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Aktan Suzgun M, Everest E, Kucukyurt S, Tutuncu M, Uygunoglu U, Eskazan AE, Ture U, Budka H, Sav A, Siva A. Erdheim-Chester disease of brain parenchyma without any systemic involvement: A case report and review of literature. Neuropathology 2024; 44:59-67. [PMID: 37357975 DOI: 10.1111/neup.12930] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/08/2023] [Accepted: 06/11/2023] [Indexed: 06/27/2023]
Abstract
Erdheim-Chester disease is a non-Langerhans cell histiocytosis syndrome characterised by histiocytic infiltration of different organs and systems in the body. Erdheim-Chester disease with isolated central nervous system (CNS) involvement causes diagnostic difficulties due to the absence of systemic findings and may result in misdiagnosis and inaccurate treatment choices. The case discussed in this report exemplifies how challenging it is to diagnose Erdheim-Chester disease with isolated CNS involvement. This case, which presented with progressive pyramidocerebellar syndrome, was clinically and radiologically resistant to all immunosuppressive and immunomodulatory treatments administered. The presence of false negative results in repeated histopathological investigations and the absence of evidence for systemic disease hindered the diagnosis and treatment work-up. In this study, we reviewed and discussed the prominent features of the presented case in light of the relevant literature.
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Affiliation(s)
- Merve Aktan Suzgun
- Department of Neurology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Elif Everest
- Department of Neurology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Selin Kucukyurt
- Department of Internal Medicine, Division of Hematology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Melih Tutuncu
- Department of Neurology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Ugur Uygunoglu
- Department of Neurology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Ahmet Emre Eskazan
- Department of Internal Medicine, Division of Hematology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Ugur Ture
- Department of Neurosurgery, Yeditepe University, School of Medicine, Istanbul, Turkey
| | - Herbert Budka
- Institute of Neurology, Vienna General Hospital, Vienna, Austria
| | - Aydin Sav
- Department of Pathology, Yeditepe University, School of Medicine, Istanbul, Turkey
| | - Aksel Siva
- Department of Neurology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
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2
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Erdheim–Chester Disease with Isolated CNS Involvement: A Systematic Review of the Literature. Neurol Int 2022; 14:716-726. [PMID: 36135995 PMCID: PMC9504932 DOI: 10.3390/neurolint14030060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/03/2022] [Accepted: 08/12/2022] [Indexed: 12/05/2022] Open
Abstract
Erdheim–Chester disease (ECD) is a rare, sporadic, non-Langerhans cell histiocytosis that can have various presentations and higher mortality in patients presenting with neurological symptoms. We performed a systematic review to investigate and chronicle the frequency of neurological manifestations, imaging findings, treatments, and outcomes in published ECD patients presenting with neurological symptoms. A PubMed literature search was conducted for articles (published between January 1980 and June 2021) on ECD cases presenting with neurological manifestations. We analyzed the data of 40 patients, including our patient. Cranial neuropathies and ataxia were the most frequent clinical manifestations. A total of 50% of the symptomatic ECD CNS lesions were intraparenchymal and nearly 33% of patients died due to the disease itself or complications. CNS involvement may be the only manifestation of ECD and sometimes may require a repeat biopsy with IHC testing for excellent treatment outcomes.
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3
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Hong S, Hasegawa H, Shin M, Shinya Y, Saito N. Endoscopic Transsphenoidal Resection of Suprasellar Histiocytosis in a Patient with Erdheim-Chester Disease: A Case Report. NMC Case Rep J 2022; 8:117-122. [PMID: 35079452 PMCID: PMC8769389 DOI: 10.2176/nmccrj.cr.2020-0126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/22/2020] [Indexed: 11/25/2022] Open
Abstract
Erdheim–Chester disease (ECD) is a rare systemic disease characterized by non-Langerhans histiocytosis. Pituitary involvement, often manifesting as diabetes insipidus, is the most common central nervous system (CNS) lesion. However, significant mass formation compressing the optic apparatus is rarely reported. We present a case of ECD-related suprasellar mass treated with an endoscopic transnasal approach, with emphasis on the surgical strategy and the intraoperative findings. The mass was fibrous, significantly hard, and strongly adhered to the optic nerves, causing visual impairment. A subtotal resection was performed with preserving the adhesion between the mass and the optic nerves, and her visual symptoms improved remarkably after surgery. We highlight the surgical procedure of ECD-related suprasellar mass, from an endoscopic point of view. Due to strong adhesion of the mass to the surrounding optic apparatus and perforators, complete resection may be harmful; judicious mass reduction with preserving such adhesion would contribute to better visual outcomes.
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Affiliation(s)
- Sukwoo Hong
- Department of Neurosurgery, the University of Tokyo Hospital, Tokyo, Japan
| | - Hirotaka Hasegawa
- Department of Neurosurgery, the University of Tokyo Hospital, Tokyo, Japan
| | - Masahiro Shin
- Department of Neurosurgery, the University of Tokyo Hospital, Tokyo, Japan
| | - Yuki Shinya
- Department of Neurosurgery, the University of Tokyo Hospital, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, the University of Tokyo Hospital, Tokyo, Japan
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Fasulo S, Alkomos MF, Pjetergjoka R, Mekheal EM, Awasthi S, Chittamuri S, Kumar V, Kumar M, Akmal A, Maroules M. Erdheim-Chester disease presenting at the central nervous system. AUTOPSY AND CASE REPORTS 2021; 11:e2021321. [PMID: 34540726 PMCID: PMC8432387 DOI: 10.4322/acr.2021.321] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/10/2021] [Indexed: 11/23/2022] Open
Abstract
Erdheim-Chester disease is a rare non-Langerhans cell histiocytosis (LCH) that affects different body systems. It was recently recognized as a neoplastic disorder after identifying an activating mutation of the MAPK pathway. Neurological presentations of ECD are rare. We present a case of a 35-year-old male who presented to the emergency department with neck pain, headache and vomiting for 2 months; MRI showed multiple heterogeneous intracranial masses. Neurosurgery performed a suboccipital craniotomy, partially resected the cerebellar mass, and placed a parietal to frontal shunt catheter. Biopsy results from the cerebellar mass demonstrated cerebellar tissue involved by a diffuse proliferation of foamy histiocytes and spindle cells admixed with prominent lymphoplasmacytic infiltrate and positive for CD68, CD163, Factor XIIIa and Fascin. PET scan showed hypermetabolic uptake within the medullary portions of the diffuse abnormal lesions of the distal femurs, tibias, and fibulas, and cardiac MRI was nonsignificant. The patient was started on vemurafenib and continued to show improvement in a 3-month outpatient follow-up.
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Affiliation(s)
- Sydney Fasulo
- St. Joseph's University, Medical Center, Hematology and Oncology Department, Paterson, NJ, USA.,St. George's University, School of Medicine, Grenada, West Indies, Granada
| | - Mina Fransawy Alkomos
- St. Joseph's University, Medical Center, Internal Medicine Department, Paterson, NJ, USA
| | - Rovena Pjetergjoka
- St. Joseph's University, Medical Center, Internal Medicine Department, Paterson, NJ, USA
| | - Erinie M Mekheal
- St. Joseph's University, Medical Center, Internal Medicine Department, Paterson, NJ, USA
| | - Sharon Awasthi
- St. Joseph's University, Medical Center, Internal Medicine Department, Paterson, NJ, USA
| | - Sahithi Chittamuri
- St. Joseph's University, Medical Center, Hematology and Oncology Department, Paterson, NJ, USA
| | - Vinod Kumar
- St. Joseph's University, Medical Center, Hematology and Oncology Department, Paterson, NJ, USA
| | - Mehandar Kumar
- St. Joseph's University, Medical Center, Hematology and Oncology Department, Paterson, NJ, USA
| | - Amer Akmal
- St. Joseph's University, Medical Center, Pathology Department, Paterson, NJ, USA
| | - Michael Maroules
- St. Joseph's University, Medical Center, Hematology and Oncology Department, Paterson, NJ, USA
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5
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Jeon I, Choi JH. Isolated thoracic intramedullary Erdheim-Chester disease presenting with paraplegia: a case report and literature review. BMC Musculoskelet Disord 2021; 22:270. [PMID: 33711983 PMCID: PMC7955615 DOI: 10.1186/s12891-021-04061-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 02/08/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Erdheim-Chester disease (ECD) is a rare, idiopathic, systemic non-Langerhans cell histiocytosis involving long bone and visceral organs. Central nervous system (CNS) involvement is uncommon and most cases develop as a part of systemic disease. We present a rare case of variant ECD as an isolated intramedullary tumor. CASE PRESENTATION A 75-year-old female patient with a medical history of diabetes and hypertension presented with sudden-onset flaccid paraparesis for 1 day. Neurological examination revealed grade 2-3 weakness in both legs, decreased deep tendon reflex, loss of anal tone, and numbness below T4. Leg weakness deteriorated to G1 before surgery. Preoperative magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) showed an intramedullary mass lesion at T2-T4 with no systemic lesion, which was heterogeneous enhancement pattern with cord swelling and edema from C7 to T6. Gross total removal was achieved for the white-gray-colored and soft-natured intramedullary mass lesion with an ill-defined boundary. Histological finding revealed benign histiocytic proliferation with foamy histiocytes and uniform nuclei. We concluded it as an isolated intramedullary ECD. The patient showed self-standing and walkable at 18-month with no evidence of recurrence and new lesion on spine MRI and whole-body FDG-PET/CT until sudden occurrence of unknown originated thoracic cord infarction. CONCLUSIONS We experienced an extremely rare case of isolated intramedullary ECD, which was controlled by surgical resection with no adjuvant therapy. Histological examination is the most important for final diagnosis, and careful serial follow-up after surgical resection is required to identify the recurrence and progression to systemic disease.
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Affiliation(s)
- Ikchan Jeon
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Hyeonchung street 170, 42415, Daegu, South Korea.
| | - Joon Hyuk Choi
- Department of Pathology, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, South Korea
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6
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Murakami Y, Wataya-Kaneda M, Kitayama K, Arase N, Murota H, Hirayasu K, Arase H, Katayama I. Heightened BRAF
and BRAF
pseudogene expression levels in 2 Japanese patients with Erdheim-Chester disease. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2018. [DOI: 10.1002/cia2.12010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Yukako Murakami
- Dermatology; Department of Integrated Medicine; Osaka University; Osaka Japan
| | - Mari Wataya-Kaneda
- Dermatology; Department of Integrated Medicine; Osaka University; Osaka Japan
| | - Kazuko Kitayama
- Dermatology; Department of Integrated Medicine; Osaka University; Osaka Japan
| | - Noriko Arase
- Dermatology; Department of Integrated Medicine; Osaka University; Osaka Japan
- Department of Immunochemistry Graduate School of Medicine; Osaka University; Osaka Japan
| | - Hiroyuki Murota
- Dermatology; Department of Integrated Medicine; Osaka University; Osaka Japan
| | - Kouyuki Hirayasu
- Laboratory of Immunochemistry; WPI Immunology Frontier Research Center; Osaka University; Osaka Japan
| | - Hisashi Arase
- Department of Immunochemistry Graduate School of Medicine; Osaka University; Osaka Japan
| | - Ichiro Katayama
- Dermatology; Department of Integrated Medicine; Osaka University; Osaka Japan
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7
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Wagner KM, Mandel JJ, Goodman JC, Gopinath S, Patel AJ. Intracranial Erdheim-Chester Disease Mimicking Parafalcine Meningioma: Report of Two Cases and Review of the Literature. World Neurosurg 2017; 110:365-370. [PMID: 29191545 DOI: 10.1016/j.wneu.2017.11.074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 11/14/2017] [Accepted: 11/16/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Erdheim-Chester disease (ECD) is a rare, non-Langerhans cell histiocytosis that typically occurs in middle-aged patients. It is usually characterized by multifocal osteosclerotic lesions of the long-bones, however many cases have extraskeletal involvement. Central nervous system (CNS) involvement is common, but isolated CNS involvement at presentation has rarely been reported. CASE DESCRIPTION Here we report two cases of dural-based ECD mimicking meningioma on imaging with no other identified sites of disease. CONCLUSION ECD is a rare disease, with isolated CNS involvement reported only a few times in the literature. The significance of this presentation requires additional study and long-term follow up.
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Affiliation(s)
- Kathryn M Wagner
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Jacob J Mandel
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - J Clay Goodman
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Shankar Gopinath
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
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8
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Calandra CR, Bustos A, Falcon F, Arakaki N. Erdheim-Chester disease: atypical presentation of a rare disease. BMJ Case Rep 2017; 2017:bcr-2017-220827. [PMID: 29025773 DOI: 10.1136/bcr-2017-220827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
We report the clinical case of an adult patient referred to our hospital because of trismus due to a tumour in the right infratemporal and pterygomaxillary fossa. He referred hyporexia, weight loss and right trigeminal neuralgia. On physical examination, he had trismus and diplopia. On neuroimaging, the tumour invaded the central nervous system affecting the right temporal lobe and orbit, and the sellar region. Tumour biopsy revealed foamy histiocytes and isolated giant multinuclear cells immunoreactive to CD68 and negative to CD1a and S100. A diagnosis of Erdheim-Chester disease was made. Non-evidence of large bone involvement was found in neither plain radiographs nor Technetium 99 m bone scintigraphy. BRAFV600E mutation analysis was negative. Because of raised intracranial pressure, a debulking surgery of the intracranial histiocytic process was performed. The patient improved his symptoms and remains clinically stable after 12 months of treatment with pegylated interferon-α-2a 180 µg/weekly.
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Affiliation(s)
- Cristian Ricardo Calandra
- Department of Neurology, Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina.,Neurology, Hospital El Cruce de Alta Complejidad, Florencio Varela, Buenos Aires, Argentina
| | - Ariel Bustos
- Department of Neurology, Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina
| | - Florencia Falcon
- Department of Pathology, Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina
| | - Naomi Arakaki
- Department of Neuropathology, Institute for Neurological Research, FLENI, Buenos Aires, Argentina
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9
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Suzuki H, Wanibuchi M, Komatsu K, Akiyama Y, Mikami T, Sugita S, Hasegawa T, Kaya M, Takada K, Mikuni N. Erdheim-Chester Disease Involving the Central Nervous System with the Unique Appearance of a Coated Vertebral Artery. NMC Case Rep J 2017; 3:125-128. [PMID: 28664013 PMCID: PMC5386163 DOI: 10.2176/nmccrj.cr.2015-0331] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 04/29/2016] [Indexed: 01/21/2023] Open
Abstract
Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis. It is characterized by multiple xanthogranulomatous masses throughout the body, predominantly in the tibia. One of the characteristic radiological findings of the lesions associated with ECD is a “coated artery,” which is often observed in the aorta. Although approximately one-fourth of ECD cases involve the central nervous system (CNS), an intracranial-coated artery has only been reported in four cases. We report a case of ECD that involves the CNS and has the unique appearance of a coated vertebral artery (VA). These tumors entirely encase the bilateral VAs without stenosis and are attached to the dura. Cranial magnetic resonance imaging also showed multiple extra-axial tumors in the cavernous sinus, the frontal convexity, and the orbital cavity. Further investigation revealed additional extracranial lesions around the cervical carotid artery, at the bilateral tibia, and at the elbow joint. A biopsy of the cervical and tibial lesions confirmed ECD. Steroid therapy resulted in a month-long improvement of preoperative symptoms. However, the patient’s condition gradually progressed and he died of pneumonia 1 year after ECD diagnosis. The encasement of the intracranial artery by the tumor without stenosis and the dural attachment suggest ECD, which requires whole body investigation.
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Affiliation(s)
- Hime Suzuki
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Masahiko Wanibuchi
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Katsuya Komatsu
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Yukinori Akiyama
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Takeshi Mikami
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Shintaro Sugita
- Department of Surgical Pathology, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Tadashi Hasegawa
- Department of Surgical Pathology, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Mitsunori Kaya
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Kohichi Takada
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Nobuhiro Mikuni
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Hokkaido, Japan
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10
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Matzumura M, Arias-Stella J, Novak JE. Erdheim-Chester Disease: A Rare Presentation of a Rare Disease. J Investig Med High Impact Case Rep 2016; 4:2324709616663233. [PMID: 27606325 PMCID: PMC4997308 DOI: 10.1177/2324709616663233] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/11/2016] [Accepted: 07/17/2016] [Indexed: 12/04/2022] Open
Abstract
Erdheim-Chester disease (ECD) is a rare, xanthogranulomatous, non-Langerhans cell histiocytosis with frequent systemic involvement. Although the diagnosis is based on characteristic histological and radiological findings, its identification can be challenging because of its heterogeneous presentation. Osteosclerosis of long bones, often associated with bone pain, is the most common initial manifestation, followed by extraskeletal manifestations in approximately 50% of cases. There is no standard treatment for ECD, although recommendations have been made on the basis of small studies. A systematic approach to the diagnosis of ECD is important, because its manifestations may be life-threatening and may require specific management. We report an atypical presentation of ECD, with early cardiac, renal, and central nervous system involvement, and only late skeletal manifestations.
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11
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Rouco I, Arostegui J, Cánovas A, González del Tánago J, Fernández I, Zarranz J. Neurological manifestations in Erdheim-Chester disease: Two case reports. NEUROLOGÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.nrleng.2014.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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12
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Campero M, Campero S, Guerrero J, Aouba A, Castro A. Cerebral and Cutaneous Involvements of Xanthoma Disseminatum Successfully Treated with an Interleukin-1 Receptor Antagonist: A Case Report and Minireview. Dermatology 2016; 232:171-6. [PMID: 26741816 DOI: 10.1159/000442522] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/17/2015] [Indexed: 11/19/2022] Open
Abstract
A young male presented with panhypopituitarism (including diabetes insipidus) and temporal lobe epilepsy. A histology specimen of cutaneous papules was diagnostic of non-Langerhans histiocytosis. The diagnosis of xanthoma granulomata was considered based on the clinical and brain MRI findings. Brain lesions significantly worsened over time despite radiotherapy until anakinra induced a complete clinical and radiological remission of all active lesions. Although a single case, the outcome of this patient with xanthoma disseminatum treated with an interleukin-1 receptor antagonist opens and strengthens new and recent physiopathogenic and treatment perspectives for the otherwise difficult-to-treat non-Langerhans cell histiocytosis. Similar results with anakinra have been observed in patients with Erdheim-Chester disease and in multicentric reticulohistiocytosis.
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Affiliation(s)
- Mario Campero
- Departamento de Neurologx00ED;a, Clx00ED;nica Las Condes, Santiago, Chile
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13
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Srivanitchapoom P, Sathornsumetee S. Teaching Neuro Images: Erdheim-Chester disease (polyostotic sclerosing histiocytosis). Neurology 2015; 85:e79-80. [DOI: 10.1212/wnl.0000000000001911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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14
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Kon T, Nishijima H, Kon H, Watanabe M, Tomiyama M. Erdheim-Chester disease: yellow-tinge appearance on neuroendoscopic imaging. Neurol Sci 2015; 36:2159-60. [PMID: 26173499 DOI: 10.1007/s10072-015-2331-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 07/06/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Tomoya Kon
- Department of Neurology, Aomori Prefectural Central Hospital, 2-1-1 Higashi-Tsukurimichi, Aomori, 030-8553, Japan.
| | - Haruo Nishijima
- Department of Neurology, Aomori Prefectural Central Hospital, 2-1-1 Higashi-Tsukurimichi, Aomori, 030-8553, Japan
| | - Hiroyuki Kon
- Department of Neurosurgery, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Mika Watanabe
- Department of Pathology, Tohoku University Hospital, Sendai, Japan
| | - Masahiko Tomiyama
- Department of Neurology, Aomori Prefectural Central Hospital, 2-1-1 Higashi-Tsukurimichi, Aomori, 030-8553, Japan
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15
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Bosco J, Allende A, Varikatt W, Lee R, Stewart GJ. Does the BRAFV600Emutation herald a new treatment era for Erdheim-Chester disease? A case-based review of a rare and difficult to diagnose disorder. Intern Med J 2015; 45:348-51. [DOI: 10.1111/imj.12685] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 12/20/2014] [Indexed: 12/24/2022]
Affiliation(s)
- J. Bosco
- Department of Clinical Immunology and Allergy; Westmead Hospital; Sydney New South Wales Australia
- Department of Allergy; Immunology and Respiratory Medicine; Alfred Hospital; Melbourne Victoria Australia
| | - A. Allende
- Department of Tissue Pathology and Diagnostic Oncology; Westmead Hospital; Sydney New South Wales Australia
| | - W. Varikatt
- Department of Tissue Pathology and Diagnostic Oncology; Westmead Hospital; Sydney New South Wales Australia
| | - R. Lee
- Department of Radiology; Westmead Hospital; Sydney New South Wales Australia
| | - G. J. Stewart
- Department of Clinical Immunology and Allergy; Westmead Hospital; Sydney New South Wales Australia
- University of Sydney; Sydney New South Wales Australia
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16
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17
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Rouco I, Arostegui J, Cánovas A, González Del Tánago J, Fernández I, Zarranz JJ. Neurological manifestations in Erdheim-Chester disease: Two case reports. Neurologia 2014; 31:426-8. [PMID: 24735941 DOI: 10.1016/j.nrl.2014.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 01/16/2014] [Accepted: 01/19/2014] [Indexed: 10/25/2022] Open
Affiliation(s)
- I Rouco
- Servicio de Neurología, Hospital Universitario de Cruces, Osakidetza, Baracaldo, Vizcaya, España.
| | - J Arostegui
- Servicio de Reumatología, Hospital Universitario de Cruces, Osakidetza, Baracaldo, Vizcaya, España
| | - A Cánovas
- Servicio de Medicina Interna, Hospital Universitario de Cruces, Osakidetza, Baracaldo, Vizcaya, España
| | - J González Del Tánago
- Servicio de Anatomía Patológica, Hospital Universitario de Cruces, Osakidetza, Baracaldo, Vizcaya, España
| | - I Fernández
- Servicio de Medicina Nuclear, Hospital Universitario de Cruces, Osakidetza, Baracaldo, Vizcaya, España
| | - J J Zarranz
- Servicio de Neurología, Hospital Universitario de Cruces, Osakidetza, Baracaldo, Vizcaya, España
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18
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Campbell RN, Liew MS, Gan HK, Cher L. Mistaken identity: granular cell astrocytoma masquerading as histiocytosis of the central nervous system. J Clin Neurosci 2014; 21:1457-9. [PMID: 24594450 DOI: 10.1016/j.jocn.2013.10.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 10/10/2013] [Accepted: 10/18/2013] [Indexed: 12/01/2022]
Abstract
Granular cell astrocytoma (GCA) is an uncommon malignant glial tumour that is associated with a poor prognosis. GCA cells have some morphological and immunohistochemical similarities to macrophages. In this case, a small biopsy contained no typical astrocytoma and large rounded lesional cells were interpreted as negative for glial fibrillary acidic protein and S100 and positive for CD68, a commonly used marker for macrophages. A diagnosis of a histiocytosis was made. When the patient failed to respond to first and second line therapy, tumour resection was undertaken and the pathology then showed typical morphologic and immunohistochemical features of glioblastoma (astrocytoma World Health Organization grade IV).
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Affiliation(s)
- Robert N Campbell
- Joint Austin-Ludwig Oncology Unit, Level 4 Olivia Newton-John Cancer & Wellness Centre, Austin Hospital, 145 Studley Road, Heidelberg, VIC 3084, Australia
| | - Mun Sem Liew
- Joint Austin-Ludwig Oncology Unit, Level 4 Olivia Newton-John Cancer & Wellness Centre, Austin Hospital, 145 Studley Road, Heidelberg, VIC 3084, Australia
| | - Hui K Gan
- Joint Austin-Ludwig Oncology Unit, Level 4 Olivia Newton-John Cancer & Wellness Centre, Austin Hospital, 145 Studley Road, Heidelberg, VIC 3084, Australia
| | - Lawrence Cher
- Joint Austin-Ludwig Oncology Unit, Level 4 Olivia Newton-John Cancer & Wellness Centre, Austin Hospital, 145 Studley Road, Heidelberg, VIC 3084, Australia; Neurology Unit, Austin Health, VIC, Australia.
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19
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Jain RS, Sannegowda RB, Jain R, Mathur T. Erdheim-Chester disease with isolated craniocerebral involvement. BMJ Case Rep 2013; 2013:bcr2012006823. [PMID: 23592809 PMCID: PMC3645836 DOI: 10.1136/bcr-2012-006823] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Erdheim-Chester disease (ECD) is a rare non-Langerhans form of histiocytosis with distinctive radiographic and pathological features. Intracranial involvement is further a rarity, usually producing diabetes insipidus or cerebellar-brainstem symptoms. We report a 40-year-old man presenting with recurrent secondarily generalised seizures. An MRI scan of the brain revealed multiple enhancing intracranial masses in frontal, temporal and parietal regions. Biopsy from the left frontotemporal lesion confirmed it to be a rare case of ECD. The patient received a short course of corticosteroids initially and subsequently remained well-controlled on antiepileptic therapy alone. A repeat MRI of his brain showed significant resolution of lesions. Osteolytic lesions in the skull vault were detected during follow-up which also disappeared. Interestingly, there was no involvement of long bones or any other system even after 12 years of follow-up.
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Affiliation(s)
- Rajendra Singh Jain
- Department of Neurology, SMS Medical College Hospital, Jaipur, Rajasthan, India.
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20
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Sharma M, Vettiyil B, Bartlett E, Yu E. Suprasellar non-Langerhans cell histiocytosis (Erdheim-Chester disease)--a case report. Clin Imaging 2013; 37:354-7. [PMID: 23465991 DOI: 10.1016/j.clinimag.2012.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 06/11/2012] [Indexed: 11/19/2022]
Abstract
Erdheim-Chester disease (ECD) is an uncommon non-Langerhans cell histiocytosis that affects multiple body systems and can present clinically in a myriad of ways. An adult onset is most common with bony involvement and constitutional symptoms. We report the case of a 52-year-old female presenting with diabetes insipidus and a suprasellar mass on imaging, with no evidence of extracerebral involvement. Histopathology was consistent with ECD.
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Affiliation(s)
- Manas Sharma
- Head and Neck Imaging, Princess Margaret Hospital, Toronto M5G 2M9.
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21
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Alexiev BA, Staats PN. Erdheim-Chester disease with prominent pericardial effusion. Diagn Cytopathol 2013; 42:530-4. [DOI: 10.1002/dc.22957] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 01/01/2013] [Indexed: 12/29/2022]
Affiliation(s)
- Borislav A. Alexiev
- Department of Pathology; University of Maryland Medical Center; Baltimore Maryland
| | - Paul N. Staats
- Department of Pathology; University of Maryland Medical Center; Baltimore Maryland
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22
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Purgina B, Jaffe R, Monaco SE, Khalbuss WE, Beasley HS, Dunn JA, Pantanowitz L. Cytomorphology of Erdheim-Chester disease presenting as a retroperitoneal soft tissue lesion. Cytojournal 2011; 8:22. [PMID: 22279491 PMCID: PMC3263029 DOI: 10.4103/1742-6413.91242] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 11/30/2011] [Indexed: 12/14/2022] Open
Abstract
Erdheim–Chester disease (ECD) is a rare, multisystem disorder of macrophages. Patients manifest with histiocytic infiltrates that lead to xanthogranulomatous lesions in multiple organ systems. The cytologic features of this disorder are not well characterized. As a result, the cytologic diagnosis of ECD can be very challenging. The aim of this report is to describe the cytomorphology of ECD in a patient presenting with a retroperitoneal soft tissue lesion. A 54-year-old woman with proptosis and diabetes insipidus was found on imaging studies to have multiple intracranial lesions, sclerosis of both femurs and a retroperitoneal soft tissue mass. Fine needle aspiration (FNA) and a concomitant core biopsy of this abnormal retroperitoneal soft tissue revealed foamy, epithelioid and multinucleated histiocytes associated with fibrosis. The histiocytes were immunoreactive for CD68, CD163, Factor XIIIa and fascin, and negative for S100, confirming the diagnosis of ECD. ECD requires a morphologic diagnosis that fits with the appropriate clinical context. This case describes the cytomorphologic features of ECD and highlights the role of cytology in helping reach a diagnosis of this rare disorder.
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Affiliation(s)
- Bibianna Purgina
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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23
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Puntambekar P, Santhakumar S, Kupsky WJ, Tselis A, Mittal S. Primary intracranial plasma cell granulomas presenting as malignant neoplasms. J Neurooncol 2011; 106:327-37. [PMID: 21786175 DOI: 10.1007/s11060-011-0667-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Accepted: 07/07/2011] [Indexed: 12/22/2022]
Abstract
Plasma cell granuloma (PCG) is an uncommon non-neoplastic mass lesion of unknown etiology. It is characterized by a polyclonal proliferation of chronic inflammatory cells, mostly mature plasma and other mononuclear cells. PCGs arising in the central nervous system are particularly rare. We report two additional cases of intracranial PCG exclusively involving the brain parenchyma. A 47 year-old woman, presenting with partial motor seizures and fluent aphasia, underwent complete excision of a well-demarcated, enhancing left parietal mass. The second patient was a 56 year-old man presenting with headaches and right-sided weakness who underwent stereotactic biopsy of an ill-defined, heterogeneously enhancing lesion in the left basal ganglia. Immunohistochemical analysis of surgical specimens showed polyclonal plasma cells and mature lymphocytes but no etiological agent. A histopathologic diagnosis of intracranial PCG was made in both cases. PCG should be part of the differential diagnosis of enhancing mass lesions of the brain. The etiology and natural history of these tumor-like lesions is not fully understood. Complete surgical excision appears to be curative. Lesions where total resection is not possible may benefit from adjuvant treatment including corticosteroids and possibly radiation therapy.
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Affiliation(s)
- Preeti Puntambekar
- Department of Neurology, Wayne State University, Detroit Medical Center, Detroit, MI, USA
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