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Alkatan HM, Fatani DR, Maktabi AMY, Alzahem TA. Clinicopathological study of ophthalmic cutaneous and mucocutaneous non-langerhans cell histiocytic lesions. BMC Ophthalmol 2024; 24:124. [PMID: 38504269 PMCID: PMC10949701 DOI: 10.1186/s12886-024-03388-8] [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: 09/21/2023] [Accepted: 03/11/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND The "C group" of the histiocytic disorders is characterized by non-Langerhans-cell histiocytic lesions in the skin, mucosal surfaces, or both, out of which Juvenile xanthogranuloma (JXG) is the most common typically affecting the skin. The eye is the most common extra-cutaneous site of JXG., we aim at providing our clinical and histopathological experience with this group of diseases including the adult-onset xanthogranuloma (AXG). METHODS This is a retrospective cohort study of all patients with the tissue diagnosis of ocular and periocular cutaneous and mucocutaneous non-LCH disorders who presented to us over a period of 25 years (January 1993 to December 2018). RESULTS Twenty patients were diagnosed as "Group C" disease with an age range of 2 months-60.9 years. Eleven patients were females (55%) and nine were males (45%). The involvement was mostly unilateral in 80.9%. All cases fell into the xanthogranuloma family with 11 JXG patients, 8 AXG patients of skin and ocular surface, and one patient with solitary reticulohistiocytoma (SRH). The clinical site of involvement in JXG was primarily in the eyelid in 5 patients (45%), ocular surface lesions in 2 (18%), iris in 2 (18%), choroidal and bilateral orbital lesions in 1 patient each (9%). The group of AXG, presented equally with eyelid lesions in 4/8 and ocular surface lesions in 4/8. The non-Langerhans' histiocytic infiltrate showed supportive immunohistochemical staining properties (reactive to CD68 marker and negative to S-100 and langerin markers). CONCLUSION Among the rare histiocytic disorders, xanthogranulomatosis is the commonest and has wide clinical manifestations. Accurate diagnosis needs to be supported by typical histopathological findings. JXG was the commonest in our study with relatively older mean age at presentation and frequent eyelid rather than iris involvement. AXG is often confused with xanthelasma when involving the eyelids with corneal limbal involvement is relatively frequent.
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Affiliation(s)
- Hind Manaa Alkatan
- Ophthalmology Department, College of Medicine, King Saud University, P.O. Box 266, Riyadh, 11362, Saudi Arabia.
- Pathology and Laboratory Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
- King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
| | - Dalal R Fatani
- Oculoplasty and Orbit Surgery, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Azza M Y Maktabi
- Pathology and Laboratory Medicine Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Tariq A Alzahem
- King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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Esen Baris M, Ciftci MD, Palamar M, Guven Yilmaz S. Iris Juvenile Xanthogranuloma Presenting with Hypopyon. Ocul Immunol Inflamm 2022; 30:2014-2016. [PMID: 34228593 DOI: 10.1080/09273948.2021.1936077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To report a case an iris juvenile xanthogranuloma presenting with hypopyon. CASE REPORT A 45-day-old infant was referred to our clinic for unilateral hypopyon. Slit-lamp examination revealed a 2 mm hypopyon in the left eye while visible areas of the iris were normal. Fundus examination was normal. Topical corticosteroids and antibiotics were initiated. The hypopyon regressed to 0.5 mm after 2 weeks of treatment. The now visible peripheral iris revealed an inferotemporal yellow-brown iris mass. Clinical findings were consistent with juvenile xanthogranuloma of the iris. The patient was referred to the pediatrics department which revealed no systemic involvement. Two months after total regression of hypopyon, the baby presented with a 3 mm spontaneous hyphema causing 50 mmHg intraocular pressure. The patient was followed with topical corticosteroids and antiglaucomatous drops until the hyphema was resolved. CONCLUSION ocular involvement, which is the most common extracutaneous 15 manifestation of juvenile xanthogranuloma, should be considered in the differential diagnosis of hypopyon and/or hyphema in young children.
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Affiliation(s)
- Mine Esen Baris
- Department of Ophthalmology, Ege University Hospital, Izmir, Turkey
| | | | - Melis Palamar
- Department of Ophthalmology, Ege University Hospital, Izmir, Turkey
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Kim J, Steeples LR, Jones NP. Ocular Involvement in the Histiocytoses: A Literature Review with an Illustrative Case Series. Ocul Immunol Inflamm 2021; 30:600-614. [PMID: 34637661 DOI: 10.1080/09273948.2021.1936566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose: To describe and illustrate recent reclassification and clinical descriptions of the histiocytoses, diagnosis and management, and effects on the eye and adnexaePatients and methods: Literature review with an illustrative case series of seven patients with histiocytosis and ophthalmic involvement from a single tertiary centre.Results: Skin lesions with signs including eyelid mass, orbital bone destruction, bizarre keratic precipitates, limbal or iris mass, haemorrhagic anterior uveitis, subretinal lesions of uncertain etiology, ischaemic retinopathy, optic neuropathy, and apparent steroid-resistant inflammations should be comprehensively investigated.Conclusions: Ophthalmic involvement in histiocytosis is rare. Clinical manifestations vary from limited single-organ disease to lethal systemic infiltration or malignancy. Radiology may identify lesions for biopsy. Histology with appropriate markers is essential. Oncology advice may be required.
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Affiliation(s)
- Jennifer Kim
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Laura R Steeples
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Nicholas P Jones
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
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Winter AW, Lyons CJ. Complete resolution of iris juvenile xanthogranuloma in an infant with topical corticosteroid treatment only. Can J Ophthalmol 2021; 57:e10-e11. [PMID: 34077746 DOI: 10.1016/j.jcjo.2021.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/13/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Aaron W Winter
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, B.C..
| | - Christopher J Lyons
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, B.C
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Rouatbi A, Chebbi A, Bouguila H. Adult xanthogranuloma of the iris, an unusual isolated location. J Fr Ophtalmol 2019; 42:e469-e471. [PMID: 31221452 DOI: 10.1016/j.jfo.2019.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/18/2019] [Accepted: 04/18/2019] [Indexed: 11/26/2022]
Affiliation(s)
- A Rouatbi
- Faculty of Medicine of Tunis (FMT), National Institute of Ophthalmology, Tunisia University of Tunis El-Manar, Tunis, Tunisia.
| | - A Chebbi
- Faculty of Medicine of Tunis (FMT), National Institute of Ophthalmology, Tunisia University of Tunis El-Manar, Tunis, Tunisia
| | - H Bouguila
- Faculty of Medicine of Tunis (FMT), National Institute of Ophthalmology, Tunisia University of Tunis El-Manar, Tunis, Tunisia
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Samuelov L, Kinori M, Chamlin SL, Wagner A, Kenner-Bell BM, Paller AS, Kruse LL, Mancini AJ. Risk of intraocular and other extracutaneous involvement in patients with cutaneous juvenile xanthogranuloma. Pediatr Dermatol 2018; 35:329-335. [PMID: 29488239 DOI: 10.1111/pde.13437] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND/OBJECTIVES Cutaneous juvenile xanthogranuloma is an uncommon, usually benign disease affecting infants and young children. Ocular and other systemic involvement have been reported, but their incidence is unclear, and the utility of routine screening is not well established. Our aim was to characterize the risk of ocular and systemic complications in children with cutaneous juvenile xanthogranuloma. METHODS In this retrospective study, we reviewed the medical charts of children with cutaneous juvenile xanthogranuloma seen at Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, between January 2000 and December 2015. A comprehensive literature review was also performed. RESULTS Of 338 children with cutaneous juvenile xanthogranuloma, 76 (median age 6 months, 51% female) met inclusion criteria. The most frequently involved site was the head and neck region (40%). In 39 patients (51%), there was a single lesion. Multiple lesions (>5) were evident in 20 patients (26%). Most cutaneous juvenile xanthogranulomas were micronodular (77%). None of the patients had ocular involvement. One patient had multiple asymptomatic hepatic nodules on imaging that regressed spontaneously within several months. Literature review of pediatric cutaneous juvenile xanthogranuloma series, including our cohort, revealed that the incidence of ocular manifestations is 0.24% (7/2949) and of systemic manifestations is 0.75% (22/2949). CONCLUSION Cutaneous juvenile xanthogranulomas are generally limited to the skin. Because eye involvement is rare, a routine eye examination is of low yield and probably not warranted in children with no ocular or visual symptoms. New recommendations for systemic screening could not be drawn from this study.
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Affiliation(s)
- Liat Samuelov
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Michael Kinori
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Sarah L Chamlin
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Annette Wagner
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Brandi M Kenner-Bell
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Amy S Paller
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Lacey L Kruse
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Anthony J Mancini
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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LaRosa C, Makkar H, Grant-Kels JM. Approach to the total body skin examination in adults and children: Kids are not just little people. Clin Dermatol 2017; 35:500-503. [DOI: 10.1016/j.clindermatol.2017.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Flockerzi E, Hager T, Seitz B. Intraocular juvenile xanthogranuloma of the iris in an adult patient. Am J Ophthalmol Case Rep 2016; 5:73-75. [PMID: 29503951 PMCID: PMC5758008 DOI: 10.1016/j.ajoc.2016.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 11/11/2016] [Accepted: 12/02/2016] [Indexed: 11/24/2022] Open
Abstract
Purpose Juvenile xanthogranuloma (JXG) is a rare histiocytic skin disease primarily of young children, which may also affect ocular structures and in particular the iris. Observations This is a case report of a fifty-year-old patient without skin lesions showing a progressive decrease of visual acuity, iris vascularization and a yellowish iris tumor in the iridocorneal angle of his right eye. Treatment with topical and systemic prednisolone led to full recovery of visual acuity, tumor regression and restitutio ad integrum. Conclusions and importance Although the juvenile xanthogranuloma is a very rare skin disease of young children, it may also affect the eye and in particular the iris in adult patients. There exists no standard treatment, the first-line therapy in most cases, however, is topical and systemic prednisolone application.
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Affiliation(s)
- Elias Flockerzi
- Department of Ophthalmology, Saarland University, 66421 Homburg, Germany
| | - Tobias Hager
- Department of Ophthalmology, Saarland University, 66421 Homburg, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University, 66421 Homburg, Germany
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Samara WA, Khoo CT, Say EAT, Saktanasate J, Eagle RC, Shields JA, Shields CL. Juvenile Xanthogranuloma Involving the Eye and Ocular Adnexa. Ophthalmology 2015; 122:2130-8. [DOI: 10.1016/j.ophtha.2015.06.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 06/02/2015] [Accepted: 06/05/2015] [Indexed: 11/15/2022] Open
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Samara WA, Khoo CTL, Magrath G, Shields CL. Multimodal imaging for detection of clinically inapparent diffuse iris juvenile xanthogranuloma. J Pediatr Ophthalmol Strabismus 2015; 52 Online:e30-3. [PMID: 25992541 DOI: 10.3928/01913913-20150506-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/06/2015] [Indexed: 11/20/2022]
Abstract
A 6-month-old female infant was referred following three episodes of spontaneous hyphema. Iris juvenile xanthogranuloma was suspected but not clinically visible. Multimodal imaging with fluorescein angiography, anterior segment optical coherence tomography, and ultrasound biomicroscopy were used to detect the flat, transparent lesion and cytopathology confirmed juvenile xanthogranuloma.
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Aburezq H, Jaeger M, Iyengar P, Zuker R. Juvenile xanthogranuloma of the nose. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2013; 12:198-200. [PMID: 24115896 DOI: 10.1177/229255030401200406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Juvenile xanthogranuloma is a type of non-Langerhans cell histiocytosis that occurs most frequently in infants and children. It is usually asymptomatic and can present as either a cutaneous or extracutaneous lesion. The present case is believed to be the first reported in the English literature of juvenile xanthogranuloma presenting as an ulcerated bleeding lesion on the dorsum of the nose.
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Affiliation(s)
- Hisham Aburezq
- Division of Plastic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario
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Kim SW, Han TY, Lee JH, Son SJ. A case of Juvenile Xanthogranuloma in the Nasal Cavity of a Neonate. Indian J Dermatol 2013; 58:411. [PMID: 24082228 PMCID: PMC3778823 DOI: 10.4103/0019-5154.117364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Seo Wan Kim
- Department of Dermatology, Eulji Medical Center, College of Medicine, Eulji University, Seoul, Korea. E-mail:
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Longmuir S, Dumitrescu A, Kwon Y, Boldt HC, Hong S. Juvenile xanthogranulomatosis with bilateral and multifocal ocular lesions of the iris, cornealscleral limbus, and choroid. J AAPOS 2011; 15:598-600. [PMID: 22153409 DOI: 10.1016/j.jaapos.2011.07.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 07/07/2011] [Accepted: 07/08/2011] [Indexed: 11/16/2022]
Abstract
A 14-month-old boy with juvenile xanthogranuloma skin lesions presented with increased intraocular pressure, hyphema, anterior uveitis, iris mass, and a subconjunctival limbal mass of the right eye. He subsequently developed a subretinal mass in the left eye. The anterior uveitis resolved after 2 periocular injections of triamcinolone in addition to the administration of topical prednisolone and oral prednisone and methotrexate. The subretinal mass in the left eye also resolved during the course of 1 year. He developed a cataract in the right eye and underwent lensectomy with anterior vitrectomy. This is the first published case in which methotrexate was used as an adjunctive treatment of juvenile xanthogranuloma in a child.
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Affiliation(s)
- Susannah Longmuir
- Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52246, USA.
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Juvenile Xanthogranuloma of the Corneal Limbus. Report of 2 Cases and Review of the Literature. Cornea 2010. [DOI: 10.1097/ico.0b013e3181d3987f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Juvenile xanthogranuloma (JXG) is a benign histiocytic skin disorder mainly encountered during infancy. Approximately 10% of cases exhibit ocular manifestations leading to serious complications. Specifically, secondary glaucoma can result in severe and blinding eye disease. We present a case of a two-month-old female with JXG related glaucoma in order to demonstrate the classic presentation and the problems commonly encountered in treating this disease. The natural history, pathogenesis, and treatment of the condition are then discussed and the pertinent literature reviewed. JXG should be considered in any case of unilateral glaucoma that presents in infancy.
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Affiliation(s)
- Zarmeena Vendal
- Glaucoma Service, Massachusetts Eye & Ear Infirmary, Boston, MA 02114, USA.
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[Juvenile xanthogranuloma of the corneoscleral limbus]. J Fr Ophtalmol 2009; 32:436.e1-6. [PMID: 19515457 DOI: 10.1016/j.jfo.2009.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Accepted: 04/12/2009] [Indexed: 11/23/2022]
Abstract
An 18-year-old patient presented with a solitary limbal tumor on his left eye that had appeared and increased in size for 3 weeks. This mass did not display any extension into the anterior chamber on gonioscopy. Excisional biopsy by lamellar sclerokeratectomy was carried out and the lesion was sent for histologic examination. The pathologic diagnosis showed the characteristic picture of juvenile xanthogranuloma with numerous Touton giant cells. There was no recurrence after a 9-month follow-up. The diagnosis of isolated ocular juvenile xanthogranuloma may be difficult and histologic examination of ocular lesions is often necessary. When juvenile xanthogranuloma affects the uvea, treatment is medical. When it appears as a limbal mass, treatment is surgical. Juvenile xanthogranuloma should always be considered a differential diagnosis of a limbal mass, especially in children.
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Hu WK, Gilliam AC, Wiersma SR, Dahms BB. Fatal congenital systemic juvenile xanthogranuloma with liver failure. Pediatr Dev Pathol 2004; 7:71-6. [PMID: 15255037 DOI: 10.1007/s10024-003-4040-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This is the second reported patient with systemic juvenile xanthogranuloma (JXG) to die with liver failure. The infant was born with multiple skin lesions and mild hepatomegaly. Direct hyperbilirubinemia was noted on the 2nd day of life, followed by progressive hepatomegaly, cholestasis, and death at 29 days of age. At autopsy, nodular tumor infiltrates of JXG were present throughout the liver, as well as in skin, abdominal lymph nodes, spleen, and pancreas.
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Affiliation(s)
- Weimin K Hu
- Department of Dermatology, University Hospitals of Cleveland and Case Western University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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Algros MP, Laithier V, Montard M, Laurent R, Kantelip B. Juvenile xanthogranuloma of the iris as the first manifestation of a neurofibromatosis. J Pediatr Ophthalmol Strabismus 2003; 40:166-7. [PMID: 12795438 DOI: 10.3928/0191-3913-20030501-13] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Marie-Paule Algros
- Department of Pathology, University Hospital Jean Minjoz, Besançon, France
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Abstract
Juvenile xanthogranuloma (JXG) is the most common non-Langerhans histiocytosis, but it rarely occurs extracutaneously. It sometimes presents with associated neurofibromatosis and Juvenile chronic myalogenous leukemia. We present a case of nasal JXG and discuss the histological characteristics, the classification, and the management.
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Affiliation(s)
- Tuan-Jen Fang
- Department of Otolaryngology, Chang-Gung Memorial Hospital, 5, Fu-Shing Street, Kweishan 333, Taoyuan, Taiwan
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Walters G, Taylor RH. Severe systemic toxicity caused by brimonidine drops in an infant with presumed juvenile xanthogranuloma. Eye (Lond) 1999; 13 ( Pt 6):797-8. [PMID: 10707152 DOI: 10.1038/eye.1999.235] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Affiliation(s)
- J Raz
- Department of Ophthalmology, Sapir Medical Center, Meir General Hospital, Kfar-Saba, Israel
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Chang MW. Update on juvenile xanthogranuloma: unusual cutaneous and systemic variants. SEMINARS IN CUTANEOUS MEDICINE AND SURGERY 1999; 18:195-205. [PMID: 10468039 DOI: 10.1016/s1085-5629(99)80017-0] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Juvenile xanthogranuloma (JXG) is a well-recognized benign disorder of infancy and early childhood characterized by yellowish cutaneous nodules that spontaneously regress over months to years. In the vast majority of children, JXG is limited to the skin and requires no treatment. Over the past two decades, unusual cutaneous and systemic forms of JXG have been increasingly reported. JXGs have been discovered, usually unexpectedly, in every organ system of the body. Correct diagnosis is crucial to prevent unnecessary invasive diagnostic and therapeutic procedures. Unusual clinical and histological variants of JXG often require immunohistochemical studies and/or electron microscopy to establish the diagnosis. Nonlipidized, giant, intramuscular, subcutaneous, and clustered JXG are but some of the variants that are discussed in this article. The immunohistochemistry of JXG, current nosology, and hypotheses regarding the origins of JXG are also reviewed.
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Affiliation(s)
- M W Chang
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, NY 10016, USA
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Hidayat AA, Mafee MF, Laver NV, Noujaim S. Langerhans' cell histiocytosis and juvenile xanthogranuloma of the orbit. Clinicopathologic, CT, and MR imaging features. Radiol Clin North Am 1998; 36:1229-40, xii. [PMID: 9884699 DOI: 10.1016/s0033-8389(05)70242-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The clinical, radiologic, and histopathologic features of two main disorders of the orbit are discussed. Group I, Langerhans cell histiocytosis (histiocytosis X, Class I), is caused by proliferation of X histiocytic Langerhans' cells. Group II is juvenile xanthogranuloma, and Class II is related to the proliferation of non-X histiocytic (monocyte-macrophage) cells. The two diseases are of unknown cause and differ in their clinical, radiologic, and histopathologic features.
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Affiliation(s)
- A A Hidayat
- Department of Ophthalmic Pathology, Armed Forces Institute of Pathology, Washington, DC, USA
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Abstract
Juvenile xanthogranuloma (JXG) is a benign, self-healing disorder characterized by solitary or multiple yellow-red nodules on the skin and, occasionally, in other organs. It is predominantly a disease of infancy or early childhood, although adults may also be affected. Histologically, JXG represents an accumulation of histiocytes lacking Birbeck granules (non-Langerhans cells), which can be differentiated from Langerhans cells by specific staining techniques. Affected persons have normal lipid metabolism. JXG is therefore classified as a normolipemic non-Langerhans cell histiocytosis. The patient's general health is not impaired and, in the absence of associated conditions, the prognosis is excellent. Diagnosis is readily made in typical cases, but may be more difficult in unusual variants.
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Shields JA, Eagle RC, Shields CL, Collins MLZ, DePotter P. Iris Juvenile Xanthogranuloma Studied by Immunohistochemistry and Flow Cytometry. Ophthalmic Surg Lasers Imaging Retina 1997. [DOI: 10.3928/1542-8877-19970201-10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
BACKGROUND Juvenile xanthogranuloma is a benign, self-limiting cutaneous disorder most commonly encountered during infancy. Approximately 10% of cases may develop ocular or adnexal involvement, most commonly in the iris. METHODS We review clinical and morphological features of four cases of iris juvenile xanthogranuloma that reflect the diagnostic and therapeutic spectrum. RESULTS Tissue diagnosis was confirmed in all cases; in one case, the disease was diagnosed with a skin biopsy and treated with local and systemic steroids, and its persistence in the iris was confirmed with a second tissue specimen obtained five months after systemic steroid treatment. CONCLUSION The diagnosis and treatment of juvenile xanthogranuloma may be straightforward, particularly in cases when the ocular lesion receives early attention and responds well to topical steroids, and when there is no hyphema. However, in other instances, this entity may be difficult to manage and may necessitate iris biopsy for diagnosis and radiation therapy for treatment.
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Affiliation(s)
- Z A Karcioglu
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Freyer DR, Kennedy R, Bostrom BC, Kohut G, Dehner LP. Juvenile xanthogranuloma: forms of systemic disease and their clinical implications. J Pediatr 1996; 129:227-37. [PMID: 8765620 DOI: 10.1016/s0022-3476(96)70247-0] [Citation(s) in RCA: 173] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Juvenile xanthogranuloma (JXG) with systemic (extracutaneous) involvement is a rare histiocytic disorder in which significant morbidity and occasional deaths may occur. The objective of this study was to characterize the spectrum of anatomic involvement, associated clinical problems, and management considerations in children with systemic JXG. STUDY DESIGN Two current cases and literature reports of 34 children with various forms of systemic AG were analyzed with respect to age, clinical presentation, site(s) of involvement, therapy, and outcome. RESULTS The median age of the 36 patients was 0.3 years (range, birth to 12 years). Symptoms were usually referable to bulky or infiltrative disease. Twenty patients had disease in two or more sites. Cutaneous lesions were present in fewer than half the patients. The most frequent extracutaneous sites of disease were the subcutaneous soft tissue (12); central nervous system (8); liver/spleen (8); lung (6); eye/orbit, oropharynx, and muscle (4 each); with three or fewer instances of disease in each of several other sites. Most patients were treated with excision or had spontaneous regression (some with organ involvement). However, 12 patients received treatment that included radiation or systemic chemotherapy. Survivors, some with long-term disabilities, included young children who had received radiation therapy to the brain, eye, skin, or heart. Two patients died of disease. CONCLUSIONS Systemic AG may involve varying numbers and combinations of extracutaneous sites. The extent of disease should be determined in patients with AG who are suspected to have systemic involvement. In contrast to the cutaneous form, systemic AG may be associated with significant complications requiring aggressive medical care. When feasible, surgical excision of lesions may be curative. Optimal treatment for symptomatic, unresectable disease is currently undefined but should be selected to minimize toxic effects in these children who are typically younger than 1 year old at presentation.
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Affiliation(s)
- D R Freyer
- Department of Pediatrics, DeVos Children's Hospital, Grand Rapids, Michigan 49503, USA
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van Leeuwen RL, Berretty PJ, Knots E, Tan-Go I. Triad of juvenile xanthogranuloma, von Recklinghausen's neurofibromatosis and trisomy 21 in a young girl. Clin Exp Dermatol 1996; 21:248-9. [PMID: 8914381 DOI: 10.1111/j.1365-2230.1996.tb00084.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Chang MW, Frieden IJ, Good W. The risk intraocular juvenile xanthogranuloma: survey of current practices and assessment of risk. J Am Acad Dermatol 1996; 34:445-9. [PMID: 8609257 DOI: 10.1016/s0190-9622(96)90437-5] [Citation(s) in RCA: 109] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Juvenile xanthogranuloma (JXG) is an uncommon, usually uncomplicated disease of childhood. Ocular involvement, however, can result in glaucoma and blindness if left untreated. The incidence of ocular complications and how best to screen for their occurrence is unknown. OBJECTIVE We attempted to ascertain management and referral practices among ophthalmologists and dermatologists and to characterize the risk for ocular complications in children with JXG. METHODS A total of 431 dermatologists and 438 ophthalmologists were surveyed. In addition, the literature was reviewed. RESULTS The response rate were 28% (dermatologists) and 44% (ophthalmologists). Most believed screening was important, but referral and surveillance practices varied widely. The survey incidence of ocular complications in patients with cutaneous JXG was approximately 0.3% (7 of 2371). The literature incidence was 0.4% (1 of 260). Children at maximum risk were 2 years of age or younger, had multiple skin lesions, and had newly diagnosed JXG. CONCLUSION Ophthalmologic screening of patients with JXG should be particularly targeted to patients with risk factors of multiple skin lesions, new diagnosis, and age of 2 years or younger.
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Affiliation(s)
- M W Chang
- Department of Dermatology, Wayne State University, Detroit, USA
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