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Itin K, Häusermann P, Itin P, Fosse N. Symmetrical Facial Giant Plaque-Type Juvenile Xanthogranuloma: Case Report and Review of the Literature. Case Rep Dermatol 2021; 13:399-406. [PMID: 34413740 PMCID: PMC8339506 DOI: 10.1159/000515151] [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: 05/29/2020] [Accepted: 02/07/2021] [Indexed: 11/19/2022] Open
Abstract
Juvenile xanthogranuloma (JXG) is the most common type of non-Langerhans cell histiocytosis. JXG is a rare benign tumor, which may be present at birth or develop later. The classical form of JXG is characterized by a red-yellowish benign papule or nodule with predilection sites on the head, neck, and trunk, although lesions can appear on extremities or extracutaneous sites. In most cases there is only one lesion, whereas numerous papules or nodules may occur. Special forms of JXG such as mixed, giant, subcutaneous, eruptive, clustered, and plaque-like have been reported and associations between JXG and systemic diseases have been made. Diagnosis mainly relies on the clinical appearance, and histology usually can confirm the disease. Here we present a very rare case of symmetrical giant facial plaque-type juvenile xanthogranuloma (SGFP-JXG) and compare it with classical JXG, variations of JXG, and discuss the differential diagnosis. A 4-year-old Caucasian female presented with plaque-like lesions composed of yellowish confluent papules on both the cheeks. The histological evaluation revealed a histiocytic lesion with a formation of Touton giant cells and immunohistochemistry results confirmed the diagnosis of the SGFP-JXG. In comparison to classical JXG, the onset of SGFP-JXG sometimes occurs later and the spontaneous resolution period may be prolonged. No associated diseases and no systemic involvements were observed. Histopathology is required to differentiate this form of JXG from other histiocytosis. To the best of our knowledge, only four cases of SGFP-JXG have been reported in the literature so far.
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Affiliation(s)
- Kaspar Itin
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Peter Häusermann
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Peter Itin
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Nicole Fosse
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
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Peruilh-Bagolini L, Silva-Astorga M, Hernández San Martín MJ, Manoli MS, Papageorgiou C, Apalla Z, Lallas A. Dermoscopy of Juvenile Xanthogranuloma. Dermatology 2020; 237:946-951. [PMID: 33075787 DOI: 10.1159/000510265] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/16/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Dermoscopy is useful for the evaluation of juvenile xanthogranuloma (JXG). The classical "setting sun" pattern is characteristic of JXG, but its sensibility appears to be limited. An extensive description of other dermoscopic findings is not available in the literature. OBJECTIVES The aim of this study was to valuate and describe the clinical and dermoscopic characteristics of a series of JXG cases. METHODS This is a retrospective descriptive study, including cases with histopathologic diagnosis of JXG, and the availability of clinical and dermoscopic images, assessed for the presence of dermoscopic features based on the available literature. RESULTS A total of 17 lesions were analyzed. 70.6% showed global symmetry, 35.3% presented the typical "setting sun" pattern. All lesions showed yellow-orange and/or pink-red structureless color. Other dermoscopic features were yellow globules (35.3%), shiny white streaks (23.5%), brown globules (17.6%), pale-brown network (11.8%), negative network (11.8%), erosion/ulceration (11.8%), rosettes (5.9%), and hemorrhage (5.9%). Scales were seen in 64.7% of patients. Vascular structures were observed in all the lesions, mostly in an irregular distribution (76.5%). The observed vessel types were dotted (52.9%), linear (52.9%), branching-arboriform (29.4%), comma-like (23.5%), hairpin-like (17.6%), globular (17.6%), coiled (11.8%), and milky-red globules (5.9%). CONCLUSIONS Symmetry, yellow/orange-pink/red color, yellow globules, shiny white streaks, and irregularly distributed different types of vascular structures are the main dermoscopic features of JXG. This is the largest dermoscopic registry of JXG published to date.
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Affiliation(s)
| | - Mariana Silva-Astorga
- Department of Dermatology, Faculty of Medicine, University of Chile, Santiago, Chile
| | | | | | | | - Zoe Apalla
- Second Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
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Ladha MA, Haber RM. Giant Juvenile Xanthogranuloma: Case Report, Literature Review, and Algorithm for Classification. J Cutan Med Surg 2018; 22:488-494. [DOI: 10.1177/1203475418777734] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Juvenile xanthogranuloma (JXG) is a member of the non-Langerhans cell group of proliferative disorders of mononuclear phagocytes. JXG is a benign tumour of histiocytic cells. Classic JXG is divided into 2 main clinical subtypes: dome-shaped papules (<0.5 cm) and single/multiple nodules (<2.0 cm). A rare variant is referred to as giant; this term encompasses JXG lesions larger than 2.0 cm. In this article, we report a case of a congenital cutaneous giant JXG. In addition, we reviewed and analyzed all cases (n = 51) of giant JXG reported in the English literature. We propose an algorithm for classifying giant JXG based on the following factors: onset of lesions (congenital and acquired), number of lesions (solitary ± satellites and multiple), morphology of cutaneous/mucosal lesions (plaque, nodular, ulcerated-nodular, macular, and other), and extracutaneous manifestations.
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Affiliation(s)
- Malika A. Ladha
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Richard M. Haber
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
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de Oliveira Rocha B, de Sousa Medeiros Torres I, Rêgo VRPDA, Fernandes JD. Erythematous, yellowish plaque on the face of a child. Int J Dermatol 2013; 52:295-6. [PMID: 23414153 DOI: 10.1111/j.1365-4632.2012.05655.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Affiliation(s)
- Deepali Jain
- Department of Pathology; Sir Ganga Ram Hospital; New Delhi
| | - Veer Singh Mehta
- Department of Neurosurgery; Paras Hospitals; Gurgaon; Haryana; India
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Gingival juvenile xanthogranuloma in an adult patient: case report with immunohistochemical analysis and literature review. ACTA ACUST UNITED AC 2009; 107:246-52. [PMID: 19138643 DOI: 10.1016/j.tripleo.2008.09.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2008] [Revised: 09/16/2008] [Accepted: 09/29/2008] [Indexed: 11/22/2022]
Abstract
Juvenile xanthogranuloma (JXG) is a non-Langerhans cell histiocytosis (nonLCH). It is a benign and self-healing disorder that generally affects infants and children. Oral lesions in adult patients are rare, although the microscopic findings are similar to those observed in other locations. A 56-year-old white man presented with a chief complaint of a gingival mass that had appeared 6 months before and had grown slowly. An intraoral examination revealed the presence of a solitary, softened gingival mass affecting the mandibular lingual gingiva at the right central incisor area. A biopsy of the lesion showed multiple large macrophages and numerous giant cells of Touton type. The immunohistochemistry positivity for CD68, fascin, factor XIIIa, alpha-antitrypsin and negativity for S-100, beta-actin, CD1a, and desmin confirmed the diagnosis of JXG. The occurrence of adult oral JXG is extremely rare. It is a nonLCH that may present variable clinical and microscopic aspects, which leads to a diversity of clinical misdiagnoses. A precise diagnosis of these lesions requires an accurate evaluation of clinical, microscopic, and immunohistochemical features.
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Palmer A, Bowling J. Dermoscopic Appearance of Juvenile Xanthogranuloma. Dermatology 2007; 215:256-9. [PMID: 17823526 DOI: 10.1159/000106586] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Accepted: 04/09/2007] [Indexed: 11/19/2022] Open
Abstract
Juvenile xanthogranuloma (JXG) is the commonest form of non-Langerhans cell histiocytosis and manifests as asymptomatic yellow-red papulonodules that usually occur in childhood and spontaneously regress within a year of formation. The diagnosis may be made by clinical examination alone and confirmed by histology in cases of diagnostic doubt. Here we report the use of dermoscopy in evaluating skin lesions suggestive of JXG. Three patients diagnosed as having JXG in our dermatology department over the last year showed a characteristic orange-yellow 'setting sun' appearance on dermoscopy. We therefore feel that the use of dermoscopy can be extended to include the examination of non-pigmented skin lesions, particularly in paediatric patients.
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Affiliation(s)
- Antony Palmer
- Department of Dermatology, Churchill Hospital, Oxford, UK.
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Pérez-Gala S, Torrelo A, Colmenero I, Contra T, Madero L, Zambrano A. [Juvenile multiple xanthogranuloma in a patient with Langerhans cell histiocytosis]. ACTAS DERMO-SIFILIOGRAFICAS 2007; 97:594-8. [PMID: 17173766 DOI: 10.1016/s0001-7310(06)73474-3] [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: 11/28/2022] Open
Abstract
We present the case of a 10-week-old girl who had erythematous papules with a yellowish hue from birth with diagnosis of Langerhans cell histiocytosis, that was accompanied by a lytic lesion in the skull and hepatic involvement. After several months of treatment with prednisone and vinblastine with skin and systemic improvement, several rounded erythematous papules with a yellowish hue appeared in the right cheek. The biopsy showed a histiocytic infiltrate with positivity for CD68 and negative staining for S100 and CD1a, with a final diagnosis of juvenile xanthogranuloma. This association has been previously described in the literature in few cases. Although several hypotheses have been suggested, the causal relationship between both entities has still not been demonstrated.
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Affiliation(s)
- S Pérez-Gala
- Servicio de Dermatología, Hospital del Niño Jesús, Menéndez Pelayo 65, 28009 Madrid, Spain
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Cabrera RA, Lacerda A, Lemos MM, Nunes JM, Mendonça ME. Multiple visceral and subcutaneous nodules in a 4-month infant. Cytopathology 2005; 16:309-11. [PMID: 16303045 DOI: 10.1111/j.1365-2303.2005.00181.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- R A Cabrera
- Serviços de Patologia Morfológica e Pediatria, Instituto Português de Oncologia de Francisco Gentil. CROL, SA, Lisbon, Portugal.
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Abstract
Juvenile xanthogranuloma (JXG) is an uncommon non-Langerhans cell histiocytosis. We investigated 148 biopsy specimens from 129 patients collected in the Kiel Pediatric Tumor Registry (KPTR) between 1965 and 2001. The clinical, histologic, and immunohistochemical characteristics of JXG were evaluated to gain more and deeper insights into the morphology and clinical behavior of JXG. Conventionally stained lesions were classified into the following morphologic subtypes: early JXG (EJXG), classic JXG (CJXG), transitional JXG (TJXG), or combined lesions with more than one basic pattern (combined JXG). Immunohistochemistry included antibodies against macrophages (Ki-M1P), S-100 protein, CD1a, and factor XIIIa (FXIIIa). Clinical data were obtained by means of a standardized questionnaire. The relative incidence of JXG in the KPTR is 0.52%. The male/female ratio was 1.4:1. The mean age was 22.4 months (median, 5 months; range, 0-244 months). A total of 34.5% of the cases of JXG were congenital, and 71.0% of the lesions were diagnosed within the first year of life. Most cases of cutaneous JXG were solitary (81.0%). Five cases (3.9%) presented with visceral (systemic) involvement. Histologically, CJXG was most frequent (47.2%), followed by EJXG (27.1%) and TJXG (16.0%). A total of 9.7% of the lesions represented combined JXG. Histiocytes, including giant cells, were positive for Ki-M1P (100%) and in most cases for FXIIIa (99%). The CD1a and S-100 protein reactions were generally negative. Clinical and follow-up data showed a generally favorable prognosis with a low relapse rate (7.0%) and even complete involution after incomplete resection. Only 1 of 5 patients with widespread congenital systemic disease died after 34 days. JXG is an uncommon, mostly cutaneous, and prognostically favorable histiocytic tumor of infancy. Simple tumor excision is the therapy for choice except in the very rare systemic JXG, in which multimodal chemotherapy is indicated.
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Affiliation(s)
- Dirk Janssen
- Department of Pediatric Pathology, University of Kiel, Kiel, Germany.
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Dehner LP. Juvenile xanthogranulomas in the first two decades of life: a clinicopathologic study of 174 cases with cutaneous and extracutaneous manifestations. Am J Surg Pathol 2003; 27:579-93. [PMID: 12717244 DOI: 10.1097/00000478-200305000-00003] [Citation(s) in RCA: 297] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Juvenile xanthogranulomas (JXG) is a histiocytic disorder, primarily but not exclusively seen throughout the first two decades of life and principally as a solitary cutaneous lesion. This study is a retrospective clinical and pathologic review of 174 cases documenting the cutaneous and extracutaneous manifestations in patients presenting from the neonatal period to 20 years of age (mean 3.3 years; median 1 year). There was a male predominance (99 male:75 female) in all categories of clinical presentation, but especially notable in the group with multiple cutaneous lesions (12 male:1 female). A solitary cutaneous lesion accounted for 67% of all cases, followed by a solitary subcutaneous or deep soft tissue mass (28 cases, 16%), multiple cutaneous lesions (13 cases, 7%), a solitary extracutaneous, nonsoft tissue lesion (9 cases, 5%), and multiple cutaneous and visceral-systemic lesions (8 cases, 5%). The recorded deaths due to disease included two neonates with systemic JXG who developed hepatic failure and thrombocytopenia and at autopsy had giant cell-neonatal hepatitis in addition to JXG in the liver and other visceral sites. A third death in a 3-month-old boy with a retroperitoneal-pelvic JXG occurred after failure to control severe hypercalcemia. The characteristic Touton giant cell in variable numbers was a consistent feature of the cutaneous lesions; however, these cells were either absent or present in reduced numbers in the various extracutaneous lesions when compared with JXG in the skin. Spindle cells intermingled among the mononuclear cells or forming short fascicles were seen in both cutaneous and extracutaneous lesions. Immunohistochemistry was performed on all extracutaneous lesions, and the constituent cells, regardless of their individual morphologic features, were uniformly positive for vimentin, CD68, and factor XIIIa and negative for S-100 protein and CD1a. It is widely held that JXG is a proliferative disorder of dendrocytes, possibly dermal dendrocytes; thus, its clinical and pathologic similarities to Langerhans cell histiocytosis are not entirely unexpected in light of the most recently proposed international classification of histiocytic disorders, which includes JXG and Langerhans cell histiocytosis together as "dendritic cell-related" histiocytoses.
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Affiliation(s)
- Louis P Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology, Barnes-Jewish and St. Louis Children's Hospitals, Washington University Medical Center, Missouri, 63110, USA.
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Flaitz C, Allen C, Neville B, Hicks J. Juvenile xanthogranuloma of the oral cavity in children: a clinicopathologic study. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2002; 94:345-52. [PMID: 12324792 DOI: 10.1067/moe.2002.122340] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE This clinicopathologic study describes the histopathologic, immunocytochemical, and electron microscopic features of oral juvenile xanthogranuloma (JXG) in children. DESIGN The study population consisted of 5 children (5 months to 10 years of age) with biopsy-proven JXGs obtained for consultation. RESULTS Lesion sites were gingiva, buccal mucosa, and tongue and were described by the clinicians as (1). irritation fibroma; (2). granulation tissue; (3). pedunculated granular nodule; (4). papilloma-like lesion; and (5). brown-red umbilicated papule. Tissue was available for histopathologic (n = 5), immunocytochemical (n = 5), and ultrastructural (n = 3) studies. Three cases showed early JXG lesions possessing abundant histiocytes, but lacking Touton giant cells. The other 2 cases had classic JXG lesions with vacuolated histiocytes and Touton giant cells. Immunocytochemical findings were (1). CD68 (KP1, PGM1), moderate to diffuse; (2). fascin, moderate to diffuse; (3). factor XIIIa, focal to diffuse; (4). alpha-1-antitrypsin, moderate to diffuse; (5). S-100 protein, focal to diffuse; and (6). CD1a, negative in all cases. Ultrastructural examination displayed histiocytic and dendritic cells lacking pentalaminar structures (Birbeck granules). CONCLUSION JXGs of the oral cavity vary in their clinical and histopathologic appearances and necessitate that Langerhans' cell disease (LCD) be excluded. JXG and Langerhans' cell disease may occur concurrently, before or after each other, in some children.
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Affiliation(s)
- Catherine Flaitz
- Division of Oral and Maxillofacial Surgery and Pathology, University of Texas-Houston Health Science Center, Dental Branch, Houston, Tex 77030, USA.
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