional biopsy without any further surgical intervention.
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Affiliation(s)
- Gregory A Plona
- Chief Resident at Montefiore Medical Center, Bronx, NY, USA.
| | - Mauricio Wiltz
- Assistant Professor, Division of Oral and Maxillofacial Surgery, Department of Dentistry, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Robert Kelsch
- Assistant Professor, Departments of Dental Medicine and Pathology and Laboratory Medicine, NSLIJ Health System, New Hyde Park, NY; Attending, Departments of Dentistry and Pathology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
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V Y, E SKR, S N B, A K, Sekhar MSM. Solitary extragnathic langerhans cell histiocytosis - a rare case. J Clin Diagn Res 2015; 9:ZD22-3. [PMID: 25954715 DOI: 10.7860/jcdr/2015/12606.5726] [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] [Received: 12/19/2014] [Accepted: 02/18/2015] [Indexed: 11/24/2022]
Abstract
Langerhans cell histiocytosis (LCH), mainly affects the skull, vertebrae, ribs and mandible in children and the long bones of adults. Symptoms range from none to pain, swelling and tenderness over the site of the lesion. This disease presents oral manifestations which can sometimes be the first expression of the condition. It occurs in three forms namely eosinophilic granuloma in which isolated or multiple bones are involved, But has a good prognosis whereas other variants Hand-Shuller-Christian disease (chronic dessiminated variant) and Letterer-Siwe disease (acute dessiminated form) have poor prognosis. Occasionally only soft tissues are affected without bony involvement. Males are more commonly affected than females. This article describes a rare variant of eosinophilic granuloma of labial mucosa without bony involvement.
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Affiliation(s)
- Yashoda V
- Post Graduate, Department of Oral and Maxillofacial Pathology, SVS Institute of Dental Sciences , Telangana, India
| | - Sharath Kumar Reddy E
- Post Graduate, Department of Oral and Maxillofacial Pathology, SVS Institute of Dental Sciences , Telangana, India
| | - Bhavani S N
- Reader, Department of Oral and Maxillofacial Pathology, SVS Institute of Dental Sciences , Telangana, India
| | - Krishna A
- Assistant Professor, Department of Oral and Maxillofacial Pathology, College of Dentistry, Al Jouf University Sakaka , Al Jouf, Kingdom of Soudi Arabia
| | - M S Muni Sekhar
- Professor and Head, Department of Oral and Maxillofacial Pathology, SVS institute of Dental Sciences , Telangana, India
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Bi L, Sun B, Lu Z, Shi Z, Wang D, Zhu Z. Langerhans cell histiocytosis with multisystem involvement in an infant: A case report. Exp Ther Med 2015; 9:2137-2140. [PMID: 26136948 DOI: 10.3892/etm.2015.2396] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 02/03/2015] [Indexed: 12/11/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a proliferative disease of histiocyte-like cells, with a wide range of clinical presentations that vary from a solitary lesion to more severe multifocal or disseminated lesions. The disease can affect any age group; however, the peak incidence rate is in infants aged between 1 and 3 years-old. Diagnosis of LCH should be based on the synthetical analysis of clinical presentations, in addition to features of imaging and histopathology. Although certain cases regress spontaneously, other patients require systemic chemotherapy together with the administration of steroids. The present study reports the case of an infant with LDH with multisystem involvement, including that of the bone, skin, orbit, spleen and lungs. The patient received chemotherapy and obtained rapid improvement in the involved systems. A total of 2.5 years after completion of the therapy, the patient still remains in follow-up and no evidence of active disease has been noted.
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Affiliation(s)
- Lintao Bi
- Department of Hematology and Oncology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Butong Sun
- Department of Hematology and Oncology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Zhenxia Lu
- Department of Hematology and Oncology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Zhangzhen Shi
- Department of Hematology and Oncology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Dan Wang
- Department of Hematology and Oncology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Zhenxing Zhu
- Department of Hematology and Oncology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
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41
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Vennamaneni NH, Majumdar S, Gautam NS, Uppala D. Langerhans cell histiocytosis (LCH) of the mandible in an adult: a rare case. BMJ Case Rep 2015; 2015:bcr-2014-207537. [PMID: 25589530 DOI: 10.1136/bcr-2014-207537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Sumit Majumdar
- Department of Oral Pathology, GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Nalam Sai Gautam
- Department of Pedodontics, GITAM Dental College, Vishakhapatnam, Andhra Pradesh, India
| | - Divya Uppala
- Department of Oral Pathology, GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
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Mondal D, Julka PK, Jana M, Walia R, Chaudhuri T. Langerhans cell histiocytosis of atlantoaxial joint in a middle-aged man presenting with deafness as first symptom and soft-tissue mass at neck showing excellent response to radiotherapy alone: Report of an extremely rare and unusual clinical condition and review of literature. Ann Indian Acad Neurol 2014; 17:429-32. [PMID: 25506166 PMCID: PMC4251018 DOI: 10.4103/0972-2327.144022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 02/23/2014] [Accepted: 03/02/2014] [Indexed: 11/18/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a disorder of clonal proliferation of dendritic cell mainly occurring in children. Spine involvement is rare. This usually presents with pain and torticollis when neck is involved. Histopathology with immunohistochemistry is confirmatory. Local curative therapy with excision or curettage is used for localized disease. Radiotherapy is usually reserved for selected cases. Systemic chemotherapy is the treatment of choice for widespread systemic disease. In this article, we present an unusual presentation of atlantoaxial LCH with mastoid involvement resulting in hearing loss as the first symptom and quadruparesis in a middle aged male patient, which was also associated with soft-tissue mass at the nape of the neck and deafness. The patient was treated with radical radiotherapy, which provided excellent response to the disease. Involvement of atlantoaxial joint and temporal bone associated with soft-tissue mass neck and deafness in a middle-aged man is an extremely rare clinical situation.
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Affiliation(s)
- Dodul Mondal
- Department of Radiation Oncology, DRBRAIRCH, All India Institute of Medical Sciences, New Delhi, India
| | - P K Julka
- Department of Radiation Oncology, DRBRAIRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Manisha Jana
- Department of Radiodiagnosis, DRBRAIRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Ritika Walia
- Department of Pathology, DRBRAIRCH, All India Institute of Medical Sciences, New Delhi, India
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Shi S, Liu Y, Fu T, Li X, Zhao S. Multifocal Langerhans cell histiocytosis in an adult with a pathological fracture of the mandible and spontaneous malunion: A case report. Oncol Lett 2014; 8:1075-1079. [PMID: 25120660 PMCID: PMC4114718 DOI: 10.3892/ol.2014.2272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 05/23/2014] [Indexed: 11/22/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is rare in the adult population and even rarer with jaw involvement. The current study presents the case of a 39-year-old male who complained of recurrent pain, swelling of the gingiva and an occasional pus-like discharge in the right mandible for one year. The patient was previously prescribed antibiotics, but this did not resolve the problem. An initial panoramic radiograph showed an osteolytic lesion and bone fracture in the right mandible. Eight months later, a new radiograph showed the spontaneous malunion of the fractured mandible. The patient was eventually diagnosed with Langerhans cell histiocytosis by histopathology and immunohistochemistry. Further lesions were found in the ribs and ilium by nuclear bone scanning. The patient was subsequently treated with systemic chemotherapy, and the lesions are currently effectively being controlled. This study is the first to show that spontaneous intralesional bone regeneration may lead to reunification of the mandible fracture caused by LCH in an adult.
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Affiliation(s)
- Sailang Shi
- Dental Clinic, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, P.R. China
| | - Yanming Liu
- Department of Oral and Maxillofacial Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Tao Fu
- Department of Oral and Maxillofacial Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Xiuzhen Li
- Department of Pathology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Shifang Zhao
- Department of Oral and Maxillofacial Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China ; School of Dentistry, Zhejiang University, Hangzhou, Zhejiang 310006, P.R. China
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Sherwani RK, Akhtar K, Qadri S, Ray PS. Eosinophilic granuloma of the mandible: a diagnostic dilemma. BMJ Case Rep 2014; 2014:bcr-2013-200274. [PMID: 24700031 DOI: 10.1136/bcr-2013-200274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Eosinophilic granuloma (EG) is a rare histiocytic disorder resulting from clonal proliferation of Langerhans cells. It accounts for less than 1% of all osseous neoplasms and has a predilection for involving the axial skeleton. Although suspicion of the disease may arise from clinical features and radiographic demonstration of destructive bone lesions, it is still difficult to make a correct diagnosis without proper pathological evaluation. This is more evident when common differentials mimicking EG, both clinically and radiologically, need to be ruled out. This report describes a case of unifocal EG of the mandible occurring in a 4-year-old boy whose initial presentation led to confusion between osteomyelitis, primary bone tumour and lymphoma. A final diagnosis of EG was established after histopathological examination of the biopsy specimen.
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Affiliation(s)
- Rana K Sherwani
- Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, UttarPradesh, India
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Berres ML, Lim KPH, Peters T, Price J, Takizawa H, Salmon H, Idoyaga J, Ruzo A, Lupo PJ, Hicks MJ, Shih A, Simko SJ, Abhyankar H, Chakraborty R, Leboeuf M, Beltrão M, Lira SA, Heym KM, Bigley V, Collin M, Manz MG, McClain K, Merad M, Allen CE. BRAF-V600E expression in precursor versus differentiated dendritic cells defines clinically distinct LCH risk groups. ACTA ACUST UNITED AC 2014; 211:669-83. [PMID: 24638167 PMCID: PMC3978272 DOI: 10.1084/jem.20130977] [Citation(s) in RCA: 276] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Langerhans cell histiocytosis (LCH) is a clonal disorder with elusive etiology, characterized by the accumulation of CD207(+) dendritic cells (DCs) in inflammatory lesions. Recurrent BRAF-V600E mutations have been reported in LCH. In this study, lesions from 100 patients were genotyped, and 64% carried the BRAF-V600E mutation within infiltrating CD207(+) DCs. BRAF-V600E expression in tissue DCs did not define specific clinical risk groups but was associated with increased risk of recurrence. Strikingly, we found that patients with active, high-risk LCH also carried BRAF-V600E in circulating CD11c(+) and CD14(+) fractions and in bone marrow (BM) CD34(+) hematopoietic cell progenitors, whereas the mutation was restricted to lesional CD207(+) DC in low-risk LCH patients. Importantly, BRAF-V600E expression in DCs was sufficient to drive LCH-like disease in mice. Consistent with our findings in humans, expression of BRAF-V600E in BM DC progenitors recapitulated many features of the human high-risk LCH, whereas BRAF-V600E expression in differentiated DCs more closely resembled low-risk LCH. We therefore propose classification of LCH as a myeloid neoplasia and hypothesize that high-risk LCH arises from somatic mutation of a hematopoietic progenitor, whereas low-risk disease arises from somatic mutation of tissue-restricted precursor DCs.
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Affiliation(s)
- Marie-Luise Berres
- Department of Oncological Sciences, 2 Tisch Cancer Institute, and 3 Immunology Institute, Mount Sinai School of Medicine, New York, NY 10029
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Langerhans cell histiocytosis in childhood – Review, symptoms in the oral cavity, differential diagnosis and report of two cases. J Craniomaxillofac Surg 2014; 42:93-100. [DOI: 10.1016/j.jcms.2013.03.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 03/25/2013] [Accepted: 03/25/2013] [Indexed: 12/26/2022] Open
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Other Bone Diseases. Oral Radiol 2014. [DOI: 10.1016/b978-0-323-09633-1.00023-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Brierley DJ, Chee CKM, Speight PM. A review of paediatric oral and maxillofacial pathology. Int J Paediatr Dent 2013; 23:319-29. [PMID: 23496300 DOI: 10.1111/ipd.12029] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This review aims to summarise common paediatric oral and maxillofacial pathology. It will focus on lesions that have a particular predilection for children, lesions that impart significant morbidity or rare and important entities which paediatric specialists may be less familiar with. Although the vast majority of pathology encountered will be benign or require minimal intervention, there are also lesions that may require urgent referral to an appropriate specialist, multidisciplinary team care and significant surgery. Recognition and appreciation of the clinicopathological features should facilitate an appreciation that the growth, anatomy, physiology or relationship of the maxillofacial structures may have been altered by the pathological entity or treatment received.
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Affiliation(s)
- Daniel J Brierley
- Unit of Oral and Maxillofacial Pathology, The School of Clinical Dentistry, Sheffield, UK
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Cho YA, Yoon HJ, Hong SD, Lee JI, Hong SP. Hypothetical pathogenesis of eosinophilic infiltration in Langerhans cell histiocytosis of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:734-42. [PMID: 23773614 DOI: 10.1016/j.oooo.2013.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 04/16/2013] [Accepted: 04/21/2013] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The present study investigated the densities of mast cells and CCL-11/eotaxin-1 expression of tumor cells in Langerhans cell histiocytosis (LCH) of the jaw. STUDY DESIGN Eleven LCH cases arising in the jaws were selected. We evaluated eotaxin-1 expression in LCH cells via immunohistochemical staining. Toluidine blue was used to stain mast cells, with 20 periapical granuloma specimens serving as the control group. RESULTS In all 7 patients with multifocal LCH, jaw lesions were the earliest manifestation. Toluidine blue staining revealed that most of the mast cells involved in LCH were degranulated, and the number of mast cells in LCH lesions was not significantly higher than in periapical granulomas. Upon immunohistochemical examination, all patients but one showed positivity for eotaxin-1 in LCH cells. CONCLUSION This preliminary study suggests that eotaxin-1 expression in LCH cells may contribute to eosinophilic infiltration. Further studies of chemokine-receptor interactions will be needed to confirm this.
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Affiliation(s)
- Young-Ah Cho
- Lecturer, Department of Oral Pathology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
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50
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