1
|
Wang XZ, Gao XM, Wang JM, Cai H, Li J, Cao XX. Co-occurrence of Erdheim-Chester disease and clonally evolving acute myeloid leukemia with FLT3-ITD and PTPN11 mutations. Ann Hematol 2024; 103:3229-3233. [PMID: 38879649 DOI: 10.1007/s00277-024-05842-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/09/2024] [Indexed: 07/28/2024]
Abstract
Erdheim-Chester disease (ECD) is a rare histiocytosis that tends to co-exist with other myeloid malignancies. Here, we use genetic and transcriptomic sequencing to delineate a case of co-occurring BRAFV600E-mutated ECD and acute myeloid leukemia (AML), followed by AML remission and relapse. The AML relapse involved the extinction of clones with KMT2A-AFDN and FLT3-ITD, and the predominance of PTPN11-mutated subclones with distinct transcriptomic features. This case report has highlighted the screening for other myeloid malignancies at the diagnosis of ECD and the clinical significance of PTPN11-mutated AML subclones that require meticulous monitoring.
Collapse
Affiliation(s)
- Xue-Zhu Wang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Xue-Min Gao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Jun-Mei Wang
- Neuropathological Department, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing Neurosurgical Institute, Beijing, China
| | - Hao Cai
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Jian Li
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Xin-Xin Cao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| |
Collapse
|
2
|
Goyal G, Acosta-Medina AA, Abeykoon JP, Dai C, Ravindran A, Vassallo R, Ryu JH, Shah MV, Bennani NN, Young JR, Bach CR, Ruan GJ, Zanwar S, Tobin WO, Koster MJ, Davidge-Pitts CJ, Gruber LM, Dasari S, Rech KL, Go RS. Long-term outcomes among adults with Langerhans cell histiocytosis. Blood Adv 2023; 7:6568-6578. [PMID: 37698994 PMCID: PMC10641096 DOI: 10.1182/bloodadvances.2023010706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/11/2023] [Accepted: 08/29/2023] [Indexed: 09/14/2023] Open
Abstract
Advances in the treatment of Langerhans cell histiocytosis (LCH) have resulted in a growing survivor population. There is a lack of data on long-term outcomes among adults with LCH. We conducted a retrospective record review of 219 adults (aged ≥18 years) with LCH. Most common presentation was multisystem (34.2%), followed by single-system pulmonary (32%), unifocal (28.3%), and single-system multifocal (5.5%) LCH. Risk organ involvement (the liver, spleen, or bone marrow) was seen in 8.7% of cases, and 40 of 88 (45.5%) tested cases were BRAFV600E. At a median follow-up of 74 months, 5-year progression-free survival (PFS) was 58.3% and estimated median PFS was 83 months. Median overall survival (OS) was not reached; 5- and 10-year OS rates were 88.7% and 74.5%, respectively. Risk organ involvement was associated with worse PFS (hazard ratio [HR], 4.5) and OS (HR, 10.8). BRAFV600E was not associated with risk organ involvement or survival. When compared with matched unaffected US population, individuals with LCH had a significantly higher risk of overall mortality (standardized mortality ratio [SMR], 2.66), specifically among those aged <55 years at diagnosis (SMR, 5.94) and those with multisystem disease (SMR, 4.12). Second cancers occurred in 16.4% cases, including diverse hematologic and solid organ malignancies. LCH-associated deaths constituted 36.1% of deaths and occurred within 5 years of diagnosis. After 5 years, non-LCH causes of death, including second cancers, chronic obstructive pulmonary disease, and cardiovascular diseases, predominated. Our study highlights, to our knowledge, for the first time, that adults with LCH experience early and late mortality from non-LCH causes and the need for development of targeted survivorship programs to improve outcomes.
Collapse
Affiliation(s)
- Gaurav Goyal
- Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | - Chen Dai
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | | | - 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
| | | | | | | | | | | | | | | | | | | | - Lucinda M. Gruber
- Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester, MN
| | - Surendra Dasari
- Division of Biomedical Statistics and Informatics, Department of Quantitative Health Sciences, 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
| | - Mayo Clinic-University of Alabama at Birmingham Histiocytosis Working Group
- Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL
- Division of Hematology, Mayo Clinic, Rochester, MN
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
- Division of Hematology, Mayo Clinic, Rochester, MN
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
- Department of Pathology, University of Alabama at Birmingham, Birmingham AL
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
- Department of Radiology, Mayo Clinic, Jacksonville, FL
- Department of Radiology, Mayo Clinic, Rochester, MN
- Department of Neurology, Mayo Clinic, Rochester, MN
- Division of Rheumatology, Mayo Clinic, Rochester, MN
- Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester, MN
- Division of Biomedical Statistics and Informatics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| |
Collapse
|
3
|
Qiao J, Ma R, Peng X, He W. Erdheim-Chester disease with bilateral orbital masses and multi-systemic symptoms: two case reports. World J Surg Oncol 2023; 21:233. [PMID: 37525276 PMCID: PMC10388563 DOI: 10.1186/s12957-023-03123-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 07/23/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Erdheim-Chester disease (ECD) is a rare histiocytic disorder characterized by multisystem xanthogranulomatous infiltration by lipid-laden histiocytes. We report two cases of ECD involving the orbit and describe their clinicopathologic factors, treatments, and prognosis. One was a rare case of ECD complicated with primary thrombocytosis. CASE PRESENTATION This study describes two patients with bilateral orbital ECD. Both presented with proptosis and visual loss; imaging findings showed bilateral intraorbital masses. Both had different degrees of systemic symptoms (pleural effusion, pericardial effusion, ascites, and heart failure) before the ocular symptoms and did not find the cause before ophthalmic tumor resection and pathological biopsy. The diagnosis of ECD was confirmed after pathological biopsy and detection of BRAFV600E mutation. Patient 2 also with primary thrombocytosis and had a CALR mutation as well as the BRAFV600E mutation. Both patients were recommended to receive targeted therapy. Patient 1 refused targeted therapy for financial reasons and was discharged after local radiotherapy only. The patient had no light perception in either eye and no improvement in systemic symptoms. Patient 2 began targeted treatment after diagnosis and reached the discharge criteria 2 weeks later. He is in good condition at present, but unfortunately, his eyesight has not improved because of the irreversible damage to his visual function. CONCLUSION ECD is easily misdiagnosed and missed because of its rarity and diverse clinical manifestations. Orbital involvement is common in ECD, and surgery is the most frequently employed approach. Despite the surgical resection is not curative, its significance lies in biopsy to establish diagnosis and/or surgical debulking to relieve mass effect, minimizing further impairment of visual function. Targeted therapy is the most effective treatment for patients with a positive BRAF mutation gene. Evaluation of a concomitant myeloid neoplasm is also critical before initiating targeted therapies for refractory ECD.
Collapse
Affiliation(s)
- JunYi Qiao
- Department of Ophthalmology, West China Hospital of Sichuan University, Sichuan, Chengdu, 610041, China
| | - Ruixin Ma
- Department of Ophthalmology, West China Hospital of Sichuan University, Sichuan, Chengdu, 610041, China
| | - Xiaolin Peng
- Department of Ophthalmology, West China Hospital of Sichuan University, Sichuan, Chengdu, 610041, China
| | - Weimin He
- Department of Ophthalmology, West China Hospital of Sichuan University, Sichuan, Chengdu, 610041, China.
| |
Collapse
|
4
|
Silveira LDHJ, Nogueira CD, Costa CT, de Azevedo PT, Magalhães SMM, Pinheiro RF. Erdheim-Chester disease after Essential Thrombocythemia: coincidence or not? Hematol Transfus Cell Ther 2023; 45:90-94. [PMID: 34034993 PMCID: PMC9938459 DOI: 10.1016/j.htct.2021.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/13/2021] [Accepted: 01/27/2021] [Indexed: 02/06/2023] Open
|
5
|
Kazama S, Yokoyama K, Ueki T, Kazumoto H, Satomi H, Sumi M, Ito I, Yusa N, Kasajima R, Shimizu E, Yamaguchi R, Imoto S, Miyano S, Tanaka Y, Denda T, Ota Y, Tojo A, Kobayashi H. Case report: Common clonal origin of concurrent langerhans cell histiocytosis and acute myeloid leukemia. Front Oncol 2022; 12:974307. [PMID: 36185232 PMCID: PMC9523168 DOI: 10.3389/fonc.2022.974307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) and acute myeloid leukemia (AML) are distinct entities of blood neoplasms, and the exact developmental origin of both neoplasms are considered be heterogenous among patients. However, reports of concurrent LCH and AML are rare. Herein we report a novel case of concurrent LCH and AML which shared same the driver mutations, strongly suggesting a common clonal origin.An 84-year-old female presented with cervical lymphadenopathy and pruritic skin rash on the face and scalp. Laboratory tests revealed pancytopenia with 13% of blasts, elevated LDH and liver enzymes, in addition to generalised lymphadenopathy and splenomegaly by computed tomography. Bone marrow specimens showed massive infiltration of MPO-positive myeloblasts, whereas S-100 and CD1a positive atypical dendritic cell-like cells accounted for 10% of the atypical cells on bone marrow pathology, suggesting a mixture of LCH and AML. A biopsy specimen from a cervical lymph node and the skin demonstrated the accumulation of atypical cells which were positive for S-100 and CD1a. LCH was found in lymph nodes, skin and bone marrow; AML was found in peripheral blood and bone marrow (AML was predominant compared with LCH in the bone marrow).Next generation sequencing revealed four somatic driver mutations (NRAS-G13D, IDH2-R140Q, and DNMT3A-F640fs/-I715fs), equally shared by both the lymph node and bone marrow, suggesting a common clonal origin for the concurrent LCH and AML. Prednisolone and vinblastine were initially given with partial response in LCH; peripheral blood blasts also disappeared for 3 months. Salvage chemotherapy with low dose cytarabine and aclarubicin were given for relapse, with partial response in both LCH and AML. She died from pneumonia and septicemia on day 384. Our case demonstrates a common cell of origin for LCH and AML with a common genetic mutation, providing evidence to support the proposal to classify histiocytosis, including LCH, as a myeloid/myeloproliferative malignancy.
Collapse
Affiliation(s)
- Shintaro Kazama
- Department of Hematology, Nagano Red Cross Hospital, Nagano, Japan
| | - Kazuaki Yokoyama
- Division of Molecular Therapy, Institute of Medical Science, Advanced Clinical Research Center, The University of Tokyo, Tokyo, Japan
- *Correspondence: Kazuaki Yokoyama, ; Arinobu Tojo,
| | - Toshimitsu Ueki
- Department of Hematology, Nagano Red Cross Hospital, Nagano, Japan
| | - Hiroko Kazumoto
- Department of Hematology, Nagano Red Cross Hospital, Nagano, Japan
| | - Hidetoshi Satomi
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Masahiko Sumi
- Department of Hematology, Nagano Red Cross Hospital, Nagano, Japan
| | - Ichiro Ito
- Department of Pathology, Nagano Red Cross Hospital, Nagano, Japan
| | - Nozomi Yusa
- Department of Applied Genomics, Research Hospital, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Rika Kasajima
- Molecular Pathology and Genetics Division, Kanagawa Cancer Center Research Institute, Yokohama, Japan
| | - Eigo Shimizu
- Division of Health Medical Data Science, Health Intelligence Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Rui Yamaguchi
- Division of Cancer Systems Biology, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Seiya Imoto
- Division of Health Medical Data Science, Health Intelligence Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Satoru Miyano
- Department of Integrated Data Science, Medical and Dental Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yukihisa Tanaka
- Department of Diagnostic Pathology, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Tamami Denda
- Department of Diagnostic Pathology, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Yasunori Ota
- Department of Diagnostic Pathology, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Arinobu Tojo
- Department of Data Science and Faculty Affairs, Tokyo Medical and Dental University, Tokyo, Japan
- *Correspondence: Kazuaki Yokoyama, ; Arinobu Tojo,
| | - Hikaru Kobayashi
- Department of Hematology, Nagano Red Cross Hospital, Nagano, Japan
| |
Collapse
|
6
|
Erdheim-Chester disease collides with myelodysplastic neoplasm in bone marrow. Ann Diagn Pathol 2022; 58:151928. [DOI: 10.1016/j.anndiagpath.2022.151928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 02/02/2022] [Accepted: 02/11/2022] [Indexed: 11/22/2022]
|
7
|
Vanhomwegen C, Mestrez F, Faverly D, Holz S, Taylor S, Rossi C. Indolent renal involvement with BRAF V600E mutation: Erdheim-Chester, a rare disease with a wide spectrum of clinical manifestations. Clin Case Rep 2021; 9:e04683. [PMID: 34466245 PMCID: PMC8385182 DOI: 10.1002/ccr3.4683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 07/06/2021] [Accepted: 07/18/2021] [Indexed: 12/02/2022] Open
Abstract
We present the case of a patient with three-year indolent bilateral ureteral and perirenal masses. Clinical presentation, radiological context, and histopathological findings with detection of BRAF V600E mutation confirmed the diagnosis of Erdheim-Chester disease (ECD). A review of current knowledge regarding diagnosis, clinical assessment, management, and treatment of ECD is also presented.
Collapse
Affiliation(s)
| | - Fabienne Mestrez
- Nephrology DepartmentAmbroise Paré Hospital Université Libre de BruxellesBruxellesBelgium
| | - Daniel Faverly
- Pathology DepartmentAmbroise Paré Hospital Université Libre de BruxellesBruxellesBelgium
| | - Serge Holz
- Urology DepartmentAmbroise Paré Hospital Université Libre de BruxellesBruxellesBelgium
| | - Stephen Taylor
- Radiology UnitAmbroise Paré Hospital Université Libre de BruxellesBruxellesBelgium
| | - Camelia Rossi
- Infectious Disease DepartmentAmbroise Paré Hospital Université Libre de BruxellesBruxellesBelgium
| |
Collapse
|
8
|
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.
Collapse
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.
| |
Collapse
|
9
|
|
10
|
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.
Collapse
|
11
|
Li JJ, Talam S, Star P, Getta B. Atypical cutaneous histiocytic eruption in a patient with chronic myelomonocytic leukemia: A case report. J Cutan Pathol 2021; 48:680-688. [PMID: 33416192 DOI: 10.1111/cup.13957] [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: 08/27/2020] [Revised: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 11/27/2022]
Abstract
Chronic myelomonocytic leukemia (CMML) is a clonal hematopoietic stem cell malignancy with features of both a myeloproliferative neoplasm and a myelodysplastic syndrome. We present a case of 72-year-old man with CMML who presented with generalized hemorrhagic papules and plaques which on histopathology showed a peculiar infiltrate of atypical mature histiocytes. The immunohistochemical markers for Langerhans cells, indeterminate dendritic cells, and plasmacytoid dendritic cells were negative. Next generation sequencing performed on the paraffin block of the leg biopsy specimen revealed identical ASXL1, SRSF2, and KRAS mutations as seen in the CMML clone of the peripheral blood. Along with recent literature, this case illustrates the spectrum of histiocytic and dendritic cell proliferations in CMML, many of which may be clonally related to the hematopoietic malignancy.
Collapse
Affiliation(s)
- Jing Jing Li
- Department of Anatomical Pathology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Stephanie Talam
- Department of Hematology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Phoebe Star
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Bartlomiej Getta
- Department of Hematology, Liverpool Hospital, Liverpool, New South Wales, Australia
| |
Collapse
|
12
|
Kemps PG, Hebeda KM, Pals ST, Verdijk RM, Lam KH, Bruggink AH, de Lil HS, Ruiterkamp B, de Heer K, van Laar JAM, Valk PJM, Mutsaers P, Levin M, Hogendoorn PCW, van Halteren AGS. Spectrum of histiocytic neoplasms associated with diverse haematological malignancies bearing the same oncogenic mutation. J Pathol Clin Res 2021; 7:10-26. [PMID: 32852896 PMCID: PMC7737785 DOI: 10.1002/cjp2.177] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/18/2020] [Accepted: 06/25/2020] [Indexed: 12/14/2022]
Abstract
Histiocytic disorders are a spectrum of rare diseases characterised by the accumulation of macrophage-, dendritic cell-, or monocyte-differentiated cells in various tissues and organs. The discovery of recurrent genetic alterations in many of these histiocytoses has led to their recognition as clonal neoplastic diseases. Moreover, the identification of the same somatic mutation in histiocytic lesions and peripheral blood and/or bone marrow cells from histiocytosis patients has provided evidence for systemic histiocytic neoplasms to originate from haematopoietic stem/progenitor cells (HSPCs). Here, we investigated associations between histiocytic disorders and additional haematological malignancies bearing the same genetic alteration(s) using the nationwide Dutch Pathology Registry. By searching on pathologist-assigned diagnostic terms for the various histiocytic disorders, we identified 4602 patients with a putative histopathological diagnosis of a histiocytic disorder between 1971 and 2019. Histiocytosis-affected tissue samples of 187 patients had been analysed for genetic alterations as part of routine molecular diagnostics, including from nine patients with an additional haematological malignancy. Among these patients, we discovered three cases with different histiocytic neoplasms and additional haematological malignancies bearing identical oncogenic mutations, including one patient with concomitant KRAS p.A59E mutated histiocytic sarcoma and chronic myelomonocytic leukaemia (CMML), one patient with synchronous NRAS p.G12V mutated indeterminate cell histiocytosis and CMML, and one patient with subsequent NRAS p.Q61R mutated Erdheim-Chester disease and acute myeloid leukaemia. These cases support the existence of a common haematopoietic cell-of-origin in at least a proportion of patients with a histiocytic neoplasm and additional haematological malignancy. In addition, they suggest that driver mutations in particular genes (e.g. N/KRAS) may specifically predispose to the development of an additional clonally related haematological malignancy or secondary histiocytic neoplasm. Finally, the putative existence of derailed multipotent HSPCs in these patients emphasises the importance of adequate (bone marrow) staging, molecular analysis and long-term follow-up of all histiocytosis patients.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/genetics
- Erdheim-Chester Disease/genetics
- Erdheim-Chester Disease/pathology
- Erdheim-Chester Disease/therapy
- Fatal Outcome
- GTP Phosphohydrolases/genetics
- Genetic Predisposition to Disease
- Histiocytic Sarcoma/genetics
- Histiocytic Sarcoma/pathology
- Histiocytic Sarcoma/therapy
- Humans
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/pathology
- Leukemia, Myeloid, Acute/therapy
- Leukemia, Myelomonocytic, Chronic/genetics
- Leukemia, Myelomonocytic, Chronic/pathology
- Leukemia, Myelomonocytic, Chronic/therapy
- Male
- Membrane Proteins/genetics
- Middle Aged
- Mutation
- Phenotype
- Proto-Oncogene Proteins p21(ras)/genetics
- Retrospective Studies
- Treatment Outcome
Collapse
Affiliation(s)
- Paul G Kemps
- Department of PaediatricsLeiden University Medical CenterLeidenThe Netherlands
| | - Konnie M Hebeda
- Department of PathologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Steven T Pals
- Department of PathologyAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Robert M Verdijk
- Department of PathologyErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
- Department of PathologyLeiden University Medical CenterLeidenThe Netherlands
| | - King H Lam
- Department of PathologyErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
| | - Annette H Bruggink
- PALGA Foundation (Nationwide Network and Registry of Histopathology and Cytopathology)HoutenThe Netherlands
| | - Heleen S de Lil
- Department of HaematologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Bart Ruiterkamp
- Department of HaematologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Koen de Heer
- Department of HaematologyAmsterdam University Medical CentersAmsterdamThe Netherlands
- Department of HaematologyFlevoziekenhuisAlmereThe Netherlands
| | - Jan AM van Laar
- Department of Internal MedicineErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
- Department of ImmunologyErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
| | - Peter JM Valk
- Department of HaematologyErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
| | - Pim Mutsaers
- Department of HaematologyErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
| | - Mark‐David Levin
- Department of Internal MedicineAlbert Schweitzer ZiekenhuisDordrechtThe Netherlands
| | | | - Astrid GS van Halteren
- Department of PaediatricsLeiden University Medical CenterLeidenThe Netherlands
- Princess Máxima Center for Paediatric OncologyUtrechtThe Netherlands
| |
Collapse
|
13
|
Goyal G, Ravindran A, Liu Y, He R, Shah MV, Bennani NN, Patnaik MM, Rech KL, Go RS. Bone marrow findings in Erdheim-Chester disease: increased prevalence of chronic myeloid neoplasms. Haematologica 2020; 105:e84-e86. [PMID: 31624111 DOI: 10.3324/haematol.2019.234187] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
| | | | - Yuanhang Liu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Rong He
- Department of Laboratory Medicine and Pathology, Mayo Clinic
| | | | | | | | - Karen L Rech
- Department of Laboratory Medicine and Pathology, Mayo Clinic
| | | | | |
Collapse
|