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Pegoraro F, Papo M, Cohen-Aubart F, Peyronel F, Lugli G, Trambusti I, Baulier G, de Menthon M, Le Scornet T, Oziol E, Ferreira-Maldent N, Hermine O, Faucher B, Koschel D, Straetmans N, Abisror N, Terrier B, Lifermann F, Razanamahery J, Allenbach Y, Keraen J, Bulifon S, Hervier B, Buccoliero A, Charlotte F, Monzani Q, Boussouar S, Shor N, Tondo A, Barete S, Idbaih A, Tazi A, Sieni E, Amoura Z, Emile JF, Vaglio A, Haroche J. Long-term outcome and prognosis of mixed histiocytosis (Erdheim-Chester disease and Langerhans Cell Histiocytosis). EClinicalMedicine 2024; 73:102658. [PMID: 38841707 PMCID: PMC11152896 DOI: 10.1016/j.eclinm.2024.102658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 06/07/2024] Open
Abstract
Background Erdheim-Chester disease (ECD) is a rare histiocytosis that may overlap with Langerhans Cell Histiocytosis (LCH). This "mixed" entity is poorly characterized. We here investigated the clinical phenotype, outcome, and prognostic factors of a large cohort of patients with mixed ECD-LCH. Methods This retrospective study was performed at two referral centers in France and Italy (Pitié-Salpêtrière Hospital, Paris; Meyer Children's Hospital, Florence). We included children and adults with ECD diagnosed in 2000-2022 who had biopsy-proven LCH, available data on clinical presentation, treatment and outcome, and a minimum follow-up of one year. Outcomes included differences in clinical presentation and survival between mixed ECD-LCH and isolated ECD; we also investigated response to treatments and predictors of survival in the mixed cohort. Survival was analyzed using the Kaplan-Maier method and differences in survival with the long-rank test. Cox regression models were used to evaluate the potential impact of age and gender on survival and to identify predictors of non-response and survival. Findings Out of a cohort of 502 ECD patients, 69 (14%) had mixed ECD-LCH. Compared to isolated ECD, mixed ECD-LCH occurred more frequently in females (51 vs. 26%, p < 0.001) and in patients with multisystem disease (≥4 sites). Mixed ECD-LCH more frequently involved long bones (91 vs. 79%, p = 0.014), central nervous system (51 vs. 34%, p = 0.007), facial/orbit (52 vs. 38%, p = 0.031), lungs (43 vs. 28%, p = 0.009), hypothalamic/pituitary axis (51 vs. 26%, p < 0.001), skin (61 vs. 29%, p < 0.001), and lymph nodes (15 vs. 7%, p = 0.028); the BRAFV600E mutation was also more frequent in mixed ECD-LCH (81 vs. 59%, p < 0.001). Targeted treatments (BRAF and/or MEK inhibitors) induced response more frequently than conventional therapies (interferon-α, chemotherapy), either as first-line (77 vs. 29%, p < 0.001) or as any line (75 vs. 24%, p < 0.001). After a median follow-up of 71 months, 24 patients (35%) died. Survival probability was comparable between ECD alone and mixed ECD-LCH (log-rank p = 0.948). At multivariable analysis, age at diagnosis (HR 1.052, 95% CI 1.008-1.096), associated hematologic conditions (HR 3.030, 95% CI 1.040-8.827), and treatment failure (HR 9.736, 95% CI 2.919-32.481) were associated with an increased risk of death, while lytic bone lesions with a lower risk (HR 0.116, 95% CI 0.031-0.432). Interpretation Mixed ECD-LCH is a multisystem disease driven by the BRAFV600E mutation and targeted treatments are effective. Age at diagnosis, bone lesion patterns, associated hematologic conditions, and treatment failure are the main predictors of death in mixed ECD-LCH. Funding None.
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Affiliation(s)
- Francesco Pegoraro
- Sorbonne University, Internal Medicine Department 2, Institut E3M, French Reference Centre for Histiocytosis, Pitié-Salpȇtrière Hospital, CIMI INSERM-UMRS 1135, Assistance Publique-Hôpitaux de Paris, Paris, France
- Hematology and Oncology Department, Meyer Children’s Hospital IRCCS, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Matthias Papo
- Sorbonne University, Internal Medicine Department 2, Institut E3M, French Reference Centre for Histiocytosis, Pitié-Salpȇtrière Hospital, CIMI INSERM-UMRS 1135, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fleur Cohen-Aubart
- Sorbonne University, Internal Medicine Department 2, Institut E3M, French Reference Centre for Histiocytosis, Pitié-Salpȇtrière Hospital, CIMI INSERM-UMRS 1135, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Francesco Peyronel
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Nephrology and Dialysis Unit, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Gianmarco Lugli
- Rare Disease Center, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Irene Trambusti
- Hematology and Oncology Department, Meyer Children’s Hospital IRCCS, Florence, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gildas Baulier
- Internal Medicine and Clinical Immunology Department, Périgueux University Hospital, Périgueux, France
| | - Mathilde de Menthon
- Paris-Saclay University, Internal Medicine and Clinical Immunology Department, Bicetre Hospital, Assistance Publique - Hôpitaux de Paris, Le Kremlin Bicêtre, France
| | - Tanguy Le Scornet
- Internal Medicine Department, Hotel Dieu, Nantes University Hospital, Nantes, France
| | - Eric Oziol
- Internal Medicine Department, Béziers Hospital, Béziers, France
| | | | - Olivier Hermine
- Hematology Department, Hôpital Necker - Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benoit Faucher
- Internal Medicine Department, La Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Dirk Koschel
- Internal Medicine and Pneumology Department, Fachkrankenhaus Coswig, Lung Center, Coswig and Medical Department I, Division of Pneumology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Nicole Straetmans
- Hematology Department, University Hospital Saint-Luc, Brussels, Belgium
| | - Noémie Abisror
- Internal Medicine Department, Saint Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benjamin Terrier
- Internal Medicine Department, Referral Center for Rare Autoimmune and Systemic Diseases, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Jerome Razanamahery
- Internal Medicine and Clinical Immunology Department, Dijon University Hospital, Dijon, France
| | - Yves Allenbach
- Internal Medicine Department, Sorbonne University, INSERM UMRS 974, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jeremy Keraen
- Internal Medicine and Immunology Department, Cornouaille Hospital Center, Quimper, France
| | - Sophie Bulifon
- Paris-Saclay University, Faculty of Medicine, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, Le Kremlin-Bicêtre, France
- Respiratory and Intensive Care Medicine Department, Pulmonary Hypertension National Referral Center, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Baptiste Hervier
- Internal Medicine Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Frederic Charlotte
- Pathology Department, Pitié-Salpêtrière Hospital, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Quentin Monzani
- Polyvalent and Oncologic Radiology Department–Musculoskeletal Unit, Pitié-Salpêtrière Hospital, Paris, France
| | - Samia Boussouar
- Cardiovascular and Thoracic Imaging Unit, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Natalia Shor
- Neuro-Radiology Department, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Annalisa Tondo
- Hematology and Oncology Department, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Stephane Barete
- Sorbonne University, Dermatology Unit, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ahmed Idbaih
- Sorbonne University, Neuro-Oncology Department, Paris Brain Institute - ICM, Inserm, CNRS, Pitié-Salpêtrière Hospital, DMU Neurosciences, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Abdellatif Tazi
- UFR de Médecine, Paris Cité University, Paris, France
- INSERM UMR 976 Saint Louis Research Institute, Paris, France
- Pneumology Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Elena Sieni
- Hematology and Oncology Department, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Zahir Amoura
- Sorbonne University, Internal Medicine Department 2, Institut E3M, French Reference Centre for Histiocytosis, Pitié-Salpȇtrière Hospital, CIMI INSERM-UMRS 1135, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-François Emile
- EA4340 BECCOH, Versailles SQY University, Pathology Department, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne, France
| | - Augusto Vaglio
- Nephrology and Dialysis Unit, Meyer Children’s Hospital IRCCS, Florence, Italy
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Julien Haroche
- Sorbonne University, Internal Medicine Department 2, Institut E3M, French Reference Centre for Histiocytosis, Pitié-Salpȇtrière Hospital, CIMI INSERM-UMRS 1135, Assistance Publique-Hôpitaux de Paris, Paris, France
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2
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Wong A, Sharma A, Ramcharitar R. Cardiovascular manifestations of Erdheim-Chester disease: A narrative review with two cases. Vasc Med 2024; 29:313-319. [PMID: 38469821 DOI: 10.1177/1358863x241228271] [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] [Indexed: 03/13/2024]
Abstract
Erdheim-Chester disease (ECD) is a rare 'L' (Langerhans) group histiocytic neoplasm that affects a multitude of organ systems, causing osteosclerotic bone lesions, periaortic encasement ('coated' aorta), retroperitoneal fibrosis involving kidneys and ureters ('hairy kidney'), and infiltration of the central nervous system. Cardiovascular involvement can occur in up to 70% of patients and is usually found during computed tomography/magnetic resonance imaging evaluation. When present, cardiovascular symptoms can have wide variability in presentation from asymptomatic to pericarditis, fatal cardiac tamponade, myocardial infarction, conduction abnormalities, heart failure, renal artery stenosis, and claudication. Cardiac involvement found on imaging includes right atrial pseudotumor, right atrioventricular groove infiltration, and pericardial effusions. ECD can involve the large- and medium-sized arteries, often seen as periarterial thickening (commonly coating the aorta) with stenosis/occlusion. Although more cardiovascular ECD cases have begun to be published in the literature, more data are needed on the outcomes of these patients, as well as how cardiovascular manifestations respond to treatment of ECD.
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Affiliation(s)
- Alan Wong
- Department of Vascular Medicine, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Aditya Sharma
- Department of Vascular Medicine, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Randy Ramcharitar
- Department of Vascular Medicine, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
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3
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Saha MK. Overview of Vasculitides in Adults. Neuroimaging Clin N Am 2024; 34:1-12. [PMID: 37951696 DOI: 10.1016/j.nic.2023.07.007] [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] [Indexed: 11/14/2023]
Abstract
Vasculitis is characterized by the inflammation of blood vessels. Vasculitides refers to the different forms of vasculitis, often classified according to the size of the blood vessel that is involved. Vasculitis may occur as a primary process or secondary to many systemic diseases. This topic provides an overview of the clinical features, diagnosis, and classification of the different forms of vasculitides.
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Affiliation(s)
- Manish K Saha
- Division of Nephrology, University of North Carolina, Chapel Hill, NC, USA.
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4
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Şener YZ. Factors Related to Coronary Artery Ectasia. Angiology 2023; 74:704. [PMID: 36651646 DOI: 10.1177/00033197231152942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Yusuf Ziya Şener
- Department of Cardiology, Beypazarı State Hospital, Ankara, Turkey
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5
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Banks SA, Sartori Valinotti JC, Go RS, Abeykoon JP, Goyal G, Young JR, Koster MJ, Vassallo R, Ryu JH, Davidge-Pitts CJ, Ravindran A, Bennani NN, Shah MV, Rech KL, Tobin WO. Neurological Manifestations of Histiocytic Disorders. Curr Neurol Neurosci Rep 2023; 23:277-286. [PMID: 37209319 DOI: 10.1007/s11910-023-01272-4] [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] [Accepted: 04/04/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE OF REVIEW Histiocytic disorders, including Erdheim-Chester disease (ECD), Langerhans cell histiocytosis (LCH), and Rosai-Dorfman disease (RDD), are rare neoplasms that may present with a spectrum of neurologic involvement. Diagnostic delay is common due to heterogeneity in presentation and challenging pathology. RECENT FINDINGS Recent advances in the treatment of these diseases targeted towards mutations in the MAP kinase pathway have led to an improved prognosis in these patients with neurologic involvement. It is critical for clinicians to have a high index of suspicion to allow for early targeted treatment and optimize neurologic outcomes. A systematic approach to diagnosis is presented in this article to allow for accurate diagnosis of these rare diseases.
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Affiliation(s)
- Samantha A Banks
- Department of Neurology, Mayo Clinic Rochester, 200 First St SW, Rochester, MN, 55905, USA
| | | | - Ronald S Go
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN, USA
| | | | - Gaurav Goyal
- Division of Hematology-Oncology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jason R Young
- Department of Radiology, Mayo Clinic in Jacksonville, Jacksonville, FL, USA
| | - Matthew J Koster
- Division of Rheumatology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Robert Vassallo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic Rochester, Rochester, MN, USA
| | - Jay H Ryu
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN, USA
| | | | - Aishwarya Ravindran
- Division of Laboratory Medicine-Hematopathology, Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - N Nora Bennani
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Mithun V Shah
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Karen L Rech
- Division of Hematopathology, Mayo Clinic Rochester, Rochester, MN, USA
| | - W Oliver Tobin
- Department of Neurology, Mayo Clinic Rochester, 200 First St SW, Rochester, MN, 55905, USA.
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6
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Jridi M, Ben Achour T, Naceur I, Smiti M, Ben Ghorbel I, Lamloum M, Said F, Houman MH. Erdheim-Chester disease: A multisystem disease case illustration with rare manifestations and treatment challenges. Clin Case Rep 2023; 11:e6996. [PMID: 36852124 PMCID: PMC9957994 DOI: 10.1002/ccr3.6996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/23/2022] [Accepted: 02/06/2023] [Indexed: 02/26/2023] Open
Abstract
Erdheim-Chester disease is a rare multisystemic disease. A 50-year-old woman, presented with a recurrent pain and swelling of the left knee. Bone scintigraphy showed increased tracer uptake of peripheral skeleton. The computed tomography showed tissular infiltration in the retroperitoneum, around the vessels. Immunohistochemistry showed CD68 (+) and CD1a (-).
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Affiliation(s)
| | | | - Ines Naceur
- Rabta University Hospital CenterTunisTunisia
| | - Monia Smiti
- Rabta University Hospital CenterTunisTunisia
| | | | | | - Fatma Said
- Rabta University Hospital CenterTunisTunisia
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7
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Chazal T, Pegoraro F, Manari G, Bettiol A, Maniscalco V, Gelain E, Charlotte F, Mazor RD, Renard-Penna R, Amoura Z, Cohen-Aubart F, Haroche J, Izzedine H, Vaglio A. Clinical phenotypes and long-term outcome of kidney involvement in Erdheim-Chester histiocytosis. Kidney Int 2023; 103:177-186. [PMID: 36374823 DOI: 10.1016/j.kint.2022.09.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/10/2022] [Accepted: 09/01/2022] [Indexed: 11/07/2022]
Abstract
Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis that frequently infiltrates the peri-kidney space ("hairy kidney" appearance), kidney pelvis and proximal ureters, leading to obstructive uropathy. Here, we analyzed the clinical characteristics, imaging findings and long-term kidney outcome of a large multicenter cohort comprising 195 consecutive patients with ECD. Retroperitoneal peri-kidney or peri-ureteral involvement was detected at diagnosis in 147 patients. Of them, 70 had hydronephrosis (bilateral in 47), and 16 with kidney atrophy (unilateral in 14). Kidney vascular peduncle infiltration was found in 60 patients, and kidney artery stenosis in 31. The estimated glomerular filtration rate (eGFR) at diagnosis was significantly lower in patients with than in those without peri-kidney involvement (median 74 vs. 98 mL/min/1.73 m2). Ureteral stenting often failed to achieve kidney function recovery. A total of 181 patients received medical therapies: first-line treatments included interferon-α (61%), BRAF-inhibitors (17%), mTOR-inhibitors (7%), or other drugs (15%). These therapies were efficacious for ECD but rarely induced kidney function improvement (one-year eGFR increase over 25% in under 10% of patients). After a median of 43 months, 19% of patients died and 5% developed kidney failure. Among patients with peri-kidney involvement, 44% developed chronic kidney disease (CKD) 3-5 at five years vs. 5% of those without. Unadjusted predictors of advanced CKD and kidney failure/death were age over 50 years, hypertension, BRAFV600E mutation, and baseline eGFR. At multivariable analysis, cardiovascular comorbidities were associated with advanced CKD, and age over 50 years with kidney failure/death. Thus, kidney involvement is common in ECD and can lead to CKD or kidney failure despite effective medical therapies or urological procedures.
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Affiliation(s)
- Thibaud Chazal
- Service de Médecine Interne, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Maladies Auto-Immunes et Systémiques, Centre National de Référence des Histiocytoses, Hôpital Pitié-Salpêtrière, Paris, France; Internal Medicine Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | | | - Gaia Manari
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | | | - Elena Gelain
- Nephrology and Dialysis Unit, Meyer Children's Hospital, Firenze, Italy
| | - Frédéric Charlotte
- Service d'Anatomie Pathologique, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Roei D Mazor
- Clinic of Histiocytic Neoplasms, Institute of Hematology, Assuta Medical Center, Tel Aviv, Israel
| | - Raphaele Renard-Penna
- Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Zahir Amoura
- Service de Médecine Interne, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Maladies Auto-Immunes et Systémiques, Centre National de Référence des Histiocytoses, Hôpital Pitié-Salpêtrière, Paris, France
| | - Fleur Cohen-Aubart
- Service de Médecine Interne, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Maladies Auto-Immunes et Systémiques, Centre National de Référence des Histiocytoses, Hôpital Pitié-Salpêtrière, Paris, France
| | - Julien Haroche
- Service de Médecine Interne, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Maladies Auto-Immunes et Systémiques, Centre National de Référence des Histiocytoses, Hôpital Pitié-Salpêtrière, Paris, France.
| | - Hassan Izzedine
- Department of Nephrology, Peupliers Hospital, Paris, France; Department of Nephrology, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Augusto Vaglio
- Nephrology and Dialysis Unit, Meyer Children's Hospital, Firenze, Italy; Department of Biomedical, Experimental and Clinical Sciences "Mario Serio," University of Firenze, Firenze, Italy.
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8
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Surgical Appearance of Aortic Involvement in Erdheim-Chester Disease: A Report of Two Cases. COR ET VASA 2022. [DOI: 10.33678/cor.2022.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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9
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Latyshev VD, Mershina EА, Kostina IE, Sinitsyn VЕ, Lukina EA. Erdheim–Chester disease with cardiac involvement. Case report. TERAPEVT ARKH 2022; 94:897-902. [DOI: 10.26442/00403660.2022.07.201737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/11/2022] [Indexed: 11/22/2022]
Abstract
ErdheimChester disease (ECD) is a rare non-Langerhans histiocytosis with multisystem inflammatory infiltrates consistent of monocytes/macrophages, reactive microenvironment and fibrotic fields. Cardiovascular involvement is one of the most frequent manifestations of ECD that can lead to life threating complications. In this article we are reporting a clinical case of ECD with cardiac involvement in a young patient.
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10
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Rare presentation of multiple thromboses in Erdheim-Chester disease: a case-based review. Int J Hematol 2022; 116:798-806. [PMID: 35687294 DOI: 10.1007/s12185-022-03393-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND ECD is a rare non-Langerhans cell histiocytosis with diverse and heterogeneous clinical manifestations, ranging from single-lesion forms to multi-system involvement, including slowly progressing unifocal forms to rapidly evolving life-threatening disease. CASE PRESENTATION A female patient presented with a 2-month history of fever. Imaging revealed multiple thromboses, bone destruction, an abnormal pituitary stalk, and clinical manifestations of diabetes insipidus. Excisional biopsy of a tibial lesion was sent for microscopic examination, and subsequent immunohistochemical testing was positive for expression of CD68 and CD163, and negative for expression of the immune markers CD1a, S100, and langerin. This confirmed the diagnosis of ECD. Treatment with methylprednisolone to inhibit the immune inflammatory response along with anti-cytokine therapy with an interleukin-6 antagonist resulted in satisfactory disease control. CONCLUSION We report a rare case of multiple thromboses, embolism, and multiple organ involvement as the main presentation of ECD, suggesting that ECD should be considered in patients presenting with multiple thromboses associated with multisystem damage. We successfully treated our patient with glucocorticoids and interleukin-6 antagonist. This patient's response to treatment suggests that hormone therapy and cytokine/chemokine therapy may be a potential novel treatment for patients with ECD without gene mutations.
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11
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Lakhani PM, Borysiewicz C, Mason J. Erdheim-Chester disease: a rare cause of bilateral renal artery stenosis, mimicking large vessel vasculitis. BMJ Case Rep 2022; 15:15/3/e242393. [PMID: 35292540 PMCID: PMC8928256 DOI: 10.1136/bcr-2021-242393] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A man in his 50s with resistant hypertension and history of Langerhans cell histiocytosis (LCH) was referred to rheumatology after suspicion of inflammatory arteritis was raised. This followed detection of bilateral renal artery stenosis during investigation for severe hypertension refractory to medical therapy. CT angiography revealed diffuse wall thickening of the abdominal aorta, in keeping with an aortitis. However, there was no serological or clinical evidence suggestive of a vasculitic process. Medical history included cranial diabetes insipidus, subclavian artery stenosis and spinal stenosis requiring surgery, over the course of 8 years. These findings led to consideration of Erdheim-Chester disease (ECD), a form of non-Langerhans cell histiocytosis, where there is abnormal proliferation of histiocytes which causes tissue fibrosis and sclerosis of the long bones. Subsequent plain radiographs of the long bones revealed appearances consistent with a diagnosis of ECD. Thus, a diagnosis of an LCH/ECD overlap syndrome was made.
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Affiliation(s)
| | | | - Justin Mason
- Rheumatology Department, Imperial College Healthcare NHS Trust, London, UK
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12
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Go RS, Jacobsen E, Baiocchi R, Buhtoiarov I, Butler EB, Campbell PK, Coulter DW, Diamond E, Flagg A, Goodman AM, Goyal G, Gratzinger D, Hendrie PC, Higman M, Hogarty MD, Janku F, Karmali R, Morgan D, Raldow AC, Stefanovic A, Tantravahi SK, Walkovich K, Zhang L, Bergman MA, Darlow SD. Histiocytic Neoplasms, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021; 19:1277-1303. [PMID: 34781268 DOI: 10.6004/jnccn.2021.0053] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Histiocytic neoplasms are rare hematologic disorders accounting for less than 1% of cancers of the soft tissue and lymph nodes. Clinical presentation and prognosis of these disorders can be highly variable, leading to challenges for diagnosis and optimal management of these patients. Treatment often consists of systemic therapy, and recent studies support use of targeted therapies for patients with these disorders. Observation ("watch and wait") may be sufficient for select patients with mild disease. These NCCN Guidelines for Histiocytic Neoplasms include recommendations for diagnosis and treatment of adults with the most common histiocytic disorders: Langerhans cell histiocytosis, Erdheim-Chester disease, and Rosai-Dorfman disease.
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Affiliation(s)
| | - Eric Jacobsen
- Dana-Farber/Brigham and Women's Cancer Center
- Massachusetts General Hospital Cancer Center
| | - Robert Baiocchi
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Ilia Buhtoiarov
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute Cleveland Clinic Children's Hospital
| | | | - Patrick K Campbell
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | - Aron Flagg
- Yale Cancer Center/Smilow Cancer Hospital
| | | | | | | | - Paul C Hendrie
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | - Filip Janku
- The University of Texas MD Anderson Cancer Center
| | - Reem Karmali
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
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13
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Moussouttas M, Roemer S, Dickson DW. Cerebral Microvascular Erdheim-Chester Disease: A Perivascular Hematopoietic Vasculopathy. Cerebrovasc Dis 2021; 50:746-751. [PMID: 34229323 DOI: 10.1159/000516803] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/23/2021] [Indexed: 11/19/2022] Open
Abstract
Erdheim-Chester disease (ECD) is a rare and elusive hematopoietic malignancy that may involve the nervous system in various ways. Cerebrovascular ECD involves the perivascular infiltration and compromise of any cervicocranial vessel by transformed proliferating histiocytes. Presented is the novel case of a patient with pathologically proven perivascular microangiopathy, manifesting in multifaceted fashion with ischemia, hemorrhage, mass lesions, and edema.
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Affiliation(s)
- Michael Moussouttas
- Cerebrovascular Division, Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Shanu Roemer
- Neuropathology Laboratory, Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Dennis W Dickson
- Neuropathology Laboratory, Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
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14
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Gori T. Coronary Vasculitis. Biomedicines 2021; 9:biomedicines9060622. [PMID: 34072772 PMCID: PMC8226826 DOI: 10.3390/biomedicines9060622] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/23/2021] [Accepted: 05/28/2021] [Indexed: 02/06/2023] Open
Abstract
The term coronary “artery vasculitis” is used for a diverse group of diseases with a wide spectrum of manifestations and severity. Clinical manifestations may include pericarditis or myocarditis due to involvement of the coronary microvasculature, stenosis, aneurysm, or spontaneous dissection of large coronaries, or vascular thrombosis. As compared to common atherosclerosis, patients with coronary artery vasculitis are younger and often have a more rapid disease progression. Several clinical entities have been associated with coronary artery vasculitis, including Kawasaki’s disease, Takayasu’s arteritis, polyarteritis nodosa, ANCA-associated vasculitis, giant-cell arteritis, and more recently a Kawasaki-like syndrome associated with SARS-COV-2 infection. This review will provide a short description of these conditions, their diagnosis and therapy for use by the practicing cardiologist.
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Affiliation(s)
- Tommaso Gori
- Kardiologie I and DZHK Standort Rhein-Main, Universitätsmedizin Mainz, 55131 Mainz, Germany
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15
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Erdheim-Chester disease: consensus recommendations for evaluation, diagnosis, and treatment in the molecular era. Blood 2021; 135:1929-1945. [PMID: 32187362 DOI: 10.1182/blood.2019003507] [Citation(s) in RCA: 193] [Impact Index Per Article: 64.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/04/2020] [Indexed: 01/18/2023] Open
Abstract
Erdheim-Chester disease (ECD) is a rare histiocytosis that was recently recognized as a neoplastic disorder owing to the discovery of recurrent activating MAPK (RAS-RAF-MEK-ERK) pathway mutations. Typical findings of ECD include central diabetes insipidus, restrictive pericarditis, perinephric fibrosis, and sclerotic bone lesions. The histopathologic diagnosis of ECD is often challenging due to nonspecific inflammatory and fibrotic findings on histopathologic review of tissue specimens. Additionally, the association of ECD with unusual tissue tropism and an insidious onset often results in diagnostic errors and delays. Most patients with ECD require treatment, except for a minority of patients with minimally symptomatic single-organ disease. The first ECD consensus guidelines were published in 2014 on behalf of the physicians and researchers within the Erdheim-Chester Disease Global Alliance. With the recent molecular discoveries and the approval of the first targeted therapy (vemurafenib) for BRAF-V600-mutant ECD, there is a need for updated clinical practice guidelines to optimize the diagnosis and treatment of this disease. This document presents consensus recommendations that resulted from the International Medical Symposia on ECD in 2017 and 2019. Herein, we include the guidelines for the clinical, laboratory, histologic, and radiographic evaluation of ECD patients along with treatment recommendations based on our clinical experience and review of literature in the molecular era.
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16
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Khanna S, Garikapati K, Goh DSL, Cho K, Lo P, Bhojaraja MV, Tarafdar S. Coronary artery vasculitis: a review of current literature. BMC Cardiovasc Disord 2021; 21:7. [PMID: 33407141 PMCID: PMC7788693 DOI: 10.1186/s12872-020-01813-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/07/2020] [Indexed: 12/17/2022] Open
Abstract
Cardiac vasculitis is recognized as a heterogeneous disease process with a wide spectrum of manifestations including pericarditis, myocarditis, valvular heart disease and less frequently, coronary artery vasculitis (CAV). CAV encompasses an emerging field of diseases which differ from conventional atherosclerotic disease and have a proclivity for the younger population groups. CAV portends multiple complications including the development of coronary artery aneurysms, coronary stenotic lesions, and thrombosis, all which may result in acute coronary syndromes. There are several aetiologies for CAV; with Kawasaki's disease, Takayasu's arteritis, Polyarteritis Nodosa, and Giant-Cell Arteritis more frequently described clinically, and in literature. There is a growing role for multi-modality imaging in assisting the diagnostic process; including transthoracic echocardiography, cardiac magnetic resonance imaging, computed tomography coronary angiography, fluorodeoxyglucose-positron emission tomography and conventional coronary angiogram with intravascular ultrasound. Whilst the treatment paradigms fundamentally vary between different aetiologies, there are overlaps with pharmacological regimes in immunosuppressive agents and anti-platelet therapies. Interventional and surgical management are is a consideration in select populations groups, within a multi-disciplinary context. Further large-scale studies are required to better appropriately outline management protocols in this niche population.
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Affiliation(s)
- Shaun Khanna
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia.
| | - Kartheek Garikapati
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia
| | - Daniel S L Goh
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia
| | - Kenneth Cho
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia
| | - Phillip Lo
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia
| | | | - Surjit Tarafdar
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia.,Faculty of Medicine, Western Sydney University, Sydney, NSW, Australia
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17
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Erdheim–Chester disease: a rapidly evolving disease model. Leukemia 2020; 34:2840-2857. [DOI: 10.1038/s41375-020-0944-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/12/2020] [Accepted: 06/17/2020] [Indexed: 01/19/2023]
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18
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Abstract
Erdheim-Chester disease (ECD) is a rare but increasingly recognized multi-system disorder. Its diagnosis and treatment require integration of clinical information, imaging studies, and pathology studies. Of note, ECD can now be defined as a clonal myeloid disorder due to mutations which activate mitogen-activated protein kinase (MAPK) pathways and where an inflammatory milieu is important in the pathogenesis and clinical manifestations of the disease. Biopsy demonstrating characteristic histopathologic features in addition to clinical and radiographic features, most often sclerosing long bone involvement, is required to establish a diagnosis. Detection of somatic MAPK pathway mutations can also assist in the differential diagnosis of ECD and related histiocytic neoplasms. Also, genetic analysis establishing BRAF and RAS mutational status is critical in all ECD patients, as these features will impact therapy with MAPK inhibition. Therapy is recommended at diagnosis in all patients, except for those patients with minimally symptomatic disease. Prospective therapeutic trials are essential to furthering therapeutic progress in ECD.
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Affiliation(s)
- Gordon Starkebaum
- University of Washington, Division of Rheumatology, 1959 NE Pacific St., Box 356428, Seattle, WA, 98195-6428, USA.
| | - Paul Hendrie
- Division of Hematology, University of Washington, 1959 NE Pacific St., Box 358081, Seattle, WA, 98195-6428, USA.
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19
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A Review of Primary Vasculitis Mimickers Based on the Chapel Hill Consensus Classification. Int J Rheumatol 2020; 2020:8392542. [PMID: 32148510 PMCID: PMC7049422 DOI: 10.1155/2020/8392542] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 01/07/2020] [Indexed: 12/13/2022] Open
Abstract
Primary systemic vasculitides are rare diseases that may manifest similarly to more commonly encountered conditions. Depending on the size of the vessel affected (large vessel, medium vessel, or small vessel), different vasculitis mimics must be considered. Establishing the right diagnosis of a vasculitis mimic will prevent unnecessary immunosuppressive therapy.
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20
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Multisystemic Imaging Findings in Chinese Patients With Erdheim-Chester Disease. AJR Am J Roentgenol 2019; 213:1179-1186. [PMID: 31532257 DOI: 10.2214/ajr.19.21523] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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21
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Goyal G, Young JR, Koster MJ, Tobin WO, Vassallo R, Ryu JH, Davidge-Pitts CJ, Hurtado MD, Ravindran A, Sartori Valinotti JC, Bennani NN, Shah MV, Rech KL, Go RS. The Mayo Clinic Histiocytosis Working Group Consensus Statement for the Diagnosis and Evaluation of Adult Patients With Histiocytic Neoplasms: Erdheim-Chester Disease, Langerhans Cell Histiocytosis, and Rosai-Dorfman Disease. Mayo Clin Proc 2019; 94:2054-2071. [PMID: 31472931 DOI: 10.1016/j.mayocp.2019.02.023] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/14/2019] [Accepted: 02/22/2019] [Indexed: 12/25/2022]
Abstract
Histiocytic neoplasms, a rare and heterogeneous group of disorders, primarily include Erdheim-Chester disease, Langerhans cell histiocytosis, and Rosai-Dorfman disease. Due to their diverse clinical manifestations, the greatest challenge posed by these neoplasms is the establishment of a diagnosis, which often leads to a delay in institution of appropriate therapy. Recent insights into their genomic architecture demonstrating mitogen-activated protein kinase/extracellular signal-regulated kinase pathway mutations have now enabled potential treatment with targeted therapies in most patients. This consensus statement represents a joint document from a multidisciplinary group of physicians at Mayo Clinic who specialize in the management of adult histiocytic neoplasms. It consists of evidence- and consensus-based recommendations on when to suspect these neoplasms and what tests to order for the diagnosis and initial evaluation. In addition, it also describes the histopathologic and individual organ manifestations of these neoplasms to help the clinicians in identifying their key features. With uniform guidelines that aid in identifying these neoplasms, we hope to improve the awareness that may lead to their timely and correct diagnosis.
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Affiliation(s)
- Gaurav Goyal
- Division of Hematology, Mayo Clinic, Rochester, MN.
| | | | | | | | - Robert Vassallo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | | - Maria D Hurtado
- Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester, MN
| | | | | | | | | | - Karen L Rech
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN.
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