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Shaker N, Shaker N, Abu Shakra R, Yenwongafi L, Pradhan D, Sangueza OP. Pulmonary Langerhans Cell Histiocytosis Post-Hodgkin Lymphoma Completely Resolved With Vinblastine in a Heavy Smoker: Coincidence or Causation? Int J Surg Pathol 2024:10668969241253216. [PMID: 38767149 DOI: 10.1177/10668969241253216] [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: 05/22/2024]
Abstract
The association among Langerhans cell histiocytosis, hematolymphoid malignancies, and heavy smoking has been addressed in medical literature to identify a possible potential link. Such occurrence can pose diagnostic challenges, as well as important clinical implications for disease progression and treatment approaches. We present pulmonary Langerhans cell histiocytosis instance in a 35-year-old male patient, with a 34-pack-year smoking history and nodular sclerosing Hodgkin lymphoma stage IIB who developed multiple bilateral lung nodules. The patient completed 6 cycles of doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine chemotherapy and radiotherapy 2 years earlier. CT chest scans revealed numerous micronodules scattered randomly throughout the upper and lower left lung lobes. Subsequent wedge resection exhibited cellular proliferation with grooved nuclei, eosinophilic cytoplasm, and surrounding inflammatory components. Immunohistochemical staining showed positive staining for S100 and CD1a confirming a diagnosis of pulmonary Langerhans cell histiocytosis. The patient responded to a 6-week treatment with vinblastine and prednisolone. A subsequent CT scan of the lungs revealed complete resolution after 3 years. This report underscores the importance of identifying pulmonary Langerhans cell histiocytosis in heavy smokers with Hodgkin lymphoma presenting with multiple nodular pulmonary lesions. For patients with Hodgkin lymphoma and a possible genetic predisposition, smoking may contribute to the overt development of pulmonary Langerhans cell histiocytosis. Therefore, smoking cessation and careful follow-up examinations are required. Further research is recommended to elucidate the underlying mechanisms of this intriguing association.
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Affiliation(s)
- Nada Shaker
- Pathology and Laboratory Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nuha Shaker
- University of Pittsburgh Medical Center Health System, Pittsburgh, PA, USA
| | - Rafat Abu Shakra
- Department of Pathology, International Medical Center Hospital, Jeddah, Saudi Arabia
| | | | | | - Omar P Sangueza
- Departments of Dermatology and Dermatopathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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García García A, Mora Pinilla J, Raboso Moreno B, Río Ramírez MT, Abad Fernández A. Cheerio Sign: Pulmonary Langerhans Cell Histiocytosis. Arch Bronconeumol 2024; 60:308-309. [PMID: 38508925 DOI: 10.1016/j.arbres.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/22/2024]
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Zhang L, Chen H, Ding Y, Wang W, Wa G, Zheng B, Wang J. Pulmonary Langerhans Cell Histiocytosis in an African Lion: A Rare Case Report. Animals (Basel) 2024; 14:1011. [PMID: 38612250 PMCID: PMC11010851 DOI: 10.3390/ani14071011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/17/2024] [Accepted: 03/24/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Feline pulmonary Langerhans cells histiocytosis (PLCH) is a rare disorder that results in progressive respiratory failure secondary to pulmonary parenchymal infiltration with Langerhans cells (LCs). A diagnosis of PLCH is proposed based on the clinical features and pathological findings and confirmed based on the infiltrating histiocytic cells. There are few documented cases of feline PLCH, and this case report of PLCH in an African Lion could present new information and aspects of this feline histiocytic disease. CASE PRESENTATION An African lion at Hohhot Zoo showing severe hyporexia and dyspnea with subsequent mental depression and emaciation died of exhaustion after a 35-day course of illness. Empirical treatment did not have a significant effect. An autopsy revealed that the lungs were enlarged and hardened due to infiltrative lesions, with many yellowish-white foci in all the lobes and sections. Furthermore, the kidneys were atrophied and had scattered grayish-white lesions on the surface. At the same time, congestion was widely distributed in various locations, including the liver, subcutaneous loose connective tissues, serosal surface and other tissues and organs. Histologically, proliferative histiocytic cells (PHCs) were scattered in the alveolar cavities, bronchioles and submucosa of bronchioles, with evident cellular and nuclear pleomorphism, and thus the alveolar septa were obliterated. The histopathological changes in other organs included chronic sclerosing glomerulonephritis, proliferated Kupffer cells in the liver, adrenal edema and interstitial connective tissue hyperplasia, as well as atrophy of the small intestines and spleen. Furthermore, immunohistochemical analysis results were strongly positive for CD1a, vimentin, S100 and E-cadherin in the membrane or cytoplasm of PHCs, supporting an LC phenotype. CONCLUSIONS Here, we present a rare pulmonary Langerhans cell histiocytosis case in an African lion.
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Affiliation(s)
- Liang Zhang
- College of Veterinary Medicine, Inner Mongolia Agricultural University, Hohhot 010018, China; (L.Z.); (H.C.); (Y.D.); (W.W.)
- Key Laboratory of Clinical Diagnosis and Treatment Techniques for Animal Disease, Ministry of Agriculture and Rural Affairs, Hohhot 010018, China
- Inner Mongolia Autonomous Region Key Laboratory of Veterinary Fundamentals and Disease Prevention and Control of Herbivorous Livestock, Hohhot 010018, China
| | - Hui Chen
- College of Veterinary Medicine, Inner Mongolia Agricultural University, Hohhot 010018, China; (L.Z.); (H.C.); (Y.D.); (W.W.)
- Key Laboratory of Clinical Diagnosis and Treatment Techniques for Animal Disease, Ministry of Agriculture and Rural Affairs, Hohhot 010018, China
- Inner Mongolia Autonomous Region Key Laboratory of Veterinary Fundamentals and Disease Prevention and Control of Herbivorous Livestock, Hohhot 010018, China
| | - Yulin Ding
- College of Veterinary Medicine, Inner Mongolia Agricultural University, Hohhot 010018, China; (L.Z.); (H.C.); (Y.D.); (W.W.)
- Key Laboratory of Clinical Diagnosis and Treatment Techniques for Animal Disease, Ministry of Agriculture and Rural Affairs, Hohhot 010018, China
- Inner Mongolia Autonomous Region Key Laboratory of Veterinary Fundamentals and Disease Prevention and Control of Herbivorous Livestock, Hohhot 010018, China
| | - Wenlong Wang
- College of Veterinary Medicine, Inner Mongolia Agricultural University, Hohhot 010018, China; (L.Z.); (H.C.); (Y.D.); (W.W.)
- Key Laboratory of Clinical Diagnosis and Treatment Techniques for Animal Disease, Ministry of Agriculture and Rural Affairs, Hohhot 010018, China
- Inner Mongolia Autonomous Region Key Laboratory of Veterinary Fundamentals and Disease Prevention and Control of Herbivorous Livestock, Hohhot 010018, China
| | - Gao Wa
- Inner Mongolia Autonomous Region Key Laboratory of Tick-Borne Zoonotic Infectious Disease, Bayan Nur 015000, China;
- Department of Medicine, College of Hetao, Bayan Nur 015000, China
| | | | - Jinling Wang
- College of Veterinary Medicine, Inner Mongolia Agricultural University, Hohhot 010018, China; (L.Z.); (H.C.); (Y.D.); (W.W.)
- Key Laboratory of Clinical Diagnosis and Treatment Techniques for Animal Disease, Ministry of Agriculture and Rural Affairs, Hohhot 010018, China
- Inner Mongolia Autonomous Region Key Laboratory of Veterinary Fundamentals and Disease Prevention and Control of Herbivorous Livestock, Hohhot 010018, China
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Johnson SR, Shaw DE, Avoseh M, Soomro I, Pointon KS, Kokosi M, Nicholson AG, Desai SR, George PM. Diagnosis of cystic lung diseases: a position statement from the UK Cystic Lung Disease Rare Disease Collaborative Network. Thorax 2024; 79:366-377. [PMID: 38182428 DOI: 10.1136/thorax-2022-219738] [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: 10/12/2022] [Accepted: 12/15/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Rare cystic lung diseases are increasingly recognised due the wider application of CT scanning making cystic lung disease management a growing part of respiratory care. Cystic lung diseases tend to have extrapulmonary features that can both be diagnostic but also require surveillance and treatment in their own right. As some of these diseases now have specific treatments, making a precise diagnosis is crucial. While Langerhans cell histiocytosis, Birt-Hogg-Dubé syndrome, lymphoid interstitial pneumonia and lymphangioleiomyomatosis are becoming relatively well-known diseases to respiratory physicians, a targeted and thorough workup improves diagnostic accuracy and may suggest other ultrarare diseases such as light chain deposition disease, cystic pulmonary amyloidosis, low-grade metastatic neoplasms or infections. In many cases, diagnostic information is overlooked leaving uncertainty over the disease course and treatments. AIMS This position statement from the Rare Disease Collaborative Network for cystic lung diseases will review how clinical, radiological and physiological features can be used to differentiate between these diseases. NARRATIVE We highlight that in many cases a multidisciplinary diagnosis can be made without the need for lung biopsy and discuss where tissue sampling is necessary when non-invasive methods leave diagnostic doubt. We suggest an initial workup focusing on points in the history which identify key disease features, underlying systemic and familial diseases and a clinical examination to search for connective tissue disease and features of genetic causes of lung cysts. All patients should have a CT of the thorax and abdomen to characterise the pattern and burden of lung cysts and extrapulmonary features and also spirometry, gas transfer and a 6 min walk test. Discussion with a rare cystic lung disease centre is suggested before a surgical biopsy is undertaken. CONCLUSIONS We suggest that this focused workup should be performed in all people with multiple lung cysts and would streamline referral pathways, help guide early treatment, management decisions, improve patient experience and reduce overall care costs. It could also potentially catalyse a national research database to describe these less well-understood and unidentified diseases, categorise disease phenotypes and outcomes, potentially leading to better prognostic data and generating a stronger platform to understand specific disease biology.
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Affiliation(s)
- Simon R Johnson
- Respiratory Medicine, University of Nottingham, Nottingham, UK
| | - Dominick E Shaw
- Respiratory Medicine, University of Nottingham, Nottingham, UK
| | - Michael Avoseh
- Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Irshad Soomro
- Department of Cellular Pathology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Kate S Pointon
- Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Maria Kokosi
- Interstitial Lung Disease Unit, Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Sujal R Desai
- Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Peter M George
- Interstitial Lung Disease Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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Buckley S, O'Reilly E, Doyle D, Murphy D. Pulmonary Langerhan's cell histocystosis presenting with bilateral simultaneous pneumothoraces - Case report. Respir Med Case Rep 2024; 48:101999. [PMID: 38496783 PMCID: PMC10940762 DOI: 10.1016/j.rmcr.2024.101999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/17/2024] [Accepted: 02/27/2024] [Indexed: 03/19/2024] Open
Abstract
We describe the case of a young male, with no significant medical history, who presented to the Emergency Department (ED) with severe respiratory compromise. He suffered a respiratory arrest shortly after presentation. An initial chest x-ray performed post intubation revealed bilateral pneumothoraces with evidence of abnormal underlying lungs. Through a series of investigations, he was diagnosed with Pulmonary Langerhans Cell Histocystosis. In this article, we outline the initial presentation, subsequent acute management and the clinical course pertaining to this man's presentation. We believe this is the first reported presentation of bilateral simultaneous pneumothoraces, with previously unknown Pulmonary Langerhans Cell histiocytosis (PLCH).
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Affiliation(s)
- Sophie Buckley
- The Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork, T12 DC4A, Ireland
| | - Emily O'Reilly
- The Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork, T12 DC4A, Ireland
| | - Deirdre Doyle
- The Department of Radiology, Cork University Hospital, Wilton, Cork, T12 DC4A, Ireland
| | - Desmond Murphy
- The Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork, T12 DC4A, Ireland
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Pai P, Nirmal A, Mathias L, Jain S, Shetty MG, Sundara BK. Molecular Mutations in Histiocytosis: A Comprehensive Survey of Genetic Alterations. Mol Biotechnol 2024:10.1007/s12033-024-01072-2. [PMID: 38376733 DOI: 10.1007/s12033-024-01072-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/07/2024] [Indexed: 02/21/2024]
Abstract
Histiocytosis represents a group of uncommon disorders characterized by the abnormal accumulation of specialized immune cells, such as macrophages, dendritic cells, or monocyte-derived cells, in various tissues and organs. Over 100 distinct subtypes have been documented, each displaying a broad spectrum of clinical presentations and histological characteristics. Till today, histiocytosis has been addressed through a combination of chemotherapy, radiotherapy, and surgery, with varying responses from individual patients. Due to its atypical symptoms, it has been prone to misdiagnosis. Advances in our understanding of the cellular and molecular aspects of these conditions are paving the way for improved diagnostic methods and targeted therapies. Researchers have extensively investigated various mutations in patient samples. However, no paper has yet provided a comprehensive summary of the collective analysis of mutations and pathways. Hence, this paper consolidates research efforts that specifically concentrate on gene mutations identified in patient samples of different subtypes of histiocytosis. These insights are essential for developing targeted therapies and improving diagnosis. Further, it provides potential insights to enhance the development of more effective therapeutic approaches for rare diseases.
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Affiliation(s)
- Padmini Pai
- Department of Biophysics, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Arnav Nirmal
- Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Lian Mathias
- Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Siya Jain
- Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Manasa Gangadhar Shetty
- Department of Biophysics, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Babitha Kampa Sundara
- Department of Biophysics, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
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Lassandro G, Picchi SG, Corvino A, Massimo C, Tamburrini S, Vanore L, Urraro G, Russo G, Lassandro F. Noninfectious Granulomatous Lung Disease: Radiological Findings and Differential Diagnosis. J Pers Med 2024; 14:134. [PMID: 38392568 PMCID: PMC10890318 DOI: 10.3390/jpm14020134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/17/2024] [Accepted: 01/21/2024] [Indexed: 02/24/2024] Open
Abstract
Granulomatous lung diseases (GLDs) are a heterogeneous group of pathological entities that can have different clinical presentations and outcomes. Granulomas are histologically defined as focal aggregations of activated macrophages, Langerhans cells, and lymphocytes, and may form in the lungs when the immune system cannot eliminate a foreign antigen and attempts to barricade it. The diagnosis includes clinical evaluation, laboratory testing, and radiological imaging, which especially consists of high-resolution computed tomography. bronchoalveolar lavage, transbronchial needle aspiration or cryobiopsy, positron emission tomography, while genetic evaluation can improve the diagnostic accuracy. Differential diagnosis is challenging due to the numerous different imaging appearances with which GLDs may manifest. Indeed, GLDs include both infectious and noninfectious, and necrotizing and non-necrotizing granulomatous diseases and the imaging appearance of some GLDs may mimic malignancy, leading to confirmatory biopsy. The purposes of our review are to report the different noninfectious granulomatous entities and to show their various imaging features to help radiologists recognize them properly and make an accurate differential diagnosis.
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Affiliation(s)
- Giulia Lassandro
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo 11, I-80147 Naples, Italy
| | - Stefano Giusto Picchi
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo 11, I-80147 Naples, Italy
| | - Antonio Corvino
- Medical, Movement and Wellbeing Sciences Department, University of Naples "Parthenope", Via Medina 40, I-80133 Naples, Italy
| | - Candida Massimo
- Department of Radiology, Monaldi Hospital, A.O. Ospedali dei Colli, Via Leonardo Bianchi, I-80131 Naples, Italy
| | - Stefania Tamburrini
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo 11, I-80147 Naples, Italy
| | - Laura Vanore
- Department of Radiology, Ospedale S. Anna e SS. Madonna della Neve, ASL NA3 Sud, Via Lenze, Boscotrecase, I-80042 Naples, Italy
| | - Giovanna Urraro
- Department of Radiology, Ospedale S. Anna e SS. Madonna della Neve, ASL NA3 Sud, Via Lenze, Boscotrecase, I-80042 Naples, Italy
| | - Giuseppe Russo
- General Direction for Health Management, ASL Napoli 3 Sud, Via Marconi, Torre del Greco, I-80059 Naples, Italy
| | - Francesco Lassandro
- Department of Radiology, Ospedale S. Anna e SS. Madonna della Neve, ASL NA3 Sud, Via Lenze, Boscotrecase, I-80042 Naples, Italy
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Barril S, Acebo P, Millan-Billi P, Luque A, Sibila O, Tarín C, Tazi A, Castillo D, Hortelano S. Bronchoalveolar cytokine profile differentiates Pulmonary Langerhans cell histiocytosis patients from other smoking-related interstitial lung diseases. Respir Res 2023; 24:320. [PMID: 38111019 PMCID: PMC10729426 DOI: 10.1186/s12931-023-02622-z] [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: 06/26/2023] [Accepted: 11/29/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Pulmonary Langerhans cell histiocytosis (PLCH) is a rare interstitial lung disease (ILD) associated with smoking, whose definitive diagnosis requires the exclusion of other forms of ILD and a compatible surgical lung biopsy. Bronchoalveolar lavage (BAL) is commonly proposed for the diagnosis of ILD, including PLCH, but the diagnostic value of this technique is limited. Here, we have analyzed the levels of a panel of cytokines and chemokines in BAL from PLCH patients, in order to identify a distinct immune profile to discriminate PLCH from other smoking related-ILD (SR-ILD), and comparing the results with idiopathic pulmonary fibrosis (IPF) as another disease in which smoking is considered a risk factor. METHODS BAL samples were collected from thirty-six patients with different ILD, including seven patients with PLCH, sixteen with SR-ILD and thirteen with IPF. Inflammatory profiles were analyzed using the Human Cytokine Membrane Antibody Array. Principal component analysis (PCA) was performed to reduce dimensionality and protein-protein interaction (PPI) network analysis using STRING 11.5 database were conducted. Finally, Random forest (RF) method was used to build a prediction model. RESULTS We have found significant differences (p < 0.05) on thirty-two cytokines/chemokines when comparing BAL from PLCH patients with at least one of the other ILD. Four main groups of similarly regulated cytokines were established, identifying distinct sets of markers for each cluster. Exploratory analysis using PCA (principal component analysis) showed clustering and separation of patients, with the two first components capturing 69.69% of the total variance. Levels of TARC/CCL17, leptin, oncostatin M (OSM) and IP-10/CXCL10 were associated with lung function parameters, showing positive correlation with FVC. Finally, random forest (RF) algorithm demonstrates that PLCH patients can be differentiated from the other ILDs based solely on inflammatory profile (accuracy 96.25%). CONCLUSIONS Our results show that patients with PLCH exhibit a distinct BAL immune profile to SR-ILD and IPF. PCA analysis and RF model identify a specific immune profile useful for discriminating PLCH.
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Affiliation(s)
- Silvia Barril
- Respiratory Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova-Santa María, Lleida, Spain
| | - Paloma Acebo
- Unidad de Terapias Farmacológicas, Instituto de Investigación de Enfermedades Raras (IIER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Paloma Millan-Billi
- Respiratory Department, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB-Sant Pau, Barcelona, Spain
- Hospital Universitario Germans Trias I Pujol, Barcelona, Spain
| | - Alfonso Luque
- Unidad de Endotelio Funcional, Unidad Funcional de Investigación de Enfermedades Crónicas (UFIEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Oriol Sibila
- Respiratory Department, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB-Sant Pau, Barcelona, Spain
| | | | - Abdellatif Tazi
- R75006, INSERM U976 Human Immunology Pathophysiology and Immunotherapy (HIPI), Institut de Recherche Saint-Louis, Université Paris Cité, Paris, France
- National Reference Center for Histiocytoses, Department of Pulmonology, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Diego Castillo
- Respiratory Department, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB-Sant Pau, Barcelona, Spain.
| | - Sonsoles Hortelano
- Unidad de Terapias Farmacológicas, Instituto de Investigación de Enfermedades Raras (IIER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
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Peng X, Liu H, Zhang X, Huo H, Liu T. Single-system pulmonary langerhans cell histiocytosis with only tracheobronchial involvement: a case report. BMC Pulm Med 2023; 23:412. [PMID: 37898805 PMCID: PMC10613386 DOI: 10.1186/s12890-023-02614-1] [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: 04/07/2023] [Accepted: 08/27/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Pulmonary Langerhans cell histiocytosis (PLCH) only with airway involvement manifested as diffuse thickening of the tracheobronchial walls is rare. CASE REPORT A 26-year-old male was admitted to the hospital with progressive wheezing, cough, and a source of blood in sputum after activity. He had no history of smoking. Chest computed tomography showed airway stenosis of different degrees with tracheobronchial wall thickening, and fiberoptic bronchoscopy demonstrated multiple nodular neoplasms in tracheobronchial, while the pulmonary parenchyma was normal. The patient's condition partially improved after excision of partial lesions by fiberoptic bronchoscope. Histopathological results showed that CD1a and S-100 immunohistochemical staining was positive, and the molecular pathological results suggested that the BRAF V600E mutation, thus confirming the diagnosis of PLCH. The treatment of partial resection and systemic chemotherapy is effective. CONCLUSIONS The possibility of PLCH needs to be considered when diffuse tracheobronchial lesions without lung parenchyma involvement are encountered, which provides experience for early clinical diagnosis and adequate treatment.
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Affiliation(s)
- Xin Peng
- Department of Radiology, The Third People's Hospital of Chengdu, Chengdu, 610031, China
- Department of Radiology, The First Hospital of China Medical University, 155 Nanjing Bei Street, Heping, Shenyang, 110001, China
| | - Hui Liu
- Department of Radiology, The First Hospital of China Medical University, 155 Nanjing Bei Street, Heping, Shenyang, 110001, China
| | - Xinyu Zhang
- Department of Geriatrics, The First Hospital of China Medical University, 155 Nanjing Bei Street, Heping, Shenyang, 110001, China.
| | - Huaibi Huo
- Department of Radiology, The First Hospital of China Medical University, 155 Nanjing Bei Street, Heping, Shenyang, 110001, China.
| | - Ting Liu
- Department of Radiology, The First Hospital of China Medical University, 155 Nanjing Bei Street, Heping, Shenyang, 110001, China.
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Rocamora-Blanch G, Climent F, Solanich X. [Histiocytosis]. Med Clin (Barc) 2023; 161:166-175. [PMID: 37263840 DOI: 10.1016/j.medcli.2023.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 06/03/2023]
Abstract
Histiocytosis is a group of rare diseases characterized by inflammation and accumulation of cells derived from monocytes and macrophages in different tissues. The symptoms are highly variable, from mild forms with involvement of a single organ to severe multisystem forms that can be life compromising. The diagnosis of histiocytosis is based on the clinic, radiological findings and pathological anatomy. A biopsy of the affected tissue is recommended in all cases as it may have therapeutic implications. During the last decade, some mutations have been identified in the affected tissue that condition activation of the MAPK/ERK and PI3K/AKT pathway, in a variable proportion depending on the type of histiocytosis. In this review we mainly focus on Langerhans Cell Histiocytosis, Erdheim-Chester Disease and Rosai-Dorfman Disease.
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Affiliation(s)
- Gemma Rocamora-Blanch
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España.
| | - Fina Climent
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España; Servicio de Anatomía Patológica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Xavier Solanich
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España
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11
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Park JK, Huang LC, Kossler AL. Erdheim-Chester disease and vemurafenib: a review of ophthalmic presentations and clinical outcomes. Orbit 2023; 42:233-244. [PMID: 35702885 DOI: 10.1080/01676830.2022.2087232] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/30/2022] [Indexed: 05/17/2023]
Abstract
PURPOSE To provide a comprehensive review of ocular and orbital manifestations of Erdheim-Chester Disease (ECD) and compare clinical outcomes with vemurafenib (INN) to historical treatments (HT). Primary outcomes are ophthalmic findings on presentation, changes in visual acuity, and mortality rate. Secondary outcomes include the progression of ocular findings, systemic involvements, and treatment modalities. METHODS All published literature from January 1983 to March 2021 was searched for ophthalmic manifestations of ECD. Clinical outcomes following HT were collected and compared with INN. RESULTS Forty-seven patients with ECD and ophthalmic presentations were identified. The mean age was 49.6 years (SD = 15.0). Proptosis (65.6%) and extraocular muscle restrictions (42.5%) were the most common presenting signs. Of 41 (87.2%) patients with orbital masses on radiologic examination, 90.2% were bilateral, and 53.7% were located in the intraconal space. Ophthalmic examination was significant for xanthelasma (27.2%), optic disc edema (34.0%), and subretinal changes (21.3%). Common treatments were systemic steroids (76.6%), interferon-α (17.0%), and cyclophosphamide (14.9%). INN was less commonly used (12.8%). The mean change in logMAR visual acuity declined with HT (29.9%) but improved with INN (79.1%) (p > 0.05). The proportion of eyes with complete vision loss increased after HT (p < 0.05). The overall mortality rate was 27.7% and notably higher in the HT group (29.3%) when compared to the INN group (16.7%) (p > 0.05). CONCLUSION ECD presents with many ophthalmic manifestations. Although the intraocular treatments remain controversial, INN should be highly considered in treating orbital ECD patients with BRAF-V600E mutations to prevent and reverse vision loss.
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Affiliation(s)
- Ji Kwan Park
- Oculofacial Plastic and Orbital Surgery, Indianapolis, Indiana, USA
| | - Laura C Huang
- Pediatric Ophthalmology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Andrea L Kossler
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA
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12
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Buschulte K, Cottin V, Wijsenbeek M, Kreuter M, Diesler R. The world of rare interstitial lung diseases. Eur Respir Rev 2023; 32:32/167/220161. [PMID: 36754433 PMCID: PMC9910344 DOI: 10.1183/16000617.0161-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/21/2022] [Indexed: 02/10/2023] Open
Abstract
The world of rare interstitial lung diseases (ILDs) is diverse and complex. Diagnosis and therapy usually pose challenges. This review describes a selection of rare and ultrarare ILDs including pulmonary alveolar proteinosis, pulmonary alveolar microlithiasis and pleuroparenchymal fibroelastosis. In addition, monogenic ILDs or ILDs in congenital syndromes and various multiple cystic lung diseases will be discussed. All these conditions are part of the scope of the European Reference Network on rare respiratory diseases (ERN-LUNG). Epidemiology, pathogenesis, diagnostics and treatment of each disease are presented.
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Affiliation(s)
- Katharina Buschulte
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), ERN-LUNG, Heidelberg, Germany
| | - Vincent Cottin
- National Reference Centre for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, UMR 754, Claude Bernard University Lyon 1, ERN-LUNG, Lyon, France
| | - Marlies Wijsenbeek
- Center for Interstitial Lung Diseases and Sarcoidosis, Department of Respiratory Medicine, Erasmus MC-University Medical Center, ERN-LUNG, Rotterdam, The Netherlands
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), ERN-LUNG, Heidelberg, Germany
| | - Rémi Diesler
- National Reference Centre for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, UMR 754, Claude Bernard University Lyon 1, ERN-LUNG, Lyon, France
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13
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Brugière O, Mercier O, Lorillon G, Tazi A, Le Pavec J. [Lung transplantation for pulmonary Langerhans' cell histiocytosis]. Rev Mal Respir 2023; 40 Suppl 1:e65-e68. [PMID: 36868974 DOI: 10.1016/j.rmr.2023.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Affiliation(s)
- O Brugière
- Service de pneumologie et transplantation pulmonaire, hôpital Foch, Suresnes, France.
| | - O Mercier
- Service de chirurgie thoracique et vasculaire et de transplantation pulmonaire, Groupe hospitalier Marie-Lannelongue-Saint-Joseph, Le Plessis-Robinson, France; Université Paris-Saclay, Le Kremlin-Bicêtre, France; UMR_S 999, université Paris-Sud, Inserm, Groupe hospitalier Marie-Lannelongue-Saint-Joseph, Le Plessis-Robinson, France
| | - G Lorillon
- Université de Paris, Inserm UMR 976 HIPI, 75006 Paris, France; Centre national de référence des histiocytoses, service de pneumologie, hôpital Saint-Louis, AP-HP, Paris, France
| | - A Tazi
- Université de Paris, Inserm UMR 976 HIPI, 75006 Paris, France; Centre national de référence des histiocytoses, service de pneumologie, hôpital Saint-Louis, AP-HP, Paris, France
| | - J Le Pavec
- Université Paris-Saclay, Le Kremlin-Bicêtre, France; UMR_S 999, université Paris-Sud, Inserm, Groupe hospitalier Marie-Lannelongue-Saint-Joseph, Le Plessis-Robinson, France; Service de pneumologie et transplantation pulmonaire, Groupe hospitalier Marie-Lannelongue-Saint-Joseph, Le Plessis-Robinson, France
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14
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Alarcon-Calderon A, Vassallo R, Yi ES, Ryu JH. Smoking-Related Interstitial Lung Diseases. Immunol Allergy Clin North Am 2023; 43:273-287. [PMID: 37055089 DOI: 10.1016/j.iac.2023.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Smoking-related interstitial lung diseases (ILDs) are a group of heterogeneous, diffuse pulmonary parenchymal disease processes associated with tobacco exposure. These disorders include pulmonary Langerhans cell histiocytosis, respiratory bronchiolitis-associated ILD, desquamative interstitial pneumonia, acute eosinophilic pneumonia, and combined pulmonary fibrosis and emphysema. This review summarizes the current evidence of pathogenesis, clinical manifestations, diagnostic approach, prognosis, and treatment modalities for these diseases. We also discuss the interstitial lung abnormalities incidentally detected in radiologic studies and smoking-related fibrosis identified on lung biopsies.
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Affiliation(s)
- Amarilys Alarcon-Calderon
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, 200 1st Street, Southwest, Rochester, MN 55905, USA
| | - Robert Vassallo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, 200 1st Street, Southwest, Rochester, MN 55905, USA
| | - Eunhee S Yi
- Department of Laboratory Medicine & Pathology, Mayo Clinic College of Medicine and Science, 200 1st Street, Southwest, Rochester, MN 55905, USA
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, 200 1st Street, Southwest, Rochester, MN 55905, USA.
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15
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Adverse Effects of Tobacco Products (Cigarettes, E-Cigarettes, Hookah, Smokeless Tobacco) Use on Health. Respir Med 2023. [DOI: 10.1007/978-3-031-24914-3_2] [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: 03/06/2023]
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16
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Kusmirek JE, Meyer CA. High-Resolution Computed Tomography of Cystic Lung Disease. Semin Respir Crit Care Med 2022; 43:792-808. [PMID: 36252611 DOI: 10.1055/s-0042-1755565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The cystic lung diseases (CLD) are characterized by the presence of multiple, thin-walled, air-filled spaces in the pulmonary parenchyma. Cyst formation may occur with congenital, autoimmune, inflammatory, infectious, or neoplastic processes. Recognition of cyst mimics such as emphysema and bronchiectasis is important to prevent diagnostic confusion and unnecessary evaluation. Chest CT can be diagnostic or may guide the workup based on cyst number, distribution, morphology, and associated lung, and extrapulmonary findings. Diffuse CLD (DCLDs) are often considered those presenting with 10 or more cysts. The more commonly encountered DCLDs include lymphangioleiomyomatosis, pulmonary Langerhans' cell histiocytosis, lymphoid interstitial pneumonia, Birt-Hogg-Dubé syndrome, and amyloidosis/light chain deposition disease.
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Affiliation(s)
- Joanna E Kusmirek
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Cristopher A Meyer
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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17
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Potapenko VG, Baykov VV, Zinchenko AV, Potikhonova NA. Langerhans cell histiocytosis in adults: literature review. ONCOHEMATOLOGY 2022. [DOI: 10.17650/1818-8346-2022-17-4-16-32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Langerhans cells histiocytosis is a variant of malignant histiocytosis. The course and symptoms vary. patients with localized forms have a better prognosis, because local therapy is effective. patients with multifocal forms of histiocytosis receive systemic drug therapy, which cures some of the patients. This review provides up-to-date data about typical presentation of the organ involvement, diagnosis, course and therapy of various forms of Langerhans cells histiocytosis.
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Affiliation(s)
| | - V. V. Baykov
- I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
| | - A. V. Zinchenko
- I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
| | - N. A. Potikhonova
- Russian Research Institute of Hematology and Transfusiology, Federal Medical and Biological Agency
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18
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Xuan S, Li Y, Wu Y, Adcock IM, Zeng X, Yao X. Langerin-expressing dendritic cells in pulmonary immune-related diseases. Front Med (Lausanne) 2022; 9:909057. [PMID: 36160158 PMCID: PMC9490018 DOI: 10.3389/fmed.2022.909057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/12/2022] [Indexed: 11/30/2022] Open
Abstract
Dendritic cells (DCs) are “frontline” immune cells dedicated to antigen presentation. They serve as an important bridge connecting innate and adaptive immunity, and express various receptors for antigen capture. DCs are divided into various subclasses according to their differential expression of cell surface receptors and different subclasses of DCs exhibit specific immunological characteristics. Exploring the common features of each sub-category has became the focus of many studies. There are certain amounts of DCs expressing langerin in airways and peripheral lungs while the precise mechanism by which langerin+ DCs drive pulmonary disease is unclear. Langerin-expressing DCs can be further subdivided into numerous subtypes based on the co-expressed receptors, but here, we identify commonalities across these subtypes that point to the major role of langerin. Better understanding is required to clarify key disease pathways and determine potential new therapeutic approaches.
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Affiliation(s)
- Shurui Xuan
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuebei Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yunhui Wu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ian M. Adcock
- Airway Disease Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Xiaoning Zeng
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xin Yao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Xin Yao
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19
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Imaging of Cystic Lung Disease. Radiol Clin North Am 2022; 60:951-962. [DOI: 10.1016/j.rcl.2022.06.006] [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]
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20
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Yamamoto C, Harada T, Sawada R, Sugimoto T, Hayata H. A case of adult multisystem Langerhans histiocytosis successfully treated by smoking cessation and radiotherapy for bone lesion. Clin Case Rep 2022; 10:e6344. [PMID: 36177069 PMCID: PMC9475122 DOI: 10.1002/ccr3.6344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/06/2022] [Accepted: 08/30/2022] [Indexed: 11/14/2022] Open
Abstract
An adult patient was diagnosed with multisystem Langerhans cell histiocytosis with lung and bone lesions. Her lung lesions improved after smoking cessation. Radiotherapy was performed for the bone lesions. Follow‐up assessment at 2 years after diagnosis showed no recurrence. Our case shows that remission is possible even without systemic treatment.
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Affiliation(s)
- Chie Yamamoto
- Department of Respiratory Medicine Fukuchiyama City Hospital Fukuchiyama Japan
| | - Taishi Harada
- Department of Oncology Fukuchiyama City Hospital Fukuchiyama Japan
| | - Ryo Sawada
- Department of Respiratory Medicine Fukuchiyama City Hospital Fukuchiyama Japan
- Department of Oncology Fukuchiyama City Hospital Fukuchiyama Japan
| | - Takumi Sugimoto
- Department of Respiratory Medicine Fukuchiyama City Hospital Fukuchiyama Japan
| | - Hiroki Hayata
- Department of Hematology Fukuchiyama City Hospital Fukuchiyama Japan
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21
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Raucherassoziierte interstitielle Lungenerkrankungen. DIE RADIOLOGIE 2022; 62:738-746. [PMID: 35736996 PMCID: PMC9433357 DOI: 10.1007/s00117-022-01025-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/25/2022] [Indexed: 11/07/2022]
Abstract
Klinisches Problem Raucherassoziierte interstitielle Lungenerkrankungen umfassen heterogene pulmonale Pathologien, deren korrekte Diagnostik prognostische und therapeutische Konsequenzen hat. In diesem Artikel werden die gängigsten raucherassoziierten interstitiellen Lungenerkrankungen beschrieben sowie eine strukturierte Herangehensweise präsentiert, welche den diagnostischen Arbeitsprozess erleichtern kann. Empfehlungen für die Praxis Die Computertomographie (CT) besitzt einen hohen Stellenwert in der Diagnose der raucherassoziierten interstitiellen Lungenerkrankungen und kann dazu beitragen, Lungenbiopsien zu verhindern. Um eine hohe diagnostische Genauigkeit zu erreichen, sollten standardisierte Untersuchungsprotokolle sowie eine strukturierte Herangehensweise in der Befundung zur Anwendung kommen. In den entzündlich dominierten Stadien der respiratorischen Bronchiolitis (RB), der respiratorischen Bronchiolitis mit interstitieller Lungenerkrankung (RB-ILD) sowie der desquamativen interstitiellen Pneumonie (DIP) haben die Beendigung des Rauchens sowie Steroide den größten therapeutischen Effekt. Bei fibrotischen Veränderungen (z. B. im Rahmen einer idiopathischen pulmonalen Fibrose [IPF]) können antifibrotische Therapien mit Pirfenidon und Nintedanib zum Einsatz kommen. Patienten mit dem Verdacht auf raucherassoziierte interstitielle Lungenerkrankung sollten in multidisziplinären Boards abgeklärt und behandelt werden.
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22
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Loss of Heterozygosity for Tuberous Sclerosis Complex and Mammalian Target of Rapamycin Signaling. Chest 2022; 162:279-280. [DOI: 10.1016/j.chest.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/10/2022] [Indexed: 11/19/2022] Open
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23
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Cai HC, Chen J, Liu T, Cai H, Duan MH, Li J, Zhou DB, Cao XX. Langerhans cell histiocytosis in adolescent patients: a single-centre retrospective study. Orphanet J Rare Dis 2022; 17:268. [PMID: 35841042 PMCID: PMC9288061 DOI: 10.1186/s13023-022-02436-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/30/2022] [Indexed: 11/19/2022] Open
Abstract
Background Langerhans cell histiocytosis (LCH) is a myeloid dendritic cell disorder frequently affecting children more than adults. The presentation of LCH varies with age, however, the clinical characteristics and genetic profiles of adolescent LCH remain elusive. To address the knowledge gap, we performed a single-centre retrospective study of 36 adolescent LCH patients aged between 14 and 17 years at Peking Union Medical College Hospital. Results At the time of diagnosis, 10 patients were classified as unifocal single system LCH (27.8%), 2 patients had pulmonary single system LCH (5.6%), 5 patients had multifocal single system LCH with bone involvement (13.9%), and 19 patients had multisystem LCH (52.8%). The most prevalent involvement in multisystem patients was the pituitary gland (78.9%), followed by the bone (42.1%), lung (42.1%), and lymph nodes (42.1%). Eight (42.1%) patients had risk organ involvement. BRAFN486_P490 was detected in 50% of patients who underwent next generation sequencing, and BRAFV600E was detected in one patient. Chemotherapies were the first line treatment in 24 patients. One patient died and thirteen patients relapsed during the follow-up. The estimated 5-year OS rate and EFS rate were 94.7% and 59.0%, respectively. Conclusions In this study, we report a large series of adolescent LCH patients. The clinical characteristics of adolescent LCH patients may be close to adult LCH. Compared with pediatric cases, adolescent LCH tends to have more pituitary lesions and pulmonary involvement, fewer skin and hematopoietic involvement, a higher frequency of BRAF deletion mutation, and a lower frequency of BRAFV600E mutation. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02436-0.
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Affiliation(s)
- Hua-Cong Cai
- Department of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jia Chen
- Department of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ting Liu
- Department of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Cai
- Department of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ming-Hui Duan
- Department of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jian Li
- Department of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Dao-Bin Zhou
- Department of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xin-Xin Cao
- Department of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. .,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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24
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Gencer A, Ozcibik G, Karakas FG, Sarbay I, Batur S, Borekci S, Turna A. Two smoking-related lesions in the same pulmonary lobe of squamous cell carcinoma and pulmonary Langerhans cell histiocytosis: A case report. World J Clin Cases 2022; 10:6722-6727. [PMID: 35979280 PMCID: PMC9294916 DOI: 10.12998/wjcc.v10.i19.6722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/14/2022] [Accepted: 04/24/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pulmonary Langerhans cell histiocytosis (PLCH) is a rare cystic lung disease usually affecting young adults. It is predicted that PLCH is a lung tumor precursor associated with dysfunction of the myeloid dendritic cells in the lung.
CASE SUMMARY A 70-year-old male patient presented with chronic cough and sputum. He had symptoms for 5 years and described shortness of breath on exertion for the previous 3 years. He had a 60 packs/year smoking history. Computerized tomography of the thorax revealed an 11-mm nodule in the right lung lower lobe superior segment and a 7-mm nodule in the right lung lower lobe poster basal segment. Those two nodules were resected by means of right thoracoscopic surgery. Pathological evaluation revealed a squamous cell carcinoma and PLCH.
CONCLUSION Coexistent squamous cell carcinoma and PLCH suggest possible association between PLCH and lung cancer.
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Affiliation(s)
- Aysegul Gencer
- Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty Campus, Istanbul 34098, Turkey
| | - Gizem Ozcibik
- Department of Thoracic Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul 34098, Turkey
| | - Fatma Gulsum Karakas
- Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty Campus, Istanbul 34098, Turkey
| | - Ismail Sarbay
- Department of Thoracic Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul 34098, Turkey
| | - Sebnem Batur
- Department of Pathology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul 34098, Turkey
| | - Sermin Borekci
- Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty Campus, Istanbul 34098, Turkey
| | - Akif Turna
- Department of Thoracic Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul 34098, Turkey
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25
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Harari S, Elia D. Should we rewrite the natural history and prognosis of pulmonary Langerhans cell histiocytosis? Eur Respir J 2022; 59:59/5/2200700. [PMID: 35618281 DOI: 10.1183/13993003.00700-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/14/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Sergio Harari
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria - Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, MultiMedica, IRCCS, Milan, Italy .,Department of Clinical Sciences and Community Health, Università di Milano, Milan, Italy
| | - Davide Elia
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria - Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, MultiMedica, IRCCS, Milan, Italy
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26
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Bhatt R, Semple T, Slater O, Nicholson AG, Casanueva L, Desai A, Hoschtitzky A, Milne P, Langley R. Extracorporeal membrane oxygenation: Bridging therapy in paediatric pulmonary Langerhans cell histiocytosis. J Paediatr Child Health 2022; 58:906-908. [PMID: 34510623 DOI: 10.1111/jpc.15712] [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: 10/27/2020] [Revised: 07/21/2021] [Accepted: 08/04/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Reena Bhatt
- Department of Paediatrics, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Thomas Semple
- Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.,National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Olga Slater
- Department of Paediatric Oncology, Great Ormond Street Hospital, London, United Kingdom
| | - Andrew G Nicholson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Lidia Casanueva
- Department of Paediatrics, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Ajay Desai
- Department of Paediatrics, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Andreas Hoschtitzky
- Department of Paediatrics, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Paul Milne
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ross Langley
- Department of Paediatrics, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.,Department of Paediatric Respiratory Medicine and Sleep Medicine, Royal Hospital for Children, Glasgow, United Kingdom
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27
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Goyal G, Tazi A, Go RS, Rech KL, Picarsic JL, Vassallo R, Young JR, Cox CW, Van Laar J, Hermiston ML, Cao XX, Makras P, Kaltsas G, Haroche J, Collin M, McClain KL, Diamond EL, Girschikofsky M. International expert consensus recommendations for the diagnosis and treatment of Langerhans cell histiocytosis in adults. Blood 2022; 139:2601-2621. [PMID: 35271698 PMCID: PMC11022927 DOI: 10.1182/blood.2021014343] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/24/2022] [Indexed: 11/20/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) can affect children and adults with a wide variety of clinical manifestations, including unifocal, single-system multifocal, single-system pulmonary (smoking-associated), or multisystem disease. The existing paradigms in the management of LCH in adults are mostly derived from the pediatric literature. Over the last decade, the discovery of clonality and MAPK-ERK pathway mutations in most cases led to the recognition of LCH as a hematopoietic neoplasm, opening the doors for treatment with targeted therapies. These advances have necessitated an update of the existing recommendations for the diagnosis and treatment of LCH in adults. This document presents consensus recommendations that resulted from the discussions at the annual Histiocyte Society meeting in 2019, encompassing clinical features, classification, diagnostic criteria, treatment algorithm, and response assessment for adults with LCH. The recommendations favor the use of 18F-Fluorodeoxyglucose positron emission tomography-based imaging for staging and response assessment in the majority of cases. Most adults with unifocal disease may be cured by local therapies, while the first-line treatment for single-system pulmonary LCH remains smoking cessation. Among patients not amenable or unresponsive to these treatments and/or have multifocal and multisystem disease, systemic treatments are recommended. Preferred systemic treatments in adults with LCH include cladribine or cytarabine, with the emerging role of targeted (BRAF and MEK inhibitor) therapies. Despite documented responses to treatments, many patients struggle with a high symptom burden from pain, fatigue, and mood disorders that should be acknowledged and managed appropriately.
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Affiliation(s)
- Gaurav Goyal
- Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Abdellatif Tazi
- Université de Paris, INSERM UMR 976, Saint Louis Research Institute, Paris, France
- French National Reference Center for Histiocytoses, Department of Pulmonology, Saint-Louis Teaching Hospital, Assistance Publique-Hôpiaux de Paris, Paris, France
| | | | - Karen L. Rech
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Jennifer L. Picarsic
- Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | | | | | - Jan Van Laar
- Department of Internal Medicine
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Michelle L. Hermiston
- Division of Pediatric Hematology-Oncology, University of California, San Francisco, San Francisco, CA
| | - Xin-Xin Cao
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Polyzois Makras
- LCH Adult Clinic
- Department of Endocrinology and Diabetes, 251 Hellenic Air Force and VA General Hospital, Athens, Greece
| | - Gregory Kaltsas
- 1st Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Greece
| | - Julien Haroche
- Service de médecine interne 2, Centre de Référence des Histiocytoses, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France
| | - Matthew Collin
- Newcastle University and Newcastle Upon Tyne Hospitals, Newcastle Upon Tyne, United Kingdom
| | - Kenneth L. McClain
- Texas Children's Cancer and Hematology Centers, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Eli L. Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael Girschikofsky
- Internal Medicine I (Hemostasis, Hematology and Stem, Cell Transplantation and Medical Oncology), Ordensklinikum Linz Elisabethinen, Linz, Austria
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The MAPK Pathway in Pulmonary Langerhans Cell Histiocytosis. Arch Bronconeumol 2022:S0300-2896(22)00314-3. [PMID: 35589455 DOI: 10.1016/j.arbres.2022.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/21/2022]
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Poellinger A, Berezowska S, Myers JL, Huber A, Funke-Chambour M, Guler S, Geiser T, Harari S, Caminati A, Zompatori M, Sverzellati N. The Octopus Sign—A New HRCT Sign in Pulmonary Langerhans Cell Histiocytosis. Diagnostics (Basel) 2022; 12:diagnostics12040937. [PMID: 35453983 PMCID: PMC9025181 DOI: 10.3390/diagnostics12040937] [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: 03/16/2022] [Accepted: 04/07/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Fibrosis in pulmonary Langerhans cell histiocytosis (PLCH) histologically comprises a central scar with septal strands and associated airspace enlargement that produce an octopus-like appearance. The purpose of this study was to identify the octopus sign on high-resolution computed tomography (HRCT) images to determine its frequency and distribution across stages of the disease. Methods: Fifty-seven patients with confirmed PLCH were included. Two experienced chest radiologists assessed disease stages as early, intermediate, or late, as well as the lung parenchyma for nodular, cystic, or fibrotic changes and for the presence of the octopus sign. Statistical analysis included Cohen’s kappa for interrater agreement and Fisher’s exact test for the frequency of the octopus sign. Results: Interobserver agreement was substantial for the octopus sign (kappa = 0.747). Significant differences in distribution of the octopus sign between stages 2 and 3 were found with more frequent octopus signs in stage 2 and fewer in stage 3. In addition, we only found the octopus sign in cases of nodular und cystic lung disease. Conclusions: The octopus sign in PLCH can be identified not only on histological images, but also on HRCT images. Its radiological presence seems to depend on the stage of PLCH.
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Affiliation(s)
- Alexander Poellinger
- Department of Diagnostic, Interventional and Pediatric Radiology, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland;
- Correspondence: ; Tel.: +41-(0)-31-63-2-24-35
| | - Sabina Berezowska
- Department of Laboratory Medicine and Pathology, Institute of Pathology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 25, 1011 Lausanne, Switzerland;
| | - Jeffrey Leon Myers
- Department of Pathology, University of Michigan Hospital, Ann Arbor, MI 48109, USA;
| | - Adrian Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland;
| | - Manuela Funke-Chambour
- Department of Pulmonary Medicine, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland; (M.F.-C.); (S.G.); (T.G.)
| | - Sabina Guler
- Department of Pulmonary Medicine, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland; (M.F.-C.); (S.G.); (T.G.)
| | - Thomas Geiser
- Department of Pulmonary Medicine, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland; (M.F.-C.); (S.G.); (T.G.)
| | - Sergio Harari
- Department of Medicine, Division of Internal Medicine, Ospedale San Giuseppe MultiMedica IRCCS, University of Milan, 20133 Milan, Italy; (S.H.); (M.Z.)
| | - Antonella Caminati
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria e Emodinamica Polmonare, Ospedale San Giuseppe, MultiMedica IRCCS, University of Milan, 20133 Milan, Italy;
| | - Maurizio Zompatori
- Department of Medicine, Division of Internal Medicine, Ospedale San Giuseppe MultiMedica IRCCS, University of Milan, 20133 Milan, Italy; (S.H.); (M.Z.)
| | - Nicola Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery, Padiglione Barbieri, University of Parma, V. Gramsci 14, 43124 Parma, Italy;
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30
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A unique presentation of Pulmonary Langerhans Cell Histiocytosis. Respir Med Case Rep 2022; 37:101635. [PMID: 35342708 PMCID: PMC8943296 DOI: 10.1016/j.rmcr.2022.101635] [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: 12/28/2021] [Revised: 02/22/2022] [Accepted: 03/10/2022] [Indexed: 11/24/2022] Open
Abstract
Pulmonary Langerhans Cell Histiocytosis (PLCH) is a diffuse lung disease that primarily affects young adults, with cigarette smoking playing a significant role in developing the disease. Patients with PLCH present with characteristic CT chest findings of small irregular nodules and upper zone cysts. Previously, larger nodules greater than 10 mm and cavitation have only been reported a few times in the literature. We describe the case of a 69-year-old male who presented with dyspnea, non-productive cough and weight loss, who was found to have multiple cavitary nodules on CT imaging of the chest. Histopathologic sampling of the lung revealed Langerhans cells which stained positive for S100 and CD1a, consistent with a diagnosis of PLCH. The patient was counselled to quit smoking as the mainstay of treatment. In 3-month follow-up his symptoms had largely resolved, with evidence of decreased nodule size on repeat CT imaging.
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31
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Liang HX, Yang YL, Zhang Q, Xie Z, Liu ET, Wang SX. Langerhans cell histiocytosis presenting as an isolated brain tumour: A case report. World J Clin Cases 2022; 10:1423-1431. [PMID: 35211579 PMCID: PMC8855195 DOI: 10.12998/wjcc.v10.i4.1423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/03/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a rare proliferative histiocyte disorder. It can affect any organ or system, especially the bone, skin, lung, and central nervous system (CNS). In the CNS, the hypothalamic-pituitary is predominantly affected, whereas the brain parenchyma is rarely affected. LCH occurring in the brain parenchyma can be easily confused with glioblastoma or brain metastases. Thus, multimodal imaging is useful for the differential diagnosis of these intracerebral lesions and detection of lesions in the other organs.
CASE SUMMARY A 47-year-old man presented with a headache for one week and sudden syncope. Brain computed tomography (CT) and magnetic resonance imaging showed an irregularly shaped nodule with heterogeneous enhancement. On 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/CT, a nodule with 18F-FDG uptake and multiple cysts in the upper lobes of both lungs were noted, which was also confirmed by high-resolution CT. Thus, the patient underwent surgical resection of the brain lesion for further examination. Postoperative pathology confirmed LCH. The patient received chemotherapy after surgery. No recurrence was observed in the brain at the 12-mo follow-up.
CONCLUSION Multimodal imaging is useful for evaluating the systemic condition of LCH, developing treatment plans, and designing post-treatment strategies.
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Affiliation(s)
- Han-Xiang Liang
- Department of Nuclear Medicine, Maoming People's Hospital, Maoming 525000, Guangdong Province, China
| | - Yue-Long Yang
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Qing Zhang
- WeiLun PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Zhi Xie
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - En-Tao Liu
- WeiLun PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Shu-Xia Wang
- WeiLun PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
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32
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Cao X, Duan M, Zhao A, Cai H, Chen J, Gao X, Liu T, Cai H, Zhang L, Sun J, Liang Z, Zhou D, Li J. Treatment outcomes and prognostic factors of patients with adult Langerhans cell histiocytosis. Am J Hematol 2022; 97:203-208. [PMID: 34797941 DOI: 10.1002/ajh.26412] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 12/30/2022]
Abstract
Adult Langerhans cell histiocytosis (LCH) remains poorly defined. We retrospectively studied 266 newly diagnosed LCH patients to understand the clinical presentation, treatment, and prognosis of adult LCH. The median age at diagnosis was 32 years (range, 18-79 years). At the time of diagnosis, 40 patients had single lesions within a single system, 18 patients had single pulmonary LCH, 26 patients had multiple lesions within a single system (SS-m), and 182 patients had multisystem disease (MS). The most common organ involved in MS patients was the bone (69.8%), followed by the pituitary (61.5%) and lung (61.0%). BRAFV600E , BRAF deletion, and MAP2K1 mutation were detected in 38.8%, 25.4%, and 19.4% patients, respectively. BRAF deletion was found more common in patients with MS LCH compared to single-system LCH (38.5% vs 7.1%, p = .004), also in patients with liver involvement (69.2% vs 14.3%, p < .001). The estimated 3-year overall survival (OS) and event-free survival (EFS) rates were 94.4% and 54.7%, respectively, in SS-m and MS LCH. Multivariate Cox regression showed that involvement of the liver or spleen at baseline predicted poor EFS and receiving cytarabine-based therapy as a first-line treatment and age older than 30 years at diagnosis predicted favorable EFS. The involvement of risk organs and age older than 50 years predicted poor OS, and receiving cytarabine-based therapy predicted favorable OS. Therefore, BRAF deletion was correlated with MS LCH, particularly those with liver involvement. Liver or spleen involvement at baseline indicates a poor prognosis, and a cytarabine-based regimen could be considered as first-line treatment for adult LCH patients.
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Affiliation(s)
- Xin‐xin Cao
- Department of Hematology, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Ming‐hui Duan
- Department of Hematology, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Ai‐lin Zhao
- Department of Hematology, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Hao Cai
- Department of Hematology, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Jia Chen
- Department of Hematology, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Xue‐min Gao
- Department of Hematology, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Ting Liu
- Department of Hematology, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Hua‐cong Cai
- Department of Hematology, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Lu Zhang
- Department of Hematology, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Jian Sun
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
- Department of Pathology, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Zhi‐yong Liang
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
- Department of Pathology, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Dao‐bin Zhou
- Department of Hematology, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Jian Li
- Department of Hematology, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
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Benattia A, Bugnet E, Walter-Petrich A, de Margerie-Mellon C, Meignin V, Seguin-Givelet A, Lorillon G, Chevret S, Tazi A. Long-term Outcomes of Adult Pulmonary Langerhans Cell Histiocytosis: A Prospective Cohort. Eur Respir J 2021; 59:13993003.01017-2021. [PMID: 34675043 DOI: 10.1183/13993003.01017-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/02/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND The long-term outcomes of adult pulmonary Langerhans cell histiocytosis (PLCH), particularly survival, are largely unknown. Two earlier retrospective studies reported a high rate of mortality, which contrasts with our clinical experience. METHODS To address this issue, all newly diagnosed PLCH patients referred to the French national reference centre for histiocytoses between 2004 and 2018 were eligible for inclusion. The primary outcome was survival, which was defined as the time from inclusion to lung transplantation or death from any cause. Secondary outcomes included the cumulative incidences of chronic respiratory failure (CRF), pulmonary hypertension (PH), malignant diseases, and extra-pulmonary involvement in initially isolated PLCH. Survival was estimated using the Kaplan-Meier method. RESULTS Two hundred six patients (mean age: 39±13 years, 60% females, 95% current smokers) were prospectively followed for a median duration of 5.1 years (interquartile range [IQR], 3.2 to 7.6). Twelve (6%) patients died. The estimated rate of survival at 10 years was 93% (95% confidence interval [CI], 89-97). The cumulative incidences of CRF and/or PH were less than 5% at both 5 and 10 years, and 58% of these patients died. Twenty-seven malignancies were observed in 23 patients. The estimated standardized incidence ratio of lung carcinoma was 17.0 (95% CI, 7.45-38.7) compared to an age- and sex-matched French population. Eight (5.1%) of the 157 patients with isolated PLCH developed extra-pulmonary involvement. CONCLUSIONS The long-term prognosis of PLCH is significantly more favourable than was previously reported. Patients must be closely monitored after diagnosis to detect severe complications early.
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Affiliation(s)
- Amira Benattia
- Centre National de Référence des Histiocytoses, Service de Pneumologie, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Emmanuelle Bugnet
- Centre National de Référence des Histiocytoses, Service de Pneumologie, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Anouk Walter-Petrich
- Biostatistics and Clinical Epidemiology Research Team (ECSTRRA), INSERM UMR-1153 (CRESS), Université de Paris, Paris, France.,Service de Biostatistique et Information Médicale, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Constance de Margerie-Mellon
- Université de Paris, INSERM UMR-1149, Paris, France.,Service de Radiologie, AP-HP, Hôpital Saint-Louis, Paris, France
| | | | - Agathe Seguin-Givelet
- Département Thoracique, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France
| | - Gwenaël Lorillon
- Centre National de Référence des Histiocytoses, Service de Pneumologie, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Sylvie Chevret
- Biostatistics and Clinical Epidemiology Research Team (ECSTRRA), INSERM UMR-1153 (CRESS), Université de Paris, Paris, France.,Service de Biostatistique et Information Médicale, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Abdellatif Tazi
- Centre National de Référence des Histiocytoses, Service de Pneumologie, AP-HP, Hôpital Saint-Louis, Paris, France .,Human Immunology Pathophysiology and Immunotherapy (HIPI) Unit, INSERM UMR-976, Institut de Recherche Saint-Louis, Université de Paris, Paris, France
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Mitogen-activating protein kinase pathway alterations in Langerhans cell histiocytosis. Curr Opin Oncol 2021; 33:101-109. [PMID: 33315630 DOI: 10.1097/cco.0000000000000707] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Langerhans cell histiocytosis (LCH) is a rare disorder characterized by the infiltration of involved tissues by specialized dendritic cells. The demonstration of the constant activation of the mitogen-activated protein kinase (MAPK) pathway in LCH lesions has been a breakthrough in the understanding of the pathogenesis of this rare disease. We will summarize the current knowledge on MAPK alterations in LCH and the new therapeutic options indicated by these findings. RECENT FINDINGS Since the description of the B-Raf proto-oncogene, serine/threonine kinase (BRAF)V600E mutation in LCH lesions, several other molecular alterations affecting the MAPK pathway have been identified in most cases. Based on these driver alterations, LCH cells were shown to be derived from hematopoietic precursors, which yielded the current concept of LCH as a myeloid inflammatory neoplasia. MAPK pathway inhibitors have emerged as an innovative therapy in severe forms of LCH, resulting in virtually no acquired resistance. However, although they are highly effective, their effect is only temporary, as the disease relapses upon discontinuation of the treatment. SUMMARY LCH is an inflammatory myeloid neoplastic disorder, driven by mutations activating the MAPK pathway. MAPK-targeted treatments represent an important stepforward in the management of patients with severe progressive LCH.
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Kee TP, Venkatanarasimha N, Mohideen SMH, Gogna A, Chan LL, Schaefer PW, Wen DW, McAdory LE, Chen RC. A Tale of Two Organ Systems: Imaging Review of Diseases Affecting the Thoracic and Neurological Systems. Part 2. Curr Probl Diagn Radiol 2021; 51:579-588. [PMID: 34304947 DOI: 10.1067/j.cpradiol.2021.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/01/2021] [Accepted: 06/16/2021] [Indexed: 11/22/2022]
Abstract
In an era of rapidly expanding knowledge and sub-specialization, it is becoming increasingly common to focus on one organ system. However, the human body is intimately linked, and disease processes affecting one region of the body not uncommonly affect the other organ systems as well. Understanding diseases from a macroscopic perspective, rather than a narrow vantage point, enables efficient and accurate diagnosis. This tenet holds true for diseases affecting both the thoracic and neurologic systems; in isolation, the radiologic appearance of disease in one organ system may be nonspecific, but viewing the pathophysiologic process in both organ systems may markedly narrow the differential considerations, and potentially lead to a definitive diagnosis. In this article, we discuss a variety of disease entities known to affect both the thoracic and neurological systems, either manifesting simultaneously or at different periods of time. Some of these conditions may show neither thoracic nor neurological manifestations. These diseases have been systematically classified into infectious, immune-mediated/ inflammatory, vascular, syndromic/ hereditary and neoplastic disorders. The underlying pathophysiological mechanisms linking both regions and radiologic appearances in both organ systems are discussed. When appropriate, brief clinical and diagnostic information is provided. Ultimately, accurate diagnosis will lead to expedited triage and prompt institution of potentially life-saving treatment for these groups of complex disorders.
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Affiliation(s)
- Tze Phei Kee
- Singapore General Hospital, Singapore; National Neuroscience Institute, Singapore.
| | | | | | | | | | | | | | | | - Robert Chun Chen
- Singapore General Hospital, Singapore; Massachusetts General Hospital, Boston, MA
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36
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Baldi BG, dos Santos Fernandes CJC, Heiden GI, Freitas CSG, Sobral JB, Kairalla RA, Carvalho CRR, Souza R. Association between pulmonary artery to aorta diameter ratio with pulmonary hypertension and outcomes in diffuse cystic lung diseases. Medicine (Baltimore) 2021; 100:e26483. [PMID: 34160461 PMCID: PMC8238321 DOI: 10.1097/md.0000000000026483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/28/2021] [Indexed: 01/04/2023] Open
Abstract
To investigate the importance of pulmonary vascular measurements on computed tomography (CT) in predicting pulmonary hypertension (PH) and worse outcomes in diffuse cystic lung diseases (DCLDs).We conducted a cross-sectional study of patients with DCLDs. Patients underwent pulmonary function tests, a six-minute walk test (6MWT), chest CT, transthoracic echocardiography, and right heart catheterization. Pulmonary artery (PA) diameter and PA-ascending aorta ratio (PA-Ao ratio) were obtained from CT. Mean pulmonary artery pressure (mPAP) from right heart catheterization was correlated with tomographic, functional, and echocardiographic variables. The association between the PA-Ao ratio with outcomes was determined by Kaplan-Meier curves.Thirty-four patients were included (18 with pulmonary Langerhans cell histiocytosis and 16 with lymphangioleiomyomatosis, mean age 46 ± 9 years). Forced expiratory volume in the first second and lung diffusing capacity for carbon monoxide were 47 ± 20% and 38 ± 21% predicted, respectively. PA diameter and PA-Ao ratio were 29 ± 6 mm and 0.95 ± 0.24, respectively. PA-Ao ratio > 1 occurred in 38.2% of patients. PA-Ao ratio was a good predictor of PH. mPAP correlated best with PA-Ao ratio, PA diameter, oxygen desaturation during six-minute walk test, and echocardiographic variables. Patients with PA-Ao ratio > 1 had greater mPAP, and a higher risk of death or lung transplantation (log-rank, P < .001) than those with PA-Ao ratio ≤ 1.The PA-Ao ratio measured on CT scan has a potential role as a non-invasive tool to predict the presence of PH and as a prognostic parameter in patients with DCLDs.
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Affiliation(s)
| | | | | | | | - Juliana Barbosa Sobral
- Laboratório de Ecocardiografia, Instituto de Radiologia (InRad), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Rogério Souza
- Divisão de Pneumologia, Instituto do Coração (InCor)
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Bugnet E, Gupta N, Lorillon G, Arbabzadeh-Bouchez S, Lemogne C, Chevret S, Tazi A. Psychological features of adult patients with langerhans cell histiocytosis. PLoS One 2021; 16:e0246604. [PMID: 33577606 PMCID: PMC7880468 DOI: 10.1371/journal.pone.0246604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/21/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The prevalence of psychological symptoms and the co-occurrence of substance abuse disorders in adult patients with Langerhans cell histiocytosis (LCH) has not been previously explored. We aimed to use validated scales to evaluate depression and anxiety symptoms experienced by adult LCH patients. METHODS In this cross-sectional study, all consecutive adult LCH patients seen at our national reference center between January 2012 and January 2013 were asked to complete the following instruments: the Hospital Anxiety and Depression scale (HADS); Barratt Impulsiveness Scale, Version 10 (BIS-10); and Cannabis Use Disorders Identification Test (CUDIT). Self-reported scores on these scales were used to determine the point prevalence of clinically significant psychological symptoms and substance use disorders in LCH patients. Patient profiles in terms of psychological features were assessed by principal component analysis including the HADS and BIS-10 instruments values, followed by hierarchical clustering. Fisher exact tests and Wilcoxon tests were used to examine the associations between disease-related parameters and high levels of anxiety and impulsivity. RESULTS Seventy-one adult LCH patients, mainly with pulmonary LCH (PLCH), completed the evaluations. Clinically significant anxiety and depression symptoms were reported by 22 (31%) and 4 (6%) subjects, respectively. Impulsivity was detected in 14% (10/71) of the patients. Seventeen percent (12/71) of the patients used cannabis on a regular basis, with 50% of these individuals (6/12) exhibiting scores consistent with cannabis use disorder. Three derived clusters of patients were identified in the principal component analysis; these patient clusters differed in successful weaning from tobacco at the time of evaluation (p = 0.03). In univariate analyses, isolated PLCH and the use of psychotropic treatments were statistically associated with clinically significant anxiety symptoms. CONCLUSIONS High levels of anxiety and impulsivity are common in adult patients with LCH. The consequences of these symptoms for the management of LCH patients warrant further evaluation.
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Affiliation(s)
- Emmanuelle Bugnet
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Centre National de Référence des Histiocytoses, Service de Pneumologie, Paris, France
| | - Nishant Gupta
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America.,Department of Veterans Affairs, Veterans Affairs Medical Center, Cincinnati, Ohio, United States of America
| | - Gwenaël Lorillon
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Centre National de Référence des Histiocytoses, Service de Pneumologie, Paris, France
| | | | - Cédric Lemogne
- Université de Paris, F-75006, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Psychiatrie de l'Adulte et du Sujet âgé, Paris, France
| | - Sylvie Chevret
- Université de Paris, F-75006, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Service de Biostatistique et Information Médicale, Paris, France.,INSERM UMR-1153 (CRESS), Biostatistics and Clinical Epidemiology research team (ECSTRRA), Paris, France
| | - Abdellatif Tazi
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Centre National de Référence des Histiocytoses, Service de Pneumologie, Paris, France.,Université de Paris, F-75006, Paris, France.,INSERM UMR-1153 (CRESS), Biostatistics and Clinical Epidemiology research team (ECSTRRA), Paris, France
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38
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McCarthy C, Bugnet E, Benattia A, Keane MP, Vedie B, Lorillon G, Tazi A. Clarifying the relationship between pulmonary langerhans cell histiocytosis and Alpha 1 antitrypsin deficiency. Orphanet J Rare Dis 2021; 16:72. [PMID: 33563302 PMCID: PMC7871552 DOI: 10.1186/s13023-021-01720-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 02/01/2021] [Indexed: 11/26/2022] Open
Abstract
Pulmonary Langerhans cell histiocytosis (PLCH) is a rare, smoking related, progressive diffuse cystic lung disease that occurs primarily in smokers. The aim of this study was to determine if there was an increase in alpha-1 antitrypsin deficient alleles or phenotypes in a large series of PLCH patients and whether serum alpha-1 antitrypsin levels correlated with markers of disease severity. Fifty PLCH patients, 24 with a diffuse cystic lung pattern and 26 with a typical nodulo-cystic pattern on imaging were included. The mean alpha-1 antitrypsin levels were in normal range for both the population with diffuse cystic lung pattern population (1.39 g/L ± 0.37) and the nodulo-cystic pattern group (1.41 g/L ± 0.21). Deficiency alleles PiZ and PiS were 1% and 2% respectively in the entire study population of 50 patients, demonstrating no increased incidence of alpha-1 antitrypsin deficiency in PLCH. Alpha-1 antitrypsin levels showed no correlation with lung function parameters or extent of cystic lesions on lung computed tomography.
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Affiliation(s)
- Cormac McCarthy
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin 4, Ireland.,School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Emmanuelle Bugnet
- Hôpital Saint-Louis, Centre National de Référence des Histiocytoses, Service de Pneumologie, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Amira Benattia
- Hôpital Saint-Louis, Centre National de Référence des Histiocytoses, Service de Pneumologie, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Michael P Keane
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin 4, Ireland.,School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Benoit Vedie
- Hôpital Européen Georges Pompidou, Service de Biochimie, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gwenaël Lorillon
- Hôpital Saint-Louis, Centre National de Référence des Histiocytoses, Service de Pneumologie, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Abdellatif Tazi
- Hôpital Saint-Louis, Centre National de Référence des Histiocytoses, Service de Pneumologie, Assistance Publique-Hôpitaux de Paris, Paris, France. .,Université de Paris, INSERM U976, Institut de Recherche Saint-Louis, 75006, Paris, France. .,Centre National de Référence des Histiocytoses, Service de Pneumologie, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75475, Paris Cedex 10, France.
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Wang J, Xie L, Miao Y, Liu X, Tang Y, Xi Y, Chang J, Wu Y, Jiang L. Adult pulmonary Langerhans cell histiocytosis might consist of two distinct groups: isolated form and extrapulmonary recidivism type. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:357. [PMID: 33708984 PMCID: PMC7944282 DOI: 10.21037/atm-20-8141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Adult pulmonary Langerhans cell histiocytosis (PLCH) is a rare form of Langerhans cell histiocytosis (LCH) that typically occurs in cigarette smokers. The clinical course of PLCH is unpredictable; the disease may resolve spontaneously, or lead to multi-organ failure and death. To better understand this idiopathic disease, we retrospectively overviewed a cohort of Asian patients with PLCHs. Methods Herein, we have provided detailed clinicopathological features and molecular findings of PLCHs in a Southwestern Chinese population, including the expressions of apoptotic protein P16, programmed cell death 1 (PD-1), and programmed cell death-ligand 1 (PD-L1). Importantly, the BRAFV600E mutation was observed in this cohort. Results In accordance with the follow up data, the cohort was subdivided into two groups, an isolated pulmonary group and extrapulmonary recidivism group. Among the isolated group, the participants were predominantly young males (<40 years old), with a history of smoking, respiratory symptoms (cough and difficulty breathing), showed more cystic lesions in computed tomography (CT) scanning, had more cellular Langerhans granulomas under the microscope, overexpression of P16 (66.7%), high PD-1 (100%) and low PD-L1 (33.3%) expressions, and no BRAFV600E mutation was detected. In contrast, the extrapulmonary recidivism group showed significantly older age (>40 years old), recurrent spontaneous pneumothorax, more nodular changes in CT scanning, more interstitial fibrosis histologically, expression rates of 100% of P16, 66.7% of PD-1, and 33.3% of PD-L1; and importantly, BRAFV600E mutation was detected in 33.3% of this subdivision. Conclusions We found that adult PLCH might consist of two distinct groups: an isolated form and extrapulmonary recidivism PLCH. Overexpression of P16 could be a diagnostic biomarker for PLCH. An extremely low mutation rate of the BRAF gene in adult PLCH in our cohort indicated that there might be other pathogeneses for this disease among Asian patients.
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Affiliation(s)
- Jing Wang
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, China.,Department of Pathology, Shanxi Tumor Hospital, Taiyuan, China
| | - Liwu Xie
- Department of Pathology, Shanxi Tumor Hospital, Taiyuan, China
| | - Yuchun Miao
- Department of Respiratory medicine, Shanxi Coal Central Hospital, Taiyuan, China
| | - Xiaoyu Liu
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, China
| | - Yuan Tang
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, China
| | - Yanfeng Xi
- Department of Pathology, Shanxi Tumor Hospital, Taiyuan, China
| | - Jiang Chang
- Department of Pathology, Shanxi Tumor Hospital, Taiyuan, China
| | - Yueqin Wu
- Department of Pathology, Shanxi Tumor Hospital, Taiyuan, China
| | - Lili Jiang
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, China
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40
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Perriot J, Underner M, Peiffer G, Arvers P. [Smoking cessation in smokers with pulmonary Langerhans cell histiocytosis - considerations from the management of ten patients]. Rev Mal Respir 2021; 38:157-163. [PMID: 33516597 DOI: 10.1016/j.rmr.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/17/2020] [Indexed: 02/05/2023]
Abstract
Pulmonary Langerhans cell histiocytosis (PLCH) belongs to the spectrum of diffuse interstitial cystic pneumonias; it affects young people of both sexes and occurs almost exclusively in tobacco smokers or co-users of tobacco and cannabis. The management of this severe chronic disease is undertaken in specialized centers. A better understanding of the pathogenic mechanisms of the disease has opened up prospects for targeted therapies. However, supporting the abstinence from inhaling noxious materials which determine its prognosis remains the cornerstone of treatment. Patients with PLCH who persist in smoking despite the diagnosis may be very dependent on tobacco, experience significant difficulties in stopping smoking, and must have access to specialist smoking cessation clinics.
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Affiliation(s)
- J Perriot
- Dispensaire Emile Roux. Centre de tabacologie et Centre de lutte antituberculeuse (CLAT 63), 11, rue Vaucanson 63100 Clermont-Ferrand, France.
| | - M Underner
- Unité de recherche clinique, Centre Hospitalier Henri-Laborit, Université de Poitiers, 86021 Poitiers, France
| | - G Peiffer
- Service de pneumologie, CHR de Metz-Thionville, 57038 Metz, France
| | - P Arvers
- Hôpital de la Croix-Rousse, Institut Rhône-Alpes-Auvergne de Tabacologie (IRAAT), Hôpital de la Croix- Rousse, 69004 Lyon, France
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41
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Ozkaya S, Alhaja E, Karaman I, Erdem D. Pulmonary langerhans cell histiocytosis: Can it originate from chest trauma? ARCHIVES OF TRAUMA RESEARCH 2021. [DOI: 10.4103/atr.atr_85_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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42
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Yavropoulou MP, Tsoli M, Kaltsas G. Neuroendocrine manifestations of Langerhans cell histiocytosis. HANDBOOK OF CLINICAL NEUROLOGY 2021; 181:127-135. [PMID: 34238452 DOI: 10.1016/b978-0-12-820683-6.00009-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a rare inflammatory myeloid neoplasia that can affect any organ or system in the human body. It is usually diagnosed during childhood but can also affect adults. Recent studies have demonstrated involvement of the hypothalamo-pituitary axis (HPA) in a significant proportion of patients with deficiencies in both anterior and posterior pituitary function that in the majority of cases are permanent and require specific hormone replacement regimes. Central diabetes insipidus is considered the most frequent abnormality of HPA involvement in LCH and can be encountered either as isolated deficiency or along with other pituitary deficiencies. Complete hormonal evaluation of pituitary hormones and long-term follow-up of LCH patients are strongly recommended, especially when pituitary involvement is established.
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Affiliation(s)
- Maria P Yavropoulou
- Endocrinology Unit, First Department of Propaedeutic and Internal Medicine, National and Kapodistrian Universtiy of Athens, Medical School, LAIKO General Hospital of Athens, Athens, Greece; Department of Medical Research, LCH Adult Clinic, Hellenic Air Force and VA General Hospital, Athens, Greece.
| | - Marina Tsoli
- Endocrinology Unit, First Department of Propaedeutic and Internal Medicine, National and Kapodistrian Universtiy of Athens, Medical School, LAIKO General Hospital of Athens, Athens, Greece; Department of Medical Research, LCH Adult Clinic, Hellenic Air Force and VA General Hospital, Athens, Greece
| | - Gregory Kaltsas
- Endocrinology Unit, First Department of Propaedeutic and Internal Medicine, National and Kapodistrian Universtiy of Athens, Medical School, LAIKO General Hospital of Athens, Athens, Greece; Department of Medical Research, LCH Adult Clinic, Hellenic Air Force and VA General Hospital, Athens, Greece
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43
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Moullet B, Kolev M, Ebner L, Langer R, Gräni C, Obmann V, Maurer M, Semmo N, Christe A, Huber AT. Adult form of Langerhans cell histiocytosis with pulmonary and hepatic involvement mimicking malignancy in a patient with chronic hepatitis C infection. Radiol Case Rep 2020; 16:327-333. [PMID: 33318775 PMCID: PMC7724096 DOI: 10.1016/j.radcr.2020.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 11/28/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a myeloid neoplasm with inflammatory properties. There are few published reports of adult LCH with liver involvement, which is still poorly understood, but shows high morbidity and mortality. We report a case of a 37-year-old woman suffering from hepatitis C showing a LCH affecting the lung as well as the liver. Consistent with histology, we found an early stage of a proliferative/granulomatous phase of hepatobiliary LCH, whereas pulmonary findings showed a nodular stage of adult pulmonary LCH. Although hepatocellular carcinoma is a common malignancy in patients suffering from hepatitis C, it is crucial to keep in mind differential diagnosis for newly appearing liver lesions.
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Affiliation(s)
- Barbara Moullet
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital, University of Bern, Freiburgstrasse 10, Inselspital, 3010, Bern, Switzerland
| | - Mirjam Kolev
- Hepatology, Department of Visceral Surgery and Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital, University of Bern, Freiburgstrasse 10, Inselspital, 3010, Bern, Switzerland
| | - Rupert Langer
- Department of Pathology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Verena Obmann
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital, University of Bern, Freiburgstrasse 10, Inselspital, 3010, Bern, Switzerland
| | - Martin Maurer
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital, University of Bern, Freiburgstrasse 10, Inselspital, 3010, Bern, Switzerland
| | - Nasser Semmo
- Hepatology, Department of Visceral Surgery and Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Christe
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital, University of Bern, Freiburgstrasse 10, Inselspital, 3010, Bern, Switzerland
| | - Adrian Thomas Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital, University of Bern, Freiburgstrasse 10, Inselspital, 3010, Bern, Switzerland
- Corresponding author.
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44
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Wu L, Leng Q, Wang Y, Wang D, Yang D. Extensive eye-oral-bronchial mucosal nodules with eosinopgillia: a rare case report and literature review. BMC Pulm Med 2020; 20:296. [PMID: 33183266 PMCID: PMC7664023 DOI: 10.1186/s12890-020-01340-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mucosal nodules can be caused by infection, inflammation and neoplastic disease. Many noninfectious diseases, such as eosinophilia, amyloidosis, sarcoidosis, Wegener's granuloma, langerhans cell histiocytosis etc., are associated with the formation of multisytem mucosal nodules, especially significant bronchial lesions. Detailed medical history, comprehensive metabolic profile, biopsy specimen and imaging examinations are required for differentiating among these disorders. The process of diagnosis and treatment of our patient's mucosal nodules was challenging, which could be helpful to similar cases. CASE PRESENTATION We represent a case of a 29-year-old woman with plentiful nodules of unknown origin on extensive mucous membranes. Biopsy specimen reports inflammatory lesions with large numbers of neutrophils, lymphocytes, and varying degrees of eosinophils. Treatment of anti-infection, anti-tussive and anti-allergic was ineffective, but glucocorticoid showed great improvement to her symptoms. CONCLUSION We experienced a rare case with plentiful nodules of unknown origin on extensive mucous membranes. She may be a specific phenotype of eosinophilia or may be a novel multisystem disease with respiratory system as the primary symptom. The diagnosis of our patient remains unclear, but tentative glucocorticoid therapy was beneficial.
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Affiliation(s)
- Lujin Wu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Wuhan, China
| | - Qianru Leng
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Wuhan, China
| | - Yan Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Wuhan, China
| | - Daowen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Wuhan, China
| | - Danlei Yang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
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45
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Delaval L, Bouaziz JD, Battistella M, Lorillon G, Tazi A. Nailing the diagnosis: severe nail involvement in adult pulmonary Langerhans cell histiocytosis. Thorax 2020; 76:102-103. [PMID: 33087547 DOI: 10.1136/thoraxjnl-2020-215678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/21/2020] [Accepted: 08/22/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Laure Delaval
- Université de Paris, UFR de Médecine Paris Nord, Paris, France.,National Reference Centre for Histiocytoses, Pulmonology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-David Bouaziz
- Université de Paris, UFR de Médecine Paris Nord, Paris, France.,Dermatology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Maxime Battistella
- Université de Paris, UFR de Médecine Paris Nord, Paris, France.,Pathology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gwenaël Lorillon
- National Reference Centre for Histiocytoses, Pulmonology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Abdellatif Tazi
- Université de Paris, UFR de Médecine Paris Nord, Paris, France .,National Reference Centre for Histiocytoses, Pulmonology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
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46
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Della Valle V, Donadieu J, Sileo C, Barkaoui MA, Héritier S, Brisse H, Boutry N, Tréguier C, Chateil JF, Petit P, Pracros JP, Chastagner P, Boyer C, Veillon F, Durand C, Mounayer C, Kambouchner M, Brauner M, Tazi A, Epaud R, Ducou le Pointe H. Chest computed tomography findings for a cohort of children with pulmonary Langerhans cell histiocytosis. Pediatr Blood Cancer 2020; 67:e28496. [PMID: 32710685 DOI: 10.1002/pbc.28496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/19/2020] [Accepted: 05/25/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This study was undertaken to describe the spectrum of lung computed-tomography (CT) findings in children with pulmonary Langerhans cell histiocytosis (PLCH) and to evaluate for this population the CT-scan nodule and cyst scores proposed by adult pulmonologists at diagnosis and during follow-up. METHODS Among 175 children with PLCH identified in the French national population-based Langerhans cell histiocytosis cohort, 60 were retrospectively selected by the availability of CT for a central review by three pediatric radiologists. These 60 patients are representative of childhood PLCH for almost all clinical aspects, except a lower percentage of risk organ involvement (38% vs 54%; P = 0.05). RESULTS The 60 children's chest CT scans (n = 218) were reviewed. At diagnosis, 63% of them had nodules, 53% had cysts, and 29% had both. The percentages of patients with nodules or cysts increased from diagnosis to peak disease activity, respectively, from 63% to 73% and from 53% to 66%. The costophrenic angle was involved in 71%. Patients with pneumothorax (25%) had a higher median cyst score. Alveolar consolidation was observed in 34%. Patients with low CT-scan nodule and cyst scores had no long-term pulmonary sequelae. CONCLUSIONS Well-known characteristics of adult PLCH (nodules and cysts) were observed in children. The chest CT scores proposed by adult pulmonologists could easily be applied to childhood PLCH. Lesions in children, unlike those in adults, are frequently located near the costophrenic angles. Alveolar consolidation might be considered an atypical feature of childhood PLCH.
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Affiliation(s)
- Valeria Della Valle
- Pediatric Radiology Department, Assistance Publique-Hopitaux de Paris (APHP), Trousseau Hospital, Paris, France.,Sorbonne Université, Paris, France
| | - Jean Donadieu
- French Referral Center for Langerhans' Cell Histiocytosis, APHP, Trousseau Hospital, Paris, France
| | - Chiara Sileo
- Pediatric Radiology Department, Assistance Publique-Hopitaux de Paris (APHP), Trousseau Hospital, Paris, France
| | - Mohamed Aziz Barkaoui
- French Referral Center for Langerhans' Cell Histiocytosis, APHP, Trousseau Hospital, Paris, France
| | - Sébastien Héritier
- French Referral Center for Langerhans' Cell Histiocytosis, APHP, Trousseau Hospital, Paris, France
| | - Hervé Brisse
- Radiology Department, Institut Curie, Paris, France
| | - Nathalie Boutry
- Radiology Department, Jeanne-de-Flandre Hospital (CHRU), Lille, France
| | | | | | - Philippe Petit
- Radiology Department, La Timone Hospital (APHM), Marseille, France
| | | | | | - Corinne Boyer
- Radiology Department, L'Archet Hospital (CHU), Nice, France
| | - Francis Veillon
- Radiology Department, Hautepierre Hospital (CHU), Strasbourg, France
| | - Chantal Durand
- Radiology Department, Couple Enfant Hospital (CHU), Grenoble, France
| | | | | | - Michel Brauner
- Radiology Department, APHP, Avicennes Hospital, Bobigny, France
| | - Abdellatif Tazi
- Pneumology Department, French Referral Center for Langerhans Cell Histiocytosis, APHP, Trousseau Hospital, Paris, France
| | - Ralp Epaud
- Service de Pédiatrie Générale, Centre Hospitalier Intercommunal, Creteil, France
| | - Hubert Ducou le Pointe
- Pediatric Radiology Department, Assistance Publique-Hopitaux de Paris (APHP), Trousseau Hospital, Paris, France.,Sorbonne Université, Paris, France
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Miao HL, Zhao AL, Duan MH, Zhou DB, Cao XX, Li J. Clinical presentation and prognostic analysis of adult patients with Langerhans cell histiocytosis with pulmonary involvement. BMC Cancer 2020; 20:911. [PMID: 32967635 PMCID: PMC7513534 DOI: 10.1186/s12885-020-07421-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 09/15/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The study aimed to investigate the clinical features and prognosis factors of adult patients with Langerhans cell histiocytosis (LCH) with pulmonary involvement, especially multisystem (MS) LCH with pulmonary involvement. METHODS We retrospectively analyzed the demographic materials, clinical features and treatment outcomes of 119 adult LCH patients with pulmonary involvement at our center from January 1990 to November 2019. RESULTS Among 119 patients, 13 (10.9%) had single-system (SS) LCH, and 106 (89.1%) had MS-LCH with pulmonary involvement. SS-LCH patients had higher smoking rate (84.6% vs 52.8%, P = 0.026) and smoking index (300 vs 200, P = 0.019) than MS-LCH patients. The percentage of respiratory symptoms of SS-LCH patients was higher than MS-LCH patients (84.6% vs 53.8%, P = 0.034). Pulmonary function was impaired in 83.8% of the patients, and DLCO was the parameter most frequently impaired, accounting for 81.1%. The median DLCO was 65.1% predicted. Patients with pneumothorax had significantly worse DLCO (P = 0.022), FEV1 (P = 0.000) and FEV1/FVC (P = 0.000) than those without pneumothorax. During the follow-up, 72.4% of the patients had stable pulmonary function, and 13.8% showed improvements after chemotherapy. The estimated 3-year OS and EFS were 89.7 and 58.3%, respectively. Patients with a baseline FEV1 ≤ 55% predicted had worse OS. A history of pneumothorax indicated worse EFS and cytarabine based therapy predicted better EFS. CONCLUSIONS An FEV1 ≤ 55% predicted and a history of pneumothorax at diagnosis indicated a poor prognosis. Cytarabine based regimen may arrest the decline in pulmonary function in LCH patients with pulmonary involvement and improve EFS.
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Affiliation(s)
- Hui-Lei Miao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Ai-Lin Zhao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Ming-Hui Duan
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Dao-Bin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Xin-Xin Cao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China.
| | - Jian Li
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China.
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Le Louet S, Barkaoui MA, Miron J, Galambrun C, Aladjidi N, Chastagner P, Kebaili K, Armari-Alla C, Lambilliotte A, Lejeune J, Moshous D, Della Valle V, Sileo C, Ducou Le Pointe H, Chateil JF, Renolleau S, Piloquet JE, Portefaix A, Epaud R, Chiron R, Bugnet E, Lorillon G, Tazi A, Emile JF, Donadieu J, Héritier S. Childhood Langerhans cell histiocytosis with severe lung involvement: a nationwide cohort study. Orphanet J Rare Dis 2020; 15:241. [PMID: 32907615 PMCID: PMC7487928 DOI: 10.1186/s13023-020-01495-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/05/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Lung involvement in childhood Langerhans cell histiocytosis (LCH) is infrequent and rarely life threatening, but occasionally, severe presentations are observed. METHODS Among 1482 children (< 15 years) registered in the French LCH registry (1994-2018), 111 (7.4%) had lung involvement. This retrospective study included data for 17 (1.1%) patients that required one or more intensive care unit (ICU) admissions for respiratory failure. RESULTS The median age was 1.3 years at the first ICU hospitalization. Of the 17 patients, 14 presented with lung involvement at the LCH diagnosis, and 7 patients (41%) had concomitant involvement of risk-organ (hematologic, spleen, or liver). Thirty-five ICU hospitalizations were analysed. Among these, 22 (63%) were secondary to a pneumothorax, 5 (14%) were associated with important cystic lesions without pneumothorax, and 8 (23%) included a diffuse micronodular lung infiltration in the context of multisystem disease. First-line vinblastine-corticosteroid combination therapy was administered to 16 patients; 12 patients required a second-line therapy (cladribine: n = 7; etoposide-aracytine: n = 3; targeted therapy n = 2). A total of 6 children (35%) died (repeated pneumothorax: n = 3; diffuse micronodular lung infiltration in the context of multisystem disease: n = 2; following lung transplantation: n = 1). For survivors, the median follow-up after ICU was 11.2 years. Among these, 9 patients remain asymptomatic despite abnormal chest imaging. CONCLUSIONS Severe lung involvement is unusual in childhood LCH, but it is associated with high mortality. Treatment guidelines should be improved for this group of patients: viral infection prophylaxis and early administration of a new LCH therapy, such as targeted therapy.
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Affiliation(s)
- Solenne Le Louet
- French Reference Center for Langerhans Cell Histiocytosis, Trousseau Hospital, 26 avenue du Dr Netter, 75012, Paris, France.
| | - Mohamed-Aziz Barkaoui
- French Reference Center for Langerhans Cell Histiocytosis, Trousseau Hospital, 26 avenue du Dr Netter, 75012, Paris, France
| | - Jean Miron
- French Reference Center for Langerhans Cell Histiocytosis, Trousseau Hospital, 26 avenue du Dr Netter, 75012, Paris, France
| | - Claire Galambrun
- Department of Pediatric Hematology and Oncology, Hôpital de la Timone, Marseille, France
| | - Nathalie Aladjidi
- Department of Pediatric Hematology and Oncology, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France
| | - Pascal Chastagner
- Department of Pediatric Hematology and Oncology, Brabois-Enfants Hospital, Centre Hospitalo-Universitaire de Nancy, Vandœuvre-lès-Nancy, France
| | - Kamila Kebaili
- Department of Paediatric Oncology, Institut d'Hémato-Oncologie Pediatrique, Lyon, France
| | - Corinne Armari-Alla
- Department of Pediatric Hematology and Oncology, Centre Hospitalo-Universitaire de Grenoble, La Tronche, France
| | - Anne Lambilliotte
- Department of Pediatric Hematology and Oncology, Centre Hospitalo-Universitaire de Lille, Lille, France
| | - Julien Lejeune
- Department of Pediatric Hematology and Oncology, Centre Hospitalo-Universitaire de Tours, Tours, France
| | - Despina Moshous
- Department of Pediatric Immunology, Hematology and Rheumatology, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Institut Imagine, Sorbonne University, Paris, France
| | - Valeria Della Valle
- Department of Radiology, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Chiara Sileo
- Department of Radiology, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hubert Ducou Le Pointe
- Department of Radiology, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-François Chateil
- Department of Radiology, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France
| | - Sylvain Renolleau
- Intensive care unit, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Eudes Piloquet
- Intensive care unit, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Ralph Epaud
- Service de Pédiatrie générale, CHIC, Créteil, France
| | - Raphaël Chiron
- Service de Pneumologie, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Emmanuelle Bugnet
- Service de Pneumologie Centre de référence des histiocytoses Hôpital Saint Louis, Paris, France
| | - Gwenaël Lorillon
- Service de Pneumologie Centre de référence des histiocytoses Hôpital Saint Louis, Paris, France
| | - Abdelatif Tazi
- Service de Pneumologie Centre de référence des histiocytoses Hôpital Saint Louis, Paris, France
- Paris University, INSERM U976, Paris, France
| | | | - Jean Donadieu
- French Reference Center for Langerhans Cell Histiocytosis, Trousseau Hospital, 26 avenue du Dr Netter, 75012, Paris, France
- Départment of Pediatric Hematology and Oncology, Sorbonne University, Paris, France
| | - Sébastien Héritier
- French Reference Center for Langerhans Cell Histiocytosis, Trousseau Hospital, 26 avenue du Dr Netter, 75012, Paris, France
- EA4340, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
- Départment of Pediatric Hematology and Oncology, Sorbonne University, Paris, France
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Elia D, Torre O, Cassandro R, Caminati A, Harari S. Ultra-rare cystic disease. Eur Respir Rev 2020; 29:29/157/190163. [PMID: 32878971 PMCID: PMC9489057 DOI: 10.1183/16000617.0163-2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 03/20/2020] [Indexed: 12/11/2022] Open
Abstract
Diffuse cystic lung diseases include a group of heterogeneous disorders characterised by the presence of cysts within the lung parenchyma, sometimes showing a characteristic computed tomography scan pattern that allows diagnosis. The pathogenetic mechanisms underlying cyst formation in the lung are still not clear and a number of hypotheses have been postulated according to the different aetiologies: ball-valve effect, ischaemic dilatation of small airways and alveoli related to infiltration and obstruction of small vessels and capillaries that supply the terminal bronchioles and connective tissue degradation by matrix metalloproteases. A wide number of lung cyst diseases have been classified into six diagnostic groups according to the aetiology: neoplastic, congenital/genetic, lymphoproliferative, infective, associated with interstitial lung diseases, and other causes. This article focuses on lymphangioleiomyomatosis, pulmonary Langerhans cell histiocytosis and Erdheim–Chester disease, Birt–Hogg–Dubé, follicular bronchiolitis and lymphocytic interstitial pneumonia, light-chain deposition disease and amyloidosis, congenital lung disease associated with aberrant lung development and growth, and cystic lung disease associated with neoplastic lesion. These cystic diseases are epidemiologically considered as ultra-rare conditions as they affect fewer than one individual per 50 000 or fewer than 20 individuals per million. Despite the rarity of this group of disorders, the increasing use of high-resolution computed tomography has improved the diagnostic yield, even in asymptomatic patients allowing prompt and correct therapy and management without the need for a biopsy. Diffuse cystic lung diseases show a characteristic CT scan pattern that often allows for diagnosis, even in asymptomatic patients, allowing prompt correct therapy and management without the needing of a biopsyhttps://bit.ly/2wIUKet
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Jouenne F, Sadoux A, Lorillon G, Louveau B, Bugnet E, Meignin V, Mourah S, Tazi A. Custom pyrosequencing assay to detect short BRAF deletions in Langerhans cell histiocytic lesions. J Clin Pathol 2020; 74:533-536. [PMID: 32873703 DOI: 10.1136/jclinpath-2020-206974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 11/04/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a rare inflammatory myeloid neoplastic disease driven by activating mutations in the mitogen-activating protein kinase signalling pathway, including the BRAF V600E mutation and BRAF deletions (BRAFdel). Next-generation sequencing and whole exome sequencing (WES) are valuable and powerful approaches for BRAFdel identification, but these techniques are costly and time consuming. Pyrosequencing is an alternative method that has the potential to rapidly and reliably identify gene deletions. We developed a custom pyrosequencing assay to detect the exon-12 BRAFdel in 18 biopsies from adult patients with LCH, which were all genotyped in parallel using Sanger sequencing and WES. A BRAFdel was detected in 7/18 (39%), 6/18 (33%) and 3/18 (17%) LCH lesions using WES, pyrosequencing and Sanger, respectively, with good concordance between the WES and pyrosequencing results (Kappa-coefficient=0.88). Therefore, our pyrosequencing assay is reliable and useful for detecting BRAFdel, particularly in BRAF V600E-negative LCH lesions, for which targeted treatment is indicated.
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Affiliation(s)
- Fanélie Jouenne
- Pharmacogenomics Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France.,INSERM U976, Université de Paris, Paris, Île-de-France, France
| | - Aurélie Sadoux
- Pharmacogenomics Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France.,INSERM U976, INSERM, Paris, Île-de-France, France
| | - Gwenaël Lorillon
- National Reference Centre for Histiocytoses, Pulmonology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
| | - Baptiste Louveau
- Pharmacogenomics Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France.,INSERM U976, INSERM, Paris, Île-de-France, France
| | - Emmanuelle Bugnet
- National Reference Centre for Histiocytoses, Pulmonology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
| | - Veronique Meignin
- Pathology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
| | - Samia Mourah
- Pharmacogenomics Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France.,INSERM U976, Université de Paris, Paris, Île-de-France, France
| | - Abdellatif Tazi
- INSERM U976, Université de Paris, Paris, Île-de-France, France .,National Reference Centre for Histiocytoses, Pulmonology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
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