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Liu R, Guo Y, Han L, Feng S, Cao J, Sun Y, Cao Z, Cui X. Somatic ARAF mutations in pediatric Langerhans cell histiocytosis: clinicopathologic, genetic and functional profiling. Clin Exp Med 2023; 23:5269-5279. [PMID: 37572153 DOI: 10.1007/s10238-023-01134-w] [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: 05/18/2023] [Accepted: 06/29/2023] [Indexed: 08/14/2023]
Abstract
ARAF mutations have been identified in a limited subset of patients with Langerhans cell histiocytosis (LCH), a rare disorder characterized by abnormal proliferation of Langerhans cells. LCH is primarily instigated by mutations in the mitogen-activated protein kinase (MAPK) signaling pathway, with BRAFV600E and MAP2K1 mutations constituting most cases. ARAF mutations in LCH highlight the heterogeneity of the disease and provide insights into its underlying molecular mechanisms. However, the occurrence of ARAF-positive LCH cases is extremely rare, with only two reported globally. Although they may be linked to a more aggressive form of LCH and a more severe clinical progression, the clinical significance and functional consequences of these mutations remain uncertain. We performed next-generation sequencing (NGS) to explore driver mutations in 148 pediatric LCH patients and recognized a series of mutations, including an identical novel somatic ARAF mutation, c.1046_1051delAGGCTT (p.Q349_F351delinsL), in four pediatric LCH patients. It was considered an ARAF hotspot mutation. All reported ARAF-positive patients worldwide exhibited characteristic pathological features of LCH, albeit with involvement across multiple systems. In vitro functional studies showed that this mutation could trigger the MAPKinase pathway and phosphorylate its downstream effectors MEK1/2 and ERK1/2 (relatively weaker than BRAFV600E). Over-activation of mutant A-Raf kinase could be inhibited by the BRAF inhibitor vemurafenib. LCH is uncommon, and ARAF mutation is even rarer. In our study, we have identified a novel hotspot somatic ARAF mutation, which has been verified through functional analysis to be an activating mutation. LCH patients with ARAF mutation typically have an unfavorable prognosis due to limited treatment experiences, although they do not exhibit a high relapse rate. To aid in the development of personalized treatment approaches and prognostic markers for LCH patients, it is recommended to conduct typical pathological and immunohistochemical examinations, as well as genetic tests utilizing a targeted gene panel or whole exome sequencing (WES), for LCH diagnosis, thereby promoting the use of inhibitor treatment strategies.
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Affiliation(s)
- Rong Liu
- Department of Hematology, Capital Institute of Pediatrics, Chaoyang District, Beijing, 100020, China
| | - Yibing Guo
- GrandOmics Inc, Haidian District, Beijing, 100081, China
| | - Lin Han
- GrandOmics Inc, Haidian District, Beijing, 100081, China
| | - Shunqiao Feng
- Department of Hematology, Capital Institute of Pediatrics, Chaoyang District, Beijing, 100020, China
| | - Jing Cao
- Department of Hematology, Capital Institute of Pediatrics, Chaoyang District, Beijing, 100020, China
| | - Yanling Sun
- GrandOmics Inc, Haidian District, Beijing, 100081, China
| | - Zhenhua Cao
- GrandOmics Inc, Haidian District, Beijing, 100081, China.
| | - Xiaodai Cui
- Clinical Central Laboratory, Capital Institute of Pediatrics, Beijing, 100020, China.
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Javadi T, Hill C, McLemore ML, Oskouei S, Bahrami A. Adult-onset Langerhans cell histiocytosis of bone: A case series highlighting a rare entity. Ann Diagn Pathol 2023; 66:152171. [PMID: 37295039 DOI: 10.1016/j.anndiagpath.2023.152171] [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: 04/29/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
Langerhans cell histiocytosis (LCH) is a neoplastic disorder derived from LCH precursor cells that can manifest as a single-system disease or a multisystem disorder. While extensively studied in children, LCH has received less attention in adult patients. We aimed to investigate the pathology and clinical course of LCH in adults presenting with a bone lesion. Cases of osseous LCH diagnosed in patients ≥18 in our center were analyzed. Histologic slides were reviewed, and clinical data were collated. Molecular analysis for BRAF mutation was performed in a subset. Twelve osseous LCH cases with classic morphology and CD1a+/S100+ immunophenotype were identified. Tumors occurred in six females and five males with a median age of 34 years (range: 18-77 years) and involved the craniofacial bones (4), pelvis (3), spine (2), appendicular skeleton (2), and rib (1). Radiographically, tumors appeared as ill-defined lytic lesions, often accompanied by cortical erosion and soft tissue extension, with pain being the most common presentation. On staging work-up with available data, two patients had multifocal bone lesions, two had multi-system disease, and four had solitary lesions. Two patients had prior or concurrent neoplasms, and 63 % of patients (5 out of 8) had a history of smoking. BRAF mutational analysis performed in six cases revealed a BRAFV600E mutation in one, negative result in one, and failed in four archived specimens. Our study highlights the importance of performing staging in patients with adult-onset LCH presenting as a bone lesion, as the clinical extent of the disease can vary widely among individuals.
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Affiliation(s)
- Tiffany Javadi
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Charles Hill
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Morgan Lee McLemore
- Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Shervin Oskouei
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Armita Bahrami
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA.
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3
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Eckstein OS, Bernhardt MB, Hood CG, Karri V, Kralik SF, McClain KL. Treatment of Langerhans cell histiocytosis with subcutaneous cytarabine. Pediatr Hematol Oncol 2023:1-9. [PMID: 36625721 DOI: 10.1080/08880018.2022.2137609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Patients with Langerhans cell histiocytosis (LCH) have been effectively treated with intravenous cytarabine. Intravenous or subcutaneous cytarabine infusions have been effective for leukemia patients, and pharmacokinetic studies have shown very similar blood levels of the drug with either route. We present three LCH patients treated with subcutaneous cytarabine either because intravenous access could not be maintained or due to patient refusal. One patient with pulmonary and skin LCH had a complete response. Another patient had a partial response of pulmonary and cutaneous lesions, but progressive bone disease. The third patient was treated for LCH-related cerebellar changes eight years after the diagnosis of isolated diabetes insipidus, with stable brain MRI for 5 years post-treatment. Subcutaneous cytarabine administration provides an alternative for patients with LCH in whom vascular access is not possible or practical, such as in some resource-limited circumstances.
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Affiliation(s)
- Olive S Eckstein
- Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, Texas, USA
| | - M Brooke Bernhardt
- Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, Texas, USA
| | - Chelsey G Hood
- Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, Texas, USA
| | - Vivekanudeep Karri
- Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, Texas, USA
| | - Stephen F Kralik
- Texas Children's Department of Radiology, Baylor College of Medicine, Houston, Texas, USA
| | - Kenneth L McClain
- Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, Texas, USA
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Riley G, Pettit T. A rare case of Haemophagocytic Lymphohistiocytosis preceding a diagnosis of Langerhans cell histiocytosis. Pediatr Blood Cancer 2022; 69:e29727. [PMID: 35652532 DOI: 10.1002/pbc.29727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Guy Riley
- Child Haematology and Oncology Centre, Waipapa Hospital, Christchurch, New Zealand
| | - Tristan Pettit
- Child Haematology and Oncology Centre, Waipapa Hospital, Christchurch, New Zealand
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Mitchell J, Kannourakis G. Does CD1a Expression Influence T Cell Function in Patients With Langerhans Cell Histiocytosis? Front Immunol 2021; 12:773598. [PMID: 34956202 PMCID: PMC8702800 DOI: 10.3389/fimmu.2021.773598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/25/2021] [Indexed: 11/13/2022] Open
Abstract
Langerhans cell histiocytosis lesions are characterized by CD1a+ myeloid lineage LCH cells and an inflammatory infiltrate of cytokines and immune cells, including T cells. T cells that recognize CD1a may be implicated in the pathology of many disease states including cancer and autoimmunity but have not been studied in the context of LCH despite the expression of CD1a by LCH cells. In this perspective article, we discuss the expression of CD1a by LCH cells, and we explore the potential for T cells that recognize CD1a to be involved in LCH pathogenesis.
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Affiliation(s)
- Jenée Mitchell
- Fiona Elsey Cancer Research Institute, Ballarat, VIC, Australia
| | - George Kannourakis
- Fiona Elsey Cancer Research Institute, Ballarat, VIC, Australia
- Federation University Australia, Ballarat, VIC, Australia
- *Correspondence: George Kannourakis,
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Kitticharoenjit P, Supakul N, Rujkijyanont P, Traivaree C, Photia A, Monsereenusorn C. Clinical characteristics and outcomes of Langerhans cell histiocytosis at a single institution in Thailand: a 20-year retrospective study. ASIAN BIOMED 2021; 15:171-181. [PMID: 37551332 PMCID: PMC10388756 DOI: 10.2478/abm-2021-0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Langerhans cell histiocytosis (LCH) is a rare disease characterized by the various systems involved and clinical manifestations with a wide range of symptoms. Objectives To describe clinical characteristics, imaging, treatment, and outcomes of pediatric LCH at Phramongkutklao Hospital, Bangkok, Thailand. Methods We conducted a 20-year retrospective review of the medical records of patients diagnosed with LCH from birth to 21 years old from January 1, 1997, to December 31, 2016. Results In all, 14 patients with median age of 2.5 years were studied. Six (43%) patients had single-system (SS) LCH. Five patients (63%) with multisystem (MS) LCH (n = 8. 57%) had risk-organ involvement (RO+). All patients had plain X-ray imaging of their skull with 11 (79%) showing abnormal findings. Tc-99m bone imaging and fluorodeoxyglucose F18 (FDG) positron emission tomography (PET)-computed tomography (CT) demonstrated abnormal findings in 8 (89%) and 4 (29%) patients, respectively. The 5-year event-free survival (EFS) for patients with RO+ MS-LCH was less than that for those without risk-organ involvement (RO-) MS-LCH and SS-LCH (20% vs. 100%, P = 0.005). Hematological dysfunction, hypoalbuminemia, and conjugated hyperbilirubinemia may be worse prognostic factors for RO+ MS-LCH. Conclusion FDG-PET-CT might have a greater accuracy to detect LCH disease than conventional plain X-ray and Tc-99m bone imaging. RO+ MS-LCH has been encountered with relapse and poor outcomes. Hematopoietic involvement, hypoalbuminemia, and conjugated hyperbilirubinemia may be worse prognostic factors for RO+ MS-LCH.
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Affiliation(s)
| | - Nucharin Supakul
- Department of Radiology and Imaging Science, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN46202, United States of America
| | - Piya Rujkijyanont
- Division of Hematology–Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok10400, Thailand
| | - Chanchai Traivaree
- Division of Hematology–Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok10400, Thailand
| | - Apichat Photia
- Division of Hematology–Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok10400, Thailand
| | - Chalinee Monsereenusorn
- Division of Hematology–Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok10400, Thailand
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Fadhel Alvarez A, Patel SP, Brasher MI, Ruggiero JE, Aneji C. Langerhans cell histiocytosis: Presentation in a preterm neonate. Cancer Rep (Hoboken) 2021; 5:e1472. [PMID: 34156158 PMCID: PMC8842702 DOI: 10.1002/cnr2.1472] [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: 04/09/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 11/11/2022] Open
Abstract
Background Langerhans cell histiocytosis (LCH) is a rare disorder in which Langerhans cells (LC) accumulate in the skin or other organs and cause tumor formation or organ damage. Cutaneous lesions can vary widely and do not predict extent of systemic disease or prognosis. Case We present a premature infant with skin findings, multisystem involvement, and immunohistochemical markers consistent with multisystem LCH. Conclusion Limited data from preterm neonates with LCH suggest that prognosis is particularly poor, with even limited cutaneous disease often rapidly progressing to become fatal, although diagnosis is not always prompt. Early diagnosis and treatment may affect prognosis.
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Affiliation(s)
- Ana Fadhel Alvarez
- Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
| | - Shaily P Patel
- Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
| | - Maya I Brasher
- Department of Pediatrics, Division of Neonatology, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
| | - Jaclyn E Ruggiero
- Department of Pediatrics, Division of Neonatology, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
| | - Chiamaka Aneji
- Department of Pediatrics, Division of Neonatology, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
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Lin CY, Lee CC, Wu KW, Yuan CT, Kuo KN, Wang TM. Solitary tibial lesion as the initial presentation of Langerhans cell histiocytosis: report of two cases and literature review. J Int Med Res 2021; 49:300060520982826. [PMID: 33472472 PMCID: PMC7829610 DOI: 10.1177/0300060520982826] [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] [Indexed: 11/30/2022] Open
Abstract
The various presentations of osseous Langerhans cell histiocytosis (LCH) make it
difficult to distinguish from other bone diseases. In addition, there is no
universally accepted protocol for managing osseous LCH for single non-central
nervous system-risk lesions. Here, the rare cases of two paediatric patients,
aged 1 and 2 years, who presented with a solitary tibial lesion at time of LCH
diagnosis, are reported. One patient progressed to multiple lesions after
curettage of the original lesion. Subsequently, both patients received
preventive chemotherapy using the Taiwan Paediatric Oncology Group (TPOG)
revised protocol for treating low risk patients with LCH, namely, TPOG
LCH2002-LR. After receiving this treatment, which included a schedule of
prednisolone and vincristine for 6 weeks, followed by prednisolone, vincristine
and 6-mercaptopurine for a further 48 weeks, both patients are free from
recurrence or progression.
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Affiliation(s)
- Chih-Yang Lin
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chia-Che Lee
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.,School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kuan-Wen Wu
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.,School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chang-Tsu Yuan
- School of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ken-Nan Kuo
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.,School of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Orthopaedic Surgery, Chiayi Christian Hospital, Chiayi, Taiwan
| | - Ting-Ming Wang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.,School of Medicine, National Taiwan University, Taipei, Taiwan
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Monteiro AC, Bonomo A. Dendritic cells development into osteoclast-type APCs by 4T1 breast tumor T cells milieu boost bone consumption. Bone 2021; 143:115755. [PMID: 33217627 DOI: 10.1016/j.bone.2020.115755] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 12/23/2022]
Abstract
Bone metastases occur in 70% of patients with advanced breast cancer, causing severe morbidity and increased mortality due to osteolytic lesions driven by osteoclasts (OCs) inside the bone marrow (BM) microenvironment. A reciprocal vicious cycle between bone remodeling system and the tumor itself is established by the release of growth factors stored in the mineralized matrix, which in turn feed the tumor, changing tumor behavior and growth. However, BM is not a passive host microenvironment for circulating tumor cells, but instead can be actively modified by the primary tumor before metastatic spread occurs. Indeed, we have shown that T cells specific for the 4T1 mammary carcinoma cell line, are characteristically RANKL+ IL-17F+ CD4+ T cells. Those cells arrive in the BM before metastatic cells and set the pre-metastatic niche. In the absence of T cell derived RANKL, there is no pre-metastatic osteolytic disease and bone metastases do not take place. Recently, dendritic cells (DCs), the main T cell partner at the beginning of the immune response, came into the spotlight as a potential source of OCs progenitors under inflammatory conditions. Regarding bone metastasis, nothing is currently known about DCs plasticity or even its partnership with tumor induced T cells for BM pre-metastatic niche formation. Here, we show that splenic CD11c+ DCs stimulated with 4T1 conditioned media (CM) efficiently differentiated into mature and activated multinucleated giant cells (DC-OC) expressing TRAP and IL-23 cytokine. More important, 4T1 CM derived DC-OCs build a positive loop which amplifies the osteolytic phenomena by maintaining the RANKL+ Th17 T cells and by its own osteoclastic activity. In conclusion, our results indicate that differentiation of OCs from DCs may be achievable in the bone pre osteolytic disease context representing an alternative OC differentiation pathway. Besides being induced by high levels of T cells pro osteoclastogenic cytokines, especially by RANKL, DC-OC keep a positive feedback loop towards osteolysis, maintaining the pro-osteoclastogenic T cell phenotype in the BM.
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Affiliation(s)
- Ana Carolina Monteiro
- Laboratory of Osteo and Tumor Immunology, Department of Immunobiology, Fluminense Federal University, Rio de Janeiro, Brazil; Laboratory on Thymus Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
| | - Adriana Bonomo
- Laboratory on Thymus Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; National Institute of Science and Technology on Neuroimmunomodulation (INCT-NIM), Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; Research Network on Neuroinflammation (RENEURIN), Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
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Hinson AR, Patel N, Kaplan J. Hemophagocytic Lymphohistiocytosis in Langerhans Cell Histiocytosis: A Case Report and Review of the Literature. J Pediatr Hematol Oncol 2021; 43:24-27. [PMID: 31725543 PMCID: PMC7737855 DOI: 10.1097/mph.0000000000001652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/13/2019] [Indexed: 11/26/2022]
Abstract
A toddler undergoing treatment for refractory Langerhans cell histiocytosis (LCH) developed concurrent hemophagocytic lymphohistiocytosis (HLH). These are thought to be distinct histiocytic disorders, with different pathophysiologies, diagnostic criteria, and treatments. HLH in a patient with LCH is thought to be quite rare. In this report, we review the presentation of our patient, as well as review the existing literature of other pediatric patients who have been diagnosed with both LCH and HLH.
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Affiliation(s)
- Ashley R.P. Hinson
- Division of Pediatric Cancer and Blood Disorders
- Atrium Health, Levine Children’s Hospital, Charlotte, NC
| | - Niraj Patel
- Division of Immunology and Infectious Diseases
- Atrium Health, Levine Children’s Hospital, Charlotte, NC
| | - Joel Kaplan
- Division of Pediatric Cancer and Blood Disorders
- Atrium Health, Levine Children’s Hospital, Charlotte, NC
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Matsubara Y, Kobayashi M, Hijikata Y, Ota Y, Hirata Y, Lim LA, Yotsuyanagi H, Tojo A. Gastrointestinal lesion in adult-onset Langerhans cell histiocytosis. Int J Clin Oncol 2020; 25:1945-1950. [PMID: 32901339 DOI: 10.1007/s10147-020-01739-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a rare disease primarily occurring in children, and commonly involves the bone and skin; gastrointestinal tract involvement is notably rare. The incidence and significance of gastrointestinal lesions in adult LCH are unclear; thus, we aimed to investigate adult Japanese cases of LCH and clarify the features of gastrointestinal involvement. METHODS We gathered clinical information on 43 Japanese cases of adult LCH and analyzed patient backgrounds, affected organs, features of the gastrointestinal lesions, and the clinical courses. RESULTS Thirteen patients underwent endoscopic examinations: an upper gastrointestinal endoscopy alone in 5, lower gastrointestinal endoscopy alone in 3, and both in 5 patients. A gastric lesion (one case), colonic lesion (one case), and both gastric and rectal lesions (one case) were detected. The three cases of gastrointestinal involvement also exhibited nongastrointestinal multisystem LCH lesions and showed no gastrointestinal symptoms or increased uptake on positron emission tomography. Endoscopy revealed small erosions without specific features; histological examinations were required for diagnosis. These three cases were treated with chemotherapy, comprising vinblastine/prednisolone, methotrexate, and daily 6-mercaptopurine, for 36 weeks; in two cases, the clinical condition remained stable for several years post-treatment. One case showed recurrence 1 year 7 months after treatment, and chemotherapy was re-administered. No case with single-system disease exhibited gastrointestinal involvement. CONCLUSIONS Although gastrointestinal LCH lesions are rare, they were more common than expected in our cases of multisystem LCH. However, these lesions were relatively small and did not affect the patients' clinical courses.
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Affiliation(s)
- Yasuo Matsubara
- Department of General Medicine, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Masayuki Kobayashi
- Department of Hematology/Oncology, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Yasuki Hijikata
- Department of General Medicine, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Yasunori Ota
- Department of Diagnostic Pathology, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Yoshihiro Hirata
- Department of General Medicine, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Lay Ahyoung Lim
- Department of General Medicine, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Hiroshi Yotsuyanagi
- Department of General Medicine, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Arinobu Tojo
- Department of Hematology/Oncology, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan.
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Kim HM, Yang WI, Lyu CJ, Hahn SM, Yoon SO. Descriptive Analysis of Histiocytic and Dendritic Cell Neoplasms: A Single-Institution Experience. Yonsei Med J 2020; 61:774-779. [PMID: 32882761 PMCID: PMC7471072 DOI: 10.3349/ymj.2020.61.9.774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/21/2020] [Accepted: 08/06/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Histiocytic and dendritic cell neoplasms are rare hematologic tumors. This study aimed to describe the epidemiologic features of the entire spectrum of histiocytic and dendritic cell neoplasms, including clinicopathological variables and patient outcomes. MATERIALS AND METHODS We comprehensively reviewed 274 patients who were diagnosed with histiocytic and dendritic neoplasms at Severance Hospital, Seoul, South Korea between 1995 and 2018. RESULTS The most common neoplasm was Langerhans cell histiocytosis (LCH), followed by dermal xanthogranuloma. Among non-LCH sarcomas, histiocytic sarcoma (HS) showed a relatively high prevalence, followed by follicular dendritic cell sarcoma (FDCS). Disseminated juvenile xanthogranuloma (DJG), Erdheim-Chester disease (ECD), indeterminate dendritic cell tumor (IDCT), and interdigitating dendritic cell sarcoma (IDCS) rarely occurred. Generally, these tumors presented in childhood, although the non-LCH sarcoma (HS/FDCS/IDCS/IDCT) group of tumors and ECD occurred in late adulthood. Multiorgan involvement and advanced Ann-Arbor stage, as well as recurrence and death of disease, were not uncommon. The non-LCH sarcoma group had the worst overall survival, compared to the DJG, ECD, and LCH groups. CONCLUSION Our findings indicate that histiocytic and dendritic cell neoplasms exhibit heterogeneous epidemiologic characteristics and that some patients may have unfavorable outcomes, especially those with non-LCH sarcoma.
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Affiliation(s)
- Hye Min Kim
- Department of Pathology, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - Woo Ick Yang
- Department of Pathology, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - Chuhl Joo Lyu
- Department of Pediatrics, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - Seung Min Hahn
- Department of Pediatrics, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - Sun Och Yoon
- Department of Pathology, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea.
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The combination of methotrexate and cytosine arabinoside in newly diagnosed adult Langerhans cell histiocytosis: a prospective phase II interventional clinical trial. BMC Cancer 2020; 20:433. [PMID: 32423455 PMCID: PMC7236107 DOI: 10.1186/s12885-020-06872-8] [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: 06/13/2019] [Accepted: 04/15/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Langerhans Cell Histiocytosis (LCH) is a rare disease puzzling both children and adults, however outcome of adult patients is unfavorable. This prospective interventional trial aims to test the efficacy and safety of the combination of methotrexate and cytosine arabinoside in adult LCH patients. METHOD A total of 36 patients enrolled diagnosed with LCH and treated in our center from 1st Jan, 2014 to 30th Jun, 2016. RESULT Nineteen patients underwent the detection of BRAF mutation, with a positive rate of 21.1%. The overall response rate was 100%, only 16.7% achieved complete response. The overall regression rate of osseous lesions was 100%. Regression of central nervous system involvement was also favorable. After a median follow-up of 44 months, the estimated event-free survival was 48.9 months, the overall survival rate was 97.2%. The risk organ involvement showed strong prognostic value, EFS was 34.1 or 54.6 months (p = 0.001) in groups with/without risk organ involvement respectively. Neutropenia and thrombocytopenia were the most common adverse effects. CONCLUSION The regimen of methotrexate and cytosine arabinoside (MA) is effective and safe in treating adult LCH patients, and timely preventions may be considered for the high incidence of hematological adverse effects. TRIAL REGISTRATION Trial No. NCT02389400 on Clinicaltrials.gov, registered on 10th Mar. 2015.
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14
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Yoon HS. A Recent Update on Histiocytic Disorder in Children: Focus on Diagnosis and Treatment. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2020. [DOI: 10.15264/cpho.2020.27.1.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hoi Soo Yoon
- Department of Pediatrics, Kyung Hee University College of Medicine, Seoul, Korea
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15
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Nirmala C, Banerjee S, Imthiyaz M, Sridevi M. Study of fatty acid profiles in fish wastes and in silico evaluation of unsaturated fatty acids for mutant B‐Raf kinase inhibition. J FOOD PROCESS ENG 2020. [DOI: 10.1111/jfpe.13272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Chockalingam Nirmala
- Department of BiotechnologyVinayaka Mission's Kirupananda Variyar Engineering College, Vinayaka Mission's Research Foundation (Deemed to be University) Salem Tamil Nadu India
| | | | - Mohammed Imthiyaz
- Department of BiotechnologyVinayaka Mission's Kirupananda Variyar Engineering College, Vinayaka Mission's Research Foundation (Deemed to be University) Salem Tamil Nadu India
| | - Muruhan Sridevi
- Department of BiotechnologyVinayaka Mission's Kirupananda Variyar Engineering College, Vinayaka Mission's Research Foundation (Deemed to be University) Salem Tamil Nadu India
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16
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Leung AKC, Lam JM, Leong KF. Childhood Langerhans cell histiocytosis: a disease with many faces. World J Pediatr 2019; 15:536-545. [PMID: 31456157 DOI: 10.1007/s12519-019-00304-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/01/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a group of diseases characterized by the proliferation and accumulation of Langerhans cells. Clinical presentations of LCH vary widely. DATA SOURCES A PubMed search was conducted using Clinical Queries with the key term "Langerhans cell histiocytosis". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. This paper is based on, but not limited to, the search results. RESULTS Generally, patients with LCH can be divided into two groups based on the extent of involvement at diagnosis, namely, single-system LCH and multisystem LCH. The involvement may be unifocal or multifocal. Patients with isolated bone lesions typically present between 5 and 15 years of age, whereas those with multisystem LCH tend to present before 5 years of age. The clinical spectrum is broad, ranging from an asymptomatic isolated skin or bone lesion to a life-threatening multisystem condition. Clinical manifestations include, among others, "punched out" lytic bone lesion, seborrheic dermatitis-like eruption, erythematous/reddish-brown crusted/scaly papules/maculopapules/plaques/patches, and eczematous lesions, diabetes insipidus, hepatosplenomegaly, cytopenias, lymphadenopathy, and an acute fulminant disseminated multisystem condition presenting with fever, skin rash, anemia, thrombocytopenia, lymphadenopathy, and hepatosplenomegaly. The diagnosis is clinicopathologic, based on typical clinical findings and histologic/immunohistochemical examination of a biopsy of lesional tissue. Positive CD1a, S100, and/or CD207 (Langerin) immunohistochemical staining of lesional cells is required for a definitive diagnosis. Watchful waiting is recommended for patients with skin-only LCH. Patients with symptomatic or refractory skin-only LCH may be treated with topical tacrolimus/corticosteroids, topical nitrogen mustard, oral methotrexate, or oral hydroxyurea. The current recommended first-line therapy for patients with multisystem LCH is 12 months therapy with prednisone and vinblastine. Mercaptopurine is added for patients with risk organ involvements. CONCLUSIONS Because of the broad spectrum of clinical manifestations and the extreme diversity of disease, LCH remains a diagnostic dilemma. Morphological identification of LCH cells and positive immunochemical staining with CD1a, S100, and/or CD207 (Langerin) of lesional cells are necessary for a definitive diagnosis.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, and The Alberta Children's Hospital, #200, 233, 16th Avenue NW, Calgary, AB, T2M 0H5, Canada.
| | - Joseph M Lam
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
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17
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Dávila Mendoza R, Figueroa Flores A, Oliveros Valdés F. Histocitiosis de células de Langerhans en su presentación focalizada en órbita. REVISTA DE LA FACULTAD DE MEDICINA 2019. [DOI: 10.22201/fm.24484865e.2019.62.4.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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18
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Kim JE, Yi WJ, Heo MS, Lee SS, Choi SC, Huh KH. Langerhans cell histiocytosis of the jaw, a mimicker of osteomyelitis on CT and MR images: A retrospective analysis. Medicine (Baltimore) 2019; 98:e16331. [PMID: 31277182 PMCID: PMC6635274 DOI: 10.1097/md.0000000000016331] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Differential diagnosis of Langerhans Cell Histiocytosis (LCH) in the jaw is essential for early treatment including systemic therapy. Records of 17 patients (6 men and 11 women; mean age, 14 years) with histologically confirmed LCH were reviewed. All the lesions occurred in the mandible. Most of the cases (n=12) were intraosseous type LCH, only 5 patients had alveolar type LCH. Patients complained of facial swelling and pain most likely. In the 14 patients who underwent CT and/or MR imaging, all LCH lesions were osteolytic, with a mean size of 23 mm. LCH presented as expansile lesions with periosteal new bone formation, perilesional sclerosis, fluid attenuation/signal within the lesion, and inflammatory changes in adjacent soft tissues on CT/MR images. Considering the major symptoms of LCH were swelling and pain, the differential diagnosis of LCH from osteomyelitis might be more difficult. The differential diagnosis for osteolytic lesions of the jaw with surrounding inflammatory changes should include LCH, especially in young patients.
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Affiliation(s)
- Jo-Eun Kim
- Department of Oral and Maxillofacial Radiology, Seoul National University Dental Hospital
| | - Won-Jin Yi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University
| | - Min-Suk Heo
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University
| | - Sam-Sun Lee
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University
| | - Soon-Chul Choi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University
| | - Kyung-Hoe Huh
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
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19
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Choi SM, Andea AA, Wang M, Behdad A, Shao L, Zhang Y, Lu X, Dittmann D, Castro J, Chen YH, Gao J. KRAS mutation in secondary malignant histiocytosis arising from low grade follicular lymphoma. Diagn Pathol 2018; 13:78. [PMID: 30322385 PMCID: PMC6190545 DOI: 10.1186/s13000-018-0758-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 10/02/2018] [Indexed: 12/16/2022] Open
Abstract
Background Transformation of follicular lymphoma most typically occurs as diffuse large B-cell lymphoma, however other forms of transformation such as classic Hodgkin lymphoma and lymphoblastic transformation can occur. Secondary malignant histiocytosis also represents a rare form of transformation, which is thought to occur due to a process of transdifferentiation whereby the lymphoma cells exhibit lineage plasticity and lose all evidence of B-cell phenotype and instead acquire the phenotype of a histiocytic neoplasm. Little is known about the underlying genetic alterations that occur during this unusual process. Comparative genetic analysis of pre- and post-transformation/transdifferentiation would be one tool by which we could better understand how this phenomenon occurs. Case presentation Here we report the clinical, immunophenotypic and genetic features of a rare case of secondary malignant histiocytosis, Langerhans cell-type (Langerhans cell sarcoma) arising from a previous low grade follicular lymphoma. FISH analysis confirmed the presence of IgH/BCL2 rearrangement in both the low grade follicular lymphoma (FL) and transformed Langerhans cells sarcoma (LCS) samples, demonstrating a clonal relationship. Comparative whole exome sequencing was then performed, which identified a KRAS p.G13D mutation in the LCS that was not present in the FL. Conclusions This report highlights genetic alterations, in particular an acquired somatic KRAS mutation, that may occur during transdifferentiation, with additional significance of KRAS mutation as a possible therapeutic target in cases which otherwise would have limited treatment options. Electronic supplementary material The online version of this article (10.1186/s13000-018-0758-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah M Choi
- Department of Pathology, Northwestern University Feinberg School of Medicine, 251 E Huron Street, Chicago, IL, 60611, USA.,Current address: Department of Pathology, University of Michigan, 5242 Medical Science Building 1, 1301 Catherine Street, Ann Arbor, MI, 48109, USA
| | - Aleodor A Andea
- Current address: Department of Pathology, University of Michigan, 5242 Medical Science Building 1, 1301 Catherine Street, Ann Arbor, MI, 48109, USA
| | - Min Wang
- Current address: Department of Pathology, University of Michigan, 5242 Medical Science Building 1, 1301 Catherine Street, Ann Arbor, MI, 48109, USA
| | - Amir Behdad
- Department of Pathology, Northwestern University Feinberg School of Medicine, 251 E Huron Street, Chicago, IL, 60611, USA
| | - Lina Shao
- Current address: Department of Pathology, University of Michigan, 5242 Medical Science Building 1, 1301 Catherine Street, Ann Arbor, MI, 48109, USA
| | - Yanming Zhang
- Current address: Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Xinyan Lu
- Department of Pathology, Northwestern University Feinberg School of Medicine, 251 E Huron Street, Chicago, IL, 60611, USA
| | - David Dittmann
- Diagnostic Molecular Biology Laboratory, Northwestern Memorial Hospital, 251 E Huron Street, Chicago, IL, 60611, USA
| | - Juan Castro
- Diagnostic Molecular Biology Laboratory, Northwestern Memorial Hospital, 251 E Huron Street, Chicago, IL, 60611, USA
| | - Yi-Hua Chen
- Department of Pathology, Northwestern University Feinberg School of Medicine, 251 E Huron Street, Chicago, IL, 60611, USA
| | - Juehua Gao
- Department of Pathology, Northwestern University Feinberg School of Medicine, 251 E Huron Street, Chicago, IL, 60611, USA.
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20
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Mitchell JM, Berzins SP, Kannourakis G. A potentially important role for T cells and regulatory T cells in Langerhans cell histiocytosis. Clin Immunol 2018; 194:19-25. [DOI: 10.1016/j.clim.2018.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/27/2018] [Accepted: 06/15/2018] [Indexed: 12/11/2022]
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21
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Soltani M, Tabatabaiefar MA, Mohsenifar Z, Pourreza MR, Moridnia A, Shariati L, Razavi SM. Genetic study of the BRAF gene reveals new variants and high frequency of the V600E mutation among Iranian ameloblastoma patients. J Oral Pathol Med 2017. [PMID: 28650588 DOI: 10.1111/jop.12610] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Ameloblastoma is a benign, slow-growing and locally invasive tumor. It is one of the most prevalent odontogenic tumors, with an incidence rate of 1% of all oral tumors and approximately 18% of odontogenic tumors. A group of genes have been investigated in patients with ameloblastoma. The BRAF V600E mutation has been implicated as the most common mutation in ameloblastoma. The presence or absence of this mutation has been associated with several clinicopathological properties, including location, age at diagnosis, histology, and prognosis. Although some populations have been investigated so far, little data are available on the Iranian population. The current research was launched to study the BRAF V600E mutation among a cohort of Iranian patients with ameloblastoma. METHODS In this clinicopathological and molecular biology study, a total of 19 formalin-fixed, paraffin-embedded tissues were studied. DNA extraction was performed, followed by PCR-sequencing of exons 10 and 15 of the BRAF gene to identify mutations. In silico analysis was performed for the identified variants. Results were analyzed by T test, Chi-square, and Fisher's exact test. RESULTS Totally, 12 of 19 samples (63%) harbored the p. V600E hotspot mutation. In addition, we identified several variants, two of which were novel. The c.1769T>G (p. V590G) and c.1751C>T (p.L584F) as the novel variants showed a possible damaging effect by in silico analysis. No variant was found within exon 10. CONCLUSIONS Our study confirms the role of BRAF mutations in ameloblastoma in the Iranian patients studied.
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Affiliation(s)
- Maryam Soltani
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Amin Tabatabaiefar
- Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Pediatric Inherited Diseases Research Center, Research Institute for Primordial Prevention of Noncommunicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zhaleh Mohsenifar
- Department of General Pathology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Pourreza
- Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abbas Moridnia
- Department of Immunology, Dezful University of Medical Sciences, Dezful, Iran
| | - Laleh Shariati
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyyed Mohammad Razavi
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran.,Dental Implant Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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22
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Peters SM, Pastagia J, Yoon AJ, Philipone EM. Langerhans Cell Histiocytosis Mimicking Periapical Pathology in a 39-year-old Man. J Endod 2017; 43:1909-1914. [DOI: 10.1016/j.joen.2017.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/22/2017] [Accepted: 05/30/2017] [Indexed: 12/23/2022]
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23
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Khan A, Peters SM, Han C, Yoon AJ, Philipone EM. A 23-year-old female with a painless left mandibular swelling. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:519-524. [PMID: 28964765 DOI: 10.1016/j.oooo.2017.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/04/2017] [Accepted: 08/18/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Alia Khan
- Columbia University College of Dental Medicine, New York, NY, USA
| | - Scott M Peters
- Division of Oral and Maxillofacial Pathology, Columbia University College of Dental Medicine, New York, NY, USA
| | - Chang Han
- Private Practice, Hackensack, NJ, USA
| | - Angela J Yoon
- Division of Oral and Maxillofacial Pathology, Columbia University College of Dental Medicine, New York, NY, USA
| | - Elizabeth M Philipone
- Division of Oral and Maxillofacial Pathology, Columbia University College of Dental Medicine, New York, NY, USA.
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24
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Cazzolla AP, Troiano G, Zhurakivska K, Maiorano E, Favia G, Lacaita MG, Marzo G, Dicuonzo F, Andresciani S, Muzio LL. Langerhans cell histiocytosis of the maxillae in a child treated only with chemotherapy: a case report. J Med Case Rep 2017; 11:130. [PMID: 28482919 PMCID: PMC5422897 DOI: 10.1186/s13256-017-1286-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 03/30/2017] [Indexed: 12/29/2022] Open
Abstract
Background Langerhans cell histiocytosis is a sporadic disease caused by an uncontrolled pathogenic clonal proliferation of dendritic cells that have Langerhans cell characteristics. New treatment protocols provided by the HISTSOC-LCH-III (NCT00276757) trial show an improvement in the survival of children with langerhans cell histiocytosis. Case presentation We report a case of Langerhans cell histiocytosis, which presented as an osteolytic lesion of the left pre-maxillae enclosing the deciduous incisor and canine in a 7-month-old white Italian boy. He was treated with chemotherapy. He achieved complete remission after 7 months and after 24 months no signs of recurrence were observed. Conclusions As a result of this treatment, anesthetic sequelae and loss of teeth were avoided; in addition, we prevented a loss of the vertical dimension of occlusion.
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Affiliation(s)
| | - Giuseppe Troiano
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Khrystyna Zhurakivska
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy. .,Clinica Odontoiatrica, Via Rovelli 50, 71122, Foggia, Italy.
| | - Eugenio Maiorano
- Department of Pathological Anatomy, University of Bari, Bari, Italy
| | - Gianfranco Favia
- Department of Translational Medicine, University of Bari, Bari, Italy
| | | | - Giuseppe Marzo
- Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Franca Dicuonzo
- Department of Neuroradiology, Policlinico of Bari, Bari, Italy
| | | | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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25
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Dimmler A, Geddert H, Werner M, Faller G. Molecular analysis of BRAF V600E mutation in multiple nodules of pulmonary Langerhans cell histiocytosis. Virchows Arch 2017; 470:429-435. [PMID: 28220299 DOI: 10.1007/s00428-017-2092-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 01/25/2017] [Accepted: 02/10/2017] [Indexed: 10/20/2022]
Abstract
Pulmonary Langerhans cell histiocytosis (PLCH) is a rare, smoking-related histiocytic disorder with variable clinical symptoms. Like in other non-pulmonary Langerhans cell proliferations, PLCH has recently been shown to harbour BRAF V600E mutations in a significant subset of cases, thus challenging the concept of PLCH being a reactive disorder. Here, we analysed 38 formalin-fixed and paraffin-embedded PLCH nodules of nine patients for BRAF mutation using two different molecular methods. Using pyrosequencing and allele-specific quantitative PCR (AS-PCR), BRAF V600E mutations were found in 16/38 (42%) and 31/37 (84%) nodules, respectively. Analysing different nodules of the same patients with pyrosequencing 3/6 patients showed a concordant BRAF mutation status. When allele-specific quantitative PCR was used, condordant results were found in 5/6 patients. Our findings clearly indicate that (a) the sensitivity of the method used is crucial in analysing BRAF mutation status, (b) AS-PCR is more sensitive in detecting BRAF V600E mutations than pyrosequencing,
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Affiliation(s)
- Arno Dimmler
- Institute of Pathology, St. Vincent's Hospital Karlsruhe, Suedendstrasse 37, 76137, Karlsruhe, Germany
| | - Helene Geddert
- Institute of Pathology, St. Vincent's Hospital Karlsruhe, Suedendstrasse 37, 76137, Karlsruhe, Germany
| | - Martin Werner
- Institute of Pathology, University of Freiburg, Freiburg, Germany
| | - Gerhard Faller
- Institute of Pathology, St. Vincent's Hospital Karlsruhe, Suedendstrasse 37, 76137, Karlsruhe, Germany.
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26
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Rossi ED, Martini M, Bizzarro T, Schmitt F, Longatto-Filho A, Larocca LM. Somatic mutations in solid tumors: a spectrum at the service of diagnostic armamentarium or an indecipherable puzzle? The morphological eyes looking for BRAF and somatic molecular detections on cyto-histological samples. Oncotarget 2017; 8:3746-3760. [PMID: 27738305 PMCID: PMC5356915 DOI: 10.18632/oncotarget.12564] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 10/03/2016] [Indexed: 12/12/2022] Open
Abstract
This review article deals with the analysis and the detection of the morphological features associated with somatic mutations, mostly BRAFV600E mutation, on both cytological and histological samples of carcinomas. Few authors demonstrated that some architectural and specific cellular findings (i.e. polygonal eosinophilic cells defined as "plump cells" and sickle-shaped nuclei) are able to predict BRAF V600E mutation in both cytological and histological samples of papillary thyroid carcinoma (PTC) as well as in other carcinomas. In the current review article we evaluated the first comprehensive analysis of the morphological prediction of BRAFV600E and other somatic mutations in different malignant lesions with the description of the possible mechanisms beneath these morphologic features. The detection of predictive morphological features, mostly on FNAC, may add helpful information to the stratification of the malignant risk and personalized management of cancers. Additionally, the knowledge of the molecular mechanism of different oncogenic drivers can lead to the organ-specific triaging selection of cases and can provide significant insight for targeted therapies in different malignant lesions.
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Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, “Agostino Gemelli” School of Medicine, Rome, Italy
| | - Maurizio Martini
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, “Agostino Gemelli” School of Medicine, Rome, Italy
| | - Tommaso Bizzarro
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, “Agostino Gemelli” School of Medicine, Rome, Italy
| | - Fernando Schmitt
- Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal
- Department of Medicine and Pathology, Laboratoire National de Santé, Luxembourg
| | - Adhemar Longatto-Filho
- Department of Pathology, Laboratory of Medical Investigation, University of São Paulo School of Medicine, Brazil
- Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Molecular Oncology Research Center, Barretos Cancer Hospital, Pio XII Foundation, Barretos, Brazil
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, “Agostino Gemelli” School of Medicine, Rome, Italy
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27
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Ma Y, Mou H, Cai X, Ma J, Lu G. Primary Inflammatory demyelinating pseudotumor in the left frontal lobe with meningeal involvement presenting as malignant neoplasms. Chin Neurosurg J 2016. [DOI: 10.1186/s41016-016-0024-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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28
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Donadieu J, Tazi A. [Histiocytosis: Better understanding for better care]. Presse Med 2016; 46:43-45. [PMID: 27816337 DOI: 10.1016/j.lpm.2016.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jean Donadieu
- AP-HP, hôpital Trousseau, service d'hémato-oncologie pédiatrique, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Hôpital Trousseau, centre de référence des histiocytoses, service d'hémato-oncologie pédiatrique, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France.
| | - Abdellatif Tazi
- AP-HP, université Paris-Diderot, Sorbonne Paris Cité, hôpital Saint-Louis, Inserm UMR 1153 CRESS, équipe de recherche en biostatistiques et épidémiologie clinique, service de pneumologie, 1, avenue Claude-Vellefaux, 75010 Paris, France
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30
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Monsereenusorn C, Minkov M, Rodriguez-Galindo C. Current treatment of Langerhans cell histiocytosis. Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2016.1230058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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31
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Bonomo A, Monteiro AC, Gonçalves-Silva T, Cordeiro-Spinetti E, Galvani RG, Balduino A. A T Cell View of the Bone Marrow. Front Immunol 2016; 7:184. [PMID: 27242791 PMCID: PMC4868947 DOI: 10.3389/fimmu.2016.00184] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 04/29/2016] [Indexed: 01/20/2023] Open
Abstract
The majority of T cells present in the bone marrow (BM) represent an activated/memory phenotype and most of these, if not all, are circulating T cells. Their lodging in the BM keeps them activated, turning the BM microenvironment into a “memory reservoir.” This article will focus on how T cell activation in the BM results in both direct and indirect effects on the hematopoiesis. The hematopoietic stem cell niche will be presented, with its main components and organization, along with the role played by T lymphocytes in basal and pathologic conditions and their effect on the bone remodeling process. Also discussed herein will be how “normal” bone mass peak is achieved only in the presence of an intact adaptive immune system, with T and B cells playing critical roles in this process. Our main hypothesis is that the partnership between T cells and cells of the BM microenvironment orchestrates numerous processes regulating immunity, hematopoiesis, and bone remodeling.
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Affiliation(s)
- Adriana Bonomo
- Cancer Program (Fio-Cancer), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; Laboratory on Thymus Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Ana Carolina Monteiro
- Laboratory on Thymus Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation , Rio de Janeiro , Brazil
| | - Triciana Gonçalves-Silva
- Laboratory on Thymus Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; Immunology and Inflammation Graduate Program, Paulo de Góes Microbiology Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eric Cordeiro-Spinetti
- Cell Biology and Technology Laboratory, Veiga de Almeida University , Rio de Janeiro , Brazil
| | - Rômulo Gonçalves Galvani
- Cancer Program (Fio-Cancer), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; Laboratory on Thymus Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; Microbiology Graduate Program, Paulo de Góes Microbiology Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alex Balduino
- Cell Biology and Technology Laboratory, Veiga de Almeida University, Rio de Janeiro, Brazil; Excellion Laboratory, Amil/UnitedHealth Group, Petrópolis, Brazil
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McDowell MM, Zhu X, Agarwal N, Nikiforova MN, Lieberman FS, Drappatz J. Response of relapsed central nervous system hairy cell leukemia to vemurafenib. Leuk Lymphoma 2016; 57:2952-2954. [PMID: 27116997 DOI: 10.1080/10428194.2016.1177773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Michael M McDowell
- a Department of Neurological Surgery , University of Pittsburgh , Pittsburgh , PA , USA
| | - Xiao Zhu
- a Department of Neurological Surgery , University of Pittsburgh , Pittsburgh , PA , USA
| | - Nitin Agarwal
- a Department of Neurological Surgery , University of Pittsburgh , Pittsburgh , PA , USA
| | - Marina N Nikiforova
- b Division of Molecular and Genomic Pathology , University of Pittsburgh , Pittsburgh , PA , USA
| | - Frank S Lieberman
- c Division of Neuro-Oncology , Hillman Cancer Center, University of Pittsburgh , Pittsburgh , PA , USA
| | - Jan Drappatz
- c Division of Neuro-Oncology , Hillman Cancer Center, University of Pittsburgh , Pittsburgh , PA , USA
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Abstract
Langerhans cell histiocytosis (LCH) is currently regarded as a myeloid neoplasm, with remarkably broad clinical spectrum, ranging from isolated skin or bone lesions to a disseminated disease that can involve nearly any organ. LCH is generally regarded as a sporadic disease that occurs predominantly in the paediatric population. The diagnosis of LCH is confirmed by immunohistochemistry (IHC) by demonstrating the presence of dendritic cell markers such as S100 protein, in addition to CD1a and langerin. Contrary to previous beliefs, recent literature reveals that the pathogenesis of LCH might involve a clonal process implicating BRAF c.1799T>A (p.Val600Glu) and other mutations [(600DLAT) B-RAF and (T599A) B-RAF, somatic MAP2K1 mutations].Through this review article, we have summarised the latest understanding of the biological and salient histological characteristics of LCH and its potential morphological mimics.
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Abstract
Hairy cell leukaemia (HCL) is a rare, indolent chronic B-cell leukaemia accounting for approximately 2% of all adult leukaemias. The recent association of the BRAF p.Val600Glu (V600E) mutation in HCL makes it a valuable molecular diagnostic marker. We compared the ability of Sanger sequencing, fluorescent single-strand conformational polymorphism (F-SSCP) and high resolution melting (HRM) analysis to detect BRAF mutations in 20 cases of HCL consisting of four archival Romanowsky stained air-dried peripheral blood and bone marrow aspirate smears, 12 mercury fixed decalcified bone marrow trephine biopsies, three formalin fixed, paraffin embedded (FFPE) splenectomy samples and one fresh peripheral blood sample. DNA was amplified and BRAF mutation status determined by the three methods above. V600E mutation was identified in 94%, 89% and 72% of HCL cases by F-SSCP, HRM and Sanger sequencing, respectively. In one case, in addition to the p.Val600Glu mutation, a p.Lys601Thr (K601T) mutation was identified. DNA from archival slide scrapings, mercury-fixed and FFPE tissue can be used to identify BRAF mutations with high sensitivity, especially using HRM/F-SSCP. The V600E mutation can be used as a supplementary molecular marker to aid in the diagnosis of HCL and the presence of the mutation may provide a target for therapy.
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Tatsuno M, Shioda Y, Iwafuchi H, Yamazaki S, Iijima K, Takahashi C, Ono H, Uchida K, Okamura O, Matubayashi M, Okuyama T, Matsumoto K, Yoshioka T, Nakazawa A. BRAF V600 mutations in Langerhans cell histiocytosis with a simple and unique assay. Diagn Pathol 2016; 11:39. [PMID: 27094161 PMCID: PMC4837618 DOI: 10.1186/s13000-016-0489-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 04/10/2016] [Indexed: 12/12/2022] Open
Abstract
Background BRAF (V-raf murine sarcoma viral oncogene homolog B1) is a serine-threonine protein kinase involved in cell survival, proliferation, and differentiation. The most common missense mutation of BRAF (mainly V600E) contributes to the incidence of various cancers, including Langerhans cell histiocytosis (LCH). BRAF inhibitors molecularly targeting the V600E mutation have been developed to counteract the effect of the mutation. To ensure the administration of effective pharmacotherapy, it is therefore imperative to develop an effective assay to screen LCH patients for the V600E mutation. However, tumor tissues of LCH typically contain many inflammatory cells which make a correct judgement of the mutation status difficult in the DNA sequence analysis. Results In this study, we present a new, highly sensitive analyzing method combining PCR, restriction enzyme digestion, and a sequencing assay using DNA extracted from formalin-fixed paraffin-embedded (FFPE) tissue specimens. TspRI is a restriction enzyme that cleaves the sequence encompassing the wild-type BRAF codon 600 into two fragments, which cannot be used as a template for subsequent BRAF PCR amplification. We therefore evaluated the sensitivity of BRAF V600 mutation detection by amplifying the primary PCR product digested with TspRI and sequencing the secondary PCR products. The V600E mutation was detected in FFPE tissue samples from 32 LCH patients; our assay was able to identify mutations in four samples that gave inconclusive results, and ten that were negative, according to standard PCR and sequencing. Conclusions We presented a new and highly sensitive method to detect BRAF V600 mutations. This screening method is expected to play an important role to select the most effective therapies.
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Affiliation(s)
- Michiko Tatsuno
- Department of Pathology, National Center for Child Health and Development, PO Box 157-8535, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan.
| | - Yoko Shioda
- Department of Children's Cancer Center, National Center for Child Health and Development, PO Box 157-8535, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan
| | - Hideto Iwafuchi
- Department of Pathology, National Center for Child Health and Development, PO Box 157-8535, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan
| | - Shigeki Yamazaki
- Department of Pathology, National Center for Child Health and Development, PO Box 157-8535, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan.,Department of Clinical Laboratory Medicine, National Center for Child Health and Development, PO Box 157-8535, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan
| | - Kenta Iijima
- Department of Clinical Laboratory Medicine, National Center for Child Health and Development, PO Box 157-8535, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan
| | - Chiaki Takahashi
- Department of Clinical Laboratory Medicine, National Center for Child Health and Development, PO Box 157-8535, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan
| | - Hiromi Ono
- Department of Pathology, National Center for Child Health and Development, PO Box 157-8535, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan.,Department of Clinical Laboratory Medicine, National Center for Child Health and Development, PO Box 157-8535, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan
| | - Kiyono Uchida
- Department of Pathology, National Center for Child Health and Development, PO Box 157-8535, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan.,Department of Clinical Laboratory Medicine, National Center for Child Health and Development, PO Box 157-8535, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan
| | - Osamu Okamura
- Department of Clinical Laboratory Medicine, National Center for Child Health and Development, PO Box 157-8535, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan
| | - Mamoru Matubayashi
- Department of Pathology, National Center for Child Health and Development, PO Box 157-8535, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan.,Department of Clinical Laboratory Medicine, National Center for Child Health and Development, PO Box 157-8535, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan
| | - Torayuki Okuyama
- Department of Clinical Laboratory Medicine, National Center for Child Health and Development, PO Box 157-8535, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan
| | - Kimikazu Matsumoto
- Department of Children's Cancer Center, National Center for Child Health and Development, PO Box 157-8535, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan
| | - Takako Yoshioka
- Department of Pathology, National Center for Child Health and Development, PO Box 157-8535, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan
| | - Atsuko Nakazawa
- Department of Pathology, National Center for Child Health and Development, PO Box 157-8535, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan.,Department of Pathology, Tokai University School of Medicine, PO Box 259-1193, 143 Shimokasuya, Isehara-shi, Kanagawa, Japan
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Liang C, Liang Q, DU C, Zhang X, Guo S. Langerhans' cell histiocytosis of the temporal fossa: A case report. Oncol Lett 2016; 11:2625-2628. [PMID: 27073529 DOI: 10.3892/ol.2016.4256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 02/01/2016] [Indexed: 11/05/2022] Open
Abstract
Langerhans' cell histiocytosis (LCH) is a rare disease with a wide spectrum of clinical manifestations, varying from an isolated lesion to systemic involvement. The etiology of this disease remains to be elucidated. The present study reports a case of LCH with temporal fossa localization in an 8-year-old male patient, who had exhibited left temporal pain and headache for 1 month. Physical examination revealed slight exophthalmos and conjunctival hemorrhage in the patient's left eye, and non-contrast computed tomography imaging of the head revealed a soft tissue mass with unclear margins located in the left temporal fossa, as well as a wide bony defect. Magnetic resonance imaging revealed a heterogeneously contrast-enhanced mass near the left temporal pole, which eroded into the patient's left orbit and maxillary sinus. The lesion was totally excised and confirmed to be LCH through biopsy.
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Affiliation(s)
- Chen Liang
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Qianlei Liang
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Changwang DU
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Xiaodong Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Shiwen Guo
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
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Ramos-Gutiérrez E, Alejo-González F, Ruiz-Rodríguez S, Garrocho-Rangel JA, Pozos-Guillén A. Langerhans cell histiocytosis: Current concepts in dentistry and case report. J Clin Exp Dent 2016; 8:e102-8. [PMID: 26855698 PMCID: PMC4739360 DOI: 10.4317/jced.52498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 08/13/2015] [Indexed: 11/23/2022] Open
Abstract
Langerhans cell histiocytosis (LCH), which is a rare granulomatous pediatric disease of unknown etiology, is characterized by the idiopathic proliferation and accumulation of abnormal and clonal Langerhans cells or their marrow precursors, resulting in localized, solitary or multiple destructive lesions. These lesions are most commonly eosinophilic granuloma, which are found in craniofacial bone structures such as the skull and mandible, skin and other organs. In children, the disease has a variable initial presentation, and the clinical course, prognosis and survival are unpredictable. The aims of this report were to present an LCH case in a girl aged 2 years, 8 months and her clinicopathological features, to describe the bucodental management provided, and to discuss special dental considerations of this disease.
Key words:Children, dental management, histiocytosis, Langerhans cells.
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Affiliation(s)
- Efraín Ramos-Gutiérrez
- DDS, Resident, Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, San Luis Potosi University, SLP, Mexico
| | - Francisco Alejo-González
- MD, MS, Associate Professor, Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, San Luis Potosi University, SLP, Mexico
| | - Socorro Ruiz-Rodríguez
- DDS, MS, Chairman, Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, San Luis Potosi University, SLP, Mexico
| | - José-Arturo Garrocho-Rangel
- DDS, MS, PhD, Associate Professor, Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, San Luis Potosi University, SLP, Mexico
| | - Amaury Pozos-Guillén
- DDS, MS, PhD, Associate Professor, Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, San Luis Potosi University, SLP, Mexico
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38
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Windebank K, Visser J, Nanduri V. Advances in the understanding and management of histiocytic disorders 2015. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.paed.2015.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pace ST, Gelman BB, Wong BR. Primary Langerhans cell histiocytosis of the lacrimal gland in an adult. Can J Ophthalmol 2016; 50:e40-3. [PMID: 26040231 DOI: 10.1016/j.jcjo.2015.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 01/17/2015] [Accepted: 02/11/2015] [Indexed: 12/22/2022]
Affiliation(s)
- S Tyler Pace
- University of Texas Medical Branch in Galveston, Galveston, Tex..
| | | | - Brian R Wong
- University of Texas Medical Branch in Galveston, Galveston, Tex
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Abstract
Langerhans cell histiocytosis (LCH) is a clonally derived neoplasm with a highly variable clinical course. Although LCH was once considered a disorder of immune regulation, the identification of activating mutations in the proto-oncogene BRAF-V600E in ∼50%-60% of cases and MEK and ERK phosphorylation in 100% of examined cases, has changed the definition of LCH to a dendritic cell neoplasm with a strong inflammatory component. Current international LCH trials are focused on further improving the outcome of high-risk multisystem LCH patients, by decreasing the reactivation rate, optimizing early salvage regimens, and preventing late sequelae. Anecdotal responses to vemurafenib, a BRAF-V600E inhibitor, have been reported in a few cases of LCH and Erdheim–Chester disease. However, the development of resistance, as well as the potential risks of cutaneous and pancreatic cancers in patients with BRAF-V600E-mutated melanoma treated with single inhibitors, suggest the need for prospective trials with BRAF inhibitors, alone or in combination with other inhibitors of this pathway, for patients with refractory or multiply-relapsed LCH. The recent discovery of somatic mutations in ARAF and in MAP2K1, which lead to activation of the RAS-RAF-MEK –ERK pathway in the setting of wild-type BRAF, as well as the finding that activating mutation in MAP2K1 are relatively insensitive to MEK inhibitors, suggest that a more detailed understanding of this pathway in LCH may be necessary for the development of more effective targeted therapies.
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Abstract
AbstractLangerhans cell histiocytosis (LCH) is a clonally derived neoplasm with a highly variable clinical course. Although LCH was once considered a disorder of immune regulation, the identification of activating mutations in the proto-oncogene BRAF-V600E in ∼50%-60% of cases and MEK and ERK phosphorylation in 100% of examined cases, has changed the definition of LCH to a dendritic cell neoplasm with a strong inflammatory component. Current international LCH trials are focused on further improving the outcome of high-risk multisystem LCH patients, by decreasing the reactivation rate, optimizing early salvage regimens, and preventing late sequelae. Anecdotal responses to vemurafenib, a BRAF-V600E inhibitor, have been reported in a few cases of LCH and Erdheim–Chester disease. However, the development of resistance, as well as the potential risks of cutaneous and pancreatic cancers in patients with BRAF-V600E-mutated melanoma treated with single inhibitors, suggest the need for prospective trials with BRAF inhibitors, alone or in combination with other inhibitors of this pathway, for patients with refractory or multiply-relapsed LCH. The recent discovery of somatic mutations in ARAF and in MAP2K1, which lead to activation of the RAS-RAF-MEK –ERK pathway in the setting of wild-type BRAF, as well as the finding that activating mutation in MAP2K1 are relatively insensitive to MEK inhibitors, suggest that a more detailed understanding of this pathway in LCH may be necessary for the development of more effective targeted therapies.
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Porto L, Schöning S, Hattingen E, Sörensen J, Jurcoane A, Lehrnbecher T. Central nervous system imaging in childhood Langerhans cell histiocytosis - a reference center analysis. Radiol Oncol 2015; 49:242-9. [PMID: 26401129 PMCID: PMC4577220 DOI: 10.1515/raon-2015-0024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 06/01/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The aim of our study was (1) to describe central nervous system (CNS) manifestations in children with Langerhans cell histiocytosis (LCH) based on images sent to a reference center and meeting minimum requirements and (2) to assess the inter-rater agreement of CNS-MRI results, which represents the overall reproducibility of this investigation. METHODS We retrospectively reviewed brain MRI examinations in children with LCH, for which MRI minimum requirements were met. Abnormalities were rated by two experienced neuroradiologists, and the inter-rater agreement was assessed. RESULTS Out of a total of 94 imaging studies, only 31 MRIs met the minimum criteria, which included T2w, FLAIR, T1w images before/after contrast in at least two different section planes, and thin post contrast sagittal slices T1w through the sella. The most common changes were osseous abnormalities, followed by solid enlargement of the pineal gland, thickened enhancing stalk and signal changes of the dentate nucleus. Whereas inter-rater agreement in assessing most of the CNS lesions was relatively high (κ > 0.61), the application of minimum criteria often did not allow to evaluate the posterior pituitary. CONCLUSIONS The diversity of radiological protocols from different institutions leads to difficulties in the diagnosis of CNS abnormalities in children with LCH. Although the inter-rater agreement between neuroradiologists was high, not all the LCH manifestations could be completely ruled out when using the minimum criteria. Brain MRIs should therefore follow LCH guideline protocols and include T1 pre-gadolinium sagittal images, and be centrally reviewed in order to improve the comparison of clinical trials.
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Affiliation(s)
- Luciana Porto
- Neuroradiology Department, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - Stefan Schöning
- Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - Elke Hattingen
- Neuroradiology Department, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - Jan Sörensen
- Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - Alina Jurcoane
- Neuroradiology Department, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - Thomas Lehrnbecher
- Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
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Popper HH. [Pulmonary Langerhans cell histiocytosis]. DER PATHOLOGE 2015; 36:451-7. [PMID: 26289803 DOI: 10.1007/s00292-015-0052-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pulmonary Langerhans cell histiocytosis is regarded as a reactive proliferation of the dendritic Langerhans cell population stimulated by chronic tobacco-derived plant proteins due to incomplete combustion but can also occur in childhood as a tumor-like systemic disease. Currently, both these forms cannot be morphologically distinguished. In the lungs a nodular proliferation of Langerhans cells occurs in the bronchial mucosa and also peripherally in the alveolar septa with an accompanying infiltration by eosinophilic granulocytes and destruction of the bronchial wall. Langerhans cells can be selectively detected with antibodies against CD1a and langerin. In the reactive isolated pulmonary form, abstinence from tobacco smoking in most patients leads to regression of infiltration and improvement of symptoms. In high-resolution computed tomography (HRCT) the small star-like scars can still be detected even after complete cessation of tobacco smoking.
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Affiliation(s)
- H H Popper
- Forschungseinheit Molekulare Lungen- & Pleurapathologie, Institut für Pathologie, Medizinische Universität Graz, Auenbruggerplatz 25, 8036, Graz, Österreich,
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Monsereenusorn C, Rodriguez-Galindo C. Clinical Characteristics and Treatment of Langerhans Cell Histiocytosis. Hematol Oncol Clin North Am 2015; 29:853-73. [PMID: 26461147 DOI: 10.1016/j.hoc.2015.06.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a disease caused by clonal proliferation of CD1a+/CD207+ cells that is characterized by a spectrum of varying degrees of organ involvement and dysfunction. Treatment of LCH is risk adapted; patients with single lesions may respond well to local treatment, whereas patients with multi-system disease and risk-organ involvement require more intensive therapy. Although survival for patients without organ dysfunction is excellent, mortality rates for patients with organ dysfunction may reach 30% to 40%. For patients with low-risk disease, although cure is almost universal, disease reactivation rates are in excess of 30%.
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Affiliation(s)
- Chalinee Monsereenusorn
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, 450 Brookline Avenue D3-133, Boston, MA 02215, USA
| | - Carlos Rodriguez-Galindo
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, 450 Brookline Avenue D3-133, Boston, MA 02215, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
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Emmanouil D, Birpou E, Chatzidimitriou K, Matsioula C, Christopoulos P, Tosios K. Hand-Schüler-Christian disease presenting with recurrent, bilateral, symmetrical mandibular lesions in an 8-year-old boy: report of a case. SPECIAL CARE IN DENTISTRY 2015; 35:316-21. [PMID: 26243405 DOI: 10.1111/scd.12126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Hand-Schüller-Christian disease (HSC) is the unisystem multifocal form of Langerhans Cell Histiocytosis (LCH) and is primarily seen in infants and children. CASE REPORT An 8-year-old boy was referred for acute mandibular pain. His medical history included otic LCH and diabetes insipidus at age of 11 months. Intraorally, a pressure sensitive swelling, and radiographically, extensive bone loss were revealed on the area of lower second primary molars. The primary molars were extracted and histological examination confirmed the final diagnosis of HSC. The patient was treated with chemotherapy and the lesions decreased considerably. Two years later, a new swelling was recorded in the same area bilaterally. Biopsy confirmed recurrent HSC disease and the patient entered an alternative chemotherapy protocol. Six months later, improvement of the lesions was revealed. CONCLUSIONS Dentists can contribute to a timely and valid identification of HSC disease by correctly differentially diagnosing lesions of head and neck.
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Affiliation(s)
- Dimitris Emmanouil
- Assistant Professor of Paediatric Dentistry, School of Dentistry, University of Athens, Athens, Greece
| | - Eleftheria Birpou
- Postgraduate student of Oral Biology, School of Dentistry, University of Athens, Athens, Greece
| | | | | | - Panos Christopoulos
- Assistant Professor of Oral and Maxillofacial Surgery, School of Dentistry, University of Athens, Athens, Greece
| | - Konstantinos Tosios
- Assistant Professor of Oral Medicine and Pathology, School of Dentistry, University of Athens, Athens, Greece
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Ribeiro KB, Degar B, Antoneli CBG, Rollins B, Rodriguez-Galindo C. Ethnicity, race, and socioeconomic status influence incidence of Langerhans cell histiocytosis. Pediatr Blood Cancer 2015; 62:982-7. [PMID: 25586293 DOI: 10.1002/pbc.25404] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 11/25/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a rare disease, and its etiology is not well understood. Population-based studies may contribute to etiologic research by defining incidence patterns. This study was designed to evaluate the descriptive epidemiology of disseminated LCH in the United States, using data from population-based cancer registries. PROCEDURE We analyzed the incidence and survival of disseminated LCH in children and adolescents (0-19 years) from 18 SEER registries during 2000-2009. Age-standardized incidence rates (ASIR) per million and rate ratios (RR) were calculated by gender, race, ethnicity, age, and socioeconomic variables (crowding, rural/urban, education, and poverty) using the SEER*Stat software 8.0.1. Relative survival (RS) estimates were calculated using Ederer II method. RESULTS One hundred forty-five cases of disseminated LCH were recorded; ASIR was 0.70/million per year. Lower ASIR was observed for blacks (vs. whites) (RR = 0.41, 95% CI 0.18-0.81), while higher ASIR was noted for Hispanics (vs. non-Hispanics) (RR = 1.63, 95% CI 1.15-2.29). Risk of LCH was higher in crowded counties (RR = 1.84, 95% CI 1.31-2.58) and also in areas with low educational level (RR = 1.49, 95% CI 1.02-2.22). Five-year relative survival was 90.0% (95% CI 83.0-94.2). Important differences in survival were noted according to gender (male: RS = 96.0 vs. female: RS = 83.4%, P = 0.029) and age (<1 year: RS = 78.5, 1-4 years: RS = 95.6%, 5-19 years: RS = 100%, P = 0.004). CONCLUSIONS This population-based study shows significant variations in the incidence of disseminated LCH by race and ethnic group, as well as the influence of socioeconomic factors. These data may provide clues to causation and point toward the need for analytical epidemiologic studies.
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Affiliation(s)
- Karina Braga Ribeiro
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Department of Social Medicine, São Paulo, Brazil
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47
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Veys PA, Nanduri V, Baker KS, He W, Bandini G, Biondi A, Dalissier A, Davis JH, Eames GM, Egeler RM, Filipovich AH, Fischer A, Jürgens H, Krance R, Lanino E, Leung WH, Matthes S, Michel G, Orchard PJ, Pieczonka A, Ringdén O, Schlegel PG, Sirvent A, Vettenranta K, Eapen M. Haematopoietic stem cell transplantation for refractory Langerhans cell histiocytosis: outcome by intensity of conditioning. Br J Haematol 2015; 169:711-8. [PMID: 25817915 DOI: 10.1111/bjh.13347] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/20/2015] [Indexed: 12/28/2022]
Abstract
Patients with Langerhans cell histiocytosis (LCH) refractory to conventional chemotherapy have a poor outcome. There are currently two promising treatment strategies for high-risk patients: the first involves the combination of 2-chlorodeoxyadenosine and cytarabine; the other approach is allogeneic haematopoietic stem cell transplantation (HSCT). Here we evaluated 87 patients with high-risk LCH who were transplanted between 1990 and 2013. Prior to the year 2000, most patients underwent HSCT following myeloablative conditioning (MAC): only 5 of 20 patients (25%) survived with a high rate (55%) of transplant-related mortality (TRM). After the year 2000 an increasing number of patients underwent HSCT with reduced intensity conditioning (RIC): 49/67 (73%) patients survived, however, the improved survival was not overtly achieved by the introduction of RIC regimens with similar 3-year probability of survival after MAC (77%) and RIC transplantation (71%). There was no significant difference in TRM by conditioning regimen intensity but relapse rates were higher after RIC compared to MAC regimens (28% vs. 8%, P = 0·02), although most patients relapsing after RIC transplantation could be salvaged with further chemotherapy. HSCT may be a curative approach in 3 out of 4 patients with high risk LCH refractory to chemotherapy: the optimal choice of HSCT conditioning remains uncertain.
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Affiliation(s)
- Paul A Veys
- Great Ormond Street Hospital for Children NHS Trust, London, UK
| | | | - K Scott Baker
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Wensheng He
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Giuseppe Bandini
- Institute of Haematology, St. Orsola University Hospital, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | | | - Jeffrey H Davis
- British Columbia's Children's Hospital, Vancouver, BC, Canada
| | | | | | | | | | | | - Robert Krance
- Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine and the Center for Cell and Gene Therapy, Houston, TX, USA
| | | | - Wing H Leung
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | | | - Paul J Orchard
- Department of Pediatrics, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Anna Pieczonka
- Department of Paediatric Oncology, Haematology & HSCT, Poznań, Poland
| | - Olle Ringdén
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Allogeneic Stem Cell Transplantation, Stockholm, Sweden
| | - Paul G Schlegel
- Department of Paediatric Haematology, Oncology, Paediatric Stem Cell Transplantation Program, University Children's Hospital Wuerzburg, Wuerzburg, Germany
| | - Anne Sirvent
- Hôpital Arnaud de Villeneuve, CHRU Montpellier, Montpellier, France
| | | | - Mary Eapen
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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48
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Successful treatment of adult Langerhans cell histiocytosis with intensified chemotherapy. Int J Hematol 2015; 102:244-8. [DOI: 10.1007/s12185-015-1778-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 03/01/2015] [Accepted: 03/02/2015] [Indexed: 10/23/2022]
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49
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Annamalai AK, Powlson AS, Kandasamy N, Lodge K, Graggaber J, Halsall DJ, Antoun NM, Cheow HK, Buttery PC, George E, Griffiths M, Price SJ, Pickard JD, Sivasothy P, Gurnell M. Hypopituitarism, pulmonary infiltration and a spontaneously resolving occipital mass. QJM 2015; 108:147-9. [PMID: 22855287 DOI: 10.1093/qjmed/hcs137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A K Annamalai
- From the Metabolic Research Laboratories, Institute of Metabolic Science, Departments of Respiratory Medicine, Clinical Biochemistry, Radiology, University of Cambridge and National Institute of Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, Department of Neurology, Department of Endocrinology, Queen Elizabeth Hospital, Kings Lynn, Histopathology and Neurosurgery, University of Cambridge and National Institute of Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | - A S Powlson
- From the Metabolic Research Laboratories, Institute of Metabolic Science, Departments of Respiratory Medicine, Clinical Biochemistry, Radiology, University of Cambridge and National Institute of Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, Department of Neurology, Department of Endocrinology, Queen Elizabeth Hospital, Kings Lynn, Histopathology and Neurosurgery, University of Cambridge and National Institute of Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | - N Kandasamy
- From the Metabolic Research Laboratories, Institute of Metabolic Science, Departments of Respiratory Medicine, Clinical Biochemistry, Radiology, University of Cambridge and National Institute of Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, Department of Neurology, Department of Endocrinology, Queen Elizabeth Hospital, Kings Lynn, Histopathology and Neurosurgery, University of Cambridge and National Institute of Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | - K Lodge
- From the Metabolic Research Laboratories, Institute of Metabolic Science, Departments of Respiratory Medicine, Clinical Biochemistry, Radiology, University of Cambridge and National Institute of Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, Department of Neurology, Department of Endocrinology, Queen Elizabeth Hospital, Kings Lynn, Histopathology and Neurosurgery, University of Cambridge and National Institute of Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | - J Graggaber
- From the Metabolic Research Laboratories, Institute of Metabolic Science, Departments of Respiratory Medicine, Clinical Biochemistry, Radiology, University of Cambridge and National Institute of Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, Department of Neurology, Department of Endocrinology, Queen Elizabeth Hospital, Kings Lynn, Histopathology and Neurosurgery, University of Cambridge and National Institute of Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | - D J Halsall
- From the Metabolic Research Laboratories, Institute of Metabolic Science, Departments of Respiratory Medicine, Clinical Biochemistry, Radiology, University of Cambridge and National Institute of Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, Department of Neurology, Department of Endocrinology, Queen Elizabeth Hospital, Kings Lynn, Histopathology and Neurosurgery, University of Cambridge and National Institute of Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | - N M Antoun
- From the Metabolic Research Laboratories, Institute of Metabolic Science, Departments of Respiratory Medicine, Clinical Biochemistry, Radiology, University of Cambridge and National Institute of Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, Department of Neurology, Department of Endocrinology, Queen Elizabeth Hospital, Kings Lynn, Histopathology and Neurosurgery, University of Cambridge and National Institute of Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | - H K Cheow
- From the Metabolic Research Laboratories, Institute of Metabolic Science, Departments of Respiratory Medicine, Clinical Biochemistry, Radiology, University of Cambridge and National Institute of Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, Department of Neurology, Department of Endocrinology, Queen Elizabeth Hospital, Kings Lynn, Histopathology and Neurosurgery, University of Cambridge and National Institute of Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | - P C Buttery
- From the Metabolic Research Laboratories, Institute of Metabolic Science, Departments of Respiratory Medicine, Clinical Biochemistry, Radiology, University of Cambridge and National Institute of Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, Department of Neurology, Department of Endocrinology, Queen Elizabeth Hospital, Kings Lynn, Histopathology and Neurosurgery, University of Cambridge and National Institute of Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | - E George
- From the Metabolic Research Laboratories, Institute of Metabolic Science, Departments of Respiratory Medicine, Clinical Biochemistry, Radiology, University of Cambridge and National Institute of Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, Department of Neurology, Department of Endocrinology, Queen Elizabeth Hospital, Kings Lynn, Histopathology and Neurosurgery, University of Cambridge and National Institute of Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | - M Griffiths
- From the Metabolic Research Laboratories, Institute of Metabolic Science, Departments of Respiratory Medicine, Clinical Biochemistry, Radiology, University of Cambridge and National Institute of Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, Department of Neurology, Department of Endocrinology, Queen Elizabeth Hospital, Kings Lynn, Histopathology and Neurosurgery, University of Cambridge and National Institute of Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | - S J Price
- From the Metabolic Research Laboratories, Institute of Metabolic Science, Departments of Respiratory Medicine, Clinical Biochemistry, Radiology, University of Cambridge and National Institute of Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, Department of Neurology, Department of Endocrinology, Queen Elizabeth Hospital, Kings Lynn, Histopathology and Neurosurgery, University of Cambridge and National Institute of Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | - J D Pickard
- From the Metabolic Research Laboratories, Institute of Metabolic Science, Departments of Respiratory Medicine, Clinical Biochemistry, Radiology, University of Cambridge and National Institute of Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, Department of Neurology, Department of Endocrinology, Queen Elizabeth Hospital, Kings Lynn, Histopathology and Neurosurgery, University of Cambridge and National Institute of Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | - P Sivasothy
- From the Metabolic Research Laboratories, Institute of Metabolic Science, Departments of Respiratory Medicine, Clinical Biochemistry, Radiology, University of Cambridge and National Institute of Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, Department of Neurology, Department of Endocrinology, Queen Elizabeth Hospital, Kings Lynn, Histopathology and Neurosurgery, University of Cambridge and National Institute of Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | - M Gurnell
- From the Metabolic Research Laboratories, Institute of Metabolic Science, Departments of Respiratory Medicine, Clinical Biochemistry, Radiology, University of Cambridge and National Institute of Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, Department of Neurology, Department of Endocrinology, Queen Elizabeth Hospital, Kings Lynn, Histopathology and Neurosurgery, University of Cambridge and National Institute of Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
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50
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Activating BRAF V600E Mutation in Aggressive Pediatric Langerhans Cell Histiocytosis. Am J Surg Pathol 2014; 38:1644-8. [DOI: 10.1097/pas.0000000000000304] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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