1
|
Rydz A, Lange M, Ługowska-Umer H, Sikorska M, Nowicki RJ, Morales-Cabeza C, Alvarez-Twose I. Diffuse Cutaneous Mastocytosis: A Current Understanding of a Rare Disease. Int J Mol Sci 2024; 25:1401. [PMID: 38338679 PMCID: PMC11154339 DOI: 10.3390/ijms25031401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/06/2024] [Accepted: 01/19/2024] [Indexed: 02/12/2024] Open
Abstract
Mastocytosis is a heterogeneous disease characterized by the expansion and accumulation of neoplastic mast cells in various tissues. Diffuse cutaneous mastocytosis (DCM) is a rare and most severe form of cutaneous mastocytosis, which typically occurs in childhood. There have been reports of a familial DCM with specific gene mutations, indicating both sporadic and hereditary factors involved in its pathogenesis. DCM is associated with severe MC mediator-related symptoms and an increased risk of anaphylaxis. The diagnosis is based on the appearance of skin lesions, which typically show generalized thickening, erythroderma, blistering dermographism, and a positive Darier's sign. Recognition, particularly in infants, is challenging due to DCMs resemblance to other bullous skin disorders. Therefore, in unclear cases, a skin biopsy is crucial. Treatment focuses on symptom management, mainly including antihistamines and mast cell stabilizers. In extremely severe cases, systemic steroids, tyrosine kinase inhibitors, phototherapy, or omalizumab may be considered. Patients should be equipped with an adrenaline autoinjector. Herein, we conducted a comprehensive review of literature data on DCM since 1962, which could help to better understand both the management and prognosis of DCM, which depends on the severity of skin lesions, intensity of mediator-related symptoms, presence of anaphylaxis, and treatment response.
Collapse
Affiliation(s)
- Agnieszka Rydz
- Student’s Scientific Circle Practical and Experimental Dermatology, Medical University of Gdansk, 80-211 Gdańsk, Poland;
| | - Magdalena Lange
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (H.Ł.-U.); (M.S.); (R.J.N.)
| | - Hanna Ługowska-Umer
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (H.Ł.-U.); (M.S.); (R.J.N.)
| | - Monika Sikorska
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (H.Ł.-U.); (M.S.); (R.J.N.)
| | - Roman J. Nowicki
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (H.Ł.-U.); (M.S.); (R.J.N.)
| | - Cristina Morales-Cabeza
- Instituto de Estudios de Mastocitosis de Castilla-La Mancha (CLMast)—Spanish Reference Center for Mastocytosis, Hospital Virgen del Valle—Complejo Hospitalario Universitario de Toledo, 45071 Toledo, Spain; (C.M.-C.); (I.A.-T.)
| | - Iván Alvarez-Twose
- Instituto de Estudios de Mastocitosis de Castilla-La Mancha (CLMast)—Spanish Reference Center for Mastocytosis, Hospital Virgen del Valle—Complejo Hospitalario Universitario de Toledo, 45071 Toledo, Spain; (C.M.-C.); (I.A.-T.)
| |
Collapse
|
2
|
Olteanu EG, Bataneant M, Puiu M, Chirita-Emandi A. When Mast Cells Run Amok: A Comprehensive Review and Case Study on Severe Neonatal Diffuse Cutaneous Mastocytosis. Genes (Basel) 2023; 14:2021. [PMID: 38002964 PMCID: PMC10671269 DOI: 10.3390/genes14112021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
Neonatal diffuse cutaneous mastocytosis (NDCM) is defined as the infiltration of the epidermis by a clonal proliferation of mast cells, observed at birth, without initial signs of systemic involvement. The typical driver mutation is in the KIT gene. We report a rare case of a boy, born at term, already presenting at birth with generalized subcutaneous nodules on the face, scalp, trunk, back, hands, and feet. The spleen, liver, and inflammatory markers were normal at birth. Tryptase was significantly elevated. A bone marrow biopsy showed no mast cell involvement at age 2 months. A punch biopsy at age 2 months revealed CD117-positive cells diffusely infiltrating the skin, with subsequent DNA NGS sequencing for the formalin-fixed paraffin embedded tissue (FFPE) identifying the pathogenic NM_000222.3:c.1504_1509dup; p.(Ala502_Tyr503dup) variant in the KIT gene previously associated with cutaneous mastocytosis. At 2 years follow-up, he had splenomegaly and multiple cervical and inguinal adenopathy, while the skin nodules persisted, especially on the scalp with accompanying pruritus. He received oral and local sodium cromoglycate, oral antihistamines, antibiotic cream for skin infection, and iron supplementation; however, compliance to treatment was relatively low. The prognosis is difficult to predict, as he developed systemic involvement, failure to thrive, and mild psychomotor delay. A case aggregation of NDCM reported in the literature was performed to provide a comprehensive overview of this rare pathology, to better understand the prognosis. NDCM is a life-threatening disease with severe complications. Almost half had severe complications, such as mast hepatosplenomegaly, adenopathy, bacterial infections, mast cell leukaemia, and systemic involvement.
Collapse
Affiliation(s)
- Emilian-Gheorghe Olteanu
- Research Center for Pharmaco-Toxicological Evaluations, Faculty of Pharmacy, “Victor Babes” University of Medicine and Pharmacy, Piaţa Eftimie Murgu Nr. 2, 300041 Timisoara, Romania;
- Center for Research and Innovation in Personalized Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Mihaela Bataneant
- Discipline of Pediatrics, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Oncology and Hematology, Clinical Emergency Hospital for Children “Louis Turcanu”, 300041 Timisoara, Romania
| | - Maria Puiu
- Discipline of Genetics and Center of Genomic Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (M.P.); (A.C.-E.)
- Regional Center of Medical Genetics Timis, Clinical Emergency Hospital for Children “Louis Turcanu”, 300041 Timisoara, Romania
| | - Adela Chirita-Emandi
- Discipline of Genetics and Center of Genomic Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (M.P.); (A.C.-E.)
- Regional Center of Medical Genetics Timis, Clinical Emergency Hospital for Children “Louis Turcanu”, 300041 Timisoara, Romania
| |
Collapse
|
3
|
Mihele DM, Nistor PA, Bruma G, Mitran CI, Mitran MI, Condrat CE, Tovaru M, Tampa M, Georgescu SR. Mast Cell Activation Syndrome Update-A Dermatological Perspective. J Pers Med 2023; 13:1116. [PMID: 37511729 PMCID: PMC10381535 DOI: 10.3390/jpm13071116] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/26/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
Mast cells (MCs) are infamous for their role in potentially fatal anaphylaxis reactions. In the last two decades, a more complex picture has emerged, as it has become obvious that MCs are much more than just IgE effectors of anaphylaxis. MCs are defenders against a host of infectious and toxic aggressions (their interactions with other components of the immune system are not yet fully understood) and after the insult has ended, MCs continue to play a role in inflammation regulation and tissue repair. Unfortunately, MC involvement in pathology is also significant. Apart from their role in allergies, MCs can proliferate clonally to produce systemic mastocytosis. They have also been implicated in excessive fibrosis, keloid scaring, graft rejection and chronic inflammation, especially at the level of the skin and gut. In recent years, the term MC activation syndrome (MCAS) was proposed to account for symptoms caused by MC activation, and clear diagnostic criteria have been defined. However, not all authors agree with these criteria, as some find them too restrictive, potentially leaving much of the MC-related pathology unaccounted for. Here, we review the current knowledge on the physiological and pathological roles of MCs, with a dermatological emphasis, and discuss the MCAS classification.
Collapse
Affiliation(s)
- Dana Mihaela Mihele
- Dermatology Department, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania
- Dermatology Department, Victor Babes Clinical Hospital of Infectious and Tropical Diseases, 030303 Bucharest, Romania
| | - Paul Andrei Nistor
- Internal Medicine Department, Emergency University Hospital Bucharest, 169 Independence Blvd, 050098 Bucharest, Romania
| | - Gabriela Bruma
- Dermatology Department, Victor Babes Clinical Hospital of Infectious and Tropical Diseases, 030303 Bucharest, Romania
| | - Cristina Iulia Mitran
- Microbiology Department, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania
| | - Madalina Irina Mitran
- Microbiology Department, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania
| | - Carmen Elena Condrat
- Fetal Medicine Excellence Research Center, Alessandrescu-Rusescu National Institute for Mother and Child Health, 020395 Bucharest, Romania
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania
| | - Mihaela Tovaru
- Dermatology Department, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania
- Dermatology Department, Victor Babes Clinical Hospital of Infectious and Tropical Diseases, 030303 Bucharest, Romania
| | - Mircea Tampa
- Dermatology Department, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania
- Dermatology Department, Victor Babes Clinical Hospital of Infectious and Tropical Diseases, 030303 Bucharest, Romania
| | - Simona Roxana Georgescu
- Dermatology Department, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania
- Dermatology Department, Victor Babes Clinical Hospital of Infectious and Tropical Diseases, 030303 Bucharest, Romania
| |
Collapse
|
4
|
FOKOLOROS C, XEPAPADAKI P, PAPADAVID E, KATOULIS A, PAPPA V, PAPAGEORGIOU S, PAPADOPOULOS NG, MAKRIS M. Mastocytosis in the Skin: Disease Heterogeneity among Children and Adults. Acta Derm Venereol 2023; 103:adv00845. [PMID: 36621914 PMCID: PMC9885279 DOI: 10.2340/actadv.v103.4461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/09/2022] [Indexed: 01/10/2023] Open
Abstract
Abstract is missing (Short communication)
Collapse
Affiliation(s)
- Christos FOKOLOROS
- Allergy Unit “D. Kalogeromitros”, 2 Department of Dermatology & Venereology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Rimini 1, GR-12462 Athens
| | - Paraskevi XEPAPADAKI
- Allergy Department, 2 Pediatric Clinic, National and Kapodistrian University of Athens
| | - Evangelia PAPADAVID
- 2 Department of Dermatology & Venereology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital
| | - Alexandros KATOULIS
- 2 Department of Dermatology & Venereology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital
| | - Vasilliki PAPPA
- Hematology Unit, 2 Department of Internal Medicine, Propaedeutic, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Sotirios PAPAGEORGIOU
- Hematology Unit, 2 Department of Internal Medicine, Propaedeutic, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | | | - Michael MAKRIS
- Allergy Unit “D. Kalogeromitros”, 2 Department of Dermatology & Venereology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Rimini 1, GR-12462 Athens
| |
Collapse
|
5
|
Matthews MR, Mullen HEK, Eubanks RA, Caruso DM, Kowal-Vern A, Foster KN. An Infant With a Hemorrhagic Rash and Cardiomyopathy. Clin Pediatr (Phila) 2022; 61:404-407. [PMID: 35238221 DOI: 10.1177/00099228221075915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Marc R Matthews
- The Arizona Burn Center, Phoenix, AZ, USA.,Valleywise Health Medical Center, Phoenix AZ, USA
| | | | | | - Daniel M Caruso
- The Arizona Burn Center, Phoenix, AZ, USA.,Valleywise Health Medical Center, Phoenix AZ, USA
| | - Areta Kowal-Vern
- The Arizona Burn Center, Phoenix, AZ, USA.,Valleywise Health Medical Center, Phoenix AZ, USA
| | - Kevin N Foster
- The Arizona Burn Center, Phoenix, AZ, USA.,Valleywise Health Medical Center, Phoenix AZ, USA
| |
Collapse
|
6
|
Yazal Erdem A, Özyörük D, Emir S, Çakmakçi S, Güleç Ceylan G, Toyran M, Civelek E, Dibek Misirlioğlu E. Clinical and Demographic Characteristics of Cutaneous Mastocytosis in Childhood: Single-center Experience. J Pediatr Hematol Oncol 2022; 44:e227-e232. [PMID: 34001789 DOI: 10.1097/mph.0000000000002196] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/05/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Mastocytosis is a rare and heterogenous disease, and in children it is generally limited to the skin and tends to regress spontaneously in adolescence. AIM In this study, demographic, clinical, and laboratory characteristics of pediatric patients with mastocytosis, and also coexisting diseases were investigated. RESULTS A total of 61 pediatric patients were included in the study. The male-to-female ratio was 2.2, the median age was 2 years (range, 0.25 to 19 y), and the median follow-up period was 2.0 years (range, 0.25 to 19 y). Types of clinical presentation at diagnosis consisted of mainly urticaria pigmentosa (45.9%). Seven patients were further investigated with suspicion of systemic mastocytosis, they were followed up, median of 9 years (range, 2.5 to 16 y), and none of them developed systemic disease. Coexisting allergic diseases were recorded in total 5 patients (8.2%). Three patients had immunoglobulin A deficiency, 1 patient had elevated immunoglobulin E level. A patient developed mature B-cell lymphoma with a heterozygous mutation in c-KIT exon 11. DISCUSSION Cutaneous mastocytosis in children may present as a complex disease with different clinical signs and symptoms. Standardized clinical criteria and guidelines for the follow-up of children with mastocytosis are required.
Collapse
Affiliation(s)
| | | | - Suna Emir
- Department of Pediatric Hematology and Oncology, Ankara Atilim University
| | | | | | - Müge Toyran
- Pediatric Allergy and Immunology, Ankara City Hospital, Children's Hospital
| | - Ersoy Civelek
- Pediatric Allergy and Immunology, Ankara City Hospital, Children's Hospital
| | | |
Collapse
|
7
|
Sathishkumar D, Balasundaram A, Mathew SM, Mathew L, Thomas M, Balasubramanian P, George R. Clinicopathological Profile of Childhood Onset Cutaneous Mastocytosis from a Tertiary Care Center in South India. Indian Dermatol Online J 2021; 12:706-713. [PMID: 34667757 PMCID: PMC8456265 DOI: 10.4103/idoj.idoj_924_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/31/2021] [Accepted: 08/19/2021] [Indexed: 11/04/2022] Open
Abstract
Background Mastocytosis is characterized by clonal proliferation of mast cells in various organs and can have isolated cutaneous or systemic involvement. Childhood-onset mastocytosis (COM) is usually cutaneous and regresses spontaneously, while adult-onset mastocytosis (AOM) is often persistent with systemic involvement. There is limited data on COM from India. Objective To elucidate the clinicopathological profile of COM. Methods We conducted a retrospective chart review of all the patients with histologically proven COM (≤16 years), presenting over 11 years (January 2009 to December 2019) to the Dermatology Department. We compiled the demographic data, clinical characteristics (morphology, extent, distribution), laboratory investigations, histopathology findings, imaging (ultrasound abdomen), c-KIT mutation results, where available, and other associated abnormalities, and grouped them according to the WHO classification for mastocytosis. Results Among the 66 patients with COM (M: F-1.6:1), 89.4% had onset before 2 years of age. The subtypes were: maculopapular cutaneous mastocytosis (MPCM: 44, 66.7%); mastocytoma of the skin (MOS: 19, 28.8%); diffuse cutaneous mastocytosis (DCM: 2, 3%) and indolent systemic mastocytosis (ISM: 1, 1.5%). Blistering was observed in 29 (43.9%) and Darier sign was elicited in 47 (71.2%) patients. Serum tryptase was elevated in 9/21 (42.9%) patients, but none had systemic mastocytosis. Three patients had c-KIT mutations (two in exon 8 and one in exon 17). Most patients were managed symptomatically and the patient with ISM improved with imatinib. Conclusion MPCM is the most common variant of COM and most patients had a disease onset before 2 years. Overall, COM had a good prognosis with rare systemic involvement, mitigating the need for extensive evaluation routinely in children.
Collapse
Affiliation(s)
- Dharshini Sathishkumar
- Department of Dermatology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Abyramy Balasundaram
- Department of Dermatology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Surya Mary Mathew
- Department of Dermatology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Lydia Mathew
- Department of Dermatology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Meera Thomas
- Department of Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | | | - Renu George
- Department of Dermatology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| |
Collapse
|
8
|
Lange M, Hartmann K, Carter MC, Siebenhaar F, Alvarez-Twose I, Torrado I, Brockow K, Renke J, Irga-Jaworska N, Plata-Nazar K, Ługowska-Umer H, Czarny J, Belloni Fortina A, Caroppo F, Nowicki RJ, Nedoszytko B, Niedoszytko M, Valent P. Molecular Background, Clinical Features and Management of Pediatric Mastocytosis: Status 2021. Int J Mol Sci 2021; 22:2586. [PMID: 33806685 PMCID: PMC7961542 DOI: 10.3390/ijms22052586] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/24/2021] [Accepted: 02/27/2021] [Indexed: 12/12/2022] Open
Abstract
Pediatric mastocytosis is a heterogeneous disease characterized by accumulation of mast cells in the skin and less frequently in other organs. Somatic or germline mutations in the KIT proto-oncogene are detected in most patients. Cutaneous mastocytosis is the most common form of the disease in children. In the majority of cases, skin lesions regress spontaneously around puberty. However, in few patients, mastocytosis is not a self-limiting disease, but persists into adulthood and can show signs of systemic involvement, especially when skin lesions are small-sized and monomorphic. Children with mastocytosis often suffer from mast cell mediator-related symptoms. Severe hypersensitivity reactions can also occur, mostly in patients with extensive skin lesions and blistering. In a substantial number of these cases, the triggering factor of anaphylaxis remains unidentified. Management of pediatric mastocytosis is mainly based on strict avoidance of triggers, treatment with H1 and H2 histamine receptor blockers, and equipment of patients and their families with epinephrine auto-injectors for use in severe anaphylactic reactions. Advanced systemic mastocytosis occurs occasionally. All children with mastocytosis require follow-up examinations. A bone marrow investigation is performed when advanced systemic mastocytosis is suspected and has an impact on therapy or when cutaneous disease persists into adulthood.
Collapse
Affiliation(s)
- Magdalena Lange
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (H.Ł.-U.); (J.C.); (R.J.N.); (B.N.)
| | - Karin Hartmann
- Division of Allergy, Department of Dermatology, University Hospital Basel and University of Basel, 4031 Basel, Switzerland;
- Department of Biomedicine, University Hospital Basel and University of Basel, 4031 Basel, Switzerland
| | - Melody C. Carter
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA;
| | - Frank Siebenhaar
- Dermatological Allergology, Department of Dermatology and Allergy, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10117 Berlin, Germany;
| | - Ivan Alvarez-Twose
- Instituto de Estudios de Mastocitosis de Castilla-La Mancha (CLMast)—Spanish Reference Center for Mastocytosis, Hospital Virgen del Valle—Complejo Hospitalario de Toledo, 45071 Toledo, Spain; (I.A.-T.); (I.T.)
| | - Inés Torrado
- Instituto de Estudios de Mastocitosis de Castilla-La Mancha (CLMast)—Spanish Reference Center for Mastocytosis, Hospital Virgen del Valle—Complejo Hospitalario de Toledo, 45071 Toledo, Spain; (I.A.-T.); (I.T.)
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, 80802 Munich, Germany;
| | - Joanna Renke
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (J.R.); (N.I.-J.)
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (J.R.); (N.I.-J.)
| | - Katarzyna Plata-Nazar
- Department of Pediatrics, Pediatric Gastroenterology, Allergology and Nutrition, Medical University of Gdańsk, 80-211 Gdańsk, Poland;
| | - Hanna Ługowska-Umer
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (H.Ł.-U.); (J.C.); (R.J.N.); (B.N.)
| | - Justyna Czarny
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (H.Ł.-U.); (J.C.); (R.J.N.); (B.N.)
| | - Anna Belloni Fortina
- Pediatric Dermatology Unit, Department of Medicine DIMED, University of Padua, 35128 Padua, Italy; (A.B.F.); (F.C.)
| | - Francesca Caroppo
- Pediatric Dermatology Unit, Department of Medicine DIMED, University of Padua, 35128 Padua, Italy; (A.B.F.); (F.C.)
| | - Roman J. Nowicki
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (H.Ł.-U.); (J.C.); (R.J.N.); (B.N.)
| | - Bogusław Nedoszytko
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (H.Ł.-U.); (J.C.); (R.J.N.); (B.N.)
| | - Marek Niedoszytko
- Department of Allergology, Medical University of Gdańsk, 80-211 Gdańsk, Poland;
| | - Peter Valent
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, 1090 Vienna, Austria;
- Ludwig Boltzmann Institute for Hematology and Hemostaseology, Medical University of Vienna, 1090 Vienna, Austria
| |
Collapse
|
9
|
Abstract
Mastocytosis is a heterogeneous group of disorders characterized by the accumulation of clonal mast cells in organs such as the skin and bone marrow. In contrast to adults, most affected children have only cutaneous involvement. This article reviews the molecular pathogenesis, skin findings, mast cell mediator-related symptoms, evaluation, and management of childhood-onset mastocytosis, noting differences from adult-onset disease. Current classification of cutaneous mastocytosis and the natural histories of different variants in pediatric patients are highlighted, with a focus on clinical manifestations with prognostic implications. A practical algorithm is provided to guide clinical assessment, laboratory and other investigations, and longitudinal monitoring, including recognition of hepatosplenomegaly as a marker of systemic disease and utilization of allele-specific quantitative PCR (ASqPCR) to detect KIT mutations in the peripheral blood. Updated information and consensus-based recommendations regarding possible triggers of mast-cell degranulation (e.g., physical, medications) are discussed, with an emphasis on patient-specific factors and avoiding excessive parental concern. Lastly, an individualized, stepwise approach to treatment of symptoms, skin-directed therapy, and potential use of kinase inhibitors for severe systemic disease is outlined.
Collapse
|
10
|
Gurnee EA, Johansen ML, Phung TL, Guo EL, Fong A, Tollefson M, Nguyen H, Brandling-Bennett H, Moriarty N, Paller AS, Huynh TN, Lawley LP. Pediatric maculopapular cutaneous mastocytosis: Retrospective review of signs, symptoms, and associated conditions. Pediatr Dermatol 2021; 38:159-163. [PMID: 33068315 DOI: 10.1111/pde.14399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/08/2020] [Accepted: 09/14/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Though maculopapular cutaneous mastocytosis is the most common form of pediatric mastocytosis, it remains unclear which patients will experience severe symptoms. We sought to better define the presentation and the cutaneous and systemic signs and symptoms in patients with maculopapular cutaneous mastocytosis. METHODS We analyzed retrospective data on 227 patients diagnosed with maculopapular cutaneous mastocytosis prior to age 15 years from five US clinical sites. We collected data on signs, symptoms, age of onset, and laboratory testing. RESULTS Median age of onset of maculopapular cutaneous mastocytosis was 3 months, with 94% of patients presenting prior to age 2 (range 0-15 years). Patients presenting before age 2 had significantly lower serum tryptase level (P = .019). Greater number of skin lesions (P = .006), number of reported skin signs and symptoms (P < .001), and higher tryptase levels (P < .001) were associated with more systemic symptoms. CONCLUSION Children with maculopapular cutaneous mastocytosis, who have greater skin involvement, higher serum tryptase level, and more skin signs and symptoms, are more likely to have systemic symptoms.
Collapse
Affiliation(s)
- Emily A Gurnee
- Department of Dermatology, Emory University, Atlanta, GA, USA
| | | | - Thuy L Phung
- Department of Pathology and Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Emily L Guo
- Department of Pathology and Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Aaron Fong
- Department of Pathology and Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | | | - Henry Nguyen
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | | | - Natalie Moriarty
- Department of Dermatology, Seattle Children's Hospital, Seattle, WA, USA
| | - Amy S Paller
- Department of Dermatology, Northwestern University, Evanston, IL, USA
| | - Thy N Huynh
- Department of Dermatology, Northwestern University, Evanston, IL, USA
| | - Leslie P Lawley
- Department of Dermatology, Emory University, Atlanta, GA, USA
| |
Collapse
|
11
|
Criteria for the Regression of Pediatric Mastocytosis: A Long-Term Follow-Up. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1695-1704.e5. [PMID: 33338682 DOI: 10.1016/j.jaip.2020.12.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Mastocytosis is a neoplastic condition characterized by the accumulation of mast cells (MCs) in 1 or more organ. Adults tend to have persistent, systemic mastocytosis, whereas MC infiltration in children is usually limited to the skin and typically regresses after several years. Both adults and children could display mast cell activation symptoms (MCASs) due to MC mediator release. In more than 85% of both adult and pediatric cases, KIT mutations are present, with the KIT D816V mutation being present in most affected adults but in only half the affected children. OBJECTIVE To identify the clinical, biological, and molecular factors associated with the regression of cutaneous mastocytosis (CM) in children, and to assess the correlation between MCASs and CM regression. METHODS Patients having suffered from pediatric-onset mastocytosis for at least 8 years were included in a longitudinal cohort study. Clinical data, the baseline serum tryptase level, the KIT sequence, and the progression of MCASs and CM were recorded. RESULTS CM regressed in 210 of the 272 included patients (77.2%; mean time to regression, 6.10 years). The rare cases of aggressive systemic mastocytosis were symptomatic from the outset. Congenital mastocytosis and the KIT D816V mutation were associated with CM regression (odds ratio, 0.48, P = .031, and 0.173, P = .031, respectively). Aggravation of MCASs over time was correlated with the persistence of skin lesions. However, the MCASs became more intense in 19% of the patients with MCASs at baseline and CM regression, justifying long-term follow-up in this setting. CONCLUSIONS Our results open up new hypotheses with regard to the spontaneous regression of CM in pediatric patients.
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Turnbull L, Calhoun DA, Agarwal V, Drehner D, Chua C. Congenital Mastocytosis: Case Report and Review of the Literature. Cureus 2020; 12:e10565. [PMID: 33101811 PMCID: PMC7577309 DOI: 10.7759/cureus.10565] [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] [Indexed: 11/23/2022] Open
Abstract
Mastocytosis is a rare infiltrative disorder characterized by mast cell proliferation within the skin and various extra-cutaneous organ systems. We report the case of a full-term neonate admitted to the neonatal intensive care unit for evaluation of diffuse skin lesions on her face, trunk and extremities. Initially, the lesions appeared to be consistent with a blueberry muffin rash. However, over a period of days the lesions became vesicular and changed in shape and number. The neonate underwent evaluation for infective etiologies, skin biopsy of the lesions, and flow cytometry analysis of the peripheral blood. The surgical pathology examination of the skin biopsy demonstrated mast cells consistent with a diagnosis of cutaneous mastocytosis. A review of relevant literature is also provided.
Collapse
Affiliation(s)
- Lacie Turnbull
- Orthopaedics and Rehabilitation, University of Florida, Gainesville, USA
| | | | | | | | - Caroline Chua
- Pediatrics, Nemours Children's Hospital, Orlando, USA
| |
Collapse
|
14
|
Rigas K, Biasoli D, Polton G, Finotello R, Murphy S, Di Palma S, Starkey M, Verganti S. Mast cell tumours in dogs less than 12 months of age: a multi-institutional retrospective study. J Small Anim Pract 2020; 61:449-457. [PMID: 32715502 DOI: 10.1111/jsap.13181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 03/24/2020] [Accepted: 04/20/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe the clinicopathological and genetic characteristics of mast cell tumours in dogs less than 12 months old. MATERIALS AND METHODS Retrospective review of dogs aged less than 12 months when diagnosed with mast cell tumours at three referral hospitals in the UK. RESULTS Sixteen pure-bred dogs were included, of which 11 were female. The median age at first presentation and diagnosis were 7.6 and 9 months, respectively. In 13 dogs the mast cell tumours were cutaneous and in three they were subcutaneous. Four cutaneous mast cell tumours were described as high-grade (Patnaik or Kiupel) and nine were Patnaik grade II; three had mitotic index of >5 in 10 high-power fields. Of the three subcutaneous tumours, two had an infiltrative growth pattern and one had mitotic index of 10 per 10 high-power fields. Of 10 tested dogs, seven had c-kit mutations in exon 11 and Ki-67 score was above the cut-off value in nine. Four of 12 cases showed evidence of metastasis in the regional lymph nodes. After varying treatment protocols, all patients were alive and disease free at a median of 1115 days after diagnosis. CLINICAL SIGNIFICANCE The prognosis of mast cell tumours in dogs less than a year old appears better than the adult counterparts, even without extensive treatment.
Collapse
Affiliation(s)
- K Rigas
- Oncology service, Small Animal Teaching Hospital, School of Veterinary Science, University of Liverpool, Leahurst Campus, Chester High Road , UK
| | - D Biasoli
- Molecular Oncology Group, Animal Health Trust, Lanwades Park, Kentford, Newmarket, CB8 7UU, UK
| | - G Polton
- Oncology department, North Downs Specialist Referrals, 3 & 4 The Brewerstreet Dairy Business Park, Brewer St, Bletchingley, RH1 4QP, UK
| | - R Finotello
- Oncology service, Small Animal Teaching Hospital, School of Veterinary Science, University of Liverpool, Leahurst Campus Chester High Road, Neston, Wirral, CH64 7TE, UK
| | - S Murphy
- Centre for Small Animal Studies, Animal Health Trust, Lanwades Park, Kentford, Newmarket, CB8 7UU, UK
| | - S Di Palma
- Molecular Oncology Group, Animal Health Trust, Lanwades Park, Kentford, Newmarket, CB8 7UU, UK.,Aptuit Srl, Italy
| | - M Starkey
- Molecular Oncology Group, Animal Health Trust, Lanwades Park, Kentford, Newmarket, CB8 7UU, UK
| | - S Verganti
- Centre for Small Animal Studies, Animal Health Trust, Lanwades Park, Kentford, Newmarket, CB8 7UU, UK
| |
Collapse
|
15
|
Srinivas SM, Agarwal R, Babu N, Naik M, Kumar R, Dhar S. Systemic mastocytosis associated with Hodgkin's lymphoma in a 4-year-old child. Pediatr Dermatol 2020; 37:713-715. [PMID: 32319109 DOI: 10.1111/pde.14183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/27/2020] [Accepted: 04/05/2020] [Indexed: 11/28/2022]
Abstract
Systemic mastocytosis with associated clonal hematologic non-mast cell lineage disease (SM-AHN) represents a specific subtype of mastocytosis and is extremely rare in children. We describe a 4-year-old child with systemic mastocytosis associated with Hodgkin's lymphoma. The child had cutaneous mastocytosis and lymphadenopathy without other clinical features of SM, which was diagnosed only by bone marrow examination.
Collapse
Affiliation(s)
- Sahana M Srinivas
- Department of Pediatric Dermatology, Indira Gandhi Institute of Child Health, Bengaluru, India
| | | | - Narendra Babu
- Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, Bengaluru, India
| | - Madhavi Naik
- Department of Pathology, St Theresa's Hospital, Bengaluru, India
| | - Rekha Kumar
- Department of Pathology, Kidwai Memorial Institute of Oncology, Bengaluru, India
| | - Sandipan Dhar
- Department of Pediatric Dermatology, Institute of Child Health, Kolkata, India
| |
Collapse
|
16
|
Ngo J, Morren MA, Bodemer C, Heimann M, Fontaine J. Feline maculopapular cutaneous mastocytosis: a retrospective study of 13 cases and proposal for a new classification. J Feline Med Surg 2019; 21:394-404. [PMID: 29860905 PMCID: PMC10814638 DOI: 10.1177/1098612x18776141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
CASE SERIES SUMMARY Cutaneous mastocytosis is a disorder rarely reported in veterinary dermatology and usually described as 'urticaria pigmentosa'. This study aimed to evaluate the diagnosis, treatment and outcome of 13 affected cats, selected from the files of a private referral dermatology practice within a period of 14 years. Breeds of the affected individuals included Sphynx (n = 9), Devon Rex (n = 2) and Sphynx/Devon Rex crossbreeds (n = 2). Females (n = 9) were over-represented and the median duration of clinical signs prior to diagnosis was 8 months. The clinical presentation of these 13 cats was compared with cases reported in the veterinary literature and classified according to the current human consensus on cutaneous mastocytosis. Three clinical forms could be distinguished in cats: (1) large papular lesions and wheals, typically localised to the head, shoulders, ventral neck and axillae, and which may spontaneously resolve (termed polymorphic maculopapular cutaneous mastocytosis); (2) erythematous dermatitis, characterised by small maculopapular lesions often associated with crusts and with a poorer prognosis (termed monomorphic maculopapular cutaneous mastocytosis); and (3) more chronic dermatitis characterised by lichenification and hyperpigmentation, similar to the human condition 'urticaria pigmentosa' (termed pigmented maculopapular cutaneous mastocytosis). Histopathology was performed in eight cases and revealed a superficial-to-deep dermatitis characterised by infiltrates of mast cells and eosinophils. The response to various treatments, including antihistamines, steroids and ciclosporin, was variable. RELEVANCE AND NOVEL INFORMATION This article reports 13 new cases of feline cutaneous mastocytosis, confirming the clinical presentation and apparent breed predisposition. The feline maculopapular cutaneous mastocytosis seems to be clinically very close to the human form. This study proposes a new classification system for the feline disease based on the current human consensus, clinical presentation and prognosis, with three different subforms: polymorphic maculopapular cutaneous mastocytosis with eventual spontaneous regression; monomorphic maculopapular cutaneous mastocytosis with chronic evolution; and pigmented maculopapular cutaneous mastocytosis.
Collapse
|
17
|
Hosking AM, Makdisi J, Ortenzio F, de Feraudy S, Smith J, Linden K. Diffuse cutaneous mastocytosis: Case report and literature review. Pediatr Dermatol 2018; 35:e348-e352. [PMID: 30187958 DOI: 10.1111/pde.13651] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A 6-month-old boy was referred to our burn unit with a recurrent bullous dermatitis, fever, and emesis, originally diagnosed as staphylococcal scalded skin syndrome (SSSS) at an outside hospital. Infectious workup was negative and shave biopsy revealed a dense, diffuse dermal infiltrate of mast cells, consistent with diffuse cutaneous bullous mastocytosis-a rare variant of cutaneous mastocytosis. Treatment included a prolonged course of corticosteroids and antihistamines. Recognition of this rare form of mastocytosis is important, as it can be easily mistaken for other pediatric bullous diseases and is associated with life-threatening complications including vasodilation, anaphylactic shock, gastrointestinal bleeding, and death.
Collapse
Affiliation(s)
- Anna-Marie Hosking
- Department of Dermatology, University of California Irvine, Irvine, California
| | - Joy Makdisi
- Department of Dermatology, University of California Irvine, Irvine, California
| | - Francesca Ortenzio
- Department of Dermatology, University of California Irvine, Irvine, California
| | | | - Janellen Smith
- Department of Dermatology, University of California Irvine, Irvine, California
| | - Kenneth Linden
- Department of Dermatology, University of California Irvine, Irvine, California
| |
Collapse
|
18
|
Otani IM, Carroll RW, Yager P, Kroshinsky D, Murphy S, Hornick JL, Akin C, Castells M, Walter JE. Diffuse cutaneous mastocytosis with novel somatic KIT mutation K509I and association with tuberous sclerosis. Clin Case Rep 2018; 6:1834-1840. [PMID: 30214774 PMCID: PMC6132108 DOI: 10.1002/ccr3.1607] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/22/2018] [Accepted: 04/30/2018] [Indexed: 01/11/2023] Open
Abstract
Diffuse cutaneous mastocytosis (DCM) is a rare but potentially fatal condition when diagnosis and targeted treatments are delayed. This case illustrates the life-threatening complications in DCM and reviews the currently available treatments. To our knowledge, this is the first report of mastocytosis with somatic K509I mutation and concomitant tuberous sclerosis.
Collapse
Affiliation(s)
- Iris M. Otani
- Division of Pulmonary, Critical Care, Allergy, and Sleep MedicineUCSF Medical CenterSan FranciscoCAUSA
| | - Ryan W. Carroll
- Division of Pediatric Critical Care MedicineDepartment of PediatricsMassGeneral Hospital for ChildrenBostonMAUSA
| | - Phoebe Yager
- Division of Pediatric Critical Care MedicineDepartment of PediatricsMassGeneral Hospital for ChildrenBostonMAUSA
| | - Daniela Kroshinsky
- Department of DermatologyMassachusetts General HospitalMassGeneral Hospital for ChildrenBostonMAUSA
| | - Sarah Murphy
- Division of Pediatric Critical Care MedicineDepartment of PediatricsMassGeneral Hospital for ChildrenBostonMAUSA
| | | | - Cem Akin
- Mastocytosis CenterBrigham and Women's HospitalBostonMAUSA
- Division of Rheumatology, Immunology and AllergyBrigham and Women's HospitalBostonMAUSA
| | - Mariana Castells
- Mastocytosis CenterBrigham and Women's HospitalBostonMAUSA
- Division of Rheumatology, Immunology and AllergyBrigham and Women's HospitalBostonMAUSA
| | - Jolan E. Walter
- Pediatric Allergy & ImmunologyMassachusetts General HospitalBostonMAUSA
- Center for Immunology and Inflammatory DiseasesMassachusetts General HospitalBostonMAUSA
| |
Collapse
|
19
|
Matito A, Azaña JM, Torrelo A, Alvarez-Twose I. Cutaneous Mastocytosis in Adults and Children: New Classification and Prognostic Factors. Immunol Allergy Clin North Am 2018; 38:351-363. [PMID: 30007456 DOI: 10.1016/j.iac.2018.04.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The skin is one of the most frequent tissues affected in patients with mastocytosis, but cutaneous lesions are highly heterogeneous in shape, size, color, number, localization, and distribution. The World Health Organization recognizes 3 subtypes of cutaneous mastocytosis (CM): maculopapular CM (MPCM), diffuse CM, and mastocytoma of skin. An international task force of experts in mastocytosis has recently proposed subdividing MPCM into monomorphic and polymorphic, which could predict the duration of the disease in children. More research is warranted to develop an improved classification of CM that ideally should incorporate robust factors with prognostic impact on disease behavior.
Collapse
Affiliation(s)
- Almudena Matito
- Instituto de Estudios de Mastocitosis de Castilla La Mancha (CLMast), Hospital Virgen del Valle, Ctra. Cobisa s/n, Toledo 45071, Spain
| | - José Manuel Azaña
- Department of Dermatology, Complejo Hospitalario Universitario de Albacete, Hospital General Universitario de Albacete, C/Hermanos Falcó nº 37, Albacete 02006, Spain
| | - Antonio Torrelo
- Department of Dermatology, Hospital Infantil Universitario del Niño Jesús, Av/Menéndez Pelayo, nº 65, Madrid 28009, Spain
| | - Iván Alvarez-Twose
- Instituto de Estudios de Mastocitosis de Castilla La Mancha (CLMast), Hospital Virgen del Valle, Ctra. Cobisa s/n, Toledo 45071, Spain.
| |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
McKinnon EL, Rand AJ, Proia AD. Solitary mastocytoma in the eyelid of an adult. Am J Ophthalmol Case Rep 2018; 9:103-105. [PMID: 29468227 PMCID: PMC5787878 DOI: 10.1016/j.ajoc.2018.01.009] [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] [Received: 08/29/2017] [Accepted: 01/02/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose To describe the ophthalmic symptoms and histopathological findings in a rare case of an eyelid mastocytoma in an adult. Observations A man in his early 60s developed a painless, non-tender, non-pruritic, mobile nodule on the right lower eyelid beneath the inferior orbital rim. The lesion grew to 15 × 9 mm over eleven months. Biopsy revealed a diffuse infiltrate of histiocytoid and spindle-shaped mast cells forming cords and small nests between collagen fibers in the superficial and deep dermis. Mast cell lineage was confirmed by immunohistochemistry. Physical examination revealed no other cutaneous lesions and no evidence of systemic disease. Serum tryptase level was normal. Annual full-body examination by a dermatologist for 4.5 years has revealed neither recurrence in the eyelid nor cutaneous involvement at other sites. Conclusions and importance Mast cell tumors limited to the human eyelid are extremely uncommon with only four previously reported cases, including one in an adult. This case highlights the rare possibility of a solitary mastocytoma presenting in the eyelid of an adult.
Collapse
Affiliation(s)
| | | | - Alan D. Proia
- Corresponding author. Duke University Medical Center, Department of Pathology, DUMC 3712, Durham, NC, 27710, USA.Duke University Medical CenterDepartment of PathologyDUMC 3712DurhamNC27710USA
| |
Collapse
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
Huang L, Wang SA, Konoplev S, Bueso-Ramos CE, Thakral B, Miranda RN, Jabbour E, Medeiros LJ, Kanagal-Shamanna R. Well-differentiated systemic mastocytosis showed excellent clinical response to imatinib in the absence of known molecular genetic abnormalities: A case report. Medicine (Baltimore) 2016; 95:e4934. [PMID: 27741105 PMCID: PMC5072932 DOI: 10.1097/md.0000000000004934] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Well-differentiated systemic mastocytosis (WDSM) is a rare, recently recognized provisional subvariant of systemic mastocytosis (SM). We report a case of WDSM that showed excellent clinical and cutaneous response to imatinib in the absence of known molecular genetic abnormalities. CLINICAL FINDINGS/DIAGNOSES We present a 24-year-old woman with childhood onset of skin manifestations that progressed to mediator-related systemic events, and a gastrointestinal tract mastocytoma. A subsequent bone marrow examination showed WDSM. Treatment with imatinib resulted in complete resolution of cutaneous lesions and systemic symptoms, which relapsed with the discontinuation of the drug. Targeted next-generation sequencing-based mutation analysis did not demonstrate any mutations in the coding regions of KIT or other genes commonly associated with myeloid neoplasms. CONCLUSIONS The diagnosis of WDSM is challenging in the absence of spindle-shaped mast cells, CD2 or CD25 expression, and KIT D816 mutation. This case illustrated the need for recognizing this unique variant of SM for diagnostic and therapeutic implications.
Collapse
Affiliation(s)
- Lanshan Huang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Sa A. Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sergej Konoplev
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carlos E. Bueso-Ramos
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Beenu Thakral
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Roberto N. Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - L. Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rashmi Kanagal-Shamanna
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Correspondence: Rashmi Kanagal-Shamanna, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 0072, Houston, TX 77030 (e-mail: )
| |
Collapse
|
24
|
Arik Yilmaz E, Orhan D, Andiran F, Soyer O. Rare cause of recurrent urticaria in childhood and its unusual presentation: Solitary mastocytoma on vulva. J Dermatol 2016; 44:213-214. [PMID: 27206703 DOI: 10.1111/1346-8138.13454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ebru Arik Yilmaz
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey
| | - Diclehan Orhan
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Fatih Andiran
- Department of Pediatric Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ozge Soyer
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey
| |
Collapse
|
25
|
Nair B, Sonthalia S, Aggarwal I. Solitary mastocytoma with positive Darier's sign. Indian Dermatol Online J 2016; 7:141-2. [PMID: 27057508 PMCID: PMC4804594 DOI: 10.4103/2229-5178.178091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Brijesh Nair
- Department of Dermatology, INHS Sanjivani Hospital, Kochi, Kerala, India
| | - Sidharth Sonthalia
- Department of Dermatology, Skinnocence: The Skin Clinic, Gurgaon, Haryana, India
| | - Ishad Aggarwal
- Department of Dermatology, IPGMER, Kolkata, West Bengal, India
| |
Collapse
|
26
|
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]
|
27
|
Slavescu KC, Chiorean R, Danescu S, Bota M, Rogojan L, Baican A. Diffuse cutaneous bullous mastocytosis with IgM deposits at dermo-epidermal junction. J Cutan Pathol 2015; 43:263-9. [DOI: 10.1111/cup.12635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 08/25/2015] [Accepted: 09/29/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Kinga Cristina Slavescu
- Department of Pediatrics II; Iuliu Hatieganu University of Medicine and Pharmacy; Cluj-Napoca Romania
| | - Roxana Chiorean
- Department of Dermatology; Iuliu Hatieganu University of Medicine and Pharmacy; Cluj-Napoca Romania
| | - Sorina Danescu
- Department of Dermatology; Iuliu Hatieganu University of Medicine and Pharmacy; Cluj-Napoca Romania
| | - Madalina Bota
- Department of Pediatrics II; Iuliu Hatieganu University of Medicine and Pharmacy; Cluj-Napoca Romania
| | - Liliana Rogojan
- Department of Pathology; Emergency Clinical Hospital; Cluj-Napoca Romania
| | - Adrian Baican
- Department of Dermatology; Iuliu Hatieganu University of Medicine and Pharmacy; Cluj-Napoca Romania
| |
Collapse
|
28
|
Clinical and histopathological analysis of 152 pigmented skin lesion excisions apart from melanocytic nevus due to cosmetic reasons. EUROPEAN JOURNAL OF PLASTIC SURGERY 2015. [DOI: 10.1007/s00238-015-1093-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
29
|
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.
Collapse
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
| |
Collapse
|
30
|
Deveza E, Locatelli F, Girardin M, Valmary-Degano S, Daguindau E, Aubin F, Humbert P, Pelletier F. [Vulvar oedema revealing systemic mastocytosis]. Ann Dermatol Venereol 2015; 142:685-9. [PMID: 26003033 DOI: 10.1016/j.annder.2015.04.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 02/25/2015] [Accepted: 04/09/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Systemic mastocytosis is characterised by abnormal proliferation of mast cells in various organs. We report an original case of systemic mastocytosis revealed by vulvar oedema. PATIENTS AND METHODS A 24-year-old patient was examined in the dermatology department for vulvar oedema appearing during sexual intercourse. She presented vasomotor dysfunction of the lower limbs, urticaria on the trunk on exertion, diarrhoea and bone pains. Laboratory tests showed serum tryptase of 29.7μg and plasma histamine at twice the normal value. Myelogram results showed infiltration by dysmorphic mast cells. Screening for c-kit D816V mutation was positive. Duodenal biopsies revealed mast-cell clusters with aggregation involving over 15 mast cells. CD2 staining was inconclusive and CD25 staining could not be done. Trabecular osteopenia was found, and we thus made a diagnosis of indolent systemic mastocytosis (ISM variant Ia) as per the WHO 2008 criteria. Symptomatic treatment was initiated (antiH1, H2, antileukotrienes) and clinical and laboratory follow-up was instituted. DISCUSSION The cutaneous signs leading to diagnosis in this patient of systemic mastocytosis involving several organs were seemingly minimal signs associated with mastocyte degranulation. This is the third recorded case of mastocytosis revealed by vulvar oedema and the first case revealing systemic involvement. The two previously reported cases of vulvar oedema revealed cutaneous mastocytosis alone. Mastocytosis, whether systemic or cutaneous, must be included among the differential diagnoses considered in the presence of vulvar oedema.
Collapse
Affiliation(s)
- E Deveza
- Unité d'allergologie, service de dermatologie, centre de compétences des mastocytoses, CHRU de Besançon, 3, boulevard Fleming, 25030 Besançon cedex, France.
| | - F Locatelli
- Unité d'allergologie, service de dermatologie, centre de compétences des mastocytoses, CHRU de Besançon, 3, boulevard Fleming, 25030 Besançon cedex, France
| | - M Girardin
- Unité d'allergologie, service de dermatologie, centre de compétences des mastocytoses, CHRU de Besançon, 3, boulevard Fleming, 25030 Besançon cedex, France
| | - S Valmary-Degano
- Service d'anatomopathologie, CHRU de Besançon, 25030 Besançon cedex, France
| | - E Daguindau
- Service d'hématologie, CHRU de Besançon, 25030 Besançon cedex, France
| | - F Aubin
- Unité d'allergologie, service de dermatologie, centre de compétences des mastocytoses, CHRU de Besançon, 3, boulevard Fleming, 25030 Besançon cedex, France; EA3181, SFR FED 4234 IBCT, université de Franche-Comté, 25030 Besançon cedex, France
| | - P Humbert
- Unité d'allergologie, service de dermatologie, centre de compétences des mastocytoses, CHRU de Besançon, 3, boulevard Fleming, 25030 Besançon cedex, France; Inserm U1098, SFR FED 4234 IBCT, université de Franche-Comté, 25030 Besançon cedex, France
| | - F Pelletier
- Unité d'allergologie, service de dermatologie, centre de compétences des mastocytoses, CHRU de Besançon, 3, boulevard Fleming, 25030 Besançon cedex, France; Inserm U1098, SFR FED 4234 IBCT, université de Franche-Comté, 25030 Besançon cedex, France
| |
Collapse
|
31
|
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
| |
Collapse
|
32
|
Gopal D, Puri P, Singh A, Ramesh V. Asymptomatic solitary cutaneous mastocytoma: a rare presentation. Indian J Dermatol 2014; 59:634. [PMID: 25484432 PMCID: PMC4248540 DOI: 10.4103/0019-5154.143588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
A 50-day-old female child presented with asymptomatic skin colored raised lesion on the dorsal aspect of the left wrist since the age of 10 days. The diagnosis of cutaneous mastocytoma was made based upon clinical and histopathological features.
Collapse
Affiliation(s)
- Dhruv Gopal
- Department of Skin and STD, Safdurjung Hospital and Vardhman Mahavir Medical College, New Delhi, India
| | - Poonam Puri
- Department of Skin and STD, Safdurjung Hospital and Vardhman Mahavir Medical College, New Delhi, India
| | - Avninder Singh
- National Institute of Pathology, Safdurjung Hospital, New Delhi, India
| | - V Ramesh
- Department of Skin and STD, Safdurjung Hospital and Vardhman Mahavir Medical College, New Delhi, India
| |
Collapse
|
33
|
Kölblinger P, Lang R, Hintner H, Laimer M. Bullous skin changes in a 5-month-old infant. J Dtsch Dermatol Ges 2014; 12:632-6. [DOI: 10.1111/ddg.12318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Peter Kölblinger
- Universitätsklinik für Dermatologie; Paracelsus Medizinische Privatuniversität; Salzburg Austria
| | - Roland Lang
- Universitätsklinik für Dermatologie; Paracelsus Medizinische Privatuniversität; Salzburg Austria
| | - Helmut Hintner
- Universitätsklinik für Dermatologie; Paracelsus Medizinische Privatuniversität; Salzburg Austria
| | - Martin Laimer
- Universitätsklinik für Dermatologie; Paracelsus Medizinische Privatuniversität; Salzburg Austria
| |
Collapse
|
34
|
Solitary mastocytoma of the vulva. Case Rep Pathol 2014; 2014:412656. [PMID: 24800094 PMCID: PMC3985194 DOI: 10.1155/2014/412656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 02/19/2014] [Indexed: 11/17/2022] Open
Abstract
Solitary mastocytoma of the skin is a rare tumor. Its occurrence in the vulva is extremely rare with only few case reports in the literature. We report a solitary mastocytoma of the vulva in a 10-year-old girl. Her systemic examination was unremarkable. The clinical and histopathological features were consistent with the diagnosis of solitary mastocytoma of the vulva. The follow-up after surgical excision was uneventful. The purpose of this communication is (i) to report a case of solitary mastocytoma occurring in an unusual site, the vulva and to show that (ii) in this case age at presentation is 10 years with infancy as common age of presentation of solitary mastocytoma, and to show that (iii) in appropriate setting this should be included in the differential diagnosis of vulval swelling.
Collapse
|
35
|
|
36
|
Abstract
Mastocytosis arises from clonal mast cell expansion and the resultant accumulation of mast cells in cutaneous and sometimes extracutaneous tissues. Recent studies have demonstrated that c-kit mutations seem to be more prevalent in pediatric mastocytosis than previously assumed, but what determines disease evolution and severity in the individual patient remains elusive. For the large majority of children, mastocytosis is a self-limited cutaneous disease that spontaneously regresses before they reach adult age. Rarely, children develop systemic disease progression that is the hallmark of adult-onset disease. Therefore, invasive diagnostic testing, including performing a bone marrow biopsy, is not routinely recommended and usually reserved for children that present with signs of systemic involvement and persistently elevated serum tryptase levels. Despite its often-transient nature and limited skin involvement, some children experience challenging disease-associated symptoms due to spontaneous or trigger-induced mast cell degranulation. Anticipation of and preparation for potential complications can in many instances avoid symptomatic exacerbations. Proper symptomatic treatment and supportive care can often improve the child's quality of life. Cytoreductive therapy is usually not indicated given the natural history of spontaneous disease resolution.
Collapse
|
37
|
Mir A, Chamlin SL. A 1-year-old boy with persistent, generalized eruption. Urticaria pigmentosa. Pediatr Ann 2014; 43:e13-5. [PMID: 24549082 DOI: 10.3928/00904481-20131223-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A healthy 1-year-old boy born at full term after an uncomplicated pregnancy presented to the dermatology clinic for a widespread eruption with gradual onset since 3 months of age. He was otherwise well, afebrile, feeding well, and gaining weight appropriately. The child was overall asymptomatic, though some of his lesions occasionally became red and pruritic. His mother noticed that after mild illnesses, he was more prone to these flares. She denied flushing, vomiting, diarrhea, respiratory distress, and irritability. He was meeting all developmental milestones and started walking at 11 months of age. The remainder of his review of systems was unremarkable, and family history was noncontributory. Physical exam revealed a well-appearing, well-nourished, playful, and interactive toddler. There were innumerable discrete and coalescing pink-brown macules and papules concentrated on the trunk and extending onto the proximal upper and lower extremities bilaterally, as well as the neck and lower face. Stroking the lesions quickly led to development of erythematous edematous wheals. There was no hepatosplenomegaly, and the lymph node exam was unremarkable.
Collapse
|
38
|
Klein NJ, Misseldine S. Anesthetic considerations in pediatric mastocytosis: a review. J Anesth 2013; 27:588-98. [DOI: 10.1007/s00540-013-1563-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 01/21/2013] [Indexed: 10/27/2022]
|
39
|
Gray C, Young L, Orchard D, Connell TG. Severe cutaneous mastocytosis in a 10-month-old infant. J Paediatr Child Health 2012; 48:1103. [PMID: 23217044 DOI: 10.1111/jpc.12000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Charmaine Gray
- Department of General Medicine; Infectious Diseases Unit; Royal Children's Hospital Melbourne; Parkville Victoria Australia
| | - Lauren Young
- Department of Dermatology; Royal Children's Hospital Melbourne; Parkville Victoria Australia
| | - David Orchard
- Department of Dermatology; Royal Children's Hospital Melbourne; Parkville Victoria Australia
| | - Tom G Connell
- Department of General Medicine; Infectious Diseases Unit; Royal Children's Hospital Melbourne; Parkville Victoria Australia
| |
Collapse
|
40
|
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]
|
41
|
Bankova LG, Walter JE, Iyengar SR, Lorenzo ME, Hornick JL, Castells MC. Generalized bullous eruption after routine vaccination in a child with diffuse cutaneous mastocytosis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2012; 1:94-6. [PMID: 24229828 DOI: 10.1016/j.jaip.2012.08.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 08/28/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Lora G Bankova
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | | | | | | | | | | |
Collapse
|
42
|
Chantorn R, Shwayder T. Death from mast cell leukemia: a young patient with longstanding cutaneous mastocytosis evolving into fatal mast cell leukemia. Pediatr Dermatol 2012; 29:605-9. [PMID: 22329485 DOI: 10.1111/j.1525-1470.2011.01650.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Mastocytosis is a broad term used for a group of disorders characterized by accumulation of mast cells in the skin with or without extracutaneous involvement. The clinical spectrum of the disease varies from only cutaneous lesions to highly aggressive systemic involvement such as mast cell leukemia. Mastocytosis can present from birth to adulthood. In children, mastocytosis is usually benign, and there is a good chance of spontaneous regression at puberty, unlike adult-onset disease, which is generally systemic and more severe. Moreover, individuals with systemic mastocytosis may be at risk of developing hematologic malignancies. We describe a girl who presented to us with a solitary mastocytoma at age 5 and later developed maculopapular cutaneous mastocytosis. At age 23, after an episode of anaphylactic shock, a bone marrow examination revealed mast cell leukemia. She ultimately died despite aggressive chemotherapy and bone marrow transplantation.
Collapse
|
43
|
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.
Collapse
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
| |
Collapse
|
44
|
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]
|
45
|
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.
Collapse
Affiliation(s)
- M Lange
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland.
| | | | | | | | | | | |
Collapse
|
46
|
Koga H, Kokubo T, Akaishi M, Iida K, Korematsu S. Neonatal onset diffuse cutaneous mastocytosis: a case report and review of the literature. Pediatr Dermatol 2011; 28:542-6. [PMID: 20678092 DOI: 10.1111/j.1525-1470.2010.01212.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Diffuse cutaneous mastocytosis is a rare variant of mast cell disease with widespread erythroderma, which is normally clinically apparent in early infancy. We report the case of a neonate who presented with diffuse erythrodermic rash and bullous lesions. Biopsy specimens showed a dense dermal infiltrate of mast cells. Serum histamine and tryptase levels were elevated. No somatic mutation of the c-kit gene was found. Blistering ceased at 5 months of age, but atopic dermatitis appeared at 6 months and allergic workup revealed a high level of food-specific IgE. Herein, we describe the case and provide the first review of the literature on neonatal onset diffuse cutaneous mastocytosis to clarify the prognosis of this condition.
Collapse
Affiliation(s)
- Hiroshi Koga
- Department of Neonatology, Center for Perinatal Medicine, Oita Prefectural Hospital, Beppu-city, Oita, Japan.
| | | | | | | | | |
Collapse
|
47
|
Castells M, Metcalfe DD, Escribano L. Diagnosis and treatment of cutaneous mastocytosis in children: practical recommendations. Am J Clin Dermatol 2011; 12:259-70. [PMID: 21668033 DOI: 10.2165/11588890-000000000-00000] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Cutaneous mastocytosis in children is a generally benign disease that can present at birth and is often associated with mast cell mediator-related symptoms including pruritus, flushing, and abdominal pain with diarrhea. The most common form of presentation is urticaria pigmentosa, also referred to as maculopapular mastocytosis. Flares of lesions are induced by triggers such as physical stimuli, changes in temperature, anxiety, medications, and exercise. The skin lesions are typically present on the extremities. Symptoms respond to topical and systemic anti-mediator therapy including antihistamines and cromolyn sodium. Remission at puberty is seen in a majority of cases. Progression to systemic mastocytosis with involvement of extracutaneous organs is not common. The cause of cutaneous mastocytosis is unknown and familial cases are rare. Mutations of c-kit have been observed in the skin of those affected. The diagnosis is established on clinical grounds and the findings on skin biopsy. Bone marrow studies are recommended if there is suspicion of progression of disease to an adult form, if cytoreductive therapy is contemplated, or if skin lesions remain present and/or tryptase levels remain elevated after puberty. The use of chemotherapy, including kinase inhibitors, is strongly discouraged unless severe hematologic disease is present, since malignant evolution is extremely rare.
Collapse
Affiliation(s)
- Mariana Castells
- Department of Medicine, Division of Rheumatology, Immunology, and Allergy, Brigham Womens Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | |
Collapse
|
48
|
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.
Collapse
Affiliation(s)
- Nargis Ahmad
- Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, UK.
| | | | | |
Collapse
|
49
|
Cutaneous mimickers of child abuse: a primer for pediatricians. Eur J Pediatr 2008; 167:1221-30. [PMID: 18661148 DOI: 10.1007/s00431-008-0792-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Accepted: 06/26/2008] [Indexed: 10/21/2022]
Abstract
The annual incidence of child abuse was estimated to be 2.8 million by the national incidence study conducted in the USA in 1993, which is a two-fold increase compared to 1986. Awareness of child abuse has been increasing since the 1960s. Although most victims of child abuse present with cutaneous lesions, many genuine skin diseases may appear as non-accidental injuries which, if not recognized, may lead to misdiagnosis of child abuse. Here, we review the most common cutaneous mimickers of child abuse in order to increase awareness of these disorders and reduce erroneous diagnosis of child abuse.
Collapse
|
50
|
Abstract
Cutaneous mastocytosis can be divided into 4 different clinical variants--urticaria pigmentosa, solitary mastocytoma, diffuse cutaneous mastocytosis, and telangiectasia macularis eruptiva perstans. Skin findings are often accompanied by symptoms secondary to mast cell release of mediators. These symptoms can be both localized to the skin lesion and systemic because of the release of mediators into the bloodstream. The majority of pediatric cases of cutaneous mastocytosis show a good prognosis with gradual resolution of both symptoms and skin lesions. This article will review each of the 4 clinical presentations focusing on pediatric-onset of disease while reviewing the literature.
Collapse
Affiliation(s)
- Laura D Briley
- PGY3- Department of Dermatology, Brody School of Medicine at East Carolina University, Greenville, North Carolina 27834, USA.
| | | |
Collapse
|