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Kulkarni AM, Gayam PKR, Aranjani JM. Advances in Understanding and Management of Erdheim-Chester Disease. Life Sci 2024; 348:122692. [PMID: 38710283 DOI: 10.1016/j.lfs.2024.122692] [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: 02/28/2024] [Revised: 04/13/2024] [Accepted: 05/03/2024] [Indexed: 05/08/2024]
Abstract
Erdheim Chester Disease (ECD) is a rare histiocytic disorder marked by infiltration of organs with CD68+ histiocytes. ECD stems from mutations of BRAF and MAP2K1 in hematopoietic stem and progenitor cells (HSPCs), which further differentiate into monocytes and histiocytes. Histopathology reveals lipid-containing histiocytes, which test positive for CD68 and CD133 in immunohistochemistry. Signs and symptoms vary and depend on the organ/s of manifestation. Definitive radiological results associated with ECD include hairy kidney, coated aorta, and cardiac pseudotumor. Treatment options primarily include anti-cytokine therapy and inhibitors of BRAF and MEK signaling.
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Affiliation(s)
- Aniruddha Murahar Kulkarni
- Department of Pharmaceutical Biotechnology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Prasanna Kumar Reddy Gayam
- Department of Pharmaceutical Biotechnology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Jesil Mathew Aranjani
- Department of Pharmaceutical Biotechnology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India.
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2
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Suster DI, Ronen S, Suster S. Selected Case From the Arkadi M. Rywlin International Pathology Slide Seminar: Involvement of Skin and Soft Tissue by Erdheim-Chester Disease. Adv Anat Pathol 2024; 31:271-274. [PMID: 38180007 DOI: 10.1097/pap.0000000000000429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Erdheim-Chester disease is a rare form of non-Langerhans cell histiocytosis that preferentially involves long bones but can affect a variety of other organs. Initial presentation with extraskeletal involvement is not unusual and is most commonly observed in the central nervous system, heart, retroperitoneum, lungs, and skin. Initial presentation of the disease as a subcutaneous soft tissue mass is exceedingly rare and may pose difficulties for diagnosis. We describe a case of Erdheim-Chester disease that initially presented as a cutaneous and subcutaneous soft tissue mass in the right posterior shoulder of a 52-year-old man.
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Affiliation(s)
- David I Suster
- Department of Pathology, Rutgers New Jersey Medical School, Newark, NJ
| | - Shira Ronen
- Department of Pathology, Cleveland Clinic Foundation, Cleveland, OH
| | - Saul Suster
- Department of Pathology, Rutgers New Jersey Medical School, Newark, NJ
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3
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King HL, Benedetti GB, Keller JJ, DeLoughery TG, Shatzel JJ, Martens KL. Dermatologic manifestations of hematologic disorders. Ann Hematol 2024:10.1007/s00277-024-05761-5. [PMID: 38662204 DOI: 10.1007/s00277-024-05761-5] [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: 02/13/2024] [Accepted: 04/14/2024] [Indexed: 04/26/2024]
Abstract
Distinguishing key morphologic features and understanding the pathophysiology of common cutaneous manifestations of hematologic disorders is essential to ensure prompt and appropriate treatment. In fact, classic cutaneous signs may provide the first clue to the diagnosis of an underlying hematologic disease. Disorders of coagulation, vascular abnormalities, or cutaneous infiltration and deposition are responsible for the underlying pathophysiology of cutaneous manifestations in the majority of cases. Hematologists often feel ill-equipped in identifying morphologic changes in the skin. Thus, the purpose of this review is to provide a comprehensive overview of classic cutaneous manifestations and diagnostic considerations of the associated hematologic conditions. Though there is a specific focus on non-malignant disorders, those straddling the spectrum of malignancy are also discussed. In many disease states, the skin may serve as an important marker of an emerging hematologic disorder, so close collaboration and multidisciplinary input remain essential to provide optimal and timely care for these patients.
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Affiliation(s)
- Hannah L King
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | | | - Jesse J Keller
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | - Thomas G DeLoughery
- Division of Hematology and Medical Oncology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road Mail Code: OC14HO, 97239, Portland, OR, USA
| | - Joseph J Shatzel
- Division of Hematology and Medical Oncology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road Mail Code: OC14HO, 97239, Portland, OR, USA
| | - Kylee L Martens
- Division of Hematology and Medical Oncology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road Mail Code: OC14HO, 97239, Portland, OR, USA.
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4
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Aromolo IF, Moltrasio C, Maronese CA, Campochiaro C, Bonometti A, Berti E, Passoni E, Marzano A. Successful treatment of cutaneous-onset Erdheim-Chester disease with cobimetinib and anakinra. Clin Exp Dermatol 2024; 49:523-525. [PMID: 38231013 DOI: 10.1093/ced/llae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/08/2023] [Accepted: 01/02/2024] [Indexed: 01/18/2024]
Abstract
Erdheim–Chester disease is a rare multisystem non-Langerhans cell histiocytosis. We report the case of a patient with BRAF wildtype Erdheim–Chester disease presenting with facial nodular xanthomas and developing systemic involvement 10 years later. The patient was successfully treated with a combination of anakinra and cobimetinib.
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Affiliation(s)
| | - Chiara Moltrasio
- Dermatology Unit, IRCCS Foundation Maggiore Policlinico Hospital, Lombardia, Milan, Italy
- Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Friuli-Venezia Giulia, Italy
| | | | | | | | - Emilio Berti
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Emanuela Passoni
- Dermatology Unit, IRCCS Foundation Maggiore Policlinico Hospital, Lombardia, Milan, Italy
| | - Angelo Marzano
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Dermatology Unit, IRCCS Foundation Maggiore Policlinico Hospital, Lombardia, Milan, Italy
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5
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Zeng Y, Wang Q, Wang X, Jiang X, Yao H, Tang X. Erdheim-Chester Disease Involving the Left Uterine Adnexa: Mimicking an Ovarian Carcinoma Clinically. Int J Surg Pathol 2023; 31:1532-1537. [PMID: 36855299 DOI: 10.1177/10668969231157780] [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: 03/02/2023]
Abstract
Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis (LCH) that results in multiorgan disease involving the skin, bones, lungs, and kidneys. Female reproductive system manifestation of ECD was rare. Herein, we report a case of ECD involving the left ovary and fallopian tube. A 69-year-old woman presented with abdominal pain for 20 days. Magnetic resonance imaging revealed a solid and cystic mass on the left pelvic cavity. Histological examination revealed ovarian and fallopian tube infiltration by abundant histiocytes, with single small nuclei and foamy cytoplasm, reactive small lymphocytes, and plasma cells. Based on histopathological and immunohistochemical findings of positivity for CD68, CD163, and BRAF V600E and negativity for CD1α and S100, the molecular finding of BRAF V600E mutation, the patient was diagnosed with ECD. Positron emission tomography examination did not reveal any other lesions. The patient recovered well 12 months after surgery without any treatment. ECD involving the left fallopian tube and ovary was rare and needed to be differentiated from LCH, Rosai-Dorfman disease (RDD), juvenile xanthogranuloma (JXG), IgG4+-related disease (IgG4+RD), and metastatic signet ring cell carcinoma.
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Affiliation(s)
- Ying Zeng
- Department of Pathology, Chongqing General Hospital, Chongqing, China
| | - Qianhui Wang
- Department of Pathology, Chongqing General Hospital, Chongqing, China
| | - Xue Wang
- Department of Pathology, Chongqing General Hospital, Chongqing, China
| | - Xin Jiang
- Department of Pathology, Chongqing General Hospital, Chongqing, China
| | - Hui Yao
- Department of Pathology, Chongqing General Hospital, Chongqing, China
| | - Xuefeng Tang
- Department of Pathology, Chongqing General Hospital, Chongqing, China
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Ahmed A, Yein K, Gor S, Qamhia N, Pawade J. Erdheim-Chester disease presenting as large vessel vasculitis. Rheumatol Adv Pract 2023; 7:rkad074. [PMID: 37675203 PMCID: PMC10477288 DOI: 10.1093/rap/rkad074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 09/08/2023] Open
Affiliation(s)
- Azeem Ahmed
- Rheumatology Department, Great Western Hospital, Swindon, UK
| | - Khin Yein
- Rheumatology Department, Great Western Hospital, Swindon, UK
| | - Shivani Gor
- Rheumatology Department, Great Western Hospital, Swindon, UK
| | - Naim Qamhia
- Department of Pathology, North Bristol NHS Trust, Bristol, UK
| | - Joya Pawade
- Department of Pathology, North Bristol NHS Trust, Bristol, UK
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7
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Vasandani N, Low JE, Liau YH, Ergun A, Balakrishnan T. Rare Cutaneous Manifestations of Erdheim Chester Disease: A Case Report and Literature Review. Cureus 2023; 15:e40712. [PMID: 37485173 PMCID: PMC10359755 DOI: 10.7759/cureus.40712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
Erdheim Chester disease (ECD) is a rare and complex non-Langerhans histiocytic systemic disease that affects multiple organ systems, including the bones, heart, lungs, and central nervous system. Fewer than 1,000 cases have been reported in the medical literature and dermatological manifestations of the disease are rare but can provide valuable diagnostic clues for this challenging disease. The cutaneous manifestations of ECD can take many forms, including nodules, plaques, papules, and xanthomas. These lesions can occur on any part of the body and may be solitary or multiple. Cutaneous manifestations of ECD have been reported to occur in up to 20% of cases, but the true prevalence may be higher, as many cases may go undiagnosed. We present the case of a 62-year-old gentleman with a history of ECD currently on vemurafenib who presented with multiple painless subcutaneous nodules on his back after an excision biopsy under local anesthetic revealed histological features of ECD. The objective of this case report is to raise awareness of ECD and its dermatological manifestations. Further research is warranted to better understand the pathogenesis and morphology of cutaneous involvement in ECD.
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Affiliation(s)
- Nikhil Vasandani
- Department of Plastic and Reconstructive Surgery, University Hospital Galway, Galway, IRL
| | - Jing Er Low
- Department of Plastic and Reconstructive Surgery, University Hospital Galway, Galway, IRL
| | - Yun Hui Liau
- Department of General Surgery, University Hospital Galway, Galway, IRL
| | - Alexander Ergun
- Department of Plastic and Reconstructive Surgery, University Hospital Galway, Galway, IRL
| | - Theogren Balakrishnan
- Department of Plastic and Reconstructive Surgery, University Hospital Galway, Galway, IRL
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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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Giardino FR, Cuomo R, Pozzi M, Marcaccini G, Bacchini S, Marzouk El Araby M, Grimaldi L, Nisi G. Erdheim–Chester Disease of the Breast: First Review and First Case of Isolated Severe Gynecomastia. Diagnostics (Basel) 2023; 13:diagnostics13071239. [PMID: 37046457 PMCID: PMC10093613 DOI: 10.3390/diagnostics13071239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/11/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
(1) Introduction: Erdheim–Chester disease (ECD) is a life-threatening condition and often a diagnostic challenge. It has recently been classified as a hematopoietic tumour, and the cases of ECD reported in the literature has dramatically increased during the last 15 years. (2) Methods: We describe the case of a 57-year-old male patient with severe gynecomastia, with a detailed description of his diagnostic iter and consequent surgical operation. We provide the first systematic review of the literature of breast involvement in ECD, following PRISMA guidelines, including 13 studies and 16 patients. (3) Results: Our report resulted to be the first case of gynecomastia as a single clinical and imaging feature of ECD described in English literature. A total of 81.3% of patients included were female. Among them, 76.9% had unilateral and nodular presentation, while male patients presented bilateral heterogeneous breast enlargement. Globally, 87.5% expressed breast alterations as their first manifestations of ECD. Only 50% presented skeletal involvement. (4) Conclusion: The reported case represents a unique addition to the literature. We found two different patterns in ECD-related breast involvement between male and female patients, an unusual M/F ratio, and a lower rate of bone involvement. Breast involvement is frequently the first clinical feature; therefore, breast caregivers should be aware of this dangerous and most likely underestimated condition.
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10
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Sharma R, Stone MS, Macfarlane DE, Bellizzi AM, Koneru G. Erdheim-Chester disease associated with an aggressive form of sclerosing cholangitis. EGYPTIAN LIVER JOURNAL 2023. [DOI: 10.1186/s43066-023-00242-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Abstract
Background
Erdheim-Chester disease (ECD) is a rare histiocytic disorder recently recognized as a neoplasm due to the discovery of activating MAPK pathway mutations. Hepatic involvement by ECD is extremely rare.
Case presentation
We describe a case of a 64-year-old male who presented with pruritis, weight loss, and cholestatic liver function tests. Magnetic resonance imaging of the abdomen showed beaded appearance of the intrahepatic biliary tree. A liver biopsy was suggestive of primary or secondary sclerosing cholangitis. Computerized tomography (CT) of the abdomen showed perinephric and periaortic soft tissue stranding suggestive of ECD. 18F-fluorodeoxyglucose positron emission/computerized tomography scan showed a mediastinal hilar mass which turned out to be follicular lymphoma. Histopathology of molluscum-like skin lesions showed CD68 + , Factor XIIIa + , and CD1a-foamy histiocytes with multiple giant cells suggestive of ECD. The patient developed recurrent episodes of ascending cholangitis and his hyperbilirubinemia continued to worsen despite stenting of a common hepatic duct stricture found on endoscopic retrograde cholangiopancreatography.
Conclusions
The absence of associated inflammatory bowel disease and anti-neutrophil cytoplasmic antibody, as well as the rapidity of disease progression, makes us consider the possibility of hepatic involvement by ECD or an overlap syndrome. We want to highlight that negative histopathology should not delay the diagnosis of ECD as effective and potentially lifesaving therapies with BRAF or MEK pathway inhibitors are now available for these patients.
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Saba-Mussali AJ, Barrera-Ochoa CA, Hernández-Ramírez H, Bazan-Rodriguez L, Carillo-Loza K, Hernández-Sánchez M, López-Alderete JA, Toussaint-Caire S, Vega-Memije ME. Cutaneous manifestations of Erdheim-Chester disease: a case report. Int J Dermatol 2021; 61:e207-e209. [PMID: 34817857 DOI: 10.1111/ijd.16000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/14/2021] [Accepted: 11/11/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Alberto J Saba-Mussali
- Dermatology and Dermatopathology Department, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | - Carlos A Barrera-Ochoa
- Dermatology and Dermatopathology Department, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | - Heidi Hernández-Ramírez
- Dermatology and Dermatopathology Department, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | | | - Karina Carillo-Loza
- Neurology Department, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | | | - Jorge A López-Alderete
- Neurology Department, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Sonia Toussaint-Caire
- Dermatology and Dermatopathology Department, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | - Maria E Vega-Memije
- Dermatology and Dermatopathology Department, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
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Rech KL, He R. Challenges in the Histopathologic Diagnosis of Histiocytic Neoplasms. J Natl Compr Canc Netw 2021; 19:1305-1311. [PMID: 34781270 DOI: 10.6004/jnccn.2021.7098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/28/2021] [Indexed: 11/17/2022]
Abstract
Histiocytic neoplasms, including Langerhans cell histiocytosis (LCH), Erdheim-Chester disease (ECD), and Rosai-Dorfman disease (RDD), present a diagnostic challenge due to nonspecific fibroinflammatory infiltrates and a diverse clinical presentation. The pathologist can play a key role in classification of these disorders through multidisciplinary collaboration and correlation of pathologic features with clinical and radiologic findings. The histopathologic differential diagnosis is broad, requiring knowledge of the possible diagnoses at each specific anatomic site, and a careful assessment to exclude other inflammatory and neoplastic disorders. An immunohistochemistry panel including CD163, CD1a, langerin, S100, Factor XIIIa, OCT2, and BRAF V600E can provide definitive diagnosis in LCH and RDD, whereas ECD requires classic clinical features as well as confirmation of an activating MAPK pathway mutation by genetic studies.
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Affiliation(s)
- Karen L Rech
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Rong He
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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Oya K, Ishitsuka Y, Nakamura Y, Watanabe R, Okiyama N, Fujimoto M, Fujisawa Y. Papulonodular lesions in Erdheim-Chester disease. J Dermatol 2021; 48:e445-e446. [PMID: 34080226 DOI: 10.1111/1346-8138.16005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/24/2021] [Accepted: 05/08/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Kazumasa Oya
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yosuke Ishitsuka
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yoshiyuki Nakamura
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Rei Watanabe
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Naoko Okiyama
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yasuhiro Fujisawa
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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14
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Kanakis M, Petrou P, Lourida G, Georgalas I. Erdheim-Chester disease: a comprehensive review from the ophthalmologic perspective. Surv Ophthalmol 2021; 67:388-410. [PMID: 34081930 DOI: 10.1016/j.survophthal.2021.05.013] [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: 07/26/2020] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 01/18/2023]
Abstract
Erdheim-Chester disease (ECD) is a rare clonal histiocytic neoplasm with less than 1200 documented cases to date. The disease is life-threatening and difficult to recognize, although increasing awareness as well as the integration of clinical, imaging, pathology information , and genetic studies have led to a recent exponential increase in new reported cases. ECD affects multiple organs and systems, including skeletal, neurologic, and cardiovascular. Pulmonary, retroperitoneal, and cutaneous lesions have also been reported in various combinations. Until the discovery that more than half of ECD patients harbor the BRAF-V600E mutation or other mutations in the mitogen-activated protein kinase (MAPK) and RAS pathways, Interferon-a was the first-line treatment. Nowadays BRAF and MEK-inhibitors targeted therapies are the mainstay of treatment. Ophthalmologic involvement occurs in 25% -30% of ECD cases, usually in the form of orbital involvement presenting with exophthalmos and ophthalmoplegia. Other ophthalmologic manifestations include palpebral xanthelasmas, anterior uveitis and vitritis, optic disk edema, choroidal infiltration, recurrent serous retinal detachment, retinal drusen-like deposits and retinal pigment epithelial changes. ECD patients can also present with ocular symptoms as a result of adverse effects of the treatment regimens. In some cases with smoldering or protean symptoms, the emergence of eye manifestations triggered the diagnosis. Ophthalmologists have to be aware of the disease, recognize the constellation of ECD symptoms, and contribute to the diagnosis, treatment, and follow-up of ECD patients.
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Affiliation(s)
| | - Petros Petrou
- G. Genimatas General Hospital, National and Kapodistrian University of Athens, 1st University Eye Clinic, Athens, Greece
| | - Giota Lourida
- Department of Internal Medicine and Infectious Disease, Sotiria Hospital, Athens, Greece
| | - Ilias Georgalas
- G. Genimatas General Hospital, National and Kapodistrian University of Athens, 1st University Eye Clinic, Athens, Greece.
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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: 177] [Impact Index Per Article: 59.0] [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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Budhram A, Rech KL, Peikert JM, Okuno SH, Go RS, Dubey D, Tobin WO. Teaching NeuroImages: Brain and Skin Involvement in Erdheim-Chester Disease. Neurology 2020; 96:e1590-e1592. [PMID: 33168700 DOI: 10.1212/wnl.0000000000011159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Adrian Budhram
- From the Departments of Neurology (A.B., D.D., W.O.T.), Pathology (K.L.R.), and Medicine (R.S.G.), Division of Hematology/Oncology, Mayo Clinic, Rochester, MN; and the Department of Medicine, Division of Dermatology (J.M.P.), and Medical Oncology (S.H.O.), Mayo Clinic Health System, Eau Claire, WI
| | - Karen L Rech
- From the Departments of Neurology (A.B., D.D., W.O.T.), Pathology (K.L.R.), and Medicine (R.S.G.), Division of Hematology/Oncology, Mayo Clinic, Rochester, MN; and the Department of Medicine, Division of Dermatology (J.M.P.), and Medical Oncology (S.H.O.), Mayo Clinic Health System, Eau Claire, WI
| | - Johann M Peikert
- From the Departments of Neurology (A.B., D.D., W.O.T.), Pathology (K.L.R.), and Medicine (R.S.G.), Division of Hematology/Oncology, Mayo Clinic, Rochester, MN; and the Department of Medicine, Division of Dermatology (J.M.P.), and Medical Oncology (S.H.O.), Mayo Clinic Health System, Eau Claire, WI
| | - Scott H Okuno
- From the Departments of Neurology (A.B., D.D., W.O.T.), Pathology (K.L.R.), and Medicine (R.S.G.), Division of Hematology/Oncology, Mayo Clinic, Rochester, MN; and the Department of Medicine, Division of Dermatology (J.M.P.), and Medical Oncology (S.H.O.), Mayo Clinic Health System, Eau Claire, WI
| | - Ronald S Go
- From the Departments of Neurology (A.B., D.D., W.O.T.), Pathology (K.L.R.), and Medicine (R.S.G.), Division of Hematology/Oncology, Mayo Clinic, Rochester, MN; and the Department of Medicine, Division of Dermatology (J.M.P.), and Medical Oncology (S.H.O.), Mayo Clinic Health System, Eau Claire, WI
| | - Divyanshu Dubey
- From the Departments of Neurology (A.B., D.D., W.O.T.), Pathology (K.L.R.), and Medicine (R.S.G.), Division of Hematology/Oncology, Mayo Clinic, Rochester, MN; and the Department of Medicine, Division of Dermatology (J.M.P.), and Medical Oncology (S.H.O.), Mayo Clinic Health System, Eau Claire, WI
| | - W Oliver Tobin
- From the Departments of Neurology (A.B., D.D., W.O.T.), Pathology (K.L.R.), and Medicine (R.S.G.), Division of Hematology/Oncology, Mayo Clinic, Rochester, MN; and the Department of Medicine, Division of Dermatology (J.M.P.), and Medical Oncology (S.H.O.), Mayo Clinic Health System, Eau Claire, WI.
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17
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Garg N, Lavi ES. Clinical and Neuroimaging Manifestations of Erdheim–Chester Disease: A Review. J Neuroimaging 2020; 31:35-44. [DOI: 10.1111/jon.12785] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 01/18/2023] Open
Affiliation(s)
- Neeta Garg
- Department of Neurology Miller School of Medicine University of Miami Miami FL
| | - Efrat Saraf Lavi
- Department of Radiology Miller School of Medicine University of Miami Miami Florida
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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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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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20
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Goyal G, Liu Y, Ravindran A, Al‐Kali A, Go RS, Patnaik MM, Rech KL. Concomitant Erdheim‐Chester disease and chronic myelomonocytic leukaemia: genomic insights into a common clonal origin. Br J Haematol 2019; 187:e51-e54. [DOI: 10.1111/bjh.16177] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Gaurav Goyal
- Division of Hematology Mayo Clinic Rochester MN USA
| | - Yuanhang Liu
- Department of Health Sciences Research Mayo Clinic Rochester MN USA
| | - Aishwarya Ravindran
- Department of Laboratory Medicine and Pathology Mayo Clinic Rochester MN USA
| | - Aref Al‐Kali
- Division of Hematology Mayo Clinic Rochester MN USA
| | - Ronald S. Go
- Division of Hematology Mayo Clinic Rochester MN USA
| | | | - Karen L. Rech
- Department of Laboratory Medicine and Pathology Mayo Clinic Rochester MN USA
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21
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Rose C. Erdheim–Chester disease: how a dermatologist can help to diagnose an extremely rare serious disorder. Br J Dermatol 2019; 182:273-274. [DOI: 10.1111/bjd.18415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- C. Rose
- Dermatopathology Laboratory Maria‐Goeppert‐Strasse 5 23562 Lübeck Germany
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