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Cancel-Artau KJ, García-Guzmán LG, Michelen-Gomez EA, Sanchez-Flores X. An Intertriginous Rash in an Infant. Pediatr Rev 2024; 45:e29-e31. [PMID: 39085188 DOI: 10.1542/pir.2023-006029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 10/11/2023] [Accepted: 11/17/2023] [Indexed: 08/02/2024]
Affiliation(s)
- Karina J Cancel-Artau
- Department of Dermatology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | | | | | - Xavier Sanchez-Flores
- Department of Dermatology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
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2
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Quoß M, Ziegler P. Testen Sie Ihr Fachwissen. AKTUELLE DERMATOLOGIE 2021. [DOI: 10.1055/a-1532-5526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Petra Ziegler
- Hautarztpraxis Dr. Winkler, Dr. Ziegler, Dinkelsbühl
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3
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Fraitag S, Boccara O. What to Look Out for in a Newborn with Multiple Papulonodular Skin Lesions at Birth. Dermatopathology (Basel) 2021; 8:390-417. [PMID: 34449594 PMCID: PMC8395860 DOI: 10.3390/dermatopathology8030043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 12/17/2022] Open
Abstract
Multiple papulonodular skin lesions at birth can indicate the presence of various benign and malignant disorders. Although the lesions’ clinical aspect (color and consistency, in particular) may steer the clinician towards one disorder or another (infantile myofibromatosis, xanthogranuloma, or metastatic neuroblastoma), the diagnosis can only be confirmed by the histopathologic assessment of a biopsy. In neonates, a rapid but accurate diagnosis is critical because skin lesions may be the first manifestation of a malignant disorder like leukemia cutis or metastatic neuroblastoma. Here, we review the various disorders that may manifest themselves as multiple skin lesions at birth.
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Affiliation(s)
- Sylvie Fraitag
- Department of Pathology, Necker-Enfants Malades Hospital, APHP, 75015 Paris, France
- Correspondence:
| | - Olivia Boccara
- Department of Dermatology, Necker-Enfants Malades Hospital, APHP, 75015 Paris, France;
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4
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Rizzoli A, Giancristoforo S, Haass C, De Vito R, Gaspari S, Scapillati E, Diociaiuti A, El Hachem M. Congenital self-healing reticulohistiocytosis in a newborn: unusual oral and cutaneous manifestations. Ital J Pediatr 2021; 47:135. [PMID: 34112212 PMCID: PMC8194160 DOI: 10.1186/s13052-021-01082-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/20/2021] [Indexed: 11/10/2022] Open
Abstract
Background Congenital self-healing reticulohistiocytosis (CSHRH), also called Hashimoto-Pritzker disease, is a rare and benign variant of Langerhans cell histiocytosis, characterized by cutaneous lesions without extracutaneous involvement. Case presentation We present a case of CSHRH with diffuse skin lesions and erosions in the oral mucosa, present since birth and lasting for 2 months, and we perform a review of the literature on Pubmed in the last 10 years. Conclusions Our case confirm that lesions on oral mucosa, actually underestimated, may be present in patients with CSHRH. Patients affected by CSHRH require a close follow-up until the first years of life, due to the unpredictable course of Langerhans cell histiocytosis, in order to avoid missing diagnosis of more aggressive types of this disorder.
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Affiliation(s)
- Alessandra Rizzoli
- Neonatal Intensive Unit, San Pietro - Fatebenefratelli Hospital, Rome, Italy
| | - Simona Giancristoforo
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio, 4, 00165, Rome, Italy.
| | - Cristina Haass
- Neonatal Intensive Unit, San Pietro - Fatebenefratelli Hospital, Rome, Italy
| | - Rita De Vito
- Pathology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Stefania Gaspari
- Department of Hematology-Oncology and Cellular and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Eleonora Scapillati
- Neonatal Intensive Unit, San Pietro - Fatebenefratelli Hospital, Rome, Italy
| | - Andrea Diociaiuti
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio, 4, 00165, Rome, Italy
| | - May El Hachem
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio, 4, 00165, Rome, Italy
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5
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Langerhans cell histiocytosis in children: History, classification, pathobiology, clinical manifestations, and prognosis. J Am Acad Dermatol 2018; 78:1035-1044. [PMID: 29754885 DOI: 10.1016/j.jaad.2017.05.059] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/15/2017] [Accepted: 05/31/2017] [Indexed: 12/16/2022]
Abstract
Langerhans cell histiocytosis (LCH) is an inflammatory neoplasia of myeloid precursor cells driven by mutations in the mitogen-activated protein kinase pathway. When disease involves the skin, LCH most commonly presents as a seborrheic dermatitis or eczematous eruption on the scalp and trunk. Evaluation for involvement of other organ systems is essential, because 9 of 10 patients presenting with cutaneous disease also have multisystem involvement. Clinical manifestations range from isolated disease with spontaneous resolution to life-threatening multisystem disease. Prognosis depends on involvement of risk organs (liver, spleen, and bone marrow) at diagnosis, particularly on presence of organ dysfunction, and response to initial therapy. Systemic treatment incorporating steroids and cytostatic drugs for at least one year has improved prognosis of multisystem LCH and represents the current standard of care.
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6
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Bedran NR, Carlos R, de Andrade BAB, Bueno APS, Romañach MJ, Milito CB. Clinicopathological and Immunohistochemical Study of Head and Neck Langerhans Cell Histiocytosis from Latin America. Head Neck Pathol 2017; 12:431-439. [PMID: 29164473 PMCID: PMC6232207 DOI: 10.1007/s12105-017-0867-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 11/13/2017] [Indexed: 01/23/2023]
Abstract
Langerhans cell histiocytosis (LCH) is an inflammatory myeloid neoplastic proliferation with variable clinical behavior caused by the accumulation of CD1a+/CD207+ histiocytes, associated with a variable number of eosinophils, lymphocytes, plasma cells and multinucleated giant cells, most commonly observed in male children. LCH is uncommon in the head and neck region, occurring as ulcerated and reddened plaques or nodules that cause destruction of adjacent soft tissues and bone. The exact etiology of LCH is still unknown and controversial, with possible etiologic role of viruses, including Epstein-Barr virus (EBV). The aim of this study was to describe the clinicopathologic and immunohistochemical features of patients with LCH of the head and neck region. Clinical data from 19 patients with LCH were obtained from the archives of the Federal University of Rio de Janeiro and the Clinical Head and Neck Center of Guatemala. All cases were submitted to morphological, immunohistochemical analysis with CD1a, CD207, CD3, CD20, CD68, S-100 and Ki-67 and in situ hybridization for EBV. Ten cases were female and 9 male, with mean age of 11.5 years. Fourteen cases were located in the oral cavity, three cases in lymph nodes, and two cases in the scalp. In regard to the oral lesions, 13 cases were intra-osseous with six cases in anterior mandible, five cases in posterior mandible, and two cases in posterior maxilla while one case was located exclusively in the gingiva. The inflammatory pattern showed variation in the number of plasma cells, eosinophils and lymphocytes, while tumor cells were positive for CD1a, S-100 and CD68 in all cases, and positive for CD207 in 18 cases. In situ hybridization for EBV were negative in all cases.
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Affiliation(s)
- Natália Rocha Bedran
- Department of Pathology, School of Medicine, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Román Carlos
- Pathology Section, Centro Clínico de Cabeza y Cuello/Hospital Herrera Llerandi, Guatemala City, Guatemala
| | - Bruno Augusto Benevenuto de Andrade
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (FO-UFRJ), Av. Carlos Chagas Filho 373, Prédio do CCS Bloco K, 2° andar Sala 56. Ilha da Cidade Universitária, Rio de Janeiro, 21941-902 Brazil
| | - Ana Paula Silva Bueno
- Pediatric Hematology Section, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mário José Romañach
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (FO-UFRJ), Av. Carlos Chagas Filho 373, Prédio do CCS Bloco K, 2° andar Sala 56. Ilha da Cidade Universitária, Rio de Janeiro, 21941-902 Brazil
| | - Cristiane Bedran Milito
- Department of Pathology, School of Medicine, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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7
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Morgan KW, Callen JP. Self-Healing Congenital Langerhans Cell Histiocytosis Presenting as Neonatal Papulovesicular Eruption. J Cutan Med Surg 2016. [DOI: 10.1177/120347540100500605] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Congenital self-healing Langerhans cell histiocytosis (CSHLCH) is a rare condition which may present at birth or during the neonatal period. It is usually characterized by the eruption of multiple, disseminated, red-brown papules and nodules which may increase in size and number during the first few weeks of life. Systemic signs are usually absent except for occasional mild hepatomegaly. Objective: We present a 3.5-kg male infant who presented at birth with numerous diffuse, erythematous, crusted erosions. He was presumed to have congenital herpes simplex virus (HSV) and was started on IV acyclovir. Histopathologic examination revealed a mixed inflammatory infiltrate with numerous histiocytes which were S-100 and peanut agglutin positive consistent with CSHLCH. Further workup did not reveal any signs of systemic involvement. Conclusion: CSHLCH has rarely been reported to present as a papulovesicular eruption at birth. In these cases, a viral etiology is commonly entertained in the differential diagnosis. Despite the spontaneous regression of skin lesions in CSHLCH, close followup is required to evaluate for systemic signs and symptoms associated with latent Letterer–Siwe disease.
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Affiliation(s)
- Kelli W. Morgan
- Department of Medicine, Division of Dermatology, University of Louisville, Louisville, Kentucky, USA
| | - Jeffrey P. Callen
- Department of Medicine, Division of Dermatology, University of Louisville, Louisville, Kentucky, USA
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8
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The natural history of skin-limited Langerhans cell histiocytosis: a single-institution experience. J Pediatr Hematol Oncol 2014; 36:613-6. [PMID: 25171449 DOI: 10.1097/mph.0000000000000248] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Prior reports of Langerhans cell histiocytosis (LCH) suggest that isolated skin involvement is rare and often progresses to systemic disease. More rapid access to pediatric subspecialty care has likely led to more frequent representation of this condition. The purpose of this study is to characterize the natural history of skin-limited LCH in an era of increased access to pediatric subspecialty care. MATERIALS AND METHODS A retrospective chart review was performed on all patients newly diagnosed with LCH between 2001 and 2012 at the Children's Hospital of Wisconsin. Extensive review of laboratory, physical examination, and imaging reports was performed and data collected for patients with biopsy-proven skin LCH. RESULTS Sixteen individuals with skin-limited LCH were identified. The median age at onset of skin eruption was birth (range, birth to 6 mo), and median duration of follow-up was 19.5 months (range, 2 wk to 10 y) from diagnosis. One patient (6%) developed pituitary disease and 1 patient (6%) had refractory skin involvement. All others experienced complete resolution. For patients without progressive or refractory disease, resolution of skin findings occurred within 7 months from onset. DISCUSSION Progression of skin-limited to multisystem LCH likely may be less frequent than previously described.
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Simko SJ, Garmezy B, Abhyankar H, Lupo PJ, Chakraborty R, Lim KPH, Shih A, Hicks MJ, Wright TS, Levy ML, McClain KL, Allen CE. Differentiating skin-limited and multisystem Langerhans cell histiocytosis. J Pediatr 2014; 165:990-6. [PMID: 25441388 PMCID: PMC4254414 DOI: 10.1016/j.jpeds.2014.07.063] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/17/2014] [Accepted: 07/28/2014] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To identify features associated with multisystem involvement and therapeutic failure in patients with skin Langerhans cell histiocytosis (LCH). STUDY DESIGN We reviewed medical records of 71 consecutive patients with LCH with skin involvement evaluated at Texas Children's Hospital and analyzed clinical features, laboratory results, and the presence of circulating cells with the BRAF-V600E mutation with respect to initial staging and clinical outcomes. RESULTS Skin disease in patients older than 18 months of age at diagnosis was associated with the presence of multisystem disease (OR, 9.65; 95% CI, 1.17-79.4). Forty percent of patients referred for presumed skin-limited LCH had underlying multisystem involvement, one-half of these with risk-organ involvement. Patients with skin-limited LCH had a 3-year progression-free survival of 89% after initial therapy, and none developed multisystem disease. Patients with skin/multisystem involvement had a 3-year progression-free survival of 44% with vinblastine/prednisone therapy, and risk-organ involvement did not correlate with failure to achieve nonactive disease. Circulating cells with BRAF-V600E were detected at higher frequency in patients with multisystem involvement (8 of 11 skin/multisystem vs 1 of 13 skin-limited; P = .002). CONCLUSION Skin-limited LCH necessitates infrequent therapeutic intervention and has a lower risk of progression relative to skin plus multisystem LCH. The less-aggressive clinical course and lack of circulating cells with the BRAF-V600E mutation in skin-limited LCH suggest a different mechanism of disease origin compared with multisystem or risk-organ disease.
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Affiliation(s)
- Stephen J. Simko
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston, TX
| | - Benjamin Garmezy
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston, TX
| | - Harshal Abhyankar
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston, TX
| | - Philip J. Lupo
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston, TX
| | | | | | - Albert Shih
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston, TX
| | - M. John Hicks
- Department of Pathology, Baylor College of Medicine, Houston, TX
| | | | - Moise L. Levy
- Pediatric Dermatology, Baylor College of Medicine, Houston, TX,Pediatric Dermatology, Dell Children’s Medical Center, Austin, TX,Dermatology, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Carl E. Allen
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston, TX
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Kwon SH, Choi JW, Kim HJ, Youn SW. Langerhans cell histiocytosis: a retrospective analysis in a Korean tertiary hospital from 2003 to 2012. J Dermatol 2013; 40:824-8. [PMID: 23957667 DOI: 10.1111/1346-8138.12232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 06/03/2013] [Indexed: 11/30/2022]
Abstract
Epidemiological study of Langerhans cell histiocytosis (LCH) has been limited due to its rarity and multisystemic involvement. The aim of this study was to investigate the epidemiological features of LCH via the clinical data warehouse (CDW). Clinical data of 30 LCH patients from the all departments of a tertiary referral hospital between 2003 and 2012 were analyzed retrospectively by searching the CDW. The male-to-female ratio was 2.8:1. The age of onset ranged 7 days to 57 years with a median of 13 years. Of the patients, 36.7% presented initial symptoms before the age of 10 years. The involved organs at diagnosis were: bone (66.7%), skin (16.7%), lungs (13.3%) and lymph node (3.3%). For all of the 30 cases, there were 31 disease sites because of a single case of multisystemic disease involving both skin and bone. Of the 96.7% of patients with single-system disease, 69.0% had bony involvement. This study elucidated the clinical features of LCH from all the departments of a tertiary hospital via the CDW, which suggests a potential role of the CDW as a new epidemiological approach for rare diseases.
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Affiliation(s)
- Soon Hyo Kwon
- Department of Dermatology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Korea
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Orle J, Mósca AM, Sousa MAJ, Lima CMO, Adriano AR, Rezende PM. Congenital self healing reticulohistiocytosis in a newborn (Hashimoto Pritzker). An Bras Dermatol 2012; 86:785-8. [PMID: 21987150 DOI: 10.1590/s0365-05962011000400026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 07/21/2010] [Indexed: 11/22/2022] Open
Abstract
Congenital self-healing reticulohistiocytosis is the benign spectrum of Langerhans Cell Histiocytosis, characterized by cutaneous lesions at birth or in the neonatal period, absence of systemic manifestations and spontaneous resolution of clinical status. Despite the benign and often self-resolving course in most patients, studies show that in some cases there may be metastasis or recurrence of the disease, emphasizing that the clinical course is variable, requiring long-term follow-up. The monitoring of the patient for a long period is important to detect possible systemic involvement, as there is a report of recurrence involving the skin, mucosa, bone and pituitary gland.
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Affiliation(s)
- Joana Orle
- Policlínica Geral do Rio de Janeiro, Instituto de Pós-Graduação Médica Carlos Chagas, Rio de Janeiro, Brasil.
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12
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Hawkes CP, Bourke JF, Fitzgibbon J, Dempsey EM. A disappearing neonatal skin lesion. Eur J Pediatr 2011; 170:1353-4. [PMID: 21720769 DOI: 10.1007/s00431-011-1516-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 06/08/2011] [Indexed: 10/18/2022]
Abstract
A preterm baby girl was noted at birth to have a firm, raised, non-tender skin lesion located over her right hip. She developed three similar smaller lesions on her ear, buttock and right knee. All lesions had resolved by 2 months of age.
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13
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Ricciardo B, Irvine A, McDermott M, Ryan J, Collins S. A case of congenital solitary Langerhans cell histiocytoma. Australas J Dermatol 2010; 52:e1-3. [DOI: 10.1111/j.1440-0960.2010.00625.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Weidner KR, Chan S, Jogi R, Glaich AS, Ostler DA, Hsu S. JAAD Grand Rounds quiz. Necrotic, ulcerated papules on a newborn male. J Am Acad Dermatol 2009; 61:544-6. [PMID: 19700029 DOI: 10.1016/j.jaad.2008.12.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2008] [Revised: 12/20/2008] [Accepted: 12/31/2008] [Indexed: 11/25/2022]
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15
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Affiliation(s)
- Barbara Riva
- Department of Pediatric Dermatology, Institute of Dermatological Sciences, IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy.
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Sharma PK, Sabhnani S, Bhardwaj M, Kar HK. Acral, pure cutaneous, self-healing, late-onset, cellulitis-like Langerhans cell histiocytosis. J Cutan Med Surg 2009; 13:43-7. [PMID: 19298771 DOI: 10.2310/7750.2008.07078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND An unusual and not yet reported clinical presentation of pure cutaneous Langerhans cell histiocytosis (LCH) that was a diagnostic dilemma. OBJECTIVE To bring to light the newer presentation of this disease. METHOD The case was managed on clinical grounds initially as cellulitis. However, after the investigations and confirmation of the diagnosis, she was managed symptomatically. RESULTS Pure cutaneous LCH may manifest in early adulthood with features of cellulitis, erythematous edematous vesicular plaques, and nodules distributed in the flexural acral areas. CONCLUSION Pure cutaneous LCH may have an acute late onset with unusual morphology as cellulitis, inverse acral distribution, and self-healing.
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Mosterd K, van Marion A, van Steensel MAM. Neonatal Langerhans' cell histiocytosis: a rare and potentially life-threatening disease. Int J Dermatol 2009; 47 Suppl 1:10-2. [PMID: 18986477 DOI: 10.1111/j.1365-4632.2008.03950.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 5-day-old girl presented with thrombocytopenia, leukopenia, anemia and crusted purpura on the skin. The diagnosis Langerhans' cell histiocytosis (LCH) was suspected on clinical grounds and subsequently confirmed by histopathological examination of a skin biopsy. Cytological examination of a bone marrow aspirate revealed numerous histiocytes, which is suspect for bone-marrow infiltration by LCH. LCH is a condition in which a clonal population of Langerhans' cells accumulates in various tissues, causing tissue damage and/or dysfunction. The prognosis of this disease depends on the age of the patient, the extent of the disease and the presence of vital organ failure. In case of organ dysfunction, systemic chemotherapy is indicated. Although very rare, LCH can be a life-threatening disease. Early diagnosis can improve chances of survival. We briefly discuss diagnostic procedures and treatment.
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Affiliation(s)
- Klara Mosterd
- Department of Dermatology, University Hospital Maastricht, and GROW Research Institute for Oncology and Developmental Biology, University of Maastricht, The Netherlands.
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18
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Le Bidre E, Lorette G, Delage M, Esteve E, Machet MC, Arbeille B, Maruani A. Extensive, erosive congenital self-healing cell histiocytosis. J Eur Acad Dermatol Venereol 2008; 23:835-6. [PMID: 19207645 DOI: 10.1111/j.1468-3083.2008.03023.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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19
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Aviner S, Ronen M, London D, Tobar A, Zangen S. Langerhans cell histiocytosis in a premature baby presenting with skin-isolated disease: case report and literature review. Acta Paediatr 2008; 97:1751-4. [PMID: 18754823 DOI: 10.1111/j.1651-2227.2008.00999.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
UNLABELLED Langerhans cell histiocytosis (LCH) in premature babies is extremely rare as is a vesicular skin rash, while gastrointestinal involvement is associated with a poor outcome. We report a case of LCH in a premature baby presented with isolated vesiculo-papulo-macular skin lesions and insidiously developed gastrointestinal symptoms, haematological and severe pulmonary involvement. We also reviewed a few cases of LCH in premature babies in the English language medical literature. LCH in preterm babies appears to be a severe systemic disease, usually lethal in-utero or post delivery. CONCLUSION Careful observation should be applied to newborns with skin-only Langerhans cell histiocytosis in order to identify in time progression to potentially fatal systemic disease.
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MESH Headings
- Biopsy
- Exanthema/diagnosis
- Exanthema/pathology
- Fatal Outcome
- Histiocytosis, Langerhans-Cell/diagnosis
- Histiocytosis, Langerhans-Cell/pathology
- Humans
- Infant, Low Birth Weight
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/diagnosis
- Infant, Premature, Diseases/pathology
- Skin/pathology
- Tomography, X-Ray Computed
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Affiliation(s)
- Shraga Aviner
- Department of Pediatrics, The Barzilai Medical Center, Ashkelon, Israel.
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20
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Abstract
Congenital Langerhans cell histiocytosis (LCH) is a rare condition with great diversity. A case of congenital skin-only LCH presenting as a "blueberry muffin baby" with a spontaneous regression by the age of 8 months is reported here. New insights into clinical manifestations and prognosis, which is not uniformly positive, are discussed. A thorough examination and a careful follow-up should be provided to these patients. Systemic therapy is warranted in multi-system disease; no consensus on treatment exists in case of LCH isolated to skin. The diagnosis of congenital self-healing LCH should be made only retrospectively.
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21
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Abstract
We report the case of a newborn with Langerhans cell histiocytosis involving the skin and multiple bones. All lesions resolved without therapy. This case underscores the benefits of a conservative approach in the absence of risk organ involvement.
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22
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Kapur P, Erickson C, Rakheja D, Carder KR, Hoang MP. Congenital self-healing reticulohistiocytosis (Hashimoto-Pritzker disease): Ten-year experience at Dallas Children's Medical Center. J Am Acad Dermatol 2007; 56:290-4. [PMID: 17224372 DOI: 10.1016/j.jaad.2006.09.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Revised: 08/29/2006] [Accepted: 09/03/2006] [Indexed: 12/22/2022]
Abstract
The real incidence of congenital self-healing reticulohistiocytosis (CSHR) may be underreported because of its high rate of spontaneous resolution and lack of clinical recognition. Currently, there are no criteria other than clinical that can reliably distinguish CSHR from cutaneous involvement by disseminated Langerhans cell histiocytosis (LCH). In this study we investigate the role of E-cadherin, Ki-67, and phosphorylated histone H3 (PHH3) immunohistochemical stains in distinguishing CSHR from disseminated LCH. We found that no significant difference was seen in the histologic features and the expression of E-cadherin, Ki-67, and PHH3 between the two groups; thus supporting the theory that CSHR and LCH represent different ends of a spectrum of the same condition.
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Affiliation(s)
- Payal Kapur
- Department of Pathology, Children's Medical Center Dallas, Texas, USA
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Takahashi T, Yoshimoto M, Kondoh N. Spontaneously regressed Langerhans cell histiocytosis of lymph nodes in an elderly patient. Intern Med 2007; 46:1757-60. [PMID: 17938535 DOI: 10.2169/internalmedicine.46.0356] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Langerhans cell tumors are neoplastic proliferation of Langerhans cells and are classified into Langerhans cell histiocytosis (LCH) and Langerhans cell sarcoma (LCS). We report a case of LCH in an 89-year-old-woman with left axillary lymphadenopathy. A histologic examination demonstrated a proliferation of histiocytoid cells which were positive for CD1a, S-100 protein, and Lagerin (CD207). Initial diagnosis was LCS based on morphologic features, high MIB-1 index, and multi-system involvement detected by FDG-PET. However, the disease disappeared spontaneously without specific treatment in six months. The disease was considered to be spontaneously regressed LCH with multi-system involvement rather than LCS.
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Fuentes Castelló MA, Montahud Posada C, Belenguer Font MJ, Pérez Ramos M, Vargas Torcal F. [Congenital presentation of nonself-healing Langerhans' cell histiocytosis]. An Pediatr (Barc) 2006; 65:634-5. [PMID: 17194340 DOI: 10.1157/13095864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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25
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Langerhans Cell Histiocytosis in Skin and Mucous Membranes. Dermatopathology (Basel) 2006. [DOI: 10.1007/3-540-30244-1_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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26
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Pavlović MD, Minić A, Zolotarevski L, Vesić S. Disseminated crusted papules in a newborn. VOJNOSANIT PREGL 2006; 63:681-3. [PMID: 16875431 DOI: 10.2298/vsp0607681p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Congenital self-healing Langerhans cell histiocytosis (Hashimoto-Pritzker disease) is the rarest form of Langerhans cell histiocytosis, usually confined to the skin and/or mucous membranes. Cutaneous eruption is mostly generalized, papular, nodular or vesicular. Despite impressive clinical presentation in a newborn it infrequently spreads to internal organs (which then portends a grave prognosis, indistinguishable from Letterer-Siwe disease). CASE REPORT We presented a full-term newborn, female, 3.3 kg who had a multitude of erythematous and crusted papules, nodules and pseudovesicles distributed all over the body, except for the mucous membranes. A biopsy and haematoxylin--eosin stain revealed dermal infiltration of pleomorphic histiocytes with eosinophilic ground-glass cytoplasm and round to bean-shaped nuclei. Over the next six weeks the eruption gradually subsided leaving no residues, or a few atrophic scars. CONCLUSION There is no need for specific treatment of congenital self-healing Langerhans cell-histiocytosis in the absence of multiorgan involvement. However, a close and regular follow-up is necessary to evaluate the children for systemic symptoms and signs.
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Affiliation(s)
- Milos D Pavlović
- Military Medical Academy, Clinic of Dermatology, Center of Pathology and Forensic Medicine, Belgrade.
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Lau L, Krafchik B, Trebo MM, Weitzman S. Cutaneous Langerhans cell histiocytosis in children under one year. Pediatr Blood Cancer 2006; 46:66-71. [PMID: 16261594 DOI: 10.1002/pbc.20479] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND To evaluate the clinical course and outcome of infants with Langerhans cell histiocytosis (LCH) involving skin and to estimate the incidence of progression to multi-system (M-S) disease in those with isolated skin involvement. METHODS A retrospective review was conducted on 22 LCH patients who were younger than 12 months at the onset of their skin eruption. RESULTS Twelve patients had isolated skin involvement at diagnosis and 10 were evaluable for progression. Four of the 10 (40%) evaluable patients progressed to multi-system (M-S) disease. Of the 10 patients with M-S disease at diagnosis, 5 had a history of a preceding skin eruption 2 to 13 months prior to diagnosis. Eleven of the 14 (79%) patients with M-S disease had risk organ involvement. The mortality rate of M-S disease was 50%. CONCLUSIONS It is important for primary caregivers to recognize that isolated cutaneous LCH in infants is not always a benign disorder. The diagnosis of self-healing cutaneous LCH should only be made in retrospect. Careful, albeit non-invasive, follow-up is recommended to monitor for disease progression and development of long-term complications.
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Affiliation(s)
- Loretta Lau
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
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28
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Weiss T, Weber L, Scharffetter-Kochanek K, Weiss JM. Solitary cutaneous dendritic cell tumor in a child: Role of dendritic cell markers for the diagnosis of skin Langerhans cell histiocytosis. J Am Acad Dermatol 2005; 53:838-44. [PMID: 16243135 DOI: 10.1016/j.jaad.2005.07.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2005] [Revised: 07/05/2005] [Accepted: 07/05/2005] [Indexed: 11/28/2022]
Abstract
We describe a child with a solitary dendritic cell (DC) tumor positive for S-100 protein, CD1a, and HLA-DR with the clinical and histopathologic features of a so-called solitary variant of congenital self-healing Hashimoto-Pritzker reticulohistiocytosis (CSHRH). CSHRH is a spontaneously regressing, benign form of Langerhans cell histiocytosis (LCH) and was thought to be a histiocytosis consisting of precursor Langerhans cells. In our study the tumor cells did not express CD68, indicating that they represent mature DCs. Because of the negative finding for Langerin, it cannot be assessed whether the tumor consists of terminally mature Langerhans cells that have lost Langerin expression upon maturation or of mature dermal DCs. This case demonstrates that the progress in DC biology necessitates reevaluation of our knowledge of LCH to better understand the different variants of the disease. Therefore the literature on CSHRH is reviewed in light of present knowledge on cutaneous DC immunology.
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Affiliation(s)
- Tina Weiss
- Department of Dermatology and Allergology, University of Ulm, Ulm, Germany.
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Key SJ, O'Brien CJ, Silvester KC, Crean SJ. Eosinophilic granuloma: resolution of maxillofacial bony lesions following minimal intervention. Report of three cases and a review of the literature. J Craniomaxillofac Surg 2004; 32:170-5. [PMID: 15113576 DOI: 10.1016/j.jcms.2004.01.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2003] [Accepted: 01/19/2004] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Langerhans' cell histiocytosis is a collective term used to describe a group of enigmatic proliferative disorders. The natural history of the disease varies from a slow, benign, localized symptomatic bony or soft tissue lesion, to a rapidly progressive widespread multiple organ disorder which is often fatal. Eosinophilic granuloma accounts for 60-70% of all cases of Langerhans' cell histiocytosis and can present as solitary (50-75%) or multifocal defects in bone. It occasionally presents as a localized soft tissue lesion. There are multiple treatment options but the response is unpredictable. AIMS We present three separate cases, of the maxillofacial skeleton where the lesions of eosinophilic granuloma resolved following incisional biopsy only. PATIENTS AND RESULTS Three patients presented with solitary lesions of the maxillofacial skeleton. All were diagnosed as Langerhans' cell histiocytosis following open curettage, which also resulted in resolution of the lesions. Follow-up has thus far been disease free. CONCLUSION For some solitary Langerhans' cell histiocytosis lesions, simple curettage is the only treatment required. The paper discusses the need to confirm the solitary nature of the disease and the need for follow-up. Reviewing the literature on the disease, the authors suggest that perhaps cellular immaturity holds the cells of the lesion in a disease state until pushed to maturity by the trauma of open curettage surgery, resulting in a complete resolution of the disease.
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Affiliation(s)
- Steven J Key
- Department of Maxillofacial Surgery, St Georges Hospital, Tooting, London, UK.
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Abstract
Congenital self-healing Langerhans cell histiocytosis (CSHLCH) is a rare variant of Langerhans cell histiocytosis, presenting at birth or in the neonatal period with cutaneous lesions that involute spontaneously. Affected infants are otherwise well with no systemic illness. A case of CSHLCH, probably the first case report from India, is described. The patient presented on the third day of life with multiple papulonodular lesions over the body, with no systemic involvement. The lesions spontaneously regressed by 6 months of age, with no evidence of relapse at 1 year of age. Although CSHLCH is a benign and self-limited condition, long-term follow-up for evidence of relapse is emphasized.
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Affiliation(s)
- Mandeep Walia
- Department of Pediatrics, VM Medical College & Safdarjang Hospital, New Delhi, India.
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Larralde M, Rositto A, Giardelli M, Gatti CF, Santos-Muñoz A. Congenital self-healing Langerhans cell histiocytosis: the need for a long term follow up. Int J Dermatol 2003; 42:245-6. [PMID: 12653927 DOI: 10.1046/j.1365-4362.2003.16142.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Congenital Self-Healing Langerhans Cell Histiocytosis: Complementary Role of Immunocytochemical and Ultrastructural Evaluation. AJSP-REVIEWS AND REPORTS 2002. [DOI: 10.1097/00132583-200209000-00006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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