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Asano T, Suzutani K, Watanabe A, Honda A, Mori N, Yashiro M, Sato S, Kobayashi H, Watanabe H, Hazama M, Kanno T, Suzuki E, Ishii S, Migita K. The utility of FDG-PET/CT imaging in the evaluation of multicentric reticulohistiocytosis: A case report. Medicine (Baltimore) 2018; 97:e11449. [PMID: 30113451 PMCID: PMC6112898 DOI: 10.1097/md.0000000000011449] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Multicentric reticulohistiocytosis (MRH) is a rare histiocytic disorder that involves the skin, joints, and visceral organs. CASE PRESENTATION We report a 67-year-old woman with MRH who presented with a 2-years history of polyarthralgia and skin nodules. Her symptoms were an inflammatory polyarthropathy with punched-out lesions of the distal interphalangeal (DIP) joints of both hands. Doppler ultrasonography of the hands showed large bone erosions with power Doppler signals in the DIP joints. F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) demonstrated increased FDG uptake in cutaneous papules surrounding the affected joints, suggesting an inflammatory process. There was no evidence of malignancy. Biopsy samples of skin nodules exhibited dermal infiltration with CD68-positive histiocytes and multinucleated giant cells. The patient was diagnosed with MRH and treated with combination therapy comprising a steroid (prednisolone), tacrolimus, methotrexate, and infliximab, which resulted in clinical improvement. Following infliximab treatment, there was a significant decrease in a bone resorption marker (tartrate-resistant acid phosphatase 5b: TRACP-5b), suggesting that tumor necrosis factor-α targeting therapy may inhibit osteoclast formation and resorption activity in patients with MRH. CONCLUSION MRH is a progressive destructive arthritic condition, and early diagnostic and therapeutic strategies are necessary to improve the outcome. FDG-PET/CT and joint ultrasonography might be noninvasive imaging modalities that could help diagnose MRH.
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Affiliation(s)
| | | | | | - Aki Honda
- Department of Dermatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima
| | | | | | | | | | | | - Momoko Hazama
- Department of Rheumatology, Ohta Nishinouchi General Hospital Foundation, Nishinouchi, Koriyama
| | - Takashi Kanno
- Department of Rheumatology, Ohta Nishinouchi General Hospital Foundation, Nishinouchi, Koriyama
| | - Eiji Suzuki
- Department of Rheumatology, Ohta Nishinouchi General Hospital Foundation, Nishinouchi, Koriyama
| | - Shiro Ishii
- Department of Radiology, Fukushima Medical University School of Medicine, Hikarigaoka, Fukushima, Fukushima, Japan
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Shima N, Murosaki T, Nagashima T, Iwamoto M, Amano Y, Nakano N, Ohtsuki M, Minota S. Multicentric Reticulohistiocytosis with Dermatomyositis-like Eruptions. Intern Med 2017; 56:2063-2066. [PMID: 28768982 PMCID: PMC5577088 DOI: 10.2169/internalmedicine.56.8297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
A 68-year-old man presented with polyarthritis, proximal muscle weakness, and erythema of the face, arms, neck, and anterior chest that resembled the V-neck sign. Initially, dermatomyositis (DM) was considered because of the erythema, polyarthritis, and muscle weakness. He also had mediastinal and hilar lymphadenopathy on contrast-enhanced computed tomography. Unexpectedly, a biopsy of the forehead skin revealed numerous multinucleated giant cells. A biopsy of a solitary nodule on the dorsum of his right middle finger revealed similar multinucleated giant cells with ground-glass cytoplasm, leading to the diagnosis of multicentric reticulohistiocytosis (MRH). Although MRH is rare, it should be remembered that MRH can mimic DM.
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Affiliation(s)
- Natsuki Shima
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Japan
| | - Takamasa Murosaki
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Japan
| | - Takao Nagashima
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Japan
| | - Masahiro Iwamoto
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Japan
| | - Yusuke Amano
- Department of Diagnostic Pathology, Jichi Medical University, Japan
| | - Naomi Nakano
- Department of Dermatology, Jichi Medical University, Japan
| | | | - Seiji Minota
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Japan
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Varilla V, Taxel P, Tannenbaum S. Metastatic Inflammatory Breast Cancer Associated With Multicentric Reticulohistiocytosis Successfully Treated With Zoledronic Acid. Clin Breast Cancer 2016; 16:e203-e207. [PMID: 27435627 DOI: 10.1016/j.clbc.2016.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/27/2016] [Accepted: 06/17/2016] [Indexed: 11/26/2022]
Affiliation(s)
| | - Pamela Taxel
- Division of Endocrinology and Metabolism, UConn Health, Farmington, CT
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Abstract
Many neoplasms of the soft tissues feature giant cells, but this article covers entities in which giant cells are a striking feature. Specifically, we consider tenosynovial giant cell tumor (localized and diffuse types; giant cell tumor of tendon sheath, and pigmented villonodular tenosynovitis), reticulohistiocytoma, juvenile xanthogranuloma, giant cell fibroblastoma (a variant form of dermatofibrosarcoma protuberans), giant cell angiofibroma (which is essentially a giant cell-rich form of solitary fibrous tumor), and phosphaturic mesenchymal tumor.
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Mokuda S, Oiwa H. Successful treatment of FKBP51-expressed multicentric reticulohistiocytosis using combination therapy with low-dose denosumab and tacrolimus. Scand J Rheumatol 2015; 45:247-9. [PMID: 26652057 DOI: 10.3109/03009742.2015.1110199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- S Mokuda
- a Department of Rheumatology , Hiroshima City Hiroshima Citizens Hospital , Hiroshima , Japan
| | - H Oiwa
- a Department of Rheumatology , Hiroshima City Hiroshima Citizens Hospital , Hiroshima , Japan
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Saibaba B, Sen RK, Das A, Sharma A. Bilateral Total Hip Arthroplasty in a Rare Case of Multicentric Reticulohistiocytosis. Clin Orthop Surg 2015; 7:509-14. [PMID: 26640636 PMCID: PMC4667121 DOI: 10.4055/cios.2015.7.4.509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 06/26/2014] [Indexed: 12/26/2022] Open
Abstract
Multicentric reticulohistiocytosis (MRH) is a rare systemic disease, which commonly manifests as muco-cutaneous papulonodules and inflammatory erosive polyarthropathy. In this research, we report the clinical manifestations and management of a rare case of MRH with destructive arthropathy of bilateral hip joints and arthritis mutilans presenting with characteristic deformities. Disabling hip arthropathy that occurs secondary to MRH can be successfully managed with bilateral total hip arthroplasty (THA). Osteopenia and acetabular bone defects must be anticipated during THA. This case is reported due to its rare occurrence and because little literature has been published regarding THA in such patients.
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Affiliation(s)
- Balaji Saibaba
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramesh Kumar Sen
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashim Das
- Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Baek IW, Yoo SH, Yang H, Park J, Kim KJ, Cho CS. A case of multicentric reticulohistiocytosis. Mod Rheumatol 2014; 27:165-168. [PMID: 25211404 DOI: 10.3109/14397595.2014.952702] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Multicentric reticulohistiocytosis (MRH) is a rare non-Langerhans histiocytosis of unknown etiology with a predilection for joint and skin. The characteristic clinical features are papulonodular skin eruptions and inflammatory polyarthritis, sometimes progressive to arthritis mutilans, a severe destructive arthropathy. Although these manifestations can present at the same time, it is more common that one feature precedes the others. Notably, these features are similar to those found in some rheumatic diseases, such as rheumatoid arthritis or dermatomyositis, and this can lead to a misdiagnosis, especially during periods where only one feature is present. Herein, we report a female patient with polyarthralgia and subsequent skin eruptions, who was eventually diagnosed with MRH. Her symptoms seemed to resemble those of some rheumatic diseases, but several features such as affected joints and the characteristic shape of the skin lesions did not correspond to that. The histological result of infiltration of histiocytes and multinucleated giant cells in the skin ultimately facilitated the correct diagnosis. In this paper, we review MRH briefly and highlight several differential points which enable us to increase the likelihood of correctly diagnosing MRH.
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Affiliation(s)
- In-Woon Baek
- a Division of Rheumatology, Department of Internal Medicine , College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Sang Hoon Yoo
- a Division of Rheumatology, Department of Internal Medicine , College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Hyun Yang
- a Division of Rheumatology, Department of Internal Medicine , College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Jeongmi Park
- a Division of Rheumatology, Department of Internal Medicine , College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Ki-Jo Kim
- a Division of Rheumatology, Department of Internal Medicine , College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Chul-Soo Cho
- a Division of Rheumatology, Department of Internal Medicine , College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
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Watanabe S, Kamada K, Imai H, Takeda H, Nose M, Murata N, Hasegawa H, Yamamoto H. An Asian case of fibroblastic rheumatism: clinical, radiological, and histological features. Mod Rheumatol 2014. [DOI: 10.3109/s10165-010-0297-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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9
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Sakamoto A, Nagamine R, Maeda T, Shuto T, Hirata G, Nakashima Y, Matsuda S, Iwamoto Y. Multicentric reticulohistiocytosis with hydrarthrosis in both knee joints: disease stabilization with synovectomy, and medication with a steroid and low-dose methotrexate. Mod Rheumatol 2014; 12:155-9. [DOI: 10.3109/s101650200026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kishikawa T, Miyashita T, Fujiwara E, Shimomura O, Yasuhi I, Niino D, Ito M, Amenomori M, Osumimoto H, Osumi M, Eguchi K, Migita K. Multicentric reticulohistiocytosis associated with ovarian cancer. Mod Rheumatol 2014. [DOI: 10.3109/s10165-007-0600-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Huang X, Zhang L, Zhang S. Multicentric reticulohistiocytosis with extra-mammillary Paget's disease: a case report. Eur J Med Res 2013; 18:38. [PMID: 24168966 PMCID: PMC3874611 DOI: 10.1186/2047-783x-18-38] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 10/14/2013] [Indexed: 11/30/2022] Open
Abstract
Multicentric reticulohistiocytosis (MRH) is a very rare systemic disease with variable phenotypic presentation and a high rate of misdiagnosis. Here we describe a patient with MRH and extra-mammillary Paget’s disease (EMPD), a diagnosis that has not previously been described in the literature.
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Affiliation(s)
| | | | - Songzhao Zhang
- The Department of Clinical Laboratory Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China.
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12
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13
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Multicentric reticulohistiocytosis presenting with papulonodular skin lesions and arthritis mutilans. Case Rep Rheumatol 2013; 2013:201563. [PMID: 23555066 PMCID: PMC3608314 DOI: 10.1155/2013/201563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 02/21/2013] [Indexed: 01/25/2023] Open
Abstract
Multicentric reticulohistiocytosis is a rare multisystem disorder of unknown etiology that is characterized by erosive polyarthritis and papulonodular lesions on the skin, mucous membranes, and internal organs. We report the case of a 54-year-old female who was misdiagnosed as having rheumatoid arthritis and underwent numerous joint replacement surgeries for progressively destructive arthritis in her hands, shoulders, hips, and knees. The patient finally received a diagnosis of multicentric reticulohistiocytosis after histopathological examination of the patient's left knee arthroplasty which revealed a diffuse histiocytic infiltrate, multinucleated giant cells, and finely granulated eosinophilic cytoplasm with a ground-glass appearance.
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Trotta F, Colina M. Multicentric reticulohistiocytosis and fibroblastic rheumatism. Best Pract Res Clin Rheumatol 2013; 26:543-57. [PMID: 23040366 DOI: 10.1016/j.berh.2012.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2012] [Indexed: 12/22/2022]
Abstract
Multicentric reticulohistiocytosis (MRH) and fibroblastic rheumatism (FR) are uncommon disorders with similar joint and skin manifestations. They are usually included among the non-Langerhans histiocytoses, but recent insights drive some criticism. The diagnosis is often challenging and must be confirmed by the histological typical features. If the skin manifestations are missing, the arthritic complaints may be confused with those of other rheumatic disorders. In these cases, only a careful clinical and radiological evaluation leads to the correct diagnosis. The natural course of the diseases may rapidly develop into disabling manifestations, making an aggressive treatment strongly recommendable. There is emerging evidence that anti-tumour necrosis factor-α agents and bisphosphonates are promising drugs for MRH, while a course of methotrexate and steroids seems to be the best option for FR. Finally, the clinician should be aware that in many cases MRH, but not FR, is associated with a large number of systemic manifestations and with malignancy. This eventuality must be accurately ruled out.
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Affiliation(s)
- Francesco Trotta
- Section of Rheumatology, Department of Clinical and Experimental Medicine, University of Ferrara, Ferrara, Italy.
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15
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Bennàssar A, Mas A, Guilabert A, Julià M, Mascaró-Galy JM, Herrero C. Multicentric reticulohistiocytosis with elevated cytokine serum levels. J Dermatol 2011; 38:905-10. [PMID: 21658110 DOI: 10.1111/j.1346-8138.2010.01146.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Multicentric reticulohistiocytosis (MRH) is an uncommon non-Langerhans cell histiocytosis of unknown etiology. It is a multisystem disorder characterised by a papulonodular skin eruption, mainly in the extensor surfaces, and destructive polyarthritis. Histologically, either cutaneous lesions or the synovium show a dense dermal infiltrate of histiocytes and multinucleated giant cells with an eosinophilic granular material in the cytoplasm. In the immunohistochemical analysis these cells stain positively with monocyte/macrophage markers (CD68 and CD45), as well as with certain cytokines (tumor necrosis factor-α, interleukin 1β and interleukin 6). Moreover, recent reports suggest an osteoclastic nature of the infiltrating cells, as they stain strongly with osteoclast tissue lytic markers including tartrate-resistant acid phosphatase and cathepsin K. We report a case of MRH presenting with clinical features of dermatomyositis. Furthermore, the patient showed elevated cytokine serum levels that lowered after therapy.
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Rudd A, Dolianitis C, Varigos G, Howard A. A case of multicentric reticulohistiocytosis responsive to azathioprine in a patient with no underlying malignancy. Australas J Dermatol 2011; 52:292-4. [DOI: 10.1111/j.1440-0960.2011.00775.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Watanabe S, Kamada K, Imai H, Takeda H, Nose M, Murata N, Hasegawa H, Yamamoto H. An Asian case of fibroblastic rheumatism: clinical, radiological, and histological features. Mod Rheumatol 2010; 20:423-6. [PMID: 20715301 DOI: 10.1007/s10165-010-0297-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We report a case of fibroblastic rheumatism (FR) in a 61-year-old woman. The patient showed sclerodactyly and polyarthritis that involved both her hands and feet joints. Levels of C-reactive protein and matrix metallopeptidase-3 were within normal range. We diagnosed her condition as FR according to both the clinical features characterized with the destructive change of multiple joints and the histological sample. This is the first FR published case of FR in an Asian individual, and 23 published cases were reviewed.
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Affiliation(s)
- Shohei Watanabe
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan.
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18
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Caltabiano R, Magro G, Vecchio GM, Lanzafame S. Solitary cutaneous histiocytosis with granular cell changes: a morphological variant of reticulohistiocytoma? J Cutan Pathol 2010; 37:287-91. [DOI: 10.1111/j.1600-0560.2009.01305.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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19
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Teo HYL, Goh BK. Multicentric reticulohistiocytosis in association with nasopharyngeal carcinoma. Clin Exp Dermatol 2009; 34:e347-8. [DOI: 10.1111/j.1365-2230.2009.03299.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Benucci M, Sulla A, Manfredi M. Cardiac engagement in multicentric reticulohistiocytosis: report of a case with fatal outcome and literature review. Intern Emerg Med 2008; 3:165-8. [PMID: 18265939 DOI: 10.1007/s11739-008-0102-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Accepted: 01/18/2007] [Indexed: 10/22/2022]
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Multicentric reticulohistiocytosis associated with ovarian cancer. Mod Rheumatol 2007; 17:422-5. [PMID: 17929137 DOI: 10.1007/s10165-007-0600-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Accepted: 05/08/2007] [Indexed: 10/22/2022]
Abstract
Multicentric reticulohistiocytosis (MR) is an uncommon disease characterized by joint and cutaneous manifestations. The diagnosis must be confirmed by histological evidence of typical histiocytes and multinucleated giant cells. Many conditions, including malignancy, have been described in association with MR. We herein report a female case of MR in whom partial improvement was obtained by steroid and low-dose methotrexate treatments. However, ovarian cancer was found and therefore a surgical resection and chemotherapy were performed. These treatments resulted in the complete resolution of the skin and joint symptoms. These findings support the close linkage between MR and malignancy and the efficacy of cytotoxic drugs for the treatment of MR.
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Luz FB, Gaspar NK, Gaspar AP, Carneiro S, Ramos-E-Silva M. Multicentric reticulohistiocytosis: a proliferation of macrophages with tropism for skin and joints, part II. Skinmed 2007; 6:227-33. [PMID: 17786100 DOI: 10.1111/j.1540-9740.2007.06051.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
In this second part of the review of multicentric reticulohistiocytosis, the authors discuss its association with other diseases, in particular, cancer, and laboratory and therapeutic aspects of this incapacitating and disfiguring disease. Histopathologic aspects are characteristic: dense mononuclear infiltrate with typical multinucleated cells that contain periodic acid-Schiff-positive and diastasis-resistant material, conferring a "ground glass" aspect when stained with hematoxylineosin.
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Affiliation(s)
- Flávio Barbosa Luz
- Sector of Dermatology, University Hospital HUCFF/UFRJ and School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
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Muñoz-Santos C, Sàbat M, Sáez A, Gratacós J, Luelmo J. Multicentric Reticulohistiocytosis-Mimicking Dermatomyositis. Dermatology 2007; 214:268-71. [PMID: 17377390 DOI: 10.1159/000099594] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Accepted: 10/06/2006] [Indexed: 11/19/2022] Open
Abstract
Multicentric reticulohistiocytosis is a rare disorder of unknown etiology, characterized by skin and mucosal papulonodular eruptions and destructive polyarthritis. Histopathological study of these lesions shows a nodular infiltrate composed of histiocytes and multinucleated giant cells, with an eosinophilic, granular, 'ground-glass' cytoplasm. We report a case of multicentric reticulohistiocytosis with skin lesions mimicking dermatomyositis and we also review previously reported cases describing such a clinical situation. Our case further emphasizes that multicentric reticulohistiocytosis can mimic clinical features of dermatomyositis. A macular or patch-like erythema in a photodistributed fashion, in addition to other clinical manifestations, can be mistaken for dermatomyositis. However, skin biopsies from these areas may early differentiate both conditions with different treatment options and morbidity.
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Affiliation(s)
- Carlos Muñoz-Santos
- Dermatology Unit, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Sabadell, Spain.
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Newman B, Hu W, Nigro K, Gilliam AC. Aggressive histiocytic disorders that can involve the skin. J Am Acad Dermatol 2006; 56:302-16. [PMID: 17097374 DOI: 10.1016/j.jaad.2006.06.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2006] [Revised: 05/16/2006] [Accepted: 06/19/2006] [Indexed: 10/24/2022]
Abstract
Histiocytoses are a heterogeneous group of disorders that are characterized by the proliferation and accumulation of reactive or neoplastic histiocytes. Three classes of histiocytoses have been defined: class I, Langerhans cell disease; class II, non-Langerhans cell histiocytic disease without features of malignancy; and class III, malignant histiocytic disorders. Although the disorders in classes I and II usually have a benign appearance on histology and are commonly non-aggressive and self-healing, some can cause debilitating or even fatal outcomes. Such cases beg the question: what stimulates aggressive behavior of a classically benign disease? New molecular information may now provide insight into the driving force behind many of the aggressive histiocytoses. In this article, we review Langerhans cell disease and seven aggressive histiocytoses that can involve skin, discuss histologic features that may forecast a poor prognosis, and discuss the molecular findings that help to explain the pathophysiology of these aggressive histiocytic disorders.
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MESH Headings
- Histiocytosis/classification
- Histiocytosis/pathology
- Histiocytosis/physiopathology
- Histiocytosis, Langerhans-Cell/diagnosis
- Histiocytosis, Langerhans-Cell/pathology
- Histiocytosis, Langerhans-Cell/physiopathology
- Histiocytosis, Non-Langerhans-Cell/diagnosis
- Histiocytosis, Non-Langerhans-Cell/pathology
- Histiocytosis, Non-Langerhans-Cell/physiopathology
- Histiocytosis, Non-Langerhans-Cell/therapy
- Humans
- Lymphohistiocytosis, Hemophagocytic/pathology
- Lymphohistiocytosis, Hemophagocytic/physiopathology
- Necrobiotic Disorders/diagnosis
- Necrobiotic Disorders/pathology
- Necrobiotic Disorders/physiopathology
- Necrobiotic Disorders/therapy
- Prognosis
- Sea-Blue Histiocyte Syndrome/pathology
- Sea-Blue Histiocyte Syndrome/physiopathology
- Sea-Blue Histiocyte Syndrome/therapy
- Skin Diseases/diagnosis
- Skin Diseases/pathology
- Skin Diseases/physiopathology
- Skin Diseases/therapy
- Xanthogranuloma, Juvenile/pathology
- Xanthogranuloma, Juvenile/physiopathology
- Xanthogranuloma, Juvenile/therapy
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Affiliation(s)
- Brenda Newman
- Department of Dermatology, Case/University Hospitals of Cleveland, Ohio 44106-5028, USA
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Chen CH, Chen CH, Chen HA, Liao HT, Lin HY. Multicentric Reticulohistiocytosis Presenting With Destructive Polyarthritis, Laryngopharyngeal Dysfunction, and a Huge Reticulohistiocytoma. J Clin Rheumatol 2006; 12:252-4. [PMID: 17023812 DOI: 10.1097/01.rhu.0000239902.91768.f9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Multicentric reticulohistiocytosis (MRH) is a rare multisystemic disease presenting with skin lesions and erosive polyarthritis and is often associated with malignancy. We describe a 60-year-old woman with diffuse papulonodular skin eruptions and progressive osteolytic bone damage over the bilateral hands, humeral head, and acromioclavicular joints within 2 years. Moreover, dysphagia and a hoarse voice occurred in this patient and an unusual huge mass-reticulohistiocytoma--developed over the left upper back. Tissue biopsy of the skin lesions, laryngeal nodules, and this large mass showed infiltration of numerous CD68(+) histiocytes and multinucleated giant cells with abundant eosinophilic ground-glass cytoplasm. Combination therapy with steroids and methotrexate improved her cutaneous, joint, and laryngopharyngeal symptoms. The large reticulohistiocytoma resolved with methylprednisolone pulse therapy. This polyarthritis, which can be confused with rheumatoid arthritis, can be diagnosed by careful immunohistochemical examination of biopsies. To prevent the irreversible disease process, early and aggressive therapy is necessary.
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Affiliation(s)
- Chun-Hsiung Chen
- Veterans General Hospital, Taipei and National Yang-Ming Medical University, Taiwan
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Abstract
BACKGROUND Histiocytic disorders are currently identified by their component cells. The non-Langerhans Cell Histiocytoses (non-LCH) are a group of disorders defined by the accumulation of histiocytes that do not meet the phenotypic criteria for the diagnosis of Langerhans cells (LCs). The non-LCH consist of a long list of diverse disorders which have been difficult to categorize. A conceptual way to think of these disorders that make them less confusing and easier to remember is proposed based on immunophenotyping and clinical presentation. RESULTS Clinically the non-LCH can be divided into 3 groups, those that predominantly affect skin, those that affect skin but have a major systemic component, and those that primarily involve extracutaneous sites, although skin may be involved. Immunohistochernically many of the non-LCH appear to arise from the same precursor cell namely the dermal dendrocyte. Juvenile Xanthogranuloma (JXG) is the model of the dermal dendrocyte-derived non-LCH. Other non-LCH with differing clinical presentation and occurring at different ages but with an identical immunophenotype appear to form a spectrum of the same disorder, deriving from the same precursor cell at different stages of maturation. They should be considered as members of a JXG family. Non-JXG family members include Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease). CONCLUSION The non-LCH can be classified as JXG family and non-JXG family and subdivided according to fairly clear-cut clinical criteria. Utilization of this type of approach will allow better categorization, easier review of the literature and more accurate therapy decision-making.
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Affiliation(s)
- Sheila Weitzman
- Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
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Affiliation(s)
- Anna Brackenridge
- Department of Diabetes and Endocrinology, Royal Surrey County Hospital, Egerton Road, Guildford GU2 7XX, UK
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Chakravarty EF, Genovese MC. Associations between rheumatoid arthritis and malignancy. Rheum Dis Clin North Am 2004; 30:271-84, vi. [PMID: 15172040 DOI: 10.1016/j.rdc.2004.01.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
There are many complex associations between rheumatoid arthritis(RA) and malignancy. Patients with rheumatic diseases on the whole appear to be at increased risk for the development of certain malignancies. The data from several studies are persuasive that the presence of RA conveys an increased risk for the development of lymphoproliferative disorders and may convey a decreased risk for the development of malignancies of the digestive tract. Understanding the complex interrelationships between RA and malignancy will lead to more accurate diagnosis of underlying pathology, more effective treatment of symptoms and underlying disease, and appropriate surveillance for the development of later complications.
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Affiliation(s)
- Eliza F Chakravarty
- Division of Immunology and Rheumatology, Stanford University School of Medicine, 1000 Welch Road, #203, Palo Alto, CA 94303, USA
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Stummvoll GH, Graninger WB. [Paraneoplastic rheumatism--musculoskeletal diseases as a first sign of hidden neoplasms]. ACTA MEDICA AUSTRIACA 2002; 29:36-40. [PMID: 11899753 DOI: 10.1046/j.1563-2571.2002.01045.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Malignancy-associated musculoskeletal syndromes can present in a variety of ways which are not distinguishable from idiopathic rheumatic diseases. Furthermore, there are some rare, but typical syndromes with a high association with neoplasms. To perform a quick and exact diagnosis while avoiding useless invasive and expensive diagnostic procedures is a major challenge for the clinician. This article focuses on the clinical features of paraneoplastic musculoskeletal syndromes and theories about the underlying pathogenesis. We try to highlight those clinical and laboratory aspects which could be a clue to hidden malignancies. Paraneoplastic rheumatic syndromes are rare conditions, but timely recognition can save lives.
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Affiliation(s)
- G H Stummvoll
- Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Währinger Gürtel 18-20, A-1090 Wien.
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Cox NH, West NC, Popple AW. Multicentric reticulohistiocytosis associated with idiopathic myelofibrosis. Br J Dermatol 2001; 145:1033-4. [PMID: 11899135 DOI: 10.1046/j.1365-2133.2001.04483.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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Abstract
BACKGROUND Multicentric reticulohistiocytosis (MR) is a rare histiocytic systemic disease mainly affecting the skin and synovia. OBJECTIVE To present the main and newest aspects of MR. METHOD A review of the current medical literature, composing a retrospective study of 96 case reports published world-wide since 1977. RESULTS Facial and hand skin nodules with symmetric arthritis were the most frequent clinical presentation. The pathognomonic sign of'coral beads' and vermicular erythematous lesions bordering nostrils, seems to be very characteristic of MR. There is a significant association with cancer. Histiocytic cells of MR are best characterized on immunohistochemistry by its immunoreactivity for vimentin, CD68 and CD45 and non-reactivity for S-100 protein, CD34 and factor XIIIa. Although the outcome of the disease is usually very limiting for the patients, treatment with immunosuppressive drugs may be useful. CONCLUSION MR is a unique histiocytic proliferative disease with a peculiar immunophenotypic pattern and distinctive clinical and histopathological aspects.
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Affiliation(s)
- F B Luz
- Sector of Dermatology, HUAP-UFF, Universidade Federal Fluminense, Niteroi, Brazil.
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Abstract
CASE REPORT The authors report the first biopsy-confirmed ocular adnexal involvement by multicentric reticulohistiocytosis. The patient was a 28-year-old black woman with a 15-year history of well-documented multicentric reticulohistiocytosis who had multiple dermal nodules and severe mutilating arthritis that had produced a characteristic telescoping deformity of the digits. Eyelid nodules were excised to relieve pseudoptosis and for cosmesis. MATERIALS The eyelid nodules were studied by routine light microscopy and a battery of immunohistochemical stains, including S-100 protein and several macrophage markers. RESULTS Microscopy disclosed an infiltrate of histiocytes and giant cells with glassy eosinophilic cytoplasm and large round or oval vesicular nuclei with prominent nucleoli set in a densely fibrotic stroma consistent with multicentric reticulohistiocytosis. The histiocytes showed positive immunoreactivity for lysozyme, but were negative for alpha-1 antichymotrypsin, S-100 protein, and neuron-specific enolase. CONCLUSION Multicentric reticulohistiocytosis should be included in the differential diagnosis of multiple eyelid nodules.
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Affiliation(s)
- R C Eagle
- Department of Pathology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107
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Abstract
MRH is somewhat similar to, and probably occasionally mistaken for, psoriatic arthritis, Reiter's syndrome, or less frequently, rheumatoid arthritis. However, several important features distinguish MRH from the other arthritides. Rheumatoid arthritis more commonly involves the metacarpophalangeal joints, while MRH ordinarily affects the distal interphalangeal and proximal interphalangeal joints. Furthermore, MRH rarely exhibits the degree of articular osteopenia that is the hallmark of rheumatoid disease. While psoriatic arthritis and Reiter's often affect the DIP joints, they rarely display the symmetry of MRH. In addition, MRH does not demonstrate the periosteal new bone formation that is seen in both psoriatic arthritis and Reiter's syndrome. Hence, the diagnosis of MRH may be made with reasonable confidence on the radiologic findings alone, even before the cutaneous nodules appear, which can then be biopsied to confirm the diagnosis.
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Affiliation(s)
- D D Maki
- Department of Radiology, University of Minnesota, Minneapolis 55455
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