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Guo Y, Zhou SH, Cao ZZ, Bao YY, Shen LF, Yao HT. Epstein-Barr Virus-Positive Langerhans Cell Sarcoma: Is There a Link? A Case Report. Front Oncol 2022; 11:769310. [PMID: 35117987 PMCID: PMC8803631 DOI: 10.3389/fonc.2021.769310] [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: 09/01/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022] Open
Abstract
Langerhans cell sarcoma (LCS) is an extremely rare, malignant neoplasm that originates from Langerhans cells (LCs). Fewer than 70 cases have been reported in the English-language literature. LCS typically involves multiple organs, including the skin, lymph nodes, lungs, bone, bone marrow, liver, spleen, and soft tissues. Several etiological factors for LCS have been proposed, including immunosuppression, virus infection, and prior hematological disease. We report a rare case of LCS with Epstein-Barr virus (EBV) infection; bilateral cervical giant cysts were the initial manifestation. To our knowledge, this is the first report of LCS with EBV infection. The case information was complete, and the relevant literature was reviewed to gain insight into LCS. The case raises new questions on the oncogenic character of EBV.
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Affiliation(s)
- Yu Guo
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Shui-Hong Zhou
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zai-Zai Cao
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yang-Yang Bao
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Li-Fang Shen
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Hong-Tian Yao
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Zhang Y, Qu Z, Fang F. Langerhans cell sarcoma originating from left knee subcutaneous tissue: A case report and literature review. Oncol Lett 2016; 12:3687-3694. [PMID: 27900055 PMCID: PMC5104150 DOI: 10.3892/ol.2016.5194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 01/22/2016] [Indexed: 12/20/2022] Open
Abstract
Langerhans cell sarcoma (LCS) is a neoplastic proliferation of Langerhans cells with notably malignant cytological features. Reports of LCS are sparsely available in English literature; to the best of our knowledge, only 55 cases have been reported. The present study reports a case of LCS originating from subcutaneous tissue of the left knee in a 75-year-old man. The diagnosis of LCS was supported by the results of magnetic resonance imaging, histological and immunohistochemical studies. The tumor began to metastasize to inguinal lymph nodes and eventually involved multiple organs. Chemotherapy and radiotherapy were administered but were ineffective, and the patient died within 2 years of diagnosis. The present case should aid in expanding the currently available knowledge concerning LCS.
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Affiliation(s)
- Yaonan Zhang
- Department of Orthopedics, Beijing Hospital, Beijing 100730, P.R. China
| | - Zongyang Qu
- Department of Anesthesiology, Beijing Hospital, Beijing 100730, P.R. China
| | - Fang Fang
- Department of Pathology, Beijing Hospital, Beijing 100730, P.R. China
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3
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Howard JEF, Masterson L, Dwivedi RC, Jani P. Langerhans cell sarcoma of the head and neck. Crit Rev Oncol Hematol 2016; 99:180-8. [PMID: 26777877 DOI: 10.1016/j.critrevonc.2015.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 11/24/2015] [Accepted: 12/23/2015] [Indexed: 12/24/2022] Open
Abstract
Head and neck Langerhans cell sarcoma (HNLCS) is a rare malignant tumor carrying a poor prognosis. The aim of this work was to perform a systematic review of HNLCS cases, examine outcomes, and develop an evidence-based management algorithm. We performed a systematic literature search yielding 16 studies with 17 cases of HNLCS; 33 studies with 55 Non-HNLCS were used as a comparison. Mean disease-specific survival was 20.5 months (SE ± 5.1) for HNLCS versus 26.2 months (SE±4.2) for non-HNLCS. There was no significant difference in disease-specific (p = 0.768) or disease-free survival (p = 0.880) between the two cohorts. There was a significant difference in both disease-specific (p = 0.044) and disease-free survival (p = 0.001) between local, locoregional and disseminated disease favoring more limited disease. HNLCS appears to present later, with more disseminated disease. Surgery remains the mainstay of treatment of local disease, however clear margins do not guarantee clearance.
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Affiliation(s)
- James E F Howard
- Department of Otolaryngology, Head and Neck Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
| | - Liam Masterson
- Department of Otolaryngology, Head and Neck Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK; Department of Pathology, Tennis Court Road, University of Cambridge, CB1 1QP, UK
| | - Raghav C Dwivedi
- Department of Otolaryngology, Head and Neck Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Piyush Jani
- Department of Otolaryngology, Head and Neck Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
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4
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Langerhans cell sarcoma: a systematic review. Cancer Treat Rev 2015; 41:320-31. [PMID: 25805533 DOI: 10.1016/j.ctrv.2015.02.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 02/27/2015] [Indexed: 02/06/2023]
Abstract
Langerhans cell sarcoma (LCS) is a rare malignant tumour of Langerhans cells with a poor outcome. Given its rarity, there is a lack of evidence regarding the most appropriate treatment for this condition. Therefore the aim of this work was to review, compile, analyse and present clinical details and to determine the optimal treatment regimen. A search of PubMed, CINAHL, EMBASE, Cochrane, CENTRAL, clinicaltrials.gov and Google Scholar was supplemented by hand searching. Data extracted included demographics, treatment, type of LCS and clinical outcome. Of 510 citations identified by a systematic literature search, 46 case series including 66 subjects with LCS met criteria for analysis. The most common treatment modality was chemotherapy, used alone or in combination in 47 cases (71%) followed by surgery in 31 cases (47%). Overall mean (S.E.) disease specific survival and disease free survival were 27.2 (3.9) and 18.3 (3.8) months respectively. There was a significant difference in both disease specific and disease free survival between the local, loco-regional and disseminated disease cohorts (DSS p=0.014; DFS p<0.001). More localised disease confers a survival advantage. Multi-modality therapy appears to be most effective, with the addition of radiotherapy to chemotherapy appearing beneficial. Complete surgical excision with clear margins being most effective for local disease control. Any adjuvant therapy should not be delayed. Bone marrow transplant appears to be the most reliable treatment in terms of outcome especially in disseminated disease however has well known patient selection and toxicity/tolerance issues. The role of cell surface markers for prognostication remains unclear.
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5
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Ma X, Li W, Du J, Cai L, Zhang J. A case of an adult Langerhans cell sarcoma. Int J Dermatol 2014; 55:92-6. [PMID: 25312302 DOI: 10.1111/ijd.12440] [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] [Received: 03/28/2013] [Revised: 06/30/2013] [Accepted: 07/29/2013] [Indexed: 12/12/2022]
Affiliation(s)
- Xiaolei Ma
- Department of Dermatology, Peking University People's Hospital, Beijing, China
| | - Wenhai Li
- Department of Dermatology, Peking University People's Hospital, Beijing, China
| | - Juan Du
- Department of Dermatology, Peking University People's Hospital, Beijing, China
| | - Lin Cai
- Department of Dermatology, Peking University People's Hospital, Beijing, China
| | - Jianzhong Zhang
- Department of Dermatology, Peking University People's Hospital, Beijing, China
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Çallı AO, Morgül Y, Alacacıoğlu İ, Bener S, Payzin B. Langerhans Cell Sarcoma of the Axillary Lymph Node: A Case Report and Review of the Literature. Turk J Haematol 2013; 30:198-203. [PMID: 26923635 PMCID: PMC4770184 DOI: 10.5152/tjh.2011.98] [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: 04/18/2011] [Accepted: 10/25/2011] [Indexed: 11/22/2022] Open
Abstract
Langerhans cell sarcoma is a rare, high-grade neoplasm with overtly malignant cytological features and the Langerhans phenotype. Herein, we present a rare case of Langerhans cell sarcoma in a 65-year-old female that presented with a painless enlarging mass in her right axillary region, along with the histopathological features and diagnostic characteristics in the light of literature on Langerhans cell sarcoma.
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Affiliation(s)
- Aylin Orgen Çallı
- İzmir Atatürk Training and Research Hospital, Department of Pathology, İzmir, Turkey. E-mail:
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7
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Valentín-Nogueras SM, Seijo-Montes R, Montalván-Miró E, Sánchez JL. Langerhans cell sarcoma: a case report. J Cutan Pathol 2013; 40:670-5. [DOI: 10.1111/cup.12113] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 09/16/2012] [Accepted: 09/30/2012] [Indexed: 12/26/2022]
Affiliation(s)
| | - Rachelle Seijo-Montes
- Department of Dermatology; University of Puerto Rico School of Medicine; San Juan; PR; USA
| | - Elena Montalván-Miró
- Department of Dermatology; University of Puerto Rico School of Medicine; San Juan; PR; USA
| | - Jorge L. Sánchez
- Department of Dermatology; University of Puerto Rico School of Medicine; San Juan; PR; USA
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Lee JY, Jung KE, Kim HS, Lee JY, Kim HO, Park YM. Langerhans cell sarcoma: a case report and review of the literature. Int J Dermatol 2013; 53:e84-7. [DOI: 10.1111/j.1365-4632.2012.05668.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Li Y, Li B, Tian XY, Li Z. Unusual cutaneous Langerhans cell sarcoma without extracutaneous involvement. Diagn Pathol 2013; 8:20. [PMID: 23388086 PMCID: PMC3570402 DOI: 10.1186/1746-1596-8-20] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 01/21/2013] [Indexed: 11/10/2022] Open
Abstract
Abstract Langerhans cell sarcoma (LCS) typically presents as cytologic atypia and clinical aggressiveness and may involve multiple organs during the progression of the disease. Primary skin LCS without any extra-cutaneous site association is extremely rare and only a few such cases have been described in the literature. We present a case of unusual primary LCS in skin occurring in a middle-aged male patient. Physical examination revealed a large ulcerated cutaneous lesion and a smaller nodular lesion were located in the skin of the extensor side of his right knee. There was no regional lymph node or any other extra-cutaneous organ involvement. Histologically, typical large and pleomorphological tumor cells with epithelioid appearance and significantly malignant cytological features were observed to infiltrate in dermis and subcutaneous tissue. By immunohistochemistry, the tumor cells were positive for CD1a, S-100 protein and largerin strongly and diffusely. However, these cells were negative for CD3, CD20, CD21, pan-cytokeratin, HMB-45, Melan-A, and MPO. A diagnosis of primary cutaneous LCS was made. The patient received systemic chemotherapy of CHOP regimen, and was on a regular follow-up period for 12 months. There was no sign of relapse of tumor or any other extra-cutaneous organ involvement by whole body positron emission tomography/computed tomography (PET/CT) study. Because LCS is a high-grade malignancy with poor prognosis, it suggests that strict histological analysis and thorough radiographic examination are necessary for accurately diagnosing this tumor even if cutaneous involvement presented only. Virtual slides http://www.diagnosticpathology.diagnomx.eu/vs/6527428618381393
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Affiliation(s)
- Yang Li
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, 58, Zhongshan Road II, Guangzhou, 510080, China
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Wang YN, Zhou XG, Wang Z. Langerhans cell sarcoma in the cervical lymph node: a case report and literature review. Acta Haematol 2013. [PMID: 23207655 DOI: 10.1159/000342103] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Langerhans cell sarcoma (LCS) is extremely rare, with only 36 cases reported in English literature. In this report we represent the case of a 77-year-old woman with a 1-month history of left neck swelling and pain. A diagnosis of LCS was rendered from pathological findings of the cervical lymph node biopsy. The patient's condition deteriorated rapidly and she died 2 days after diagnosis. A literature review in the context of the present case was performed to better enhance understanding of the early diagnosis and treatment of this unusual lesion.
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Affiliation(s)
- Yi-ni Wang
- Department of Hematology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Furmanczyk PS, Lisle AE, Caldwell RB, Kraemer KG, Mercer SE, George E, Argenyi ZB. Langerhans cell sarcoma in a patient with hairy cell leukemia: common clonal origin indicated by identical immunoglobulin gene rearrangements. J Cutan Pathol 2012; 39:644-50. [DOI: 10.1111/j.1600-0560.2012.01873.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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12
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Abstract
A 53-year-old man, who was a heavy smoker, presented with recent severe cough. Radiography demonstrated a large pulmonary mass in the right upper lung. FDG PET/CT demonstrated heterogeneous high-grade activity in the pulmonary mass located in the right upper lung (standardized uptake value of 20), with central necrosis, bilateral upper mediastinal lymphadenopathy, right supraclavicular lymphadenopathy, direct left sternal manubrium invasion, and distal bilateral peripheral lung metastasis. Histology revealed significant malignant cytologic features and CD1a- and S-100-positive cells by immunohistochemistry staining, typical for Langerhans cell sarcoma.
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13
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Yang CJ, Lee JY, Wu CC, Yin HL, Lien CT, Liu YC. An unusual pulmonary mass with mediastinal invasion and multiple intrapulmonary nodules in a 52-year-old man. Chest 2012; 141:253-258. [PMID: 22215835 DOI: 10.1378/chest.11-0360] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Chih-Jen Yang
- Division of Pulmonary and Critical Care Medicine, Kaohsiung, Taiwan; Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jui-Ying Lee
- Division of Chest Surgery, Department of Surgery, Kaohsiung, Taiwan
| | - Chun-Chieh Wu
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hsin-Ling Yin
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chi-Tun Lien
- Division of Pulmonary and Critical Care Medicine, Kaohsiung, Taiwan
| | - Yi-Chang Liu
- Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung, Taiwan; Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Kang DW, Son HJ, Baek TH, Lee HK, Huh JR, Kim JH, Park MJ. Langerhans Cell Sarcoma Arising in a Lymph Node - A Case Report and Review of the Literature -. KOREAN JOURNAL OF PATHOLOGY 2011. [DOI: 10.4132/koreanjpathol.2011.45.1.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Dong-Wook Kang
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
| | - Hyun-Jin Son
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
| | - Tae-Hwa Baek
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
| | - Hye-Kyung Lee
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
| | - Joo-Ryung Huh
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joo-Heon Kim
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
| | - Mee-Ja Park
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
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Nakayama M, Takahashi K, Hori M, Okumura T, Saito M, Yamakawa M, Tabuchi K, Hara A. Langerhans cell sarcoma of the cervical lymph node: A case report and literature review. Auris Nasus Larynx 2010; 37:750-3. [DOI: 10.1016/j.anl.2010.04.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 04/27/2010] [Accepted: 04/30/2010] [Indexed: 10/19/2022]
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16
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WANG P, WANG X, HONG J, WANG Z. Extensive cutaneous Langerhans cell histiocytosis in an elderly woman. J Dermatol 2010; 38:794-7. [DOI: 10.1111/j.1346-8138.2010.01098.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zhao G, Luo M, Wu ZY, Liu Q, Zhang B, Gao RL, Zhang ZQ. Langerhans cell sarcoma involving gallbladder and peritoneal lymph nodes: a case report. Int J Surg Pathol 2008; 17:347-53. [PMID: 18805873 DOI: 10.1177/1066896908324128] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Langerhans cell sarcoma (LCS) is a rare proliferation of Langerhans cells with overtly malignant cytologic features and spreads aggressively. LCSs show a multiorgan involvement, including skin, lymph nodes, lung, and bone. The authors report an LCS in a 74-year-old woman that involved the gallbladder and the peritoneal lymph nodes. Imaging revealed a tumor in the gallbladder and the peritoneal lymph nodes. The tumor cells were positive for CD1a, S-100 protein, and Langerin (CD207). Although the ultrastructural analysis failed to demonstrate any Birbeck granules, the histomorphological and immunohistochemical findings supported the diagnosis of LCS. After surgical resection, she showed no recurrent or metastatic signs for 8 months without any other adjuvant therapy. This is the first case of LCS involving the gallbladder and the peritoneal lymph nodes. This report also includes a review of the literature concerning this rare disease.
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Affiliation(s)
- Gang Zhao
- Department of General Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Deng A, Lee W, Pfau R, Harrington A, DiGiovani J, Prickett KA, Dare DM, Petrali JP. Primary cutaneous Langerhans cell sarcoma without Birbeck granules: indeterminate cell sarcoma? J Cutan Pathol 2008; 35:849-54. [DOI: 10.1111/j.1600-0560.2007.00907.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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ESHAP therapy effective in a patient with Langerhans cell sarcoma. Int J Hematol 2008; 87:532-537. [DOI: 10.1007/s12185-008-0075-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Revised: 02/07/2008] [Accepted: 02/25/2008] [Indexed: 12/30/2022]
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21
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Uchida K, Kobayashi S, Inukai T, Noriki S, Imamura Y, Nakajima H, Yayama T, Orwotho N, Baba H. Langerhans cell sarcoma emanating from the upper arm skin: successful treatment by MAID regimen. J Orthop Sci 2008; 13:89-93. [PMID: 18274862 DOI: 10.1007/s00776-007-1184-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Accepted: 07/20/2007] [Indexed: 02/09/2023]
Affiliation(s)
- Kenzo Uchida
- Department of Orthopaedics and Rehabilitation Medicine, Fukui University Faculty of Medical Sciences, Matsuoka, Fukui, Japan
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23
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Bohn OL, Ruiz-Argüelles G, Navarro L, Saldivar J, Sanchez-Sosa S. Cutaneous Langerhans cell sarcoma: a case report and review of the literature. Int J Hematol 2007; 85:116-20. [PMID: 17321988 DOI: 10.1532/ijh97.na0604] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Langerhans cell sarcoma (LCS) is a neoplastic proliferation of Langerhans cells that occurs in lymph nodes, liver, skin, spleen, lung, and bone. We report a case of LCS in a 47-year-old man with a 6-month history of scalp mass and cervical lymphadenopathy. Clinical and pathologic data were available. A histologic examination demonstrated a proliferation of cells with malignant cytologic features. Because of its poorly differentiated morphologic features, hematologic and nonhematologic entities were ruled out by immunohistochemical screening with a broad panel of antibodies. Ultrastructural studies demonstrating Birbeck granules and consistent expression of CD1a, S-100 protein, and langerin by immunohistochemistry were helpful in identifying the Langerhans cell origin.
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Affiliation(s)
- Olga L Bohn
- Department of Pathology, University Hospital UPAEP, Puebla, Mexico
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24
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Langerhans Cell Histiocytosis in Skin and Mucous Membranes. Dermatopathology (Basel) 2006. [DOI: 10.1007/3-540-30244-1_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Lee JS, Ko GH, Kim HC, Jang IS, Jeon KN, Lee JH. Langerhans cell sarcoma arising from Langerhans cell histiocytosis: a case report. J Korean Med Sci 2006; 21:577-80. [PMID: 16778410 PMCID: PMC2729972 DOI: 10.3346/jkms.2006.21.3.577] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Langerhans cell sarcoma (LCS) is a neoplastic proliferation of Langerhans cells that have overtly malignant cytologic features. It is a very rare disease and theoretically, it can present de novo or progress from an antecedent Langerhans cell histiocytosis (LCH). However, to our knowledge, LCS arising from an antecedent LCH has not been reported on. We present here a case of LCS arising from a pulmonary LCH. A 34 yr-old man who was a smoker, had a fever and a chronic cough. Computed tomographic (CT) scan revealed multiple tiny nodules in both lungs. The thoracoscopic lung biopsy revealed LCH. The patient quit smoking, but he received no other specific treatment. One year later, the follow up chest CT scan showed a 4 cm-sized mass in the left lower lobe of the lung. A lobectomy was then performed. Microscopic examination of the mass revealed an infiltrative proliferation of large cells that had malignant cytologic features. Immunohistochemical stains showed a strong reactivity for S-100 and CD68, and a focal reactivity for CD1a. We think this is the first case of LCS arising from LCH.
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Affiliation(s)
- Jong-Sil Lee
- Department of Pathology, College of Medicine, Gyeongsang National University, Jinju, Korea
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Billings SD, Hans CP, Schapiro BL, Martin RW, Fivenson D, Fruland JE, Moores WB, Cotton J. Langerhans cell histiocytosis associated with myelodysplastic syndrome in adults. J Cutan Pathol 2006; 33:171-4. [PMID: 16420314 DOI: 10.1111/j.0303-6987.2006.00299.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Myelodysplastic syndrome (MDS) is a group of bone marrow disorders associated with dyplasia of myeloid elements that may have cutaneous manifestations including infections, vasculitis, Sweet's syndrome, pyoderma gangrenosum, erythema elevatum diutinum, and leukemia cutis. These cutaneous manifestations are attributed to the underlying bone marrow defect. Langerhans cell histiocytosis (LCH) is primarily a pediatric disease, and rarely LCH has been described in association with pediatric MDS. We are aware of only a single case report of LCH associated with MDS in an adult. METHODS We report two new cases of LCH in elderly patients with underlying MDS. The specimens were examined by routine microscopy as well as immunohistochemical stains for S100 protein and CD1a. RESULTS Both patients were elderly men with established diagnoses of MDS. One presented with a solitary pruritic papule while the other had a 2-year history of erythematous papules involving the trunk and extremities. Histologic examination revealed intraepidermal and dermal collections of mononuclear cells with reniform nuclei. The cells were strongly positive for S100 and CD1a, confirming their identity as Langerhans cells. CONCLUSION Cutaneous LCH may be associated with underlying MDS in adults and should be considered in the differential diagnosis of cutaneous eruptions in patients with MDS.
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Affiliation(s)
- Steven D Billings
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Abstract
Proliferations of Langerhans cells can be histologically divided into cytologically benign Langerhans cell proliferations, which include the clinical syndromes of Langerhans cell histiocytosis, and cytologically malignant Langerhans cell sarcoma. We report a Langerhans cell sarcoma in a 33-year-old male that arose on the posterior thigh with subsequent regional lymph node involvement. Conventional microscopic, immunohistochemical, and ultrastructural analysis confirmed Langerhans cell differentiation. Aberrant CD31 expression, similar to that described previously in Langerhans cell histiocytosis, was prominent in this tumor, possibly enhancing its migratory capabilities.
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Jülg BD, Weidner S, Mayr D. Pulmonary manifestation of a Langerhans cell sarcoma: case report and review of the literature. Virchows Arch 2005; 448:369-74. [PMID: 16328350 DOI: 10.1007/s00428-005-0115-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Accepted: 10/10/2005] [Indexed: 10/25/2022]
Abstract
In the following, we describe the very rare case of Langerhans cell sarcoma (LCS) in the lung. Throughout the medical literature, only a few cases have been published, and, to the best of our knowledge, this is the first case to be reported in Germany. The patient was an 81-year-old man who showed symptoms such as chronic cough and weight loss. Clinical examination including needle biopsy indicated a high possibility of carcinoma in the right lung and in the mediastinum; however, the final histopathological diagnosis after immunohistochemistry gave evidence of LCS. LCS is a neoplastic proliferation of Langerhans cells with malignant cytological features exhibiting a very aggressive behaviour. LCS can be distinguished from other carcinomas, lymphomas and sarcomas by the typical morphological features of Langerhans cells and the immunophenotype with a consistent expression of S-100 protein and CD1a. In contrast to Langerhans cell histiocytosis, the LCS consists of Langerhans cells with high atypia and a very high mitotic rate.
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Affiliation(s)
- Boris Dominik Jülg
- Medizinische Poliklinik, Ludwig, Maximilian University, Munich, Germany.
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Imanaka A, Tarutani M, Itoh H, Kira M, Itami S. Langerhans cell histiocytosis involving the skin of an elderly woman: a satisfactory remission with oral prednisolone alone. J Dermatol 2005; 31:1023-6. [PMID: 15801269 DOI: 10.1111/j.1346-8138.2004.tb00648.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a disorder characterized by neoplastic proliferation of Langerhans cells that rarely involves the skin in adults. A 74-year-old woman presented with a fourteen year history of eosinophilic granuloma and bone involvement caused by LCH. She had received three combination therapy courses of curettage and radiation since 1987 and had remained free of LCH signs for seven years, after which she started to notice brown nodules on her left leg. Biopsy specimens taken from the lesions showed massive proliferations of large histiocytic cells. Immunoperoxidase stainings for CD1a and S-100 protein were positive. Electron microscopy identified Birbeck granules in the cytoplasm of the atypical Langerhans cells. Treatment with oral prednisolone alone has resulted in the patient remaining in complete remission for 12 months.
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Affiliation(s)
- Aiko Imanaka
- Department of Dermatology, Course of Molecular Medicine, Graduate School of Medicine, Osaka University, 2-2, C-5, Yamadaoka, Suita-shi, Osaka 565-0871, Japan
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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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