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Chasset F, Barete S, Charlotte F, Cohen-Aubart F, Arnaud L, Le Pelletier F, Emile JF, Francès C, Amoura Z, Haroche J. Cutaneous manifestations of Erdheim-Chester disease (ECD): Clinical, pathological, and molecular features in a monocentric series of 40 patients. J Am Acad Dermatol 2016; 74:513-20. [PMID: 26785805 DOI: 10.1016/j.jaad.2015.11.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/02/2015] [Accepted: 11/12/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Erdheim-Chester disease (ECD) is a rare form of non-Langerhans cell histiocytosis with possible cutaneous-specific involvement. OBJECTIVES We sought to describe the clinical, pathological, and molecular features of the cutaneous manifestations of 40 patients with ECD identified from a cohort of 123 patients. METHODS Confirmed cases of patients with ECD were included in a single-center retrospective observational study. Clinical and pathological cutaneous features were analyzed and BRAF(V600E) mutation was determined. RESULTS The most frequent ECD cutaneous manifestations were xanthelasma-like lesions (XLL), which occurred in 31 (25%) patients. Other ECD cutaneous lesions were patches or papulonodular lesions. Mixed form of ECD and cutaneous Langerhans cell histiocytosis presented with crusty papules of the folds in some patients. Compared with classic xanthelasma palpebrarum, ECD XLL pathology more frequently involved the reticular dermis, displayed more multinucleated or Touton cells, and showed less extensive fibrosis. BRAF(V600E) mutation was more frequently detected in patients with cutaneous involvement than in those without (76% vs 52%; P = .005) and constantly found in 10 XLL. LIMITATIONS Some clinical data were not available because of the retrospective design of the study. CONCLUSIONS XLL are the most frequent cutaneous ECD manifestations and might be targeted both for pathology and determination of BRAF mutational status.
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Affiliation(s)
- François Chasset
- E3M Institute, Service de Medecine Interne 2, French National Reference Center for Rare Systemic and Autoimmune Diseases, Assistance Publique Hôpitaux de Paris (AP-HP), Groupement Hospitalier Pitié-Salpêtrière, Paris, France; Unit of Dermatology, Assistance Publique Hôpitaux de Paris (AP-HP), Groupement Hospitalier Pitié-Salpêtrière, Paris, France; Department of Dermatology and Allergology, AP-HP, Hôpital Tenon, Paris, France
| | - Stéphane Barete
- Unit of Dermatology, Assistance Publique Hôpitaux de Paris (AP-HP), Groupement Hospitalier Pitié-Salpêtrière, Paris, France; Department of Dermatology and Allergology, AP-HP, Hôpital Tenon, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie (UPMC) Université Paris VI, Paris, France
| | - Frédéric Charlotte
- Department of Pathology, Assistance Publique Hôpitaux de Paris (AP-HP), Groupement Hospitalier Pitié-Salpêtrière, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie (UPMC) Université Paris VI, Paris, France
| | - Fleur Cohen-Aubart
- E3M Institute, Service de Medecine Interne 2, French National Reference Center for Rare Systemic and Autoimmune Diseases, Assistance Publique Hôpitaux de Paris (AP-HP), Groupement Hospitalier Pitié-Salpêtrière, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie (UPMC) Université Paris VI, Paris, France
| | - Laurent Arnaud
- E3M Institute, Service de Medecine Interne 2, French National Reference Center for Rare Systemic and Autoimmune Diseases, Assistance Publique Hôpitaux de Paris (AP-HP), Groupement Hospitalier Pitié-Salpêtrière, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie (UPMC) Université Paris VI, Paris, France
| | - François Le Pelletier
- Department of Pathology, Assistance Publique Hôpitaux de Paris (AP-HP), Groupement Hospitalier Pitié-Salpêtrière, Paris, France; Tolbiac Pathology Department, Cabinet de Pathologie Tolbiac, Paris, France
| | - Jean-François Emile
- Department of Pathology AP-HP, Hôpital Ambroise Paré, Paris, France; EA4340, Université de Versailles, Versailles, France
| | - Camille Francès
- Department of Dermatology and Allergology, AP-HP, Hôpital Tenon, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie (UPMC) Université Paris VI, Paris, France
| | - Zahir Amoura
- E3M Institute, Service de Medecine Interne 2, French National Reference Center for Rare Systemic and Autoimmune Diseases, Assistance Publique Hôpitaux de Paris (AP-HP), Groupement Hospitalier Pitié-Salpêtrière, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie (UPMC) Université Paris VI, Paris, France
| | - Julien Haroche
- E3M Institute, Service de Medecine Interne 2, French National Reference Center for Rare Systemic and Autoimmune Diseases, Assistance Publique Hôpitaux de Paris (AP-HP), Groupement Hospitalier Pitié-Salpêtrière, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie (UPMC) Université Paris VI, Paris, France.
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Harb D, Ghosn S, Sleiman R, Bourji L, Salman S, Abbas O. Adult-onset langerhans cell histiocytosis mimicking folliculitis decalvans. J Eur Acad Dermatol Venereol 2015; 29:391-392. [PMID: 25756155 DOI: 10.1111/jdv.12396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- D Harb
- American University of Beirut Medical Center, Beirut, Lebanon
| | - S Ghosn
- American University of Beirut Medical Center, Beirut, Lebanon
| | - R Sleiman
- American University of Beirut Medical Center, Beirut, Lebanon
| | - L Bourji
- American University of Beirut Medical Center, Beirut, Lebanon
| | - S Salman
- American University of Beirut Medical Center, Beirut, Lebanon
| | - O Abbas
- American University of Beirut Medical Center, Beirut, Lebanon
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3
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Lasek-Duriez A, Charkaluk ML, Gosset P, Modiano P. Histiocytose langerhansienne congénitale et « Blueberry Muffin Baby ». Ann Dermatol Venereol 2014; 141:130-3. [DOI: 10.1016/j.annder.2013.10.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 03/07/2013] [Accepted: 10/28/2013] [Indexed: 10/25/2022]
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4
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Hu S, Wang W, Wang C, Ma R, Xiao Z, Dong H. Langerhans cell histiocytosis presenting as a multi-system disorder in an infant. Int J Dermatol 2012; 51:709-12. [PMID: 22607290 DOI: 10.1111/j.1365-4632.2011.04984.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sheng Hu
- Departments of Anesthesiology Hematology, Xijing Hospital, Fourth Military University, Xi'an, Shaanxi Province, China
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5
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Abstract
A full-term female baby was admitted to our hospital at the postnatal age of 37 days with generalized vesiculopapular, crateriform skin lesions. Physical examination revealed a well-nourished baby without fever, hepatosplenomegaly or lymphadenopathy. Laboratory examination was normal except for thrombocytosis (platelet count, 970 x 10(3)/microL). All studies for herpes simplex virus, including culture, polymerase chain reaction and IgM, were negative except for an antigen test from the vesicles for herpes simplex virus type 1, which was positive. Chest X-ray showed increased reticulogranular infiltration over bilateral lung fields and some osteolytic lesions at the left parietal bone. Skin biopsy revealed infiltration of Langerhans cells and eosinophils, plus positive CD1a and S-100 stains. The diagnosis was reconfirmed by a second hospital and chemotherapy was given. In this case report, the differential diagnoses of neonatal vesiculopapular skin lesions, and the classification and outcome of neonatal Langerhans cell histiocytosis are presented.
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Affiliation(s)
- Tzu-Ying Yang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
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6
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Kwon H, Lee JH, Kim SK, Park YL, Lee JS, Cho MK. Langerhans cell histiocytosis presenting as brown lichenoid patches. Ann Dermatol 2009; 21:277-80. [PMID: 20523803 DOI: 10.5021/ad.2009.21.3.277] [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: 11/10/2008] [Accepted: 12/24/2008] [Indexed: 11/08/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is related diseases characterized by proliferation of Langerhans cell with involvement of bone, skin, lung and other organs. LCH usually occurs in childhood and are presented as multiple small papules or eczematoid lesion mostly. We report a 50-year-old man with 3 brown lichenoid patches on left dorsal foot. He was diagnosed pulmonary LCH 5 years ago. Typical LC cells on skin lesion and CD1 complex positive staining confirm the diagnosis of LCH. We consider brown lichenoid patches may be a previously unreported cutaneous presentation in cutaneous or multisystem LCH.
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Affiliation(s)
- Hyuk Kwon
- Department of Dermatology, College of Medicine, Soonchunhyang University, Seoul, Korea
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Abstract
Langerhans cell histiocytosis (LCH), especially with an involvement limited to the skin, is a rare entity in adults. In formulating a differential diagnosis of a solitary skin lesion, LCH is rarely considered. Morphologically, cells seen in LCH can mimic those seen in a melanocytic tumor; moreover, they both show S-100 protein reactivity with immunoperoxidase staining. A 63-year-old male presented to a dermatology clinic with a solitary hyperpigmented macule on his right calf. A biopsy specimen showed epithelioid cells within the dermis, singly and in small groups, surrounded and infiltrated by collections of histiocytes and lymphocytes. These cells were diffusely positive for S-100 and negative for Melan-A. A diagnosis of malignant melanoma, spitzoid variant, was rendered, and the patient was sent to our melanoma center for surgical treatment. On histologic examination, some of the lesional cells had reniform, vesicular nuclei with central grooves. Additional immunoperoxidase staining showed strong, diffuse positivity for CD1a, supporting the diagnosis of LCH. LCH is morphologically similar to and can be misdiagnosed as malignant melanoma. It is important to be aware of this pitfall and utilize immunohistochemical and ultrastructural analysis to achieve correct diagnosis.
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8
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Shaffer MP, Walling HW, Stone MS. Langerhans cell histiocytosis presenting as blueberry muffin baby. J Am Acad Dermatol 2005; 53:S143-6. [PMID: 16021165 DOI: 10.1016/j.jaad.2005.01.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Blueberry muffin baby is a descriptive term for purpuric lesions reflective of extramedullary hematopoeisis. The clinical lesions most commonly result from intrauterine infections, such as rubella and cytomegalovirus, and less commonly with malignancy and hematologic disorders. Langerhans cell histiocytosis is a clonal proliferation of dendritic histiocytes in the skin. This has very rarely been associated with a blueberry muffin presentation. We report the case of a newborn with typical lesions of cutaneous hematopoiesis and lytic bone lesions related to Langerhans cell histiocytosis. At birth, approximately 40 2 mm to 5 mm purpuric, nonblanching macules were scattered on the trunk, extremities, and soles of our patient. Laboratory studies were unremarkable and cultures were negative. Skin biopsy showed a dermal proliferation of histiocytes staining positive for S100 and Cd1a. Pediatric bone surveys, chest radiographs, and computed tomography scans of the head were normal. Six months later, the skin lesions had resolved, but radiographs revealed lytic bone lesions of the right tibia, right ilium, and left pubic ramus, consistent with skeletal Langerhans cell histiocytosis.
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Affiliation(s)
- Matthew P Shaffer
- Department of Dermatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Hancox JG, James AP, Madden C, Wallace CA, McMichael AJ. Adult Onset Folliculocentric Langerhans Cell Histiocytosis Confined to the Scalp. Am J Dermatopathol 2004; 26:123-6. [PMID: 15024194 DOI: 10.1097/00000372-200404000-00007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a pleomorphic disease entity characterized by local or disseminated atypical Langerhans cells found most commonly in bone, lungs, mucocutaneous structures, and endocrine organs. Cutaneous disease occurs in approximately one quarter of all cases. Cutaneous findings include soft-tissue swelling, eczematous changes, a seborrheic dermatitis-like appearance, and ulceration. We report a rare case of LCH confined to the scalp with folliculocentric infiltrates. This 32-year-old male patient presented with follicularly based erythema, scale, and pustules unresponsive to topicals and oral antibiotics. The patient's lesions mimicked lichen planopilaris and folliculitis decalvans during the disease process. On hematoxylin and eosin stain, scalp biopsy showed a perivascular interstitial patchy lichenoid mononuclear cell infiltrate that focally abutted follicular infundibula. Prominent mononuclear cells having reniform nuclei were present, and immunoperoxidase stains for CD1a confirmed Langerhans cell differentiation. Serological and imaging workup failed to display systemic involvement.
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Affiliation(s)
- John G Hancox
- *Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA
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Ioannidou D, Krasagakis K, Panayiotidis J, Stefanidou M, Alexandrakis M, Toscat A. Langerhans’ cell histiocytosis and haemophagocytic lymphohistiocytosis in an elderly patient. J Eur Acad Dermatol Venereol 2003; 17:702-5. [PMID: 14761143 DOI: 10.1046/j.1468-3083.2003.00840.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We present a case of a 78-year-old man suffering from a chronic psoriasiform eruption, with rapid deterioration over the previous 8 weeks. Langerhans' cell histiocytosis with skin and bone involvement was diagnosed, and there was evidence of liver and lung dysfunction. The patient was treated with prednisolone and etoposide, and initially experienced a partial improvement. Three weeks later, haemophagocytic lymphohistiocytosis and subsequently a large pulmonary abscess with sepsis attributed to opportunistic gram-negative enterobacteriaceae Serratia marcescens developed, and the patient died. The present case of Langerhans' cell histiocytosis is of particular interest because of the previously unreported development of haemophagocytic lymphohistiocytosis in the elderly population.
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Affiliation(s)
- D Ioannidou
- Department of Dermatology, Heraklion University General Hospital, Crete, Greece.
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Holme SA, Mills CM. Adult primary cutaneous Langerhans' cell histiocytosis mimicking nodular prurigo. Clin Exp Dermatol 2002; 27:250-1. [PMID: 12072022 DOI: 10.1046/j.1365-2230.2002.10344.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Ben Ghorbel I, Houman MH, B'chir S, Chamakhi S, Miled M. [A disseminated form of Langerhans histiocytosis associated with diabetes insipidus and diabetes mellitus]. Rev Med Interne 2001; 22:469-74. [PMID: 11402519 DOI: 10.1016/s0248-8663(01)00373-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Langerhans' cell histiocytosis is a rare disorder of unknown etiology characterized by a wide clinical spectrum and varied behavior. Diabetes insipidus is a relatively common feature in Langerhans' cell histiocytosis. The presence of both diabetes insipidus and mellitus associated with histiocytosis in an adult is rare. To our knowledge, only three previous cases have been reported. EXEGESIS We report the clinical presentation, pathologic findings and clinical progress in an adult female who had disseminated Langerhans' cell histiocytosis (hypothalamic infiltration, multifocal bone involvement) associated with both diabetes insipidus and mellitus. CONCLUSION The pathogenesis of diabetes mellitus in such an association will be discussed.
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Affiliation(s)
- I Ben Ghorbel
- Service de médecine interne, hôpital La Rabta, 1007 Tunis, Tunisie
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13
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Histiocitosis de células de Langerhans en un paciente anciano asociada a leucemia mielomonocítica crónica. ACTAS DERMO-SIFILIOGRAFICAS 2001. [DOI: 10.1016/s0001-7310(01)76474-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Gottlöber P, Weber L, Behnisch W, Bezold G, Peter RU, Kerscher M. Langerhans cell histiocytosis in a child presenting as a pustular eruption. Br J Dermatol 2000; 142:1234-5. [PMID: 10848754 DOI: 10.1046/j.1365-2133.2000.03556.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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15
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Braun-Falco O, Plewig G, Wolff HH, Burgdorf WHC. Histiocytoses. Dermatology 2000. [DOI: 10.1007/978-3-642-97931-6_64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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16
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Morand JJ, Colineau X, Carsuzaa F, Lescout JM, Carloz E, Jacquet P, Benderitter T. [Vulvar and gingival ulcers and skull tumors]. Rev Med Interne 1998; 19:931-4. [PMID: 9887463 DOI: 10.1016/s0248-8663(99)80068-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- J J Morand
- Service de dermatologie, hôpital d'instruction des armées Sainte-Anne, Toulon, France
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