1
|
Rodríguez-Duque MS, Martín Soler P, González Vela MC, Gómez Román JJ. [Combined histiocytosis of the Langerhans group (Langerhans cell histiocytosis and Erdheim-Chester disease) in a 64-year-old man with BRAF and NRAS mutations: a case report]. REVISTA ESPANOLA DE PATOLOGIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ANATOMIA PATOLOGICA Y DE LA SOCIEDAD ESPANOLA DE CITOLOGIA 2023; 56:186-190. [PMID: 37419557 DOI: 10.1016/j.patol.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 06/07/2021] [Accepted: 07/04/2021] [Indexed: 07/09/2023]
Abstract
We present a case of a 64-year-old male with a history of Crohn's disease who presented with an episode of acute abdominal pain. He was being investigated for a dermatological lesion. A skin and lung biopsy both revealed histiocytosis of the "L" (Langerhans) group. The skin biopsy showed a proliferation of histiocytic cells expressing Langerin, CD1a and S100 and the molecular study was positive for the BRAF p.V600E mutation. In the lung biopsy, a proliferation of histiocytic cells was found, which were positive for CD68 and S100 and negative for Langerin and CD1a; mutations in NRAS c.38G>A in exon 2 (p.G13D) were also detected.
Collapse
Affiliation(s)
| | - Paula Martín Soler
- Servicio de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - M Carmen González Vela
- Servicio de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Jose Javier Gómez Román
- Servicio de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, Santander, España
| |
Collapse
|
2
|
Motamedi M, Ferrara G, Yacyshyn E, Osman M, Abril A, Rahman S, Netchiporouk E, Gniadecki R. Skin disorders and interstitial lung disease: Part I-Screening, diagnosis, and therapeutic principles. J Am Acad Dermatol 2023; 88:751-764. [PMID: 36228941 DOI: 10.1016/j.jaad.2022.10.001] [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: 06/20/2022] [Revised: 09/26/2022] [Accepted: 10/02/2022] [Indexed: 11/07/2022]
Abstract
Numerous inflammatory, neoplastic, and genetic skin disorders are associated with interstitial lung disease (ILD), the fibrosing inflammation of lung parenchyma that has significant morbidity and mortality. Therefore, the dermatologist plays a major role in the early detection and appropriate referral of patients at risk for ILD. Part 1 of this 2-part CME outlines the pathophysiology of ILD and focuses on clinical screening and therapeutic principles applicable to dermatological patients who are at risk for ILD. Patients with clinical symptoms of ILD should be screened with pulmonary function tests and high-resolution chest computed tomography. Screening for pulmonary hypertension should be considered in high-risk patients. Early identification and elimination of pulmonary risk factors, including smoking and gastroesophageal reflux disease, are essential in improving respiratory outcomes. First-line treatment interventions for ILD in a dermatological setting include mycophenolate mofetil, but the choice of therapeutic agents depends on the nature of the primary disease, the severity of ILD, and comorbidities and should be the result of a multidisciplinary assessment. Better awareness of ILD among medical dermatologists and close interdisciplinary collaborations are likely to prevent treatment delays improving long-term outcomes.
Collapse
Affiliation(s)
- Melika Motamedi
- Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada
| | - Giovanni Ferrara
- Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Elaine Yacyshyn
- Division of Rheumatology, University of Alberta, Edmonton, Alberta, Canada
| | - Mohammed Osman
- Division of Rheumatology, University of Alberta, Edmonton, Alberta, Canada
| | - Andy Abril
- Division of Rheumatology, Mayo Clinic, Jacksonville, Florida
| | - Samia Rahman
- Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Robert Gniadecki
- Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|
3
|
Gallego CT, Bueno J, Cruces E, Stelow E, Mancheño N, Flors L. Histiocitosis pulmonar: más allá de la histiocitosis de células de Langerhans relacionada con el tabaco. RADIOLOGIA 2019; 61:215-224. [DOI: 10.1016/j.rx.2018.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 10/05/2018] [Accepted: 11/16/2018] [Indexed: 10/27/2022]
|
4
|
Pulmonary histiocytosis: Beyond Langerhans cell histiocytosis related to smoking. RADIOLOGIA 2019. [DOI: 10.1016/j.rxeng.2019.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
5
|
Rosai-Dorfman Disease: Rare Pulmonary Involvement Mimicking Pulmonary Langerhans Cell Histiocytosis and Review of the Literature. Case Rep Radiol 2018; 2018:2952084. [PMID: 29850355 PMCID: PMC5907517 DOI: 10.1155/2018/2952084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/07/2018] [Indexed: 12/31/2022] Open
Abstract
Rosai-Dorfman disease (RDD), also known as sinus histiocytosis with massive lymphadenopathy, is a rare nonmalignant lymphohistiocytic proliferative disorder. We report a patient with RDD who presented with multiple skin lesions, pulmonary involvement, and CT manifestations mimicking Langerhans cell histiocytosis, which improved after initiation of corticosteroid treatment.
Collapse
|
6
|
Zanelli M, Smith M, Mengoli MC, Spaggiari L, De Marco L, Lococo F, Puma F, Ascani S. Erdheim-Chester disease: description of two illustrative cases involving the lung. Histopathology 2018; 73:167-172. [PMID: 29469219 DOI: 10.1111/his.13501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM Erdheim-Chester disease represents a clonal systemic proliferation of histiocytes. Bone is the most common site of involvement, although almost any organ, including the lungs, can be affected. METHODS AND RESULTS The diagnosis of Erdheim-Chester disease can be difficult, owing to its rarity and protean presentation. Correlation between clinical, radiological and histological findings is mandatory for identification of the disease. Foamy histiocytes, lacking Langerhans cell markers, represent the typical histological findings, although their absence does not rule out Erdheim-Chester disease. Identification of BRAF mutation can be helpful in making the diagnosis, and allows for the development and application of targeted therapies in this setting. CONCLUSIONS Herein, we describe two cases presenting with lung involvement and vertebral lesions, lacking the more typical long-bone involvement. One case histologically mimicked Rosai-Dorfman disease. However, both cases harboured the pathognomonic BRAFV600E mutation.
Collapse
Affiliation(s)
- Magda Zanelli
- Pathology Unit, Azienda Unità Sanitaria Locale-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Maxwell Smith
- Department of Pathology and Laboratory Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Maria C Mengoli
- Pathology Unit, Azienda Unità Sanitaria Locale-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Lucia Spaggiari
- Radiology Unit, Azienda Unità Sanitaria Locale-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Loredana De Marco
- Pathology Unit, Azienda Unità Sanitaria Locale-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Filippo Lococo
- Thoracic Surgery, Azienda Unità Sanitaria Locale-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Puma
- Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Stefano Ascani
- Pathology Unit, Ospedale di Terni, University of Perugia, Perugia, Italy
| |
Collapse
|
7
|
Vargas D, Richards JC, Ocazionez D, Sirajuddin A, Browne L, Restrepo CS. Cardiothoracic manifestations of primary histiocytoses. Br J Radiol 2016; 89:20160347. [PMID: 27603510 DOI: 10.1259/bjr.20160347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The objectives of this article were: (1) to review common and rare manifestations of systemic and pulmonary Langerhans cell histiocytosis, Rosai-Dorfman disease, Erdheim-Chester disease and juvenile xanthogranuloma; (2) to provide the reader with important pathologic, epidemiologic and clinical features of these diseases. The histiocytoses are a diverse group of diseases which typically manifest with multiorgan involvement. Understanding the pathologic, epidemiologic and clinical features of these entities can help the radiologist suggest an accurate diagnosis of histiocytosis when typical imaging features are encountered.
Collapse
Affiliation(s)
- Daniel Vargas
- 1 Department of Radiology, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - J Caleb Richards
- 6 Department of Radiology, National Jewish Health. Denver, CO, USA
| | - Daniel Ocazionez
- 2 Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Arlene Sirajuddin
- 3 Department of Medical Imaging, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Lorna Browne
- 4 Department of Radiology, Children's Hospital of Colorado, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Carlos S Restrepo
- 5 Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| |
Collapse
|
8
|
DeMartino E, Go RS, Vassallo R. Langerhans Cell Histiocytosis and Other Histiocytic Diseases of the Lung. Clin Chest Med 2016; 37:421-30. [DOI: 10.1016/j.ccm.2016.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
9
|
Ahuja J, Kanne JP, Meyer CA, Pipavath SNJ, Schmidt RA, Swanson JO, Godwin JD. Histiocytic disorders of the chest: imaging findings. Radiographics 2016; 35:357-70. [PMID: 25763722 DOI: 10.1148/rg.352140197] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Histiocytic disorders of the chest comprise a broad spectrum of diseases. The lungs may be involved in isolation or as part of systemic disease. Some of these disorders are primary and have unknown etiology, and others result from a histiocytic response to a known cause. Among primary histiocytic disorders, pulmonary Langerhans cell histiocytosis (PLCH) is the most common; others include Erdheim-Chester disease and Rosai-Dorfman disease. Adult PLCH occurs almost exclusively in adults aged 20-40 years who smoke. Pediatric PLCH is extremely rare and typically occurs as part of multisystemic disease. Erdheim-Chester disease affects middle-aged and older adults; thoracic involvement usually occurs as part of systemic disease. Rosai-Dorfman disease affects children and young adults and manifests as painless cervical lymphadenopathy. Examples of secondary histiocytic disorders are storage diseases such as Gaucher disease, Niemann-Pick disease, and Fabry disease; pneumoconiosis such as silicosis and coal workers' pneumoconiosis; and infections such as Whipple disease and malakoplakia. These disorders are characterized at histopathologic examination on the basis of infiltration of alveoli or the pulmonary interstitium by histiocytes, which are a group of cells that includes macrophages and dendritic cells. Dendritic cells are a heterogeneous group of nonphagocytic antigen-presenting immune cells. Immunohistochemical markers help to distinguish among various primary histiocytic disorders. Characteristic radiologic findings in the appropriate clinical context may obviate biopsy to establish a correct diagnosis. However, in the absence of these findings, integration of clinical, pathologic, and radiologic features is required to establish a diagnosis.
Collapse
Affiliation(s)
- Jitesh Ahuja
- From the Departments of Radiology (J.A., S.N.J.P., J.O.S., J.D.G.) and Pathology (R.A.S.), University of Washington, 1959 NE Pacific St, UW Mailbox 357115, Seattle, WA 98195; and Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, Wis (J.P.K., C.A.M.)
| | | | | | | | | | | | | |
Collapse
|
10
|
Yokokawa Y, Taki T, Chinen Y, Kobayashi S, Nagoshi H, Akiyama M, Morimoto A, Ida H, Taniwaki M. Unique clonal relationship between T-cell acute lymphoblastic leukemia and subsequent Langerhans cell histiocytosis withTCRrearrangement andNOTCH1mutation. Genes Chromosomes Cancer 2015; 54:409-17. [DOI: 10.1002/gcc.22252] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 02/09/2015] [Indexed: 12/31/2022] Open
Affiliation(s)
- Yuichi Yokokawa
- Department of Molecular Diagnostics and Therapeutics; Kyoto Prefectural University of Medicine Graduate School of Medical Science; Kyoto Japan
- Department of Pediatrics; The Jikei University School of Medicine; Tokyo Japan
| | - Tomohiko Taki
- Department of Molecular Diagnostics and Therapeutics; Kyoto Prefectural University of Medicine Graduate School of Medical Science; Kyoto Japan
| | - Yoshiaki Chinen
- Department of Molecular Hematology and Oncology; Kyoto Prefectural University of Medicine Graduate School of Medical Science; Kyoto Japan
| | - Satoru Kobayashi
- Department of Molecular Hematology and Oncology; Kyoto Prefectural University of Medicine Graduate School of Medical Science; Kyoto Japan
| | - Hisao Nagoshi
- Department of Molecular Hematology and Oncology; Kyoto Prefectural University of Medicine Graduate School of Medical Science; Kyoto Japan
| | - Masaharu Akiyama
- Department of Pediatrics; The Jikei University School of Medicine; Tokyo Japan
- Division of Molecular Genetics, Institute of DNA Medicine, The Jikei University School of Medicine; Tokyo Japan
| | - Akira Morimoto
- Department of Pediatrics; Jichi Medical University School of Medicine; Shimotsuke Tochigi Japan
| | - Hiroyuki Ida
- Department of Pediatrics; The Jikei University School of Medicine; Tokyo Japan
| | - Masafumi Taniwaki
- Department of Molecular Hematology and Oncology; Kyoto Prefectural University of Medicine Graduate School of Medical Science; Kyoto Japan
| |
Collapse
|
11
|
Cohen-Barak E, Rozenman D, Schafer J, Krausz J, Dodiuk-Gad R, Gabriel H, Shani-Adir A. An unusual co-occurrence of Langerhans cell histiocytosis and Rosai-Dorfman disease: report of a case and review of the literature. Int J Dermatol 2013; 53:558-63. [DOI: 10.1111/ijd.12051] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Dganit Rozenman
- Department of Dermatology; Haemek Medical Center; Afula Israel
| | - Jan Schafer
- Department of Pathology; Haemek Medical Center; Afula Israel
| | - Judith Krausz
- Department of Pathology; Haemek Medical Center; Afula Israel
| | - Roni Dodiuk-Gad
- Department of Dermatology; Haemek Medical Center; Afula Israel
| | - Hertzel Gabriel
- Department of Pediatrics A; Haemek Medical Center; Afula Israel
| | - Ayelet Shani-Adir
- Department of Dermatology; Haemek Medical Center; Afula Israel
- Rappaport School of Medicine; Technion; Haifa Israel
| |
Collapse
|
12
|
Histiocytic disorders of the gastrointestinal tract. Hum Pathol 2013; 44:683-96. [DOI: 10.1016/j.humpath.2012.05.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 05/12/2012] [Accepted: 05/16/2012] [Indexed: 12/27/2022]
|
13
|
Venn-Watson S, Daniels R, Smith C. Thirty year retrospective evaluation of pneumonia in a bottlenose dolphin Tursiops truncatus population. DISEASES OF AQUATIC ORGANISMS 2012; 99:237-42. [PMID: 22832722 DOI: 10.3354/dao02471] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Pneumonia is one of the most common causes of morbidity in bottlenose dolphins Tursiops truncatus. To better understand associations of pneumonia with demographics, microbiology, pathology, and histopathology, a retrospective study on 42 dolphins from the US Navy Marine Mammal Program dolphin population was conducted (1980 to 2010). A total of 21 (50%) of the dolphins evaluated had pneumonia confirmed by histopathology. Bacterial and fungal pneumonia was present in 42.9 and 28.6% of cases (9 and 6 cases), respectively, with Staphylococcus aureus as the most common confirmed pathogen (4 cases, 19%). Other pathogens identified as the cause of pneumonia were Cryptococcus neoformans, Erysipelothrix rhusiopathiae, Histoplasma capsulatum, parainfluenza virus, Proteus species, Pseudomonas aeruginosa, and Streptococcus zooepidemicus. Neither sex nor age was a predictor of pneumonia. While many of the infections involved disseminated disease, lungs were consistently the most severely affected organs. The present study demonstrates the high susceptibility of dolphins to respiratory infections. Areas that warrant further investigation include eosinophilic pneumonia, chronic infections, co-infections, and metabolic or iron-storage diseases. There is a continuing need to improve the early diagnosis and effective treatment of pneumonia in dolphins.
Collapse
|
14
|
Greiwe AC, Miller K, Farver C, Lau CT. AIRP Best Cases in Radiologic-Pathologic Correlation: Pulmonary Langerhans Cell Histiocytosis. Radiographics 2012; 32:987-90. [DOI: 10.1148/rg.324115015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
15
|
Monaco SE, Schuchert MJ, Khalbuss WE. Diagnostic difficulties and pitfalls in rapid on-site evaluation of endobronchial ultrasound guided fine needle aspiration. Cytojournal 2010; 7:9. [PMID: 20607094 PMCID: PMC2895875 DOI: 10.4103/1742-6413.64385] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Accepted: 04/24/2010] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND One of the novel techniques utilizing fine needle aspiration (FNA) in the diagnosis of mediastinal and lung lesions is the endobronchial ultrasound (EBUS)-guided FNA. In this study, we describe five cases which had a discrepancy between on-site evaluation and final diagnosis, or a diagnostic dilemma when rendering the preliminary diagnosis, in order to illustrate some of the diagnostic difficulties and pitfalls that can occur in EBUS FNA. METHODS A total of five EBUS FNA cases from five patients were identified in our records with a discrepancy between the rapid on-site evaluation (ROSE) and final diagnosis, or that addressed a diagnostic dilemma. All of the cases had histological confirmation or follow-up. The cytomorphology in the direct smears, cell block, and immunohistochemical stains were reviewed, along with the clinical history and other available information. RESULTS Two cases were identified with a nondefinitive diagnosis at ROSE that were later diagnosed as malignant (metastatic signet-ring cell adenocarcinoma and metastatic renal cell carcinoma (RCC)) on the final cytological diagnosis. Three additional cases were identified with a ROSE and final diagnosis of malignant (large cell neuroendocrine carcinoma (LCNEC) and two squamous cell carcinomas), but raised important diagnostic dilemmas. These cases highlight the importance of recognizing discohesive malignant cells and bland neoplasms on EBUS FNA, which may lead to a negative or a nondefinitive preliminary diagnosis. Neuroendocrine tumors can also be difficult due to the wide range of entities in the differential diagnosis, including benign lymphocytes, lymphomas, small and nonsmall cell carcinomas, and the lack of immunohistochemical stains at the time of ROSE. Finally, the background material in EBUS FNAs may be misleading and unrelated to the cells of interest. CONCLUSIONS This study illustrates the cytomorphology of five EBUS FNA cases that address some of the diagnostic challenges witnessed while examining these specimens during ROSE. Many of the difficulties faced can be attributed to the baseline cellularity of the aspirates, the bronchial contamination, the difficulty identifying neoplasms with bland cytology, the wide spectrum of diseases that can occur in the mediastinum with overlapping cytomorphologic features, the mismatch between the background material and the cell populations present, and the overall unfamiliarity with these types of specimens.
Collapse
Affiliation(s)
- Sara E Monaco
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | |
Collapse
|