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Sakr HI, Buckley K, Baiocchi R, Zhao WJ, Hemminger JA. Erdheim Chester disease in a patient with Burkitt lymphoma: a case report and review of literature. Diagn Pathol 2018; 13:94. [PMID: 30474563 PMCID: PMC6260675 DOI: 10.1186/s13000-018-0772-2] [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: 09/19/2018] [Accepted: 11/12/2018] [Indexed: 01/18/2023] Open
Abstract
Background Erdheim Chester disease (ECD) is a rare, non-Langerhans cell histiocytosis characterized by widespread tissue infiltration by CD68-positive, CD1a-negative foamy histiocytes. ECD can be difficult to identify, and diagnosis relies on the presence of histiocytes with certain histologic and immunophenotypic features in an appropriate clinical and radiologic setting. Clinical signs and symptoms are variable depending on which organ systems are involved. Most patients have at least skeletal involvement with bone pain as well as fatigue. Other common manifestations include diabetes insipidus, cardiac, periaortic, or retro-orbital infiltration/fibrosis, kidney impairment, xanthelasmas, among others. Case presentation Herein, we describe a case of BRAF-mutation positive ECD in a patient with Burkitt lymphoma, and we review recent literature. Conclusion Underlying BRAF and other MAPK pathway mutations are identified in approximately 50% of cases of ECD, which aids in diagnosis as well as enables novel targeted treatments. ECD patients have an increased risk of myeloid neoplasms; however, unlike other histiocytoses, an association with lymphoproliferative disorders has not been recognized.
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Affiliation(s)
- Hany I Sakr
- Department of Pathology, The Ohio State University Wexner Medical Center, 410 W. 10th Ave, N#308, Columbus, OH, 43210, USA
| | - Kaila Buckley
- Department of Pathology, The Ohio State University Wexner Medical Center, 410 W. 10th Ave, N#308, Columbus, OH, 43210, USA.
| | - Robert Baiocchi
- Department of Internal Medicine (Hematology), The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Weiqiang John Zhao
- Department of Pathology, The Ohio State University Wexner Medical Center, 410 W. 10th Ave, N#308, Columbus, OH, 43210, USA
| | - Jessica A Hemminger
- Department of Pathology, The Ohio State University Wexner Medical Center, 410 W. 10th Ave, N#308, Columbus, OH, 43210, USA
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de Miguel Criado J, Aguilera Del Hoyo LF, García Del Salto L, Cueva Pérez E, Casado Cerrada J, Nieto Llanos S, Porro Fernández JC, Fraga Rivas P. Case 224: Cardiac Involvement in Erdheim-Chester Disease. Radiology 2015; 277:916-21. [PMID: 26599930 DOI: 10.1148/radiol.2015131751] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
History A 61-year-old man with no relevant medical history was admitted to the emergency department with symptoms of congestive heart failure and a 1-week history of chest pain, progressive dyspnea, abdominal swelling, bipedal edema, and anorexia. Laboratory test results, including complete blood count and electrolyte, creatinine, creatine phosphokinase, and troponin T levels were normal. Electrocardiographic findings were unremarkable. Initial chest radiography showed an enlarged heart with bilateral pleural effusion. Transthoracic echocardiography revealed an irregular right atrial mass and moderate to severe pericardial effusion. The patient subsequently underwent computed tomography (CT) of the chest, abdomen, and pelvis followed by cardiac magnetic resonance (MR) imaging for further evaluation of the atrial mass. Because of the suspected diagnosis, conventional radiography of the skeleton was performed.
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Affiliation(s)
- Jaime de Miguel Criado
- From the Departments of Radiology (J.d.M.C., L.F.A.d.H., L.G.d.S., E.C.P., P.F.R.), Internal Medicine (J.C.C.), Pathology (S.N.L.), and Cardiology (J.C.P.F.), Hospital del Henares-Unidad Central de Radiodiagnóstico, c/Marie Curie s/n, 28822 Coslada, Spain
| | - Luis F Aguilera Del Hoyo
- From the Departments of Radiology (J.d.M.C., L.F.A.d.H., L.G.d.S., E.C.P., P.F.R.), Internal Medicine (J.C.C.), Pathology (S.N.L.), and Cardiology (J.C.P.F.), Hospital del Henares-Unidad Central de Radiodiagnóstico, c/Marie Curie s/n, 28822 Coslada, Spain
| | - Laura García Del Salto
- From the Departments of Radiology (J.d.M.C., L.F.A.d.H., L.G.d.S., E.C.P., P.F.R.), Internal Medicine (J.C.C.), Pathology (S.N.L.), and Cardiology (J.C.P.F.), Hospital del Henares-Unidad Central de Radiodiagnóstico, c/Marie Curie s/n, 28822 Coslada, Spain
| | - Eva Cueva Pérez
- From the Departments of Radiology (J.d.M.C., L.F.A.d.H., L.G.d.S., E.C.P., P.F.R.), Internal Medicine (J.C.C.), Pathology (S.N.L.), and Cardiology (J.C.P.F.), Hospital del Henares-Unidad Central de Radiodiagnóstico, c/Marie Curie s/n, 28822 Coslada, Spain
| | - Jesús Casado Cerrada
- From the Departments of Radiology (J.d.M.C., L.F.A.d.H., L.G.d.S., E.C.P., P.F.R.), Internal Medicine (J.C.C.), Pathology (S.N.L.), and Cardiology (J.C.P.F.), Hospital del Henares-Unidad Central de Radiodiagnóstico, c/Marie Curie s/n, 28822 Coslada, Spain
| | - Santiago Nieto Llanos
- From the Departments of Radiology (J.d.M.C., L.F.A.d.H., L.G.d.S., E.C.P., P.F.R.), Internal Medicine (J.C.C.), Pathology (S.N.L.), and Cardiology (J.C.P.F.), Hospital del Henares-Unidad Central de Radiodiagnóstico, c/Marie Curie s/n, 28822 Coslada, Spain
| | - José Carlos Porro Fernández
- From the Departments of Radiology (J.d.M.C., L.F.A.d.H., L.G.d.S., E.C.P., P.F.R.), Internal Medicine (J.C.C.), Pathology (S.N.L.), and Cardiology (J.C.P.F.), Hospital del Henares-Unidad Central de Radiodiagnóstico, c/Marie Curie s/n, 28822 Coslada, Spain
| | - Patricia Fraga Rivas
- From the Departments of Radiology (J.d.M.C., L.F.A.d.H., L.G.d.S., E.C.P., P.F.R.), Internal Medicine (J.C.C.), Pathology (S.N.L.), and Cardiology (J.C.P.F.), Hospital del Henares-Unidad Central de Radiodiagnóstico, c/Marie Curie s/n, 28822 Coslada, Spain
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Clinical considerations and key issues in the management of patients with Erdheim-Chester Disease: a seven case series. BMC Med 2014; 12:221. [PMID: 25434739 PMCID: PMC4248471 DOI: 10.1186/s12916-014-0221-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 11/03/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Erdheim-Chester Disease (ECD), a non Langerhans' cell histiocytosis of orphan nature and propensity for multi-systemic presentations, comprises an intricate medical challenge in terms of diagnosis, treatment and complication management. OBJECTIVES The objectives are to report the clinical, radiological and pathological characteristics, as well as cardinal therapeutic approaches to ECD patients and to provide clinical analyses of the medical chronicles of these complex patients. METHODS Patients with biopsy proven ECD were audited by a multi-disciplinary team of specialists who formed a coherent timeline of all the substantial clinical events in the evolution of their patients' illness. RESULTS Seven patients (five men, two women) were recruited to the study. The median age at presentation was 53 years (range: 39 to 62 years). The median follow-up time was 36 months (range: 1 to 72 months). Notable ECD involvement sites included the skeleton (seven), pituitary gland (seven), retroperitoneum (five), central nervous system (four), skin (four), lungs and pleura (four), orbits (three), heart and great vessels (three) and retinae (one). Prominent signs and symptoms were fever (seven), polyuria and polydipsia (six), ataxia and dysarthria (four), bone pain (four), exophthalmos (three), renovascular hypertension (one) and dyspnea (one). The V600E BRAF mutation was verified in three of six patients tested. Interferon-α treatment was beneficial in three of six patients treated. Vemurafenib yielded dramatic neurological improvement in a BRAF mutated patient. Infliximab facilitated pericardial effusion volume reduction. Cladribine improved cerebral blood flow originally compromised by perivenous lesions. CONCLUSIONS ECD is a complex, multi-systemic, clonal entity coalescing both neoplastic and inflammatory elements and strongly dependent on impaired RAS/RAF/MEK/ERK signaling.
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Palazzuoli A, Mazzei MA, Ruocco G, Volterrani L. Constrictive pericarditis in Erdheim-Chester disease: an integrated echocardiographic and magnetic resonance approach. Int J Cardiol 2014; 174:e38-41. [PMID: 24768396 DOI: 10.1016/j.ijcard.2014.04.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 04/02/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Alberto Palazzuoli
- Department of Medical, Surgical and Neuro Sciences, Internal Medicine Unit Cardiology Section, Le Scotte Hospital, Siena, Italy.
| | - Maria Antonietta Mazzei
- Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, Le Scotte Hospital, Siena, Italy
| | - Gaetano Ruocco
- Department of Medical, Surgical and Neuro Sciences, Internal Medicine Unit Cardiology Section, Le Scotte Hospital, Siena, Italy
| | - Luca Volterrani
- Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, Le Scotte Hospital, Siena, Italy
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