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Abstract
Mastocytoses are characterized by clonal proliferation of mast cells in various tissues. In childhood, cutaneous mastocytosis (CM) occurs almost exclusively. It is confined to the skin, and has a good prognosis. The most common form is the maculopapular cutaneous mastocytosis (MPCM), formerly called urticaria pigmentosa. A distinction is made between a monomorphic variant of MPCM with multiple small, roundish maculopapular skin lesions and the - more common - polymorphic variant with larger lesions of variable size. One quarter of CM diagnosed in childhood are mastocytomas, which often occur solitary or at multiple sites. The diffuse variant of CM (DCM), which affects 5% of children with CM, should be distinguished from these forms. Systemic mastocytoses (SM) with mast cell infiltrates in the bone marrow or other extracutaneous tissues, such as the gastrointestinal tract, occur predominantly in adults. The diagnosis of CM is usually made clinically: Manifestation in infancy, typical morphology and distribution, pathognomonic Darier sign. Basal serum tryptase is determined if DCM or systemic mastocytosis are to be diagnosed. Children with mastocytosis should be managed in a specialized outpatient clinic. For affected families, detailed information about the clinical picture including prognosis assessment is essential. Mast cell mediated symptoms are controlled by oral non-sedating antihistamines if needed.
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2
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Shibata Y, Hirota S, Saito I, Asahina A. Diffuse cutaneous mastocytosis: Identification of KIT mutation and long-term follow-up with serum tryptase level. J Dermatol 2021; 48:672-675. [PMID: 33521998 DOI: 10.1111/1346-8138.15764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/24/2020] [Accepted: 12/25/2020] [Indexed: 11/27/2022]
Abstract
Diffuse cutaneous mastocytosis (DCM) is the least common subtype of cutaneous mastocytotis and is generally more severe than other subtypes. We herein report a case of DCM with the consequence of a long-term follow-up. A 4-month-old boy visited with a 3-month history of diffuse erythema that gradually worsened. Darier's sign was positive. The plasma histamine level was 4.95 ng/mL, and the serum tryptase and c-Kit (CD117) levels were 33.3 and 27.4 ng/mL, respectively. Histopathology of the biopsied specimen showed dermal papillary edema and infiltration of mast cells identified by c-Kit and toluidine blue staining. Amplification and direct sequencing of genomic DNA extracted from the skin biopsy specimen revealed the presence of a deletion of codon 419 in exon 8 (c.1255_1257delGAC [p. Asp419del]). There was no evidence of systemic infiltration of mast cells in this case, and we started topical corticosteroid and oral antihistamine with the diagnosis of DCM. Diffuse erythema subsided constantly with age in parallel with chronological decline of serum tryptase level, and it is no longer apparent presently at the age of 7 years, leaving only faint brown spots. Blister formation did not occur throughout the course. Our case indicates that spontaneous resolution can be expected even in DCM after a long period of time, and that serum tryptase level serves as a good surrogate marker to monitor the clinical course.
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Affiliation(s)
- Yuka Shibata
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo College of Medicine, Hyogo, Japan
| | - Ikuo Saito
- Department of Pathology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Akihiko Asahina
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
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3
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Santosh T, Sharma T, Patra S, Asati DP, Chaurasia JK, Joshi D, Kapoor N. Cutaneous mastocytosis-Conglomerate of diagnostic tools: A report of four cases. INDIAN J PATHOL MICR 2021; 64:587-590. [PMID: 34341280 DOI: 10.4103/ijpm.ijpm_970_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Mast cells are naturally distributed in the dermis, respiratory, gastrointestinal/genitourinary mucosa, adjacent to blood vessels, lymphatics, and peripheral nerves. The most common site for the abnormal accumulation of mast cells is the skin, which is known as cutaneous mastocytosis. We report four cases of cutaneous mastocytosis with erythematous maculopapular to bullous lesion along with a positive Darier sign. Skin biopsy, with special stains like Toluidine blue, Giemsa stain, immunohistochemistry (IHC) for CD117, and serum tryptase level correlations were done. Mastocytosis can affect only the cutaneous sites or involve multiple organs. It is most common in infancy with varied clinical presentations, thus requiring a high index of suspicion with histopathological correlation. Although the prognosis is good, there remains a risk of sudden mast cell degranulation due to triggering agents and subsequent collapse.
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Affiliation(s)
- Tummidi Santosh
- Department of Pathology, AIIMS, Mangalagiri, Andhra Pradesh, India
| | - Tanya Sharma
- Department of Pathology and Lab Medicine, AIIMS, Bhopal, Madhya Pradesh, India
| | - Suman Patra
- Department of Dermatology, STD and Leprosy, AIIMS, Bhopal, Madhya Pradesh, India
| | - Dinesh P Asati
- Department of Dermatology, STD and Leprosy, AIIMS, Bhopal, Madhya Pradesh, India
| | - Jai K Chaurasia
- Department of Pathology and Lab Medicine, AIIMS, Bhopal, Madhya Pradesh, India
| | - Deepti Joshi
- Department of Pathology and Lab Medicine, AIIMS, Bhopal, Madhya Pradesh, India
| | - Neelkamal Kapoor
- Department of Pathology and Lab Medicine, AIIMS, Bhopal, Madhya Pradesh, India
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4
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Di Raimondo C, Del Duca E, Silvaggio D, Di Prete M, Lombardo P, Mazzeo M, Spallone G, Campione E, Botti E, Bianchi L. Cutaneous mastocytosis: A dermatological perspective. Australas J Dermatol 2020; 62:e1-e7. [PMID: 33040350 DOI: 10.1111/ajd.13443] [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: 04/25/2020] [Revised: 07/14/2020] [Accepted: 07/20/2020] [Indexed: 12/01/2022]
Abstract
Mastocytosis is a rare disease characterised by expansion and collection of clonal mast cells in various organs including the skin, bone marrow, spleen, lymph nodes and gastrointestinal tract. The prevalence of mastocytosis has been estimated to be one in 10 000, while the estimated incidence is one per 100 000 people per year. Cutaneous mastocytosis is classified into (i) maculopapular cutaneous mastocytosis, also known as urticaria pigmentosa; (ii) diffuse cutaneous mastocytosis; and (iii) mastocytoma of the skin. In adults, cutaneous lesions are usually associated with indolent systemic mastocytosis and have a chronic evolution. Paediatric patients, on the contrary, have often cutaneous manifestations without systemic involvement and usually experience a spontaneous regression. Diagnosis of cutaneous mastocytosis may be challenging due to the rarity of the disease and the overlap of cutaneous manifestations. This short review describes pathogenesis and clinical aspects of cutaneous mastocytosis with a focus on diagnosis and currently available therapies.
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Affiliation(s)
| | - Ester Del Duca
- Department of Dermatology, University of Roma Tor Vergata, Rome, Italy
| | | | - Monia Di Prete
- Department of Anatomic Pathology, University of Rome Tor Vergata, Rome, Italy
| | - Paolo Lombardo
- Department of Dermatology, University of Roma Tor Vergata, Rome, Italy
| | - Mauro Mazzeo
- Department of Dermatology, University of Roma Tor Vergata, Rome, Italy
| | - Giulia Spallone
- Department of Dermatology, University of Roma Tor Vergata, Rome, Italy
| | - Elena Campione
- Department of Dermatology, University of Roma Tor Vergata, Rome, Italy
| | - Elisabetta Botti
- Department of Dermatology, University of Roma Tor Vergata, Rome, Italy
| | - Luca Bianchi
- Department of Dermatology, University of Roma Tor Vergata, Rome, Italy
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5
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Li Y, Li X, Liu X, Kang L, Liu X. Genotypic and phenotypic characteristics of Chinese neonates with cutaneous mastocytosis: a case report and literature review. J Int Med Res 2020; 48:300060520952621. [PMID: 32883129 PMCID: PMC7479863 DOI: 10.1177/0300060520952621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/04/2020] [Indexed: 11/17/2022] Open
Abstract
Mastocytosis is an accumulation of clonal mast cells within tissues and it is most commonly caused by an activating mutation in the KIT gene. In this study, we report a neonatal case who presented with diffuse cutaneous mastocytosis (CM) at birth. In China, nine other cases of neonatal-onset CM have been reported in the literature since 2006. In those cases, diffuse CM and urticaria pigmentosa were the main symptoms, and mutations in exon 17 at codon 816 in KIT were identified.
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Affiliation(s)
- Yanfang Li
- Department of Neonatology, Qilu Children’s Hospital, Cheeloo
College of Medicine, Shandong University, Jinan, Shandong, China
- Department of Pediatrics, Qilu Hospital, Cheeloo College of
Medicine, Shandong University, Jinan, Shandong, China
| | - Xiaoying Li
- Department of Neonatology, Qilu Children’s Hospital, Shandong
University, Jinan, Shandong, China
| | - Xianghong Liu
- Department of Neonatology, Qilu Children’s Hospital, Shandong
University, Jinan, Shandong, China
| | - Lili Kang
- Department of Neonatology, Qilu Children’s Hospital, Shandong
University, Jinan, Shandong, China
| | - Xinjie Liu
- Department of Pediatrics, Qilu Hospital, Cheeloo College of
Medicine, Shandong University, Jinan, Shandong, China
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Leru PM, Anton VF, Ureche C, Zurac S, Bratu O, Neagoe CD. Mast cell activation syndromes - evaluation of current diagnostic criteria and laboratory tools in clinical practice (Review). Exp Ther Med 2020; 20:2348-2351. [PMID: 32765713 DOI: 10.3892/etm.2020.8947] [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: 05/15/2020] [Accepted: 06/16/2020] [Indexed: 01/15/2023] Open
Abstract
Mast cell activation syndromes (MCAS) represent a heterogeneous clinical entity caused by episodic and severe mast cell activation, including primary and secondary mast cell disorders (MCDs). The group of primary or clonal MCDs refers to systemic mastocytosis, other clonal MCAS and hereditary hypertryptasemia, while the secondary MCAS is characterized by normal mast cells (MCs) which are activated by external triggers, such as allergens or physical stimuli. Another category of MCAS is the idiopathic form, when no trigger or genetic mutation can be identified. Symptoms of mast cell activation are due to release of specific mediators and can be seen in many diseases, such as allergies, with localized or systemic clinical manifestations. Confirmation of MCAS is based on diagnostic criteria proposed by an international group of experts and the best available evidence in this field. It is generally accepted that the clinical picture of MCAS is non-specific and there are few available laboratory tools, making it difficult for clinicians to identify and confirm this entity. The diagnosis is established after exclusion of other possible clinical entities in most of the cases. Therefore, the actual diagnostic criteria of MCASs, some relevant clinical aspects and laboratory tools used in clinical practice were reviewed.
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Affiliation(s)
- Polliana Mihaela Leru
- Family Medicine Department, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Internal Medicine Clinic, 'Colentina' Clinical Hospital, 020125 Bucharest, Romania
| | - Vlad Florin Anton
- Internal Medicine Clinic, 'Colentina' Clinical Hospital, 020125 Bucharest, Romania
| | - Corina Ureche
- Internal Medicine Clinic, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540139 Târgu Mureş, Romania
| | - Sabina Zurac
- Family Medicine Department, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Pathology, 'Colentina' Clinical Hospital, 020125 Bucharest, Romania
| | - Ovidiu Bratu
- Family Medicine Department, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Urology Clinic, Central Military Emergency University Hospital, 010825 Bucharest, Romania.,Academy of Romanian Scientists, 050045 Bucharest, Romania
| | - Carmen Daniela Neagoe
- Internal Medicine and Gastroenterology Clinic, Emergency County Hospital, 200642 Craiova, Romania.,Gastroenterology Department, University of Medicine and Pharmacy, 200349 Craiova, Romania
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Zhang H, Ma Y, Yan B, Yang X, Li Y, Guan J, Dong R, Liu Y, Gai Z. Establishment of a human induced pluripotent stem cell line (SDQLCHi005-A) from a patient with mastocytosis carrying heterozygous mutation in KIT gene. Stem Cell Res 2019; 40:101565. [PMID: 31522012 DOI: 10.1016/j.scr.2019.101565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 08/27/2019] [Accepted: 08/29/2019] [Indexed: 11/26/2022] Open
Abstract
We established an induced pluripotent stem cell (iPSC) line from peripheral blood mononuclear cells of a Chinese neonate with mastocytosis carrying heterozygous mutation (c.2447A > T (p.D816V)) in KIT gene by episomal vector (EV) reprogramming system. This iPSC line carrying KIT gene mutation, was free of exogenous gene, showed a normal karyotype, expressed pluripotency markers and exhibited differentiation potential.
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Affiliation(s)
- Haiyan Zhang
- Pediatric Research Institute, Qilu Children's Hospital of Shandong University, Jinan, Shandong 250022, China
| | - Yanyan Ma
- Pediatric Research Institute, Qilu Children's Hospital of Shandong University, Jinan, Shandong 250022, China
| | - Beibei Yan
- Neonatal Department, Qilu Children's Hospital of Shandong University, Jinan, Shangdong 250022, China
| | - Xiaomeng Yang
- Pediatric Research Institute, Qilu Children's Hospital of Shandong University, Jinan, Shandong 250022, China
| | - Yue Li
- Pediatric Research Institute, Qilu Children's Hospital of Shandong University, Jinan, Shandong 250022, China
| | - Jingyun Guan
- Pediatric Research Institute, Qilu Children's Hospital of Shandong University, Jinan, Shandong 250022, China
| | - Rui Dong
- Pediatric Research Institute, Qilu Children's Hospital of Shandong University, Jinan, Shandong 250022, China
| | - Yi Liu
- Pediatric Research Institute, Qilu Children's Hospital of Shandong University, Jinan, Shandong 250022, China.
| | - Zhongtao Gai
- Pediatric Research Institute, Qilu Children's Hospital of Shandong University, Jinan, Shandong 250022, China; Neonatal Department, Qilu Children's Hospital of Shandong University, Jinan, Shangdong 250022, China
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8
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Jenkinson HA, Lundgren AD, Carter MC, Diaz LZ, Levy ML. Management of a neonate with diffuse cutaneous mastocytosis: Case report and literature review. Pediatr Dermatol 2019; 36:486-489. [PMID: 30828864 DOI: 10.1111/pde.13801] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Mastocytosis is an accumulation of clonal mast cells within tissues, commonly caused by mutations in the KIT proto-oncogene. This report describes the management of a neonate with diffuse cutaneous mastocytosis (DCM) caused by a rare activating KIT mutation, specifically internal tandem duplication of the Ala502Tyr503 pair on exon 9, and reviews current data regarding work-up of DCM in pediatric patients.
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Affiliation(s)
- Helena A Jenkinson
- Department of Dermatology, McGovern Medical School at The University of Texas at Houston, Houston, Texas
| | - Ashley D Lundgren
- Department of Internal Medicine (Dermatology), Dell Medical School at The University of Texas at Austin, Austin, Texas.,Pediatric/Adolescent Dermatology, Dell Children's Medical Center, Austin, Texas
| | - Melody C Carter
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Lucia Z Diaz
- Department of Internal Medicine (Dermatology), Dell Medical School at The University of Texas at Austin, Austin, Texas.,Pediatric/Adolescent Dermatology, Dell Children's Medical Center, Austin, Texas.,Department of Pediatrics, Dell Medical School, Austin, Texas
| | - Moise L Levy
- Department of Internal Medicine (Dermatology), Dell Medical School at The University of Texas at Austin, Austin, Texas.,Pediatric/Adolescent Dermatology, Dell Children's Medical Center, Austin, Texas.,Department of Pediatrics, Dell Medical School, Austin, Texas
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9
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Agharbi FZ. [Isolated mastocytoma in children: a case study]. Pan Afr Med J 2019; 32:45. [PMID: 31143350 PMCID: PMC6522148 DOI: 10.11604/pamj.2019.32.45.14356] [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: 11/09/2017] [Accepted: 01/16/2019] [Indexed: 11/24/2022] Open
Abstract
Le mastocytome solitaire est la forme la plus fréquente de mastocytose chez l'enfant. Son pronostic est bon comme toutes les autres formes de mastocytoses de l'enfant avec possibilité de régression spontanée. Les dermocorticoïdes peuvent accélérer cette régression comme c'est le cas chez notre patient.
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10
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Wagner N, Staubach P. Mastocytosis - pathogenesis, clinical manifestation and treatment. J Dtsch Dermatol Ges 2019; 16:42-57. [PMID: 29314691 DOI: 10.1111/ddg.13418] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 11/14/2017] [Indexed: 01/08/2023]
Abstract
The term mastocytosis designates a group of rare disorders characterized by typical skin lesions, frequently associated episodes of anaphylaxis, and clinical symptoms related to the release of various mediators. Dermatologists/allergists are frequently the first to establish the diagnosis. The condition is based on clonal mast cell proliferation, usually in the skin or bone marrow and only rarely in the gastrointestinal tract or other tissues. In general, mastocytosis has a good prognosis in terms of life expectancy. Rare variants - including mast cell leukemia, aggressive mastocytosis, and the exceedingly rare mast cell sarcoma - require cytoreductive therapy. In cases associated with hematological neoplasms, the prognosis depends on the underlying hematologic disorder.
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Affiliation(s)
- Nicola Wagner
- Department of Dermatology, University Medical Center, Erlangen, Germany
| | - Petra Staubach
- Department of Dermatology, University Medical Center, Mainz, Germany
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11
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Abstract
Profound hypotension and cardiac arrest after commencement of combined spinal and general anaesthesia in a patient for knee replacement surgery raised the suspicion of anaphylaxis. This seemed to be confirmed when a mast cell tryptase test taken about 90 minutes after the onset of the hypotension was elevated. However, subsequent intradermal skin testing twelve weeks later did not identify a causal drug. Repeat mast cell tryptase at the time showed the same elevation, which led to the correct diagnosis of mastocytosis and a secondary diagnosis that the patient's hypotension and cardiac arrest were the result of her spinal anaesthesia. If the serum tryptase is elevated during the event but no allergic agent can be identified, a further serum tryptase should be taken several weeks later to exclude a persistent elevation due to mastocytosis.
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Affiliation(s)
- W J Russell
- Department of Anaesthesia, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia
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12
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Roskoski R. The role of small molecule Kit protein-tyrosine kinase inhibitors in the treatment of neoplastic disorders. Pharmacol Res 2018; 133:35-52. [DOI: 10.1016/j.phrs.2018.04.020] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 04/23/2018] [Indexed: 12/25/2022]
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Popadić S, Gajić-Veljić M, Marenović B, Nikolić M. Diffuse Cutaneous Mastocytosis in a Child - a Case Report. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2018. [DOI: 10.1515/sjdv-2017-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Mastocytosis refers to a group of diseases characterized by a clonal proliferation and accumulation of mast cells in one or more tissues/organs with different clinical presentations. In children, limited cutaneous forms of mastocytosis are rather frequent, while systemic mastocytosis is rare. The diagnosis of cutaneous mastocytosis is based on clinical findings and histopathology. We present a patient who developed skin lesions at the age of 18 months. Clinical findings, confirmed by histopathology, were consistent with diffuse cutaneous mastocytosis. The follow-up period was 7 years. The treatment included oral antihistamines in combination with mast cell stabilizers, mild topical steroids and avoidance of friction. During the follow-up period, there were no signs of systemic involvement, and the quality of life was preserved, despite the large surface of affected skin. This case report should increase the awareness and knowledge of clinicians about this rare form of cutaneous mastocytosis in the pediatric population.
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Affiliation(s)
- Svetlana Popadić
- Clinic of Dermatovenereology, Clinical Center of Serbia , Belgrade , Serbia
- Department of Dermatovenereology, School of Medicine , University of Belgrade , Belgrade , Serbia
| | - Mirjana Gajić-Veljić
- Clinic of Dermatovenereology, Clinical Center of Serbia , Belgrade , Serbia
- Department of Dermatovenereology, School of Medicine , University of Belgrade , Belgrade , Serbia
| | - Biljana Marenović
- Clinic of Dermatovenereology, Clinical Center of Serbia , Belgrade , Serbia
| | - Miloš Nikolić
- Clinic of Dermatovenereology, Clinical Center of Serbia , Belgrade , Serbia
- Department of Dermatovenereology, School of Medicine , University of Belgrade , Belgrade , Serbia
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14
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Wagner N, Staubach P. Mastozytose - Pathogenese, Klinik und Therapie. J Dtsch Dermatol Ges 2018; 16:42-59. [PMID: 29314684 DOI: 10.1111/ddg.13418_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 11/14/2017] [Indexed: 01/08/2023]
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15
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Chatterjee M, Sengupta S, Chakravarty C, Ramasubban S, Bhartia S, Khan S, Agarwal VK. Indolent Systemic Mastocytosis Manifesting as Protracted Anaphylactic Shock. Indian J Crit Care Med 2018; 22:311-313. [PMID: 29743774 PMCID: PMC5930539 DOI: 10.4103/ijccm.ijccm_497_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Systemic mastocytosis is a rare disease due to abnormal proliferation of mast cells (MCs). A case of indolent systemic mastocytosis is presented here. After anesthetic induction for elective thyroid swelling with propofol and atracurium followed by endotracheal intubation, a 57-year-old female patient developed acute hypotension, sinus tachycardia, red rashes, increased airway pressure along with difficult ventilation, and desaturation. She developed multiorgan failure subsequently. MC tryptase level was persistently high. Bone marrow study revealed mastocytosis. She required antihistaminic, steroid, and organ support. With treatment, organ functions recovered gradually. Atracurium precipitated anaphylactic shock causing severe morbidity in this patient.
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Affiliation(s)
- Manidipam Chatterjee
- Department of Critical Care Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | - Saikat Sengupta
- Department of Anaesthesiology, Perioperative Medicine and Pain, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | | | - Suresh Ramasubban
- Department of Critical Care Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | - Shilpa Bhartia
- Department of Hemato Oncology, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | - Sujoy Khan
- Department of Allergy and Immunology, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | - Vikash Kumar Agarwal
- Department of Oncosurgery, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
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16
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Gallogly MM, Lazarus HM, Cooper BW. Midostaurin: a novel therapeutic agent for patients with FLT3-mutated acute myeloid leukemia and systemic mastocytosis. Ther Adv Hematol 2017; 8:245-261. [PMID: 29051803 DOI: 10.1177/2040620717721459] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/28/2017] [Indexed: 12/12/2022] Open
Abstract
The development of FLT3-targeted inhibitors represents an important paradigm shift in the management of patients with highly aggressive fms-like tyrosine kinase 3-mutated (FLT3-mut) acute myeloid leukemia (AML). Midostaurin is an orally administered type III tyrosine kinase inhibitor which in addition to FLT3 inhibits c-kit, platelet-derived growth factor receptors, src, and vascular endothelial growth factor receptor. Midostaurin is the first FLT3 inhibitor that has been shown to significantly improve survival in younger patients with FLT3-mut AML when given in combination with standard cytotoxic chemotherapy based on the recently completed RATIFY study. Its role for maintenance therapy after allogeneic transplantation and use in combination with hypomethylating agents for older patients with FLT3-mut has not yet been defined. Midostaurin also has recently been shown to have significant activity in systemic mastocytosis and related disorders due to its inhibitory effect on c-kit bearing a D816V mutation. Activation of downstream pathways in both of these myeloid malignancies likely plays an important role in the development of resistance, and strategies to inhibit these downstream targets may be synergistic. Incorporating patient factors and tumor characteristics, such as FLT3 mutant to wild-type allele ratios and resistance mutations, likely will be important in the optimization of midostaurin and other FLT3 inhibitors in the treatment of myeloid neoplasms.
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Affiliation(s)
- Molly M Gallogly
- Department of Medicine, University Hospitals Cleveland Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Hillard M Lazarus
- Department of Medicine, University Hospitals Cleveland Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Brenda W Cooper
- Department of Medicine, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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17
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Heinze A, Kuemmet TJ, Chiu YE, Galbraith SS. Longitudinal Study of Pediatric Urticaria Pigmentosa. Pediatr Dermatol 2017; 34:144-149. [PMID: 28133781 DOI: 10.1111/pde.13066] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND/OBJECTIVES Urticaria pigmentosa (UP) is the most common form of mastocytosis in children and is associated with systemic signs, symptoms, and triggers. To our knowledge, the effect of UP on children's quality of life has not been studied. The objective of the current study was to characterize the natural history, triggers, and complications of pediatric UP, identify prognostic indicators, and determine its effect on quality of life. METHODS Between 2002 and 2007, children with three or more mastocytomas diagnosed by a pediatric dermatologist were recruited during visits at the Children's Hospital of Wisconsin Dermatology Clinic (Milwaukee, WI). Research visits were conducted every 3 years and telephone interviews yearly. The Children's Dermatology Life Quality Index was administered to subjects 4 years of age and older at enrollment. Laboratory test results were collected for subjects younger than 4 years at enrollment. Subjects were followed until UP resolution or study end in August 2015. RESULTS The final cohort size was 43 subjects followed for a median of 8.1 years. Twenty-six subjects were followed through study completion. At age 12 years, 6 patients had disease resolution and 14 remained active. Patients who had disease resolution before age 12 years were more likely to be male and had fewer years of age and smaller lesions, fewer affected areas, and earlier onset. Common medications and anesthetics resulted in no serious reactions. Hymenoptera stings occurred in 51%, with no reports of anaphylaxis. No patient reported a severe effect on quality of life, with most indicating mild to no effect. CONCLUSION Severe complications are not common with historically identified triggers. Disease does not resolve before adolescence in most children. UP has a minimal effect on quality of life for most children.
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Affiliation(s)
- Adam Heinze
- Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Yvonne E Chiu
- Section of Pediatric Dermatology, Departments of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sheila S Galbraith
- Department of Dermatology, Mayo Clinic Health System, Eau Claire, Wisconsin
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18
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Proshutinskaya DV, Makoveckaya OS. Clinical features of mastocytosis at pediatric patients. VESTNIK DERMATOLOGII I VENEROLOGII 2017. [DOI: 10.25208/0042-4609-2017-93-1-12-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Mastocytosis is relevant to heterogeneous disease group characterized with redundant accumulation and proliferation of mast cells in tissues. The skin form of mastocytosis is mainly occurs in children. The article contains the current data on etiology, pathogenesis, classification, clinical forms, diagnosis, prophylactics and mastocytosis treatment at children.
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19
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Abstract
Cutaneous mastocytosis is characterized by a pathologic increase in mast cells in the skin and may also involve extracutaneous organs. Symptoms, which are triggered by mast cell degranulation, vary depending on the burden of skin disease and the presence of extracutaneous disease. The clinical presentation, risk of systemic disease, pathogenesis, prognosis, and treatment options differ, largely depending on age at presentation. In the pediatric population, spontaneous remission is typical, generally by puberty, whereas in adults, progression is observed. Extracutaneous involvement and associated hematologic disorders seldom occur in children, as opposed to adults. It is therefore important to avoid overreliance on adult-based approaches to management of cutaneous mastocytosis in the pediatric population. We focus on differences in presentation, workup, and management of pediatric- and adult-onset cutaneous mast cell disorders.
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Affiliation(s)
- Marti J Rothe
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT.
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
| | - Hanspaul S Makkar
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
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20
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Pascual JC, Bañuls J, Albares MP, Vergara G, Belinchón I, Silvestre JF, Betlloch I. Presentation of Telangiectasia Macularis Eruptiva Perstans as a Long-Standing Solitary Plaque Associated with Renal Carcinoma. J Cutan Med Surg 2016. [DOI: 10.1177/120347540300700507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Mastocytosis is a rare disease characterized by a primary pathological increase in mast cells in different tissues. The skin is the most frequently affected organ. Cutaneous mastocytosis, including urticaria pigmentosa, solitary mastocytoma, diffuse cutaneous mastocytosis, and telangiectasia macularis eruptiva perstans (TMEP), is usually distinguished from systemic mastocytosis. TMEP is characterized mainly by telangiectatic macules. Objective and Methods: We report a case of TMEP with an unusual clinical presentation as a solitary plaque of telangiectatic macules. A renal clear cell carcinoma was detected in a workup for systemic mastocytosis. We discuss the clinical and histological findings and treatment of TMEP. Conclusions: TMEP is a rare form of mastocytosis, which occurs mainly in adults, generally has a good prognosis, and little tendency to urticate or show constitutional symptoms. Clinicians should consider this disorder when confronted with a progressive atypical telangiectatic lesion. However, the malignant neoplasm also found in this patient is of uncertain significance.
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Affiliation(s)
| | - José Bañuls
- Department of Dermatology, Hospital General de Alicante, Alicante, Spain
| | - Ma Pilar Albares
- Department of Dermatology, Hospital General de Alicante, Alicante, Spain
| | - Gloria Vergara
- Department of Dermatology, Hospital General de Alicante, Alicante, Spain
| | - Isabel Belinchón
- Department of Dermatology, Hospital General de Alicante, Alicante, Spain
| | | | - Isabel Betlloch
- Department of Dermatology, Hospital General de Alicante, Alicante, Spain
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21
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Wiechers T, Rabenhorst A, Schick T, Preussner LM, Förster A, Valent P, Horny HP, Sotlar K, Hartmann K. Large maculopapular cutaneous lesions are associated with favorable outcome in childhood-onset mastocytosis. J Allergy Clin Immunol 2015; 136:1581-1590.e3. [DOI: 10.1016/j.jaci.2015.05.034] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 05/21/2015] [Accepted: 05/27/2015] [Indexed: 12/27/2022]
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22
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Hartmann K, Escribano L, Grattan C, Brockow K, Carter MC, Alvarez-Twose I, Matito A, Broesby-Olsen S, Siebenhaar F, Lange M, Niedoszytko M, Castells M, Oude Elberink JNG, Bonadonna P, Zanotti R, Hornick JL, Torrelo A, Grabbe J, Rabenhorst A, Nedoszytko B, Butterfield JH, Gotlib J, Reiter A, Radia D, Hermine O, Sotlar K, George TI, Kristensen TK, Kluin-Nelemans HC, Yavuz S, Hägglund H, Sperr WR, Schwartz LB, Triggiani M, Maurer M, Nilsson G, Horny HP, Arock M, Orfao A, Metcalfe DD, Akin C, Valent P. Cutaneous manifestations in patients with mastocytosis: Consensus report of the European Competence Network on Mastocytosis; the American Academy of Allergy, Asthma & Immunology; and the European Academy of Allergology and Clinical Immunology. J Allergy Clin Immunol 2015; 137:35-45. [PMID: 26476479 DOI: 10.1016/j.jaci.2015.08.034] [Citation(s) in RCA: 219] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 07/27/2015] [Accepted: 08/06/2015] [Indexed: 01/03/2023]
Abstract
Cutaneous lesions in patients with mastocytosis are highly heterogeneous and encompass localized and disseminated forms. Although a classification and criteria for cutaneous mastocytosis (CM) have been proposed, there remains a need to better define subforms of cutaneous manifestations in patients with mastocytosis. To address this unmet need, an international task force involving experts from different organizations (including the European Competence Network on Mastocytosis; the American Academy of Allergy, Asthma & Immunology; and the European Academy of Allergology and Clinical Immunology) met several times between 2010 and 2014 to discuss the classification and criteria for diagnosis of cutaneous manifestations in patients with mastocytosis. This article provides the major outcomes of these meetings and a proposal for a revised definition and criteria. In particular, we recommend that the typical maculopapular cutaneous lesions (urticaria pigmentosa) should be subdivided into 2 variants, namely a monomorphic variant with small maculopapular lesions, which is typically seen in adult patients, and a polymorphic variant with larger lesions of variable size and shape, which is typically seen in pediatric patients. Clinical observations suggest that the monomorphic variant, if it develops in children, often persists into adulthood, whereas the polymorphic variant may resolve around puberty. This delineation might have important prognostic implications, and its implementation in diagnostic algorithms and future mastocytosis classifications is recommended. Refinements are also suggested for the diagnostic criteria of CM, removal of telangiectasia macularis eruptiva perstans from the current classification of CM, and removal of the adjunct solitary from the term solitary mastocytoma.
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Affiliation(s)
- Karin Hartmann
- Department of Dermatology, University of Cologne, Cologne, Germany; Department of Dermatology, University of Luebeck, Luebeck, Germany.
| | - Luis Escribano
- Servicio Central de Citometria (NUCLEUS), Centro de Investigacion del Cancer (IBMCC; CSIC/USAL) and Department of Medicine and IBSAL, University of Salamanca, Salamanca, Spain
| | - Clive Grattan
- Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany
| | - Melody C Carter
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Ivan Alvarez-Twose
- Instituto de Estudios de Mastocitosis de Castilla La Mancha (CLMast), Hospital Virgen del Valle, Toledo, Spain
| | - Almudena Matito
- Instituto de Estudios de Mastocitosis de Castilla La Mancha (CLMast), Hospital Virgen del Valle, Toledo, Spain
| | - Sigurd Broesby-Olsen
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - Frank Siebenhaar
- Department of Dermatology and Allergy, Interdisciplinary Mastocytosis Center Charité, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Magdalena Lange
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland
| | - Marek Niedoszytko
- Department of Allergology, Medical University of Gdansk, Gdansk, Poland
| | - Mariana Castells
- Division of Rheumatology, Immunology, and Allergy, Harvard Medical School, Brigham and Women's Hospital, Boston, Mass
| | - Joanna N G Oude Elberink
- Department of Allergology, Groningen Research Institute for Asthma and COPD, University Medical Center of Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Roberta Zanotti
- Section of Hematology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston, Mass
| | - Antonio Torrelo
- Department of Dermatology, Hospital del Nino Jesus, Madrid, Spain
| | - Jürgen Grabbe
- Department of Dermatology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Anja Rabenhorst
- Department of Dermatology, University of Cologne, Cologne, Germany
| | - Boguslaw Nedoszytko
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland
| | | | - Jason Gotlib
- Division of Hematology, Department of Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Andreas Reiter
- III. Medizinische Klinik, Universitätsmedizin Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Deepti Radia
- Department of Haematology, Guys and St Thomas' NHS Foundation Trust, Guys Hospital, London, United Kingdom
| | - Olivier Hermine
- Department of Hematology, National Reference Center of Mastocytosis, INSERM U1163, CNRS ERL8564, Imagine Institute, Université Paris Descartes, Sorbonne, Paris Cité, Paris, France
| | - Karl Sotlar
- Institute of Pathology, Ludwig-Maximilians-Universität, Munich, Germany
| | - Tracy I George
- Department of Pathology, University of New Mexico, Albuquerque, NM
| | | | - Hanneke C Kluin-Nelemans
- Department of Hematology, University Hospital Groningen, University of Groningen, Groningen, The Netherlands
| | - Selim Yavuz
- Department of Internal Medicine, Division of Hematology, University of Istanbul, Istanbul, Turkey
| | - Hans Hägglund
- Hematology Center Karolinska, Karolinska University Hospital, Stockholm, Sweden
| | - Wolfgang R Sperr
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Lawrence B Schwartz
- Department of Internal Medicine, Division of Rheumatology, Allergy & Immunology, Richmond, Va
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Marcus Maurer
- Department of Dermatology and Allergy, Interdisciplinary Mastocytosis Center Charité, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Gunnar Nilsson
- Clinical Immunology and Allergy, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hans-Peter Horny
- Institute of Pathology, Ludwig-Maximilians-Universität, Munich, Germany
| | - Michel Arock
- Molecular Oncology and Pharmacology, LBPA CNRS UMR8113, Ecole Normale Supérieure de Cachan, Cachan, France
| | - Alberto Orfao
- Servicio Central de Citometria (NUCLEUS), Centro de Investigacion del Cancer (IBMCC; CSIC/USAL) and Department of Medicine and IBSAL, University of Salamanca, Salamanca, Spain
| | - Dean D Metcalfe
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Cem Akin
- Division of Rheumatology, Immunology, and Allergy, Harvard Medical School, Brigham and Women's Hospital, Boston, Mass
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria
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23
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Tüysüz G, Özdemir N, Apak H, Kutlubay Z, Demirkesen C, Celkan T. Childhood mastocytosis: results of a single center. TURK PEDIATRI ARSIVI 2015; 50:108-13. [PMID: 26265895 PMCID: PMC4523983 DOI: 10.5152/tpa.2015.2332] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 01/27/2015] [Indexed: 11/22/2022]
Abstract
AIM We aimed to retrospectively evaluate histopathological, demographic and clinical findings of children with mastocytosis diagnosed with mastocytosis in our clinic. MATERIAL AND METHODS The files of 21 patients diagnosed with mastocytosis between 2000 and 2014 in our clinic were retrospectively analyzed. RESULTS All patients had cutaneous mastocytosis, 19 patients had urticaria pigmentosa and 2 patients had mastocytoma. The male-female ratio was: 1/1.6. The median age for onset of disease was 12.1 months and the disease occured in the newborn period in 3 patients. While all patients had eruption, 10 patients had pruritis, 1 patient had a bullous formation, 1 patient had abdominal pain and 1 patient had attacks of redness throughout the body and a sense of burning in the chest. Two patients had a positive familial history. The diagnosis was confirmed with skin biopsy in all patients. The median follow up time of the patients were 5 years. The patients were treated with H1, H2 antihistaminics, local moisturizing creams and topical corticosteroid drugs. The lesions resolved completely in 4 patients who reached to puberty and 7 patients had marked improvement in a 5.5 year-follow-up period. Ten patients had stabile lesions in a 3.6 year-follow-up period. CONCLUSIONS Most cases of childhood mastocytosis are observed in the form of cutaneous mastocytosis. The prognosis is good; the disease limits itself and is prone to regress in the adolescent period.
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Affiliation(s)
- Gülen Tüysüz
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Nihal Özdemir
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Hilmi Apak
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Zekayi Kutlubay
- Department of Dermatology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Cuyan Demirkesen
- Department of Pathology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Tiraje Celkan
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
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24
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Méni C, Bruneau J, Georgin-Lavialle S, Le Saché de Peufeilhoux L, Damaj G, Hadj-Rabia S, Fraitag S, Dubreuil P, Hermine O, Bodemer C. Paediatric mastocytosis: a systematic review of 1747 cases. Br J Dermatol 2015; 172:642-51. [DOI: 10.1111/bjd.13567] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2014] [Indexed: 01/08/2023]
Affiliation(s)
- C. Méni
- Service de Dermatologie de l'Adulte et de l'Enfant; Faculté de Médecine et AP-HP; Hôpital Necker-Enfants Malades; Centre de Référence des Mastocytoses, CEREMAST; Université Paris Descartes; Paris Sorbonne Cité; 149 Rue de Sèvres 75743 Paris Cedex 15 France
| | - J. Bruneau
- Service d'Anatomie et Cytologie Pathologiques; Faculté de Médecine et AP-HP; Hôpital Necker-Enfants Malades; Université Paris Descartes; Paris Sorbonne Cité; 149 Rue de Sèvres 75743 Paris Cedex 15 France
- INSERM U1163 and CNRS ERL 8254; Laboratory of Physiopathology and Treatment of Hematological Disorders; Hôpital Necker-Enfants Malades; 149 Rue des Sèvres 75743 Paris Cedex 15 France
- AP-HP Necker-Enfants Malades; Institut Imagine; Université Sorbonne Paris Cité; 149 Rue des Sèvres 75743 Paris Cedex 15 France
| | - S. Georgin-Lavialle
- Service de Médecine Interne; Faculté de Médecine et AP-HP; Hôpital Tenon; Université Pierre et Marie Curie; 20 Rue de la Chine 75020 Paris France
| | - L. Le Saché de Peufeilhoux
- Service de Dermatologie de l'Adulte et de l'Enfant; Faculté de Médecine et AP-HP; Hôpital Necker-Enfants Malades; Centre de Référence des Mastocytoses, CEREMAST; Université Paris Descartes; Paris Sorbonne Cité; 149 Rue de Sèvres 75743 Paris Cedex 15 France
| | - G. Damaj
- Centre de Référence des Mastocytoses, CEREMAST; Faculté de Médecine et AP-HP; Hôpital Necker-Enfants Malades; 149 rue de Sèvres 75743 Paris Cedex 15 France
- Service d'Hématologie Adultes; Faculté de Médecine et Centre Hospitalier Universitaire de Caen; Avenue côte de Nacre 14000 Caen France
| | - S. Hadj-Rabia
- Service de Dermatologie de l'Adulte et de l'Enfant; Faculté de Médecine et AP-HP; Hôpital Necker-Enfants Malades; Centre de Référence des Mastocytoses, CEREMAST; Université Paris Descartes; Paris Sorbonne Cité; 149 Rue de Sèvres 75743 Paris Cedex 15 France
- AP-HP Necker-Enfants Malades; Institut Imagine; Université Sorbonne Paris Cité; 149 Rue des Sèvres 75743 Paris Cedex 15 France
| | - S. Fraitag
- Service d'Anatomie et Cytologie Pathologiques; Faculté de Médecine et AP-HP; Hôpital Necker-Enfants Malades; Université Paris Descartes; Paris Sorbonne Cité; 149 Rue de Sèvres 75743 Paris Cedex 15 France
| | - P. Dubreuil
- Centre de Référence des Mastocytoses, CEREMAST; Faculté de Médecine et AP-HP; Hôpital Necker-Enfants Malades; 149 rue de Sèvres 75743 Paris Cedex 15 France
- Inserm, U1068, CRCM, Signaling, Hematopoiesis and Mechanism of Oncogenesis; Institut Paoli-Calmettes; Université d' Aix-Marseille; F-13284 Marseille France
- UMR7258; CNRS; F-13009 Marseille France
| | - O. Hermine
- INSERM U1163 and CNRS ERL 8254; Laboratory of Physiopathology and Treatment of Hematological Disorders; Hôpital Necker-Enfants Malades; 149 Rue des Sèvres 75743 Paris Cedex 15 France
- AP-HP Necker-Enfants Malades; Institut Imagine; Université Sorbonne Paris Cité; 149 Rue des Sèvres 75743 Paris Cedex 15 France
- Centre de Référence des Mastocytoses, CEREMAST; Faculté de Médecine et AP-HP; Hôpital Necker-Enfants Malades; 149 rue de Sèvres 75743 Paris Cedex 15 France
- Service d'Hématologie Adultes; Faculté de Médecine et AP-HP; Hôpital Necker-Enfants Malades; Université Paris Descartes; Paris Sorbonne Cité; 149 Rue des Sèvres 75743 Paris Cedex 15 France
| | - C. Bodemer
- Service de Dermatologie de l'Adulte et de l'Enfant; Faculté de Médecine et AP-HP; Hôpital Necker-Enfants Malades; Centre de Référence des Mastocytoses, CEREMAST; Université Paris Descartes; Paris Sorbonne Cité; 149 Rue de Sèvres 75743 Paris Cedex 15 France
- AP-HP Necker-Enfants Malades; Institut Imagine; Université Sorbonne Paris Cité; 149 Rue des Sèvres 75743 Paris Cedex 15 France
- Centre de Référence des Mastocytoses, CEREMAST; Faculté de Médecine et AP-HP; Hôpital Necker-Enfants Malades; 149 rue de Sèvres 75743 Paris Cedex 15 France
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25
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Abstract
Mastocytosis is a rare myeloid neoplasm characterized by abnormal proliferation and accumulation of mast cells in one or more organ systems including the skin, bone marrow, liver, spleen, lymph nodes and gastrointestinal tract. An infant presenting with bullous lesions is an even rarer clinical presentation of cutaneous mastocytosis. The symptoms and complications are mostly in proportion to the mast cell degranulation in tissues. Management is focused on preventing and treating this event. We report a three-month-old infant with bullous mastocytosis to enhance awareness about this rare diagnosis.
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Affiliation(s)
- Dinesh Prasad Asati
- Department of Dermatology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Anurag Tiwari
- Consultant Dermatologist, Centre for Skin Diseases and Laser Treatment, Bhopal, Madhya Pradesh, India
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26
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Ranieri G, Marech I, Pantaleo M, Piccinno M, Roncetti M, Mutinati M, Rizzo A, Gadaleta CD, Introna M, Patruno R, Sciorsci RL. In vivo model for mastocytosis: A comparative review. Crit Rev Oncol Hematol 2014; 93:159-69. [PMID: 25465741 DOI: 10.1016/j.critrevonc.2014.10.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 10/01/2014] [Accepted: 10/22/2014] [Indexed: 12/27/2022] Open
Abstract
Human mastocytosis are heterogeneous group of neoplastic diseases characterized by a different degree of uncontrolled mast cell (MC) proliferation and activation. Interestingly, human mastocytosis share several biological and clinical features with canine mast cell disorders, so called canine mast cell tumors (CMCTs). These CMCTs are the most common spontaneous cutaneous tumors found in dogs representing a valid model to study neoplastic mast cell disorders. It has been discovered that the pathological activation of c-Kit receptor (c-KitR), expressed by MCs, has been involved in the pathogenesis of neoplastic MC disorders. In this review we have focused on human mastocytosis in terms of: (i) epidemiology and classification; (ii) pathogenesis at molecular levels; (iii) clinical presentation. In addition, we have summarized animal models useful to study neoplastic MC disorders including CMCTs and murine transgenic models. Finally, we have revised therapeutic approaches mostly common in human and canine MCTs and novel tyrosine kinase inhibitors approved for CMCTs and recently translated in human clinical trials.
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Affiliation(s)
- Girolamo Ranieri
- Diagnostic and Interventional Radiology Unit with Integrated Section of Translational Medical Oncology, National Cancer Research Centre Istituto Tumori "Giovanni Paolo II", Bari, Italy.
| | - Ilaria Marech
- Diagnostic and Interventional Radiology Unit with Integrated Section of Translational Medical Oncology, National Cancer Research Centre Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Marianna Pantaleo
- Department of Emergency and Organ Transplantation (D.E.T.O.), Veterinary Medical School, Università "Aldo Moro", Bari, Italy
| | - Mariagrazia Piccinno
- Department of Emergency and Organ Transplantation (D.E.T.O.), Veterinary Medical School, Università "Aldo Moro", Bari, Italy
| | - Maria Roncetti
- Department of Emergency and Organ Transplantation (D.E.T.O.), Veterinary Medical School, Università "Aldo Moro", Bari, Italy
| | - Maddalena Mutinati
- Department of Emergency and Organ Transplantation (D.E.T.O.), Veterinary Medical School, Università "Aldo Moro", Bari, Italy
| | - Annalisa Rizzo
- Department of Emergency and Organ Transplantation (D.E.T.O.), Veterinary Medical School, Università "Aldo Moro", Bari, Italy
| | - Cosmo Damiano Gadaleta
- Diagnostic and Interventional Radiology Unit with Integrated Section of Translational Medical Oncology, National Cancer Research Centre Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Marcello Introna
- Department of Pathology, Veterinary Medical School, Università "Aldo Moro", Bari, Italy
| | - Rosa Patruno
- Department of Prevention and Animal Health, ASL BAT, Barletta, Italy
| | - Raffaele Luigi Sciorsci
- Department of Emergency and Organ Transplantation (D.E.T.O.), Veterinary Medical School, Università "Aldo Moro", Bari, Italy
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27
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Lee HW, Jeong YI, Choi JC, Lee MW, Choi JH, Moon KC, Koh JK. Two Cases of Telangiectasia Macularis Eruptiva Perstans Demonstrated by Immunohistochemistry for C-Kit (CD 117). J Dermatol 2014; 32:817-20. [PMID: 16361734 DOI: 10.1111/j.1346-8138.2005.tb00851.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2005] [Accepted: 05/02/2005] [Indexed: 11/30/2022]
Abstract
Telangiectasia macularis eruptiva perstans (TMEP) is an uncommon form of cutaneous mastocytosis that occurs exclusively in adults. Histologically, TMEP presents with scattered mast cells lined up around the dilated capillaries and venules of the superficial vascular plexus. In some cases, the number of mast cells falls within the range observed in normal skin and therefore cannot be detected by routine histologic examination. We used immunohistochemical staining for c-kit (CD 117) for the definitive diagnosis in two patients with TMEP. One of them was successfully treated with topical application of pimecrolimus.
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Affiliation(s)
- Hae-Woong Lee
- Department of Dermatology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
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28
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Kinneman L, Molloy B, Nguyen V, Loizou D, Silverman R, Mensah-Bonsu N, Enav B, Johal J, Plassmeyer M, Ryherd M, Austin L, Limgala R, Brown M, Gupta R, Noonan L, Hider P, Alpan O. Diffuse Cutaneous Mastocytosis, Bullous Variant, Presenting in a Six-Month-Old Infant. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 2:341-2. [DOI: 10.1016/j.jaip.2014.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/13/2014] [Accepted: 02/19/2014] [Indexed: 10/25/2022]
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29
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Verma R, Vasudevan B, Vijendran P, Mitra D. A rare case of bullous mastocytosis in a child associated with bathing trunk nevus. Int J Dermatol 2014; 53:761-3. [DOI: 10.1111/j.1365-4632.2012.05647.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: 11/28/2022]
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30
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Wang HJ, Lin ZM, Zhang J, Yin JH, Yang Y. A new germline mutation in KIT associated with diffuse cutaneous mastocytosis in a Chinese family. Clin Exp Dermatol 2013; 39:146-9. [PMID: 24289326 DOI: 10.1111/ced.12225] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2013] [Indexed: 11/27/2022]
Abstract
Diffuse cutaneous mastocytosis (DCM) is an extremely rare disease characterized by massive proliferation of mast cells infiltrating the entire skin. We report a Chinese family with indolent DCM, and detection of a new germline KIT mutation located in the fifth immunoglobulin-like loop of the KIT protein, which probably results in a gain-of-function effect and consequent overactivation of mast cells. Our report expands the knowledge of correlations between the genotype of KIT mutations and the phenotype of DCM.
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Affiliation(s)
- H J Wang
- Department of Dermatology, Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
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Arase N, Wataya-Kaneda M, Oiso N, Arase H, Katayama I. CD1a-positive familial cutaneous mastocytosis without germ-line or somatic mutations in c-kit. Br J Dermatol 2013; 169:201-4. [DOI: 10.1111/bjd.12265] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- N. Arase
- Department of Dermatology; Graduate School of Medicine; Osaka University; 2-2, Yamadaoka Suita Osaka 565-0871 Japan
| | - M. Wataya-Kaneda
- Department of Dermatology; Graduate School of Medicine; Osaka University; 2-2, Yamadaoka Suita Osaka 565-0871 Japan
| | - N. Oiso
- Department of Dermatology; Faculty of Medicine; Kinki University; Osakasasayama Japan
| | - H. Arase
- Laboratory of Immunochemistry; WPI Immunology Frontier Research Center; Department of Immunochemistry; Research Institute for Microbial Diseases; Osaka University; Suita Japan
- Core Research for Evolutional Science and Technology; Japan Science and Technology Agency; Kawaguchi Japan
| | - I. Katayama
- Department of Dermatology; Graduate School of Medicine; Osaka University; 2-2, Yamadaoka Suita Osaka 565-0871 Japan
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How I treat patients with indolent and smoldering mastocytosis (rare conditions but difficult to manage). Blood 2013; 121:3085-94. [DOI: 10.1182/blood-2013-01-453183] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Abstract
Indolent systemic mastocytosis (SM) patients have a varied clinical presentation, ranging from predominantly cutaneous symptoms to recurrent systemic symptoms (eg, flushing, palpitations, dyspepsia, diarrhea, bone pain) that can be severe and potentially life threatening (anaphylaxis). Mastocytosis patients without skin involvement pose a diagnostic challenge; a high index of suspicion is needed in those with mast cell–degranulation symptoms, including anaphylaxis following Hymenoptera stings or other triggers. Modern-era molecular and flow-cytometric diagnostic methods are very sensitive and can detect minimal involvement of bone marrow with atypical/clonal mast cells; in some cases, full diagnostic criteria for SM are not fulfilled. An important aspect of treatment is avoidance of known symptom triggers; other treatment principles include a stepwise escalation of antimediator therapies and consideration of cytoreductive therapies for those with treatment-refractory symptoms. The perioperative management of mastocytosis patients is nontrivial; a multidisciplinary preoperative assessment, adequate premedications, and close intra- and postoperative monitoring are critical. Smoldering mastocytosis is a variant with high systemic mast cell burden. While its clinical course can be variable, there is greater potential need for cytoreductive therapies (eg, interferon-alpha, cladribine) in this setting. A systematic approach to the diagnosis and treatment of indolent SM using a case-based approach of representative clinical scenarios is presented here.
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Fuller SJ. New Insights into the Pathogenesis, Diagnosis, and Management of Mastocytosis. Hematol Oncol Clin North Am 2012; 26:1143-68. [DOI: 10.1016/j.hoc.2012.08.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Lange M, Nedoszytko B, Górska A, Żawrocki A, Sobjanek M, Kozlowski D. Mastocytosis in children and adults: clinical disease heterogeneity. Arch Med Sci 2012; 8:533-41. [PMID: 22852012 PMCID: PMC3400919 DOI: 10.5114/aoms.2012.29409] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 03/14/2011] [Accepted: 04/10/2011] [Indexed: 11/23/2022] Open
Abstract
Mastocytosis is a clonal disease of the hematopoietic stem cell. The condition consists of a heterogeneous group of disorders characterized by a pathological accumulation of mast cells in tissues including the skin, bone marrow, liver, spleen and the lymph nodes. Mastocytosis is a rare disease which occurs both in children and adults. Childhood onset mastocytosis is usually cutaneous and transient while in adults the condition commonly progresses to a systemic form. The heterogeneity of clinical presentation of mastocytosis is typically related to the tissue mast cell burden, symptoms due to the release of mast cell mediators, the type of skin lesions, the patient's age at the onset and associated haematological disorders. Therefore, a multidisciplinary approach is recommended. The present article provides an overview of clinical symptoms, diagnostic criteria and treatment of mastocytosis to facilitate the diagnosis and management of mastocytosis patients in clinical practice.
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Affiliation(s)
- Magdalena Lange
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Poland
| | - Bogusław Nedoszytko
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Poland
| | | | - Anton Żawrocki
- Department of Pathomorphology, Medical University of Gdansk, Poland
| | - Michał Sobjanek
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Poland
| | - Dariusz Kozlowski
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
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Deverrière G, Carré D, Nae I, Cailliez D, Boulloche J. [Bullous mastocytosis in infancy: a rare presentation]. Arch Pediatr 2012; 19:722-5. [PMID: 22664234 DOI: 10.1016/j.arcped.2012.04.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Revised: 02/18/2012] [Accepted: 04/24/2012] [Indexed: 12/30/2022]
Abstract
Mastocytosis is a rare condition related to an abnormal proliferation of mast cells and their accumulation in tissues. Cutaneous mastocytosis is the most common form and mainly affects newborns and infants. The symptoms are caused by the release of mediators contained in mast cells, including histamine. Mastocytosis may be associated with a mutation in the gene encoding the c-kit receptor. Clinically, there are different dermatological findings, which combine acute cutaneous, digestive, or even hemodynamic manifestations in varying degrees. The diagnosis is confirmed by the histological study of a skin sample. We report here the case of a 4-month-old infant suffering from diffuse cutaneous bullous mastocytosis, a very rare variety of mastocytosis. This infant had an erosive and bullous manifestation of dermatosis, initially confused with impetigo. The proliferation of bullous lesions led to her hospitalization. Codeine intake for pain was responsible for a large and extensive bullous reaction associated with anaphylactic shock. This context of bullous spread occurring after taking codeine led to the suspicion of bullous diffuse cutaneous mastocytosis, a diagnosis that was confirmed histologically. This observation demonstrates the difficulty of mastocytosis diagnosis, mostly due to its rarity, especially in its diffuse bullous forms. The rapid deterioration of this patient, after the codeine prescription, emphasizes the importance of the eviction of histamine-releaser compounds in the management of this disease.
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Affiliation(s)
- G Deverrière
- Service de pédiatrie, groupe hospitalier du Havre, 55 bis, rue Gustave-Flaubert, 76600 Le Havre, France.
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Lange M, Niedoszytko M, Renke J, Gleń J, Nedoszytko B. Clinical aspects of paediatric mastocytosis: a review of 101 cases. J Eur Acad Dermatol Venereol 2011; 27:97-102. [DOI: 10.1111/j.1468-3083.2011.04365.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lange M, Niedoszytko M, Nedoszytko B, Łata J, Trzeciak M, Biernat W. Diffuse cutaneous mastocytosis: analysis of 10 cases and a brief review of the literature. J Eur Acad Dermatol Venereol 2011; 26:1565-71. [PMID: 22092511 DOI: 10.1111/j.1468-3083.2011.04350.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Diffuse cutaneous mastocytosis (DCM) is an extremely rare disease characterized by mast cell (MCs) infiltration of the entire skin. Little is known about the natural course of DCM. OBJECTIVES We decided to characterize clinical manifestations, the frequency of MCs mediator-related symptoms and anaphylaxis, risk of systemic mastocytosis (SM) and prognosis, based on 10 cases of DCM, the largest series published to date. METHODS Diffuse cutaneous mastocytosis, DCM was confirmed by histopathological examination of skin samples in all cases. SCORing Mastocytosis (SCORMA) Index was used to assess the intensity of DCM. The analysis of clinical symptoms and laboratory tests, including serum tryptase levels was performed. Bone marrow biopsy was done only in selected cases. RESULTS Large haemorrhagic bullous variant of DCM (five cases) and infiltrative small vesicular variant (five cases) were identified. The skin symptoms appeared in age-dependent manner; blistering predominated in infancy, whereas grain-leather appearance of the skin and pseudoxanthomatous presentation developed with time. SM was not recognized in any of the patients. Mast cell mediator-related symptoms were present in all cases. Anaphylactic shock occurred in three patients. Follow-up performed in seven cases revealed slight improvement of skin symptoms, reflected by decrease of SCORMA Index in all of them. Serum tryptase levels declined with time in six cases. CONCLUSIONS Diffuse cutaneous mastocytosis, DCM is a heterogeneous, severe, cutaneous disease, associated with mediator-related symptoms and risk of anaphylactic shock. Although our results suggest generally favourable prognosis, the review of the literature indicate that SM may occur. Therefore, more guarded prognosis should be given in DCM patients.
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Affiliation(s)
- M Lange
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland.
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Watkins CE, Bokor WB, Leicht S, Youngberg G, Krishnaswamy G. Telangiectasia macularis eruptiva perstans: more than skin deep. Dermatol Reports 2011; 3:e12. [PMID: 25386256 PMCID: PMC4211494 DOI: 10.4081/dr.2011.e12] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 07/06/2011] [Accepted: 07/07/2011] [Indexed: 01/08/2023] Open
Abstract
Systemic mastocytosis is a rare disease involving the infiltration and accumulation of active mast cells within any organ system. By far, the most common organ affected is the skin. Cutaneous manifestations of mastocytosis, including Urticaria Pigmentosa (UP), cutaneous mastocytoma or telangiectasia macularis eruptive perstans (TMEP), may indicate a more serious and potentially life-threatening underlying disease. The presence of either UP or TMEP in a patient with anaphylactic symptoms should suggest the likelihood of systemic mastocytosis, with the caveat that systemic complications are more likely to occur in patients with UP. TMEP can usually be identified by the typical morphology, but a skin biopsy is confirmative. In patients with elevated tryptase levels or those with frequent systemic manifestations, a bone marrow biopsy is essential in order to demonstrate mast cell infiltration. Further genetic testing for mutations of c-kit gene or the FIP1L1 gene may help with disease classification and/or therapeutic approaches. Rarely, TMEP has been described with malignancy, radiation therapy, and myeloproliferative disorders. A few familial cases have also been described. In this review, we discuss the clinical features, diagnosis and management of patients with TMEP. We also discuss the possible molecular pathogenesis and the role of genetics in disease classification and treatment.
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Affiliation(s)
- Casey E Watkins
- East Tennessee State University, Quillen College of Medicine, Johnson City, TN
| | - Winston B Bokor
- East Tennessee State University, Quillen College of Medicine, Johnson City, TN
| | - Stuart Leicht
- East Tennessee State University, Quillen College of Medicine, Johnson City, TN; ; Department of Dermatology, Quillen College of Medicine, Johnson City, TN
| | - George Youngberg
- East Tennessee State University, Quillen College of Medicine, Johnson City, TN; ; Department of Pathology, Quillen College of Medicine, Johnson City, TN
| | - Guha Krishnaswamy
- East Tennessee State University, Quillen College of Medicine, Johnson City, TN; ; Department Allergy and Immunology, Quillen College of Medicine, Johnson City, TN; ; Veterans Affairs Medical Center, Mountain Home, TN, USA
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Nowak A, Gibbs BF, Amon U. Pre-inpatient evaluation on quality and impact of care in systemic mastocytosis and the influence of hospital stay periods from the perspective of patients: a pilot study. J Dtsch Dermatol Ges 2011; 9:525-32. [DOI: 10.1111/j.1610-0387.2011.07638.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Brazzelli V, Grasso V, Manna G, Barbaccia V, Merante S, Boveri E, Borroni G. Indolent systemic mastocytosis treated with narrow-band UVB phototherapy: study of five cases. J Eur Acad Dermatol Venereol 2011; 26:465-9. [PMID: 21564325 DOI: 10.1111/j.1468-3083.2011.04098.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mastocytoses represent a heterogeneous group of stem cell disorders marked by an abnormal hyperplasia and accumulation of mast cells in one or more tissues, including bone marrow, gastrointestinal tract, liver, spleen, lymph nodes and skin. Indolent systemic mastocytosis (ISM) is characterized by red-brownish and pruriginous maculopapular lesions, a bone marrow infiltration without functional impairment and an indolent clinical course with a good prognosis. In particular, the most common cutaneous symptoms are urticarial rash and mild-to-high pruritus. OBJECTIVES This study analyses the clinical outcome of patients affected by ISM with prevalent pruriginous cutaneous symptoms and a scarce response to anti-histamines treated using narrowband ultraviolet B (NB-UVB) phototherapy. METHODS Narrowband ultraviolet B phototherapy was administered in a UV-irradiation cabin equipped with fluorescent UVB lamps with a peak emission at 311-313 nm. The perception of pruritus severity was assessed using the Visual Analogue Scale (VAS) before starting the treatment and at each control. RESULTS A complete remission of the cutaneous lesions and pruritus was documented in all patients after a median of 40.3 UV treatments and a median cumulative dose of 51.4 J/cm(2), with a lasting remission over a 6-month follow-up. The median VAS score at the beginning of the treatment was 86.6 (SD=6.64), whereas it decreased to 6.66 (SD=3.75) after 3 months of therapy. CONCLUSIONS Our work provides evidence that NB-UVB phototherapy is useful for the treatment of the cutaneous symptoms and pruritus in ISM.
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Affiliation(s)
- V Brazzelli
- Department of Human and Hereditary Pathology, Institute of Dermatology, University of Pavia and Foundation IRCCS Policlinico San Matteo, Pavia, Italy.
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Abstract
Adult mastocytosis is usually persistent and caused by c-KIT codon 816-activating mutations. Pediatric mastocytosis is often transient, and the molecular mechanism driving mast cell proliferation in pediatric cases remains unclear. In this issue, Bodemer et al. report novel c-KIT mutations in a large percentage of pediatric cases, identifying both similarities and fundamental differences in the mechanisms causing adult and pediatric mastocytosis.
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Ribatti D, Nico B, Finato N, Crivellato E, Beltrami C. Co-localization of tryptase and cathepsin-G in mast cells in cutaneous mastocytosis. Cancer Lett 2009; 279:209-12. [DOI: 10.1016/j.canlet.2009.01.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Revised: 01/27/2009] [Accepted: 01/28/2009] [Indexed: 11/30/2022]
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Janakiramanan N, Chambers D, Dowling GJ. A rare presentation of solitary mastocytoma in the palm of an infant. J Plast Reconstr Aesthet Surg 2009; 63:e197-8. [PMID: 19502121 DOI: 10.1016/j.bjps.2009.02.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Revised: 02/08/2009] [Accepted: 02/10/2009] [Indexed: 11/16/2022]
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Abstract
INTRODUCTION Mastocytosis is a rare heterogeneous disease of bone marrow origin which arises as a consequence of abnormal growth and/or accumulation of clonal mast cells in one or more organs. Sixty-five percent of patients with mastocytosis are children in whom it usually regresses around puberty. Adult patients with mastocytosis have been identified as at high risk of widespread mast cell degranulation in the perioperative period, this finding has not been reported in pediatric patients. This information has been repeated in mastocytosis websites where it has the potential to cause disproportionate alarm in parents. METHODS We considered our experience of six children with mastocytosis together with a review of the literature to examine other reports of anesthesia in children with mastocytosis. Our literature search found 57 general anesthetics in 39 children with mastocytosis. In addition, we searched for information about current consensus in diagnosis, classification and treatment of mastocytosis and in vitro and in vivo studies looking at mast cell behavior in response to drugs commonly used during anesthesia. DISCUSSION The literature search revealed that general anesthesia has precipitated life threatening complications in adult patients with systemic mastocytosis (SM) but no such complications have been described in children with mastocytosis. Our own experience with children with mastocytosis is of uneventful anesthesia. Advances in the understanding of the genetic basis of mastocytosis suggest that pediatric cutaneous mastocytosis (CM) and SM are different entities. SM in children is extremely rare and is associated with elevated baseline serum tryptase. There are few reports of anesthesia in this group. CONCLUSION The risks for most pediatric patients are overstated by mastocytosis websites. Most pediatric patients with CM do not appear to be at risk of widespread mast cell degranulation during anesthesia but because of the small number of cases reported, the risk cannot be ascertained with confidence. Children with SM and a high baseline serum tryptase (marker of mast cell burden) may merit extra precautions but experience in this subgroup is even more limited. Drugs which cause minimal histamine release can be selected from the range of drugs available in most pediatric centers without compromise to technique.
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Affiliation(s)
- Nargis Ahmad
- Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, UK.
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Nedoszytko B, Niedoszytko M, Lange M, van Doormaal J, Gleń J, Zabłotna M, Renke J, Vales A, Buljubasic F, Jassem E, Roszkiewicz J, Valent P. Interleukin-13 promoter gene polymorphism -1112C/T is associated with the systemic form of mastocytosis. Allergy 2009; 64:287-94. [PMID: 19178408 DOI: 10.1111/j.1398-9995.2008.01827.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Mastocytosis is a heterogenous disease involving mast cells (MC) and their progenitors. Cutaneous and systemic variants of the disease have been reported. In contrast to cutaneous mastocytosis (CM), patients with systemic mastocytosis (SM) are at risk to develop disease progression or a nonMC-lineage haematopoietic neoplasm. Little is known, however, about factors predisposing for the development of SM. One factor may be cytokine regulation of MC progenitors. METHODS We examined the role of the interleukin-13 (IL-13) promoter gene polymorphism -1112C/T, known to be associated with increased transcription, in mastocytosis using allele-specific polymerase chain reaction method. Serum tryptase and IL-13 levels were determined by immunoassay, and expression of the IL-13 receptor in neoplastic MC by reverse transcription-polymerase chain reaction and flow cytometry. RESULTS The frequency of the -1112T allele of the IL-13 promoter was significantly higher in patients with SM compared with CM (P < 0.008) and in mastocytosis patients compared with healthy controls (P < 0.0001). Correspondingly, the polymorphism was found to correlate with an elevated serum tryptase level (P = 0.004) and with adult-onset of the disease (P < 0.0015), both of which are almost invariably associated with SM. Serum IL-13 levels were also higher in SM patients compared with CM (P = 0.011), and higher in CT- than in CC carriers (P < 0.05). Finally, we were able to show that neoplastic human MC display IL-13 receptors and grow better in IL-13-containing medium. CONCLUSIONS The -1112C/T IL-13 gene polymorphism and the resulting 'hypertranscription' may predispose for the development of SM.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Alleles
- Cell Line, Tumor
- Child
- Child, Preschool
- Gene Frequency
- Genetic Predisposition to Disease
- Genotype
- Humans
- Infant
- Interleukin-13/blood
- Interleukin-13/genetics
- Interleukin-13/immunology
- Mastocytosis, Systemic/genetics
- Mastocytosis, Systemic/immunology
- Middle Aged
- Polymorphism, Genetic
- Promoter Regions, Genetic
- Receptors, Interleukin-13/genetics
- Receptors, Interleukin-13/immunology
- Receptors, Interleukin-13/metabolism
- Tryptases/blood
- Tryptases/genetics
- Tryptases/immunology
- Young Adult
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Affiliation(s)
- B Nedoszytko
- Department of Dermatology, Medical university of Gdańsk. Gdańsk, Poland
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Georgin-Lavialle S, Barete S, Suarez F, Lepelletier Y, Bodemer C, Dubreuil P, Lortholary O, Hermine O. Actualités sur la compréhension et le traitement des mastocytoses systémiques. Rev Med Interne 2009; 30:25-34. [DOI: 10.1016/j.revmed.2008.01.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Revised: 01/26/2008] [Accepted: 01/28/2008] [Indexed: 01/08/2023]
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Case report of mastocytosis in an adult. South Med J 2008; 102:91-3. [PMID: 19077784 DOI: 10.1097/smj.0b013e3181827871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A case of adult-onset mastocytosis is presented to illustrate the classification, signs, symptoms, workup, treatment, and prognosis for this unusual condition. Although there is no cure for mastocytosis, symptoms of histamine release can be minimized with oral antihistamines. Ongoing surveillance of organ systems affected remains important. Our patient's mast cell disease predisposed him to bone loss, but there was no evidence of disease beyond the skin. He has done well with continued follow up monitoring his serum tryptase and oral antihistamine treatment.
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Systemic mastocytosis involving the gastrointestinal tract: clinicopathologic and molecular study of five cases. Mod Pathol 2008; 21:1508-16. [PMID: 18931652 DOI: 10.1038/modpathol.2008.158] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Systemic mastocytosis is an uncommon condition characterized by abnormal proliferation of mast cells in one or more organ. The specific D816V KIT mutation is present in most cases. Gastrointestinal symptoms occur commonly but histologic characterization of gastrointestinal involvement is incomplete. The purpose of this study was (1) to describe the clinicopathologic features in five patients with systemic mastocytosis involving the gastrointestinal tract and (2) to determine whether gastrointestinal involvement is associated with the usual D816V mutation or a different mutation. Clinical details were obtained from the hospital of origin or referring pathologist. Histologic features were documented in slides stained with hematoxylin and eosin, mast cell tryptase and CD117. Molecular analysis for the D816V KIT mutation was performed on formalin-fixed paraffin-embedded sections. Symptoms included diarrhea/loose stools (n=5), abdominal pain (n=4), vomiting (n=3) and weight loss (n=3). Other findings included cutaneous lesions of mastocytosis (n=4), malabsorption (n=2), hypoalbuminemia (n=2) and constitutional growth delay (n=1). Sites of gastrointestinal involvement included the colon (n=5), duodenum (n=3) and terminal ileum (n=3). Endoscopic/gross findings included mucosal nodularity (n=4), erosions (n=2) and loss of mucosal folds (n=2). In three patients the endoscopic appearance was considered consistent with inflammatory bowel disease. All cases showed increased mast cell infiltration of the lamina propria, confirmed by immunohistochemistry for mast cell tryptase and CD117. In two cases, mast cells had abundant clear cytoplasmic resembling histiocytes. Marked eosinophil infiltrates were present in four patients, in one patient leading to confusion with eosinophilic colitis. Architectural distortion was noted in three cases. The D816V KIT mutation was present in all four cases tested. In conclusion, gastrointestinal involvement by systemic mastocytosis is characterized by a spectrum of morphologic features that can be mistaken for inflammatory bowel disease, eosinophilic colitis or histiocytic infiltrates. Systemic mastocytosis involving the gastrointestinal tract is associated with the usual D816V KIT mutation.
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Horny HP, Sotlar K, Valent P, Hartmann K. Mastocytosis: a disease of the hematopoietic stem cell. DEUTSCHES ARZTEBLATT INTERNATIONAL 2008; 105:686-92. [PMID: 19623287 DOI: 10.3238/arztebl.2008.0686] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Accepted: 06/09/2008] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Mastocytosis is an unusual clonal disease of the hematopoietic stem cell. METHODS This article is based on a selective literature search and on the authors' clinical and pathological experience. RESULTS The clinical manifestations of mastocytosis range from cutaneous mastocytosis, a common, prognostically favorable presentation, to mast cell leukemia, a rare, life-threatening disease. The mediator-induced symptoms usually respond well to H1 antihistamines. Therapeutic standards for cytoreduction in the progressive, systemic forms of mastocytosis are still lacking. DISCUSSION Because some of the manifestations of mastocytosis are nonspecific and can be mimicked by other diseases, there is a risk of two types of diagnostic error: Mastocytosis may remain undiagnosed when it is actually present, or it may be diagnosed even though morphological and molecular findings rule out mastocytosis. Well-defined criteria should be used to differentiate mastocytosis from other diseases with a similar clinical presentation.
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