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Isolated Langerhans Cell Histiocytosis of the Vulva in a 28-Year-Old Lady: A Report of a Case and Brief Review of the Literature. Case Rep Dermatol Med 2022; 2022:8483008. [PMID: 35801255 PMCID: PMC9256389 DOI: 10.1155/2022/8483008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/14/2022] [Accepted: 06/12/2022] [Indexed: 11/24/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare, proliferative disorder of Langerhans' cells. The presentation can vary from single organ involvement to multisystem and disseminated in severe cases, affecting children more than adults. Isolated vulvar involvement of LCH in a 28-year-old woman has rarely been described and also there are limited data for diagnosis and treatment. Herein, we report the case of a 28-year-old woman with isolated vulvar LCH, misdiagnosed with herpes simplex infection, successfully treated with thalidomide.
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Mauro E, Stefani PM, Gherlinzoni F. Adult Langerhans cell histiocytosis and immunomodulatory drugs: Review and analysis of thirty-four case reports. World J Hematol 2019; 8:1-9. [DOI: 10.5315/wjh.v8.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 10/26/2019] [Accepted: 12/08/2019] [Indexed: 02/05/2023] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare neoplastic disease in dendritic cells. LCH is classified as either a single-system (SS) or multisystem (MS) disease. There is not a standard first-line treatment for LCH in adults. We analyzed the efficacy and safety of immunomodulatory drugs (IMiDs) by searching PubMed/MEDLINE for case reports previously published. The clinical response (nonactive disease or active disease that regressed) was 94% in SS and 53% in MS. IMiDs should only be considered for adults with cutaneous SS involvement; in MS, they should be used only for patients not eligible for more aggressive treatments.
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Affiliation(s)
- Endri Mauro
- Hematology Unit, Ca’Foncello Hospital, Treviso 31100, Italy
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Primary Langerhans Cell Histiocytosis of the Vulva in a Postmenopausal Woman: Response to Treatment With Oral Methotrexate. J Low Genit Tract Dis 2019; 22:169-170. [PMID: 29474236 DOI: 10.1097/lgt.0000000000000375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jorgensen EM, Chen PP, Rutter S, Cron JA. Vulvar Lesions in an 8-Year-Old Girl: Cutaneous Manifestations of Multisystem Langerhans Cell Histiocytosis. J Pediatr Adolesc Gynecol 2018; 31:153-155. [PMID: 28993226 DOI: 10.1016/j.jpag.2017.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/31/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a rare localized or systemic disease characterized by proliferation of myeloid-derived dendritic cells. Vulvar lesions might be the herald symptom of LCH and might mimic other cutaneous lesions. Prognosis varies widely on the basis of the extent and spread of disease. CASE An 8-year-old girl with a 4-month history of vulvar lesions resistant to topical steroids was referred by her pediatrician. Vulvar biopsy was diagnostic for LCH. Imaging studies revealed a left hip lesion consistent with LCH. The patient was subsequently treated for multisystem LCH with vinblastine and prednisone. SUMMARY AND CONCLUSION Although rare, LCH might be diagnosed by gynecologic providers and should be included in the differential diagnosis of genital lesions. We recommend having a low threshold for performing biopsy of vulvar lesions.
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Affiliation(s)
- Elisa M Jorgensen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut.
| | - Peter P Chen
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Sarah Rutter
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Julia A Cron
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
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Affiliation(s)
- Edward Chen
- University of Alabama School of Medicine, Birmingham, Alabama
| | - Peter Pavlidakey
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Naveed Sami
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
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Edelbroek JR, Vermeer MH, Jansen PM, Stoof TJ, van der Linden MMD, Horváth B, van Baarlen J, Willemze R. Langerhans cell histiocytosis first presenting in the skin in adults: frequent association with a second haematological malignancy. Br J Dermatol 2013; 167:1287-94. [PMID: 22835048 DOI: 10.1111/j.1365-2133.2012.11169.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) in adults first presenting in the skin is rare. Guidelines for staging, treatment and follow-up are lacking. OBJECTIVES To better define staging procedures, treatment results and clinical course in adult patients with LCH first presenting in the skin. METHODS Eighteen adult patients with LCH first presenting in the skin were collected from five centres collaborating in the Dutch Cutaneous Lymphoma Group. Clinical records and (skin) biopsy specimens were reviewed and follow-up data were obtained. A literature search on adult patients with LCH presenting in the skin was performed. RESULTS Staging procedures showed extracutaneous disease in three of 16 patients who were adequately staged. One patient had a histologically confirmed lytic LCH bone lesion, while two patients had a myelodysplastic syndrome. During follow-up two of 18 patients developed extracutaneous localizations of LCH. Five patients developed a second haematological malignancy, including (myelo)monocytic leukaemia (two cases), histiocytic sarcoma (one case), diffuse large B-cell lymphoma (one case) and peripheral T-cell lymphoma (one case). Review of the literature revealed six other adult patients with a second haematological malignancy preceding or following a diagnosis of LCH. CONCLUSIONS The results of the present study suggest an increased risk of a second haematological malignancy in adult patients with LCH presenting in the skin. Extensive staging at presentation and long-term follow-up are therefore warranted in such patients.
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Affiliation(s)
- J R Edelbroek
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
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Chang JC, Blake DG, Leung BV, Plaza JA. Langerhans cell histiocytosis associated with lichen sclerosus of the vulva: case report and review of the literature. J Cutan Pathol 2012; 40:279-83. [DOI: 10.1111/cup.12051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 08/28/2012] [Accepted: 10/12/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Jason C. Chang
- Department of Pathology; Medical College of Wisconsin; Milwaukee; WI; USA
| | - David G. Blake
- Department of Hematology/Oncology; Aurora St. Luke's Medical Center; Milwaukee; WI; USA
| | - Belinda V. Leung
- Department of Obstetrics and Gynecology; Aurora St. Luke's Medical Center; Milwaukee; WI; USA
| | - Jose A. Plaza
- Department of Pathology; Medical College of Wisconsin; Milwaukee; WI; USA
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El-Safadi S, Dreyer T, Oehmke F, Muenstedt K. Management of adult primary vulvar Langerhans cell histiocytosis: review of the literature and a case history. Eur J Obstet Gynecol Reprod Biol 2012; 163:123-8. [PMID: 22464205 DOI: 10.1016/j.ejogrb.2012.03.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 02/10/2012] [Accepted: 03/08/2012] [Indexed: 01/27/2023]
Abstract
Primary vulvar Langerhans cell histiocytosis (LCH) is extremely rare and there are no standard treatment options. This review of the published literature with a case report aimed to clarify the optimal treatment for patients with this condition. Medline and PubMed were searched and all cases of primary vulvar LCH reported as single case reports or small case series were reviewed. A patient with vulvar LCH treated in this department is also reported. Twenty-seven cases, including the reported case, were reviewed. First-line treatments included surgery, radiotherapy, chemotherapy, thalidomide and local treatment. The mean follow-up time was 21.1±17.7 months. Although no patient died from the disease, recurrence rates were high (62%) and the mean time to relapse was 10.9±11.8 months (range 1-36 months). Treatment with thalidomide was successful, resulting in long-lasting remission. Disease recurrence is likely after surgery and or radiotherapy, and these treatments together with chemotherapy affect the patient's wellbeing adversely. Although definitive conclusions await further work, thalidomide has minimal adverse effects, is easy to administer and should be considered as a first-line treatment or as maintenance therapy in some patients.
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Affiliation(s)
- Samer El-Safadi
- Department of Gynaecology and Obstetrics, University Hospital Giessen and Marburg GmbH, Giessen, Klinikstrasse 33, D-35392 Giessen, Germany.
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Jiang W, Li L, He YM, Yang KX. Langerhans cell histiocytosis of the female genital tract: a literature review with additional three case studies in China. Arch Gynecol Obstet 2011; 285:99-103. [DOI: 10.1007/s00404-011-2113-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 10/06/2011] [Indexed: 11/24/2022]
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Foley S, Panting K, Bell H, Leonard N, Franks A. Rapid resolution of primary vulval adult Langerhans cell histiocytosis with very potent topical corticosteroids. Australas J Dermatol 2011; 52:e8-e14. [DOI: 10.1111/j.1440-0960.2009.00585.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Simons M, Van De Nieuwenhof HP, Van Der Avoort IA, Bulten J, De Hullu JA. A patient with lichen sclerosus, Langerhans cell histiocytosis, and invasive squamous cell carcinoma of the vulva. Am J Obstet Gynecol 2010; 203:e7-10. [PMID: 20541173 DOI: 10.1016/j.ajog.2010.04.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 03/03/2010] [Accepted: 04/12/2010] [Indexed: 11/26/2022]
Abstract
We report a patient with vulvar lichen sclerosus, Langerhans cell histiocytosis (LCH), and later vulvar cancer. In LCH, high amounts of non functional Langerhans cells are present in the affected tissue, making it possible that LCH may have contributed to vulvar cancer development in this patient.
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Hwang C, Kim YJ, Seo YJ, Park JK, Lee JH, Lee Y. Isolated Langerhans cell histiocytosis of the vulva in an infant. Pediatr Dermatol 2009; 26:751-3. [PMID: 20199460 DOI: 10.1111/j.1525-1470.2009.01028.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Langerhans cell histiocytosis affecting only the vulva of a child is very rare. We report a 1-year-old female infant with isolated Langerhans cell histiocytosis presenting as pruritic papules confined to the vulva, confirmed by histopathology with immunohistochemical staining.
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Affiliation(s)
- Chul Hwang
- Department of Dermatology, College of Medicine Chungnam National University, Daejeon 301-721, Korea
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Isolated Langerhans cell histiocytosis of the vulva: a case report and review of the literature. ACTA ACUST UNITED AC 2007. [DOI: 10.1007/s10397-007-0351-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mottl H, Rob L, Stary J, Kodet R, Drahokoupilova E. Langerhans cell histiocytosis of vulva in adolescent. Int J Gynecol Cancer 2007; 17:520-4. [PMID: 17362323 DOI: 10.1111/j.1525-1438.2007.00791.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) affecting child vulva alone is a very rare disease. Only 13 cases of primary vulvar LCH have been previously reported in the medical literature. We describe an additional case in which the LCH was confined to the vulva, with review of the literature. A 16.5-year-old girl presented with papulous and ulcerative lesions on her labia majora and minora. The biopsy revealed a typical histopathologic finding consistent with LCH. A metastatic work-up did not reveal any evidence of the disease except on the vulva. Treatment was carried out according to LCH II protocol. The patient was diagnosed with a recurrent disorder in the vulva 8 months after the completion of primary chemotherapy. For this reason, she underwent second line treatment with 2-chlorodeoxyadenosine. Eighteen months after the second line chemotherapy, the patient has no signs of a local or systemic recurrence. Primary LCH of vulva is very unusual, but we have to keep in mind this possibility when an adolescent girl presents with an atypical chronic lesion on the vulva. This patient appears to be the first case of adolescent 16.5 year old having a solely cutaneous lesion of the vulva
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Affiliation(s)
- H Mottl
- Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University, Motol, Prague, Czech Republic.
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Abstract
BACKGROUND Few new drugs for treatment of Langerhans cell histiocytosis (LCH) have been studied. Tumor necrosis factor-alpha (TNF-alpha) is a prime therapeutic target since it appears to be present in elevated amounts in LCH lesions. Thalidomide inhibits TNF-alpha production by affecting the gene promoter as well as other anti-cytokine effects. PROCEDURES A Phase II trial of thalidomide for treatment of LCH patients who had failed primary and at least one secondary regimen was conducted. Sixteen patients were enrolled: nine males and seven females ranging in age from 19 months to 45 years. Six patients were high risk (HR) because of spleen, liver, lung, or bone marrow involvement. The low risk (LR) patients included six with bone/skin LCH, one with multiple bone, one with skin/bone/pituitary, one with skin/bone/brain, and one with skin only disease involvement. Fifteen patients remained on treatment from 3 weeks to over 1 year. RESULTS Among the LR patients there were four complete responses, three partial responses, and two with no response to thalidomide. No HR patient responded to thalidomide and all died of pulmonary, liver, or bone marrow failure. Thalidomide may have played a role in the pulmonary failure. Other toxicities that required stopping therapy included neutropenia, peripheral neuropathy, and fatigue. CONCLUSIONS Thalidomide is an effective therapy for some LR patients with LCH, but showed no significant responses in HR patients. Dose-limiting toxicities may reduce its efficacy in LR patients. Additional trials with improved anti-TNF therapies would appear warranted.
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Affiliation(s)
- Kenneth L McClain
- Baylor College of Medicine, Texas Children's Cancer Center/Hematology Service, Houston, Texas, USA.
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Venizelos ID, Mandala E, Tatsiou ZA, Acholos V, Goutzioulis M. Primary Langerhans Cell Histiocytosis of the Vulva. Int J Gynecol Pathol 2006; 25:48-51. [PMID: 16306784 DOI: 10.1097/01.pgp.0000172085.84631.37] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Langerhans cell histiocytosis (LCH) of the female genital tract is very rare. A review of the literature revealed that only 12 cases of primary vulvar LCH have previously been published. We describe an additional case of LCH in which the disease was confined to the vulva. A 64-year-old woman was admitted to our hospital with a nodular mass on her left labium minus, and complete surgical excision was performed. On histological and immunohistochemical examination, the tumor fulfilled the criteria of LCH. A metastatic workup did not reveal any evidence of disease beyond the vulva. The patient received local radiotherapy, and 22 months later she is in excellent condition without local recurrence or metastatic disease.
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Affiliation(s)
- Ioannis D Venizelos
- Department of Pathology, Hippokration General Hospital, Thessaloniki, Greece.
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Padula A, Medeiros LJ, Silva EG, Deavers MT. Isolated vulvar Langerhans cell histiocytosis: report of two cases. Int J Gynecol Pathol 2005; 23:278-83. [PMID: 15213605 DOI: 10.1097/01.pgp.0000130042.31203.b0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Two cases of Langerhans cell histiocytosis involving the vulva are reported. The clinical features of Case 1 have been previously reported. The patients, aged 31 (Case 1) and 52 (Case 2) years, had disease limited to the vulva at the time of diagnosis. In both cases, the vulvar lesions were composed of Langerhans cells with twisted nuclei and nuclear grooves, associated with eosinophils and other inflammatory cells. Immunohistochemical studies using fixed, paraffin-embedded tissue sections showed that the Langerhans cells were positive for CD1A and S-100 protein in both cases, supporting the morphologic diagnosis. The first patient had multiple local recurrences during 3 years despite radiation therapy and vulvectomy, but is currently in remission and being treated with thalidomide. The second patient experienced disseminated disease involving multiple bony sites and the mouth despite radiation therapy. Including the present two cases, 6 of 18 (33%) cases of isolated vulvar LCH subsequently disseminated, most commonly to bone; other patients had local recurrences. Thus isolated vulvar LCH has the potential for aggressive clinical behavior, either as local recurrence or disseminated disease. New treatment modalities are needed for this disease.
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Affiliation(s)
- Anthony Padula
- Department of Hematopathology, The University of Texas-M. D. Anderson Cancer Center, Houston, Texas 77030-4095, USA
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