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Chianca V, Lanckoroński M, Curti M, Chalian M, Sudoł-Szopińska I, Giraudo C, Del Grande F. Whole-Body Magnetic Resonance Imaging in Rheumatology. Radiol Clin North Am 2024; 62:865-876. [PMID: 39059977 DOI: 10.1016/j.rcl.2024.02.008] [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] [Indexed: 07/28/2024]
Abstract
This review focuses on the most frequent whole-body MRI applications in patients with rheumatological pathologies, for which this tool can be helpful to both radiologists and clinicians. It reports technical aspects of the acquisition of both 1.5 and 3.0 T scanners. The article lists the main findings that help radiologists during the evaluation of a specific pathology, both in the diagnostic phase and during follow-up.
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Affiliation(s)
- Vito Chianca
- Istituto di Imaging Della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, Lugano 6900 Switzerland.
| | - Michał Lanckoroński
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartanska 1 Street, Warsaw 02-637, Poland
| | - Marco Curti
- Istituto di Imaging Della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, Lugano 6900 Switzerland
| | - Majid Chalian
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA, USA
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartanska 1 Street, Warsaw 02-637, Poland
| | - Chiara Giraudo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health - DCTV, University of Padova, Padova, Italy
| | - Filippo Del Grande
- Istituto di Imaging Della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, Lugano 6900 Switzerland; Facoltà di Scienze Biomediche, Università Della Svizzera Italiana, Via Buffi 13, Lugano 6900, Switzerland
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Guàrdia-Ruiz N, López-Miñarro IM, Obregón-Martínez E, Asensio-Sánchez VM. Langerhans cell histiocytosis mimicking acute dacryocystitis. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2024:S2173-5794(24)00104-X. [PMID: 38901610 DOI: 10.1016/j.oftale.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/14/2024] [Indexed: 06/22/2024]
Abstract
Langerhans cell histiocytosis (LCH) is a myeloid neoplasm characterized by clonal neoplastic proliferation of Langerhans-type dendritic cells associated with an inflammatory infiltrate predominantly composed of lymphocytes and eosinophils. In this article, we present an unusual case of LCH with significant swelling in the left lacrimal sac region in a 3-year-old child, clinically mimicking acute dacryocystitis. Microscopically, it showed intense inflammatory infiltrate and histiocytes with irregular nuclei. The tumor cells were positive for S-100 protein, CD1a, and CD207 (langerin). Molecular study was positive for the V600E/E2/D mutation (EXON 15). This case emphasizes the importance of careful clinical, radiographic, and microscopic evaluation, as some neoplasms may mimic common benign lesions.
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Affiliation(s)
- N Guàrdia-Ruiz
- Servicio de Oftalmología, Hospital Clínico Universitario, Valladolid, Spain.
| | - I M López-Miñarro
- Servicio de Oftalmología, Hospital Clínico Universitario, Valladolid, Spain
| | - E Obregón-Martínez
- Servicio de Anatomía Patológica, Hospital Clínico Universitario, Valladolid, Spain
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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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Wang W, Liu X, Yang S, Peng X, Ma Y, Xiong X, Li Y. Serum levels of soluble interleukin 2 receptor (sIL-2R), tumor necrosis factor-alpha (TNF-α), and immunoglobulin M are correlated with the disease extent in childhood Langerhans cell histiocytosis. J Cancer Res Clin Oncol 2023; 149:11431-11442. [PMID: 37389594 DOI: 10.1007/s00432-023-04991-w] [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: 04/05/2023] [Accepted: 06/15/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE This study aimed to identify peripheral parameters associated with the severity of Langerhans cell histiocytosis (LCH) and to look for indicators associated with improvement in LCH patients with risk-organ involvement. METHODS This study enrolled LCH patients who were assessed as active disease-better (AD-B) after treatment. Patients were divided into the single system (SS) group, multisystem disease without risk-organ involvement (RO- MS) group, and multisystem disease with risk-organ involvement (RO + MS) group. Serum cytokines, immunoglobulins, and lymphocyte subsets were measured at admission for all three groups. Changes in these indicators after treatment were also analyzed. RESULTS From January 2015 to January 2022, a total of 46 patients were recruited in the present study, including 19 patients (41.3%) in the SS group, 16 patients (34.8%) in the RO- MS group, and 11 patients (23.9%) in the RO + MS group. Serum levels of soluble interleukin 2 receptor (sIL-2R) (> 912.5 U/mL), tumor necrosis factor-alpha (TNF-α) (> 20.3 pg/mL), and immunoglobulin M (< 1.12 g/L) were found to be effective in identifying patients in the RO + MS group. Furthermore, the levels of sIL-2R (SS vs RO + MS: P = 0.002, RO- MS vs RO + MS: P = 0.018) and CD8 + T-cell count (SS vs RO + MS: P = 0.028) significantly declined in the RO + MS group after treatment, indicating disease improvement. CONCLUSIONS The levels of sIL-2R and TNF-α were positively correlated with the extent of disease, while the levels of IgM were negatively correlated with the extent of disease. Additionally, the levels of sIL-2R and CD8 + T-cell count could serve as useful indicators to evaluate the treatment response in RO + MS-LCH patients.
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Affiliation(s)
- Wenxia Wang
- Department of Hematology/Oncology, Children's Medical Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoshan Liu
- Department of Hematology/Oncology, Children's Medical Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shu Yang
- Department of Hematology/Oncology, Children's Medical Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaomin Peng
- Department of Hematology/Oncology, Children's Medical Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yuhan Ma
- Department of Hematology/Oncology, Children's Medical Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xilin Xiong
- Department of Hematology/Oncology, Children's Medical Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yang Li
- Department of Hematology/Oncology, Children's Medical Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
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Guo Y, Huang Q. Diagnosis and treatment of isolated rib Langerhans cell histiocytosis in an adult: A case report. Front Surg 2023; 10:1084137. [PMID: 36911612 PMCID: PMC9992715 DOI: 10.3389/fsurg.2023.1084137] [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: 10/30/2022] [Accepted: 01/31/2023] [Indexed: 02/24/2023] Open
Abstract
Langerhans cell histiocytosis (LCH) was first proposed in 1987 to define the disorder characterized by the proliferation of abnormal Langerhans cells. It is more likely to occur in children younger than 15 years of age. Single-site and single-system LCH of rib is rare in adults. We present a rare case of isolated rib LCH in a 61-year-old male patient and expound the diagnosis and treatment of the disease. A 61-year-old male patient who presented with a 15-day history of dull pain in the left chest was admitted to our hospital. PET/CT image showed obvious osteolytic bone destruction and abnormal fluorodeoxy-glucose (FDG) uptake (maximum standardized uptake value: 14.5) in the right fifth rib with local soft tissue mass formation. The patient was eventually confirmed the diagnosis of LCH by immunohistochemistry stain and treated with rib surgery. A thorough review of the literature regarding diagnosis and treatment of LCH is presented in this study.
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Affiliation(s)
- Yaxin Guo
- Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - QiFeng Huang
- Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
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Langerhans Cell Histiocytosis Manifests with Acute Severe Hypernatremia during Hospitalization. Case Rep Nephrol 2022; 2022:6120644. [PMID: 36274908 PMCID: PMC9586834 DOI: 10.1155/2022/6120644] [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: 08/11/2022] [Revised: 09/26/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022] Open
Abstract
Central diabetes insipidus (DI) is characterized by a deficiency in arginine vasopressin (AVP), an antidiuretic hormone leading to excessive free water loss in the urine and hypernatremia. Central DI can be the first presentation of several occult diseases. However, patients with central DI who have functioning thirst mechanisms and access to water may initially exhibit normal sodium levels. We report a 57-year-old woman who was admitted to the hospital due to cholangitis. Her initial serum sodium was normal and she rapidly developed severe hypernatremia after fluid restriction. The results of the laboratory workup indicated DI, which dramatically responded to desmopressin. MRI showed an ill-defined faint hyper signal intensity in T1, T2/FLAIR lesions involving the bilateral hypothalamus. The histopathological findings confirmed the diagnosis of Langerhans cell histiocytosis (LCH) with multiorgan involvement. Serum sodium returned to normal after receiving desmopressin and water replacement therapy.
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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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Cariello V, Lombardo P, Castelli L, Brillantino C, De Fusco C, Rossi A, Minelli R, Paviglianiti G, Grassi R, Rossi E. Integrated imaging of systemic Langerhans cell histiocytosis in an infant. Radiol Case Rep 2022; 17:2747-2753. [PMID: 35990570 PMCID: PMC9388885 DOI: 10.1016/j.radcr.2022.05.016] [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: 03/14/2022] [Revised: 04/30/2022] [Accepted: 05/05/2022] [Indexed: 11/26/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a myeloid neoplasm characterized by a clonal proliferation of CD1a+/CD207+ dendritic cells. Although individuals of any age can be affected, the disease is most common in infants younger than 5 years of age, especially males. A wide range of manifestations, from asymptomatic to aggressive, have been described, along with multiorgan involvement. Even though the majority of bone lesions are observed, skin, lymph nodes, brain and lungs can also be involved. The involvement of hematopoietic system, including bone marrow, liver and spleen, is less frequent yet associated with worse prognosis, due to a worse treatment response. Diagnosis of LCH is based on the integration of clinical, laboratory, and radiological data; however, only histopathological examination might confirm it. As far as the spleen involvement is concerned, according to literature, it has been reported in about 15% patients with multisystem involvement, nonetheless only a few cases show parenchymal lesions. The present study reports the case of an infant with LCH with multisystem involvement, including bone, skin, liver, and spleen, with evidence of parenchymal lesions.
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Bidner N, Schnack C, Brix JM, Ludvik B. [A female patient with earache, polyuria and polydipsia]. Dtsch Med Wochenschr 2022; 147:855-857. [PMID: 35785784 DOI: 10.1055/a-1869-0732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Langerhans cell histiocytosis is a rare inflammatory bone marrow neoplasia that frequently affects bone, lung, skin and pituitary gland. Due to its broad spectrum of clinical presentation, an appropriate diagnosis might be difficult. HISTORY A 54-year-old female patient complained of pain in her right ear for 5 months. On account of similar complaints, a mastoidectomy had already been performed 3 years ago. Histology at that time revealed nonspecific inflammation. Furthermore, she reported excessive thirst. FINDINGS AND DIAGNOSIS Computed tomography of the temporal bones showed osteolysis in the mastoid. Magnetic resonance imaging and bone scintigraphy assessed these changes as uncharacteristically inflammatory. Polydipsia proved to be a symptom of central diabetes insipidus in the water deprivation test. Finally, remastoidectomy provided histologic evidence of Langerhans cell histiocytosis. THERAPY AND COURSE Besides systemic chemotherapy with cytarabine, the patient also received denosumab and desmopressin. CONCLUSION Langerhans cell histiocytosis involving cranial bones is often associated with diabetes Insipidus. Knowledge about the distinctive constellation may lead to a more rapid diagnosis and improved prognosis.
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Affiliation(s)
- Nora Bidner
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie und Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen, Klinik Landstraße, Wien
| | - Christoph Schnack
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie und Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen, Klinik Landstraße, Wien
| | - Johanna M Brix
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie und Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen, Klinik Landstraße, Wien
| | - Bernhard Ludvik
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie und Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen, Klinik Landstraße, Wien
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Elia D, Torre O, Vasco C, Geginat J, Abrignani S, Bulgheroni E, Carelli E, Cassandro R, Pacheco-Rodriguez G, Steagall WK, Moss J, Harari S. Pulmonary Langerhans cell histiocystosis (PLCH) and lymphangioleiomyomatosis (LAM) have circulating cells with loss of heterozygosity of the TSC2 gene. Chest 2022; 162:385-393. [PMID: 35231481 PMCID: PMC9470734 DOI: 10.1016/j.chest.2022.02.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/31/2022] [Accepted: 02/11/2022] [Indexed: 12/08/2022] Open
Abstract
BACKGROUND Lymphangioleiomyomatosis (LAM) and pulmonary Langerhans Cell Histiocytosis (PLCH) are cystic lung diseases in which a neoplastic cell is believed to be responsible for disease pathogenesis. The neoplastic LAM cell has mutations in the Tuberous Sclerosis Complex (TSC) genes, TSC1 or TSC2, whereas the neoplastic PLCH cell may have mutations in several genes, e.g., BRAF, NRAS, MAP2K1. These mutations are not specific for PLCH and they have been described in multiple cancers. TSC1 or TSC2 mutations and loss of heterozygosity (LOH) have also been described in cancers. RESEARCH QUESTION Is TSC2 LOH specific to LAM or is it also found in PLCH too? STUDY DESIGN We recruited LAM patients (53) and Healthy Volunteers (22) and compared the presence of cells with TSC2 LOH with PLCH patients (12). Blood and urine samples were collected for analysis. METHODS Fluorescence-activated cell sorting (FACS) was used to identify subpopulations of cells from blood and urine samples. We isolated CD45-CD235a-, CD45-CD235a+, CD45+CD235a- cells from blood following density gradient separation. Cells were screened for TSC2 LOH at 5 microsatellites markers (i.e., kg8, D16S3395, D16S3024, D16S521, D16S291). We obtained four cell subpopulations from urine (i.e., CD44v6+CD9+; CD44v6+CD9-; CD44v6-CD9+; CD44v6-CD9). RESULTS Using FACS, cells were isolated from blood and urine from PLCH patients that showed TSC2 LOH. Healthy volunteers did not have cells with TSC2 LOH. As a control, cells isolated from blood and urine from LAM patients gave results similar to those reported previously. These data show that TSC2 LOH is found in patients with cystic lung diseases with potential neoplastic characteristics, as well as in patients with cancer. INTERPRETATION The presence of TSC2 LOH in circulating cells is not specific for LAM. The data suggest that chromosomal abnormalities affecting the TSC2 gene are found in other diseases associated with cells having cancer-like neoplastic cells.
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Affiliation(s)
- Davide Elia
- Division of Pulmonary and Critical Care Medicine, San Giuseppe Hospital MultiMedica IRCCS, Milan, Italy
| | - Olga Torre
- Division of Pulmonary and Critical Care Medicine, San Giuseppe Hospital MultiMedica IRCCS, Milan, Italy
| | - Chiara Vasco
- Istituto Nazionale di Genetica Molecolare "Romeo ed Enrica Invernizzi", Milan, Italy
| | - Jens Geginat
- Istituto Nazionale di Genetica Molecolare "Romeo ed Enrica Invernizzi", Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Department of Medicine, Ospedale San Giuseppe MultiMedica IRCCS, Milan, Italy
| | - Sergio Abrignani
- Istituto Nazionale di Genetica Molecolare "Romeo ed Enrica Invernizzi", Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Department of Medicine, Ospedale San Giuseppe MultiMedica IRCCS, Milan, Italy
| | - Elisabetta Bulgheroni
- Istituto Nazionale di Genetica Molecolare "Romeo ed Enrica Invernizzi", Milan, Italy
| | - Elena Carelli
- Istituto Nazionale di Genetica Molecolare "Romeo ed Enrica Invernizzi", Milan, Italy
| | - Roberto Cassandro
- Division of Pulmonary and Critical Care Medicine, San Giuseppe Hospital MultiMedica IRCCS, Milan, Italy
| | - Gustavo Pacheco-Rodriguez
- Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Wendy K Steagall
- Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Joel Moss
- Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Sergio Harari
- Division of Pulmonary and Critical Care Medicine, San Giuseppe Hospital MultiMedica IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Department of Medicine, Ospedale San Giuseppe MultiMedica IRCCS, Milan, Italy
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Ma Q, Li Q, Wei Y. A Rare Case of an Intestinal Ulcer. Gastroenterology 2022; 162:e7-e8. [PMID: 34146567 DOI: 10.1053/j.gastro.2021.05.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Qiang Ma
- Department of Pathology, Chongqing, China
| | - Qin Li
- Department of Gastroenterology, Daping Hospital, Army Medical University of PLA, Chongqing, China
| | - Yanling Wei
- Department of Gastroenterology, Daping Hospital, Army Medical University of PLA, Chongqing, China.
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12
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de Vries F, van Furth WR, Biermasz NR, Pereira AM. Hypophysitis: A comprehensive overview. Presse Med 2021; 50:104076. [PMID: 34687912 DOI: 10.1016/j.lpm.2021.104076] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/27/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022] Open
Abstract
Hypophysitis is defined as inflammation of the pituitary gland. It is a heterogeneous condition as it can originate from different parts of the pituitary gland, can be caused by different pathophysiological processes, and can be isolated or the manifestation of a underlying systemic disease. Hypophysitis usually presents with endocrine deficiencies, including diabetes insipidus, with varying patterns. A subset of patients presents with mass effects. The last decades major progress has been made in the understanding of this disease. New forms are now recognized, new diagnostics are being developed, and specific treatments are proposed. This review provides an overview of the current knowledge on hypophysitis using an aetiology-based approach and provides the clinician with a stepwise approach to the patient with (suspected) hypophysitis.
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Affiliation(s)
- F de Vries
- Department of Neurosurgery and Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, the Netherlands; Department of Medicine, Division of Endocrinology and Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, the Netherlands
| | - W R van Furth
- Department of Neurosurgery and Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, the Netherlands
| | - N R Biermasz
- Department of Medicine, Division of Endocrinology and Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, the Netherlands
| | - A M Pereira
- Department of Medicine, Division of Endocrinology and Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, the Netherlands
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Ono K, Okui T, Kunisada Y, Obata K, Masui M, Ryumon S, Ibaragi S, Nakamura T, Sasaki A. A case of langerhans cell histiocytosis of the mandible that spontaneously regressed after biopsy in a child. Clin Case Rep 2021; 9:e04321. [PMID: 34194804 PMCID: PMC8223692 DOI: 10.1002/ccr3.4321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/20/2021] [Accepted: 04/26/2021] [Indexed: 12/24/2022] Open
Abstract
In younger patients of LCH, we should consider that the effectiveness of follow-up without aggressive treatment for SS-type LCH in the oral and maxillofacial bone. However, there are very rare case in which an SS-type LCH recurred after showing a healing tendency. Regular follow-up must be performed even after healing.
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Affiliation(s)
- Kisho Ono
- Department of Oral and Maxillofacial SurgeryDentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
| | - Tatsuo Okui
- Department of Oral and Maxillofacial SurgeryDentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
- Department of Oral and Maxillofacial SurgeryFaculty of MedicineShimane UniversityShimaneJapan
| | - Yuki Kunisada
- Department of Oral and Maxillofacial SurgeryDentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
| | - Kyoichi Obata
- Department of Oral and Maxillofacial SurgeryDentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
| | - Masanori Masui
- Department of Oral and Maxillofacial SurgeryDentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
| | - Shoji Ryumon
- Department of Oral and Maxillofacial SurgeryDentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
| | - Soichiro Ibaragi
- Department of Oral and Maxillofacial SurgeryDentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
| | - Tomoya Nakamura
- Department of Oral and Maxillofacial SurgeryDentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
| | - Akira Sasaki
- Department of Oral and Maxillofacial SurgeryDentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
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14
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Savina VY, Solovyeva SE, Dolzhansky OV, Metelin AV. [Clinical and morphological analysis of Langerhans cell histiocytosis in a child of early age]. Khirurgiia (Mosk) 2021:101-104. [PMID: 34032796 DOI: 10.17116/hirurgia2021062101] [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: 11/17/2022]
Abstract
The authors characterize a rare variant of Langerhans cell histiocytosis in a child of early age. Multiple-system form including liver damage is characterized by a particularly severe course, especially in early childhood. The authors report clinical, morphological and immunohistochemical data of the patient aged 1 year and 11 months. It is shown that timely diagnosis of this disease should be carried out in close cooperation of surgeons and morphologists.
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Affiliation(s)
- V Yu Savina
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
| | - S E Solovyeva
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
| | - O V Dolzhansky
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
| | - A V Metelin
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
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15
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Gwacham NI, Ward D, McKenzie ND. Isolated vulvar Langerhans cell histiocytosis. Gynecol Oncol Rep 2021; 36:100785. [PMID: 34036139 PMCID: PMC8134974 DOI: 10.1016/j.gore.2021.100785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 04/30/2021] [Indexed: 11/24/2022] Open
Abstract
Primary vulvar Langerhans cell histiocytosis is rare with less than 40 reported cases. Diagnosis of vulvar LCH requires prompt metastatic workup to rule out multisystem involvement. Treatment protocols for isolated vulvar LCH vary widely and there is not an established standard of care. Continue surveillance is warranted even after prolonged periods of remission.
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Affiliation(s)
- Nnamdi I Gwacham
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL, USA
| | - David Ward
- Department of Pathology, AdventHealth Orlando, Orlando, FL, USA
| | - Nathalie D McKenzie
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL, USA
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16
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Faden I, Avitzur Y, Abla O, Parra DA. Findings encountered in percutaneous cholangiography in a case of post-transplant recurrence of hepatic Langerhans cell histiocytosis with biliary involvement. Pediatr Transplant 2021; 25:e13838. [PMID: 32985784 DOI: 10.1111/petr.13838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/26/2020] [Accepted: 08/12/2020] [Indexed: 01/13/2023]
Abstract
This case report describes a four-year-old boy who presented with the diagnosis of LCH with liver involvement. This required a living-related liver transplant one year later. The primary disease recurred in the transplanted liver 6 months post-transplant and led to progressive biliary dilatation. A percutaneous trans-hepatic cholangiogram was performed five years after transplant, showing a pattern of multifocal biliary duct strictures mimicking the pattern of primary sclerosing cholangitis and a stenosis of the biliary-enteric anastomosis. Despite management with an internal-external biliary drain, the stenosis of the biliary-enteric anastomosis evolved to an occlusion one year after drain removal. This was associated with progression of the changes in the biliary tree, this time associated with significant saccular dilatations secondary to the multiple areas of stenosis. Due to these findings and progressive deterioration of the function of the graft, the patient required re-transplantation. This report illustrates the findings in imaging of the biliary tree secondary to the recurrence of LCH after liver transplantation, which may help to recognize this complication to physicians facing a similar clinical scenario.
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Affiliation(s)
- Iyad Faden
- Division of Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Radiology and Medical Imaging, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Yaron Avitzur
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Oussama Abla
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Hematology and Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Dimitri A Parra
- Division of Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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17
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Kinoshita M, Ogawa Y, Honobe A, Tomita O, Oishi N, Shimada S, Kondo T, Kawamura T. Expression of CD1 molecules and colony-stimulating factor 1 receptor in indeterminate cell histiocytosis. J Dermatol 2021; 48:1086-1089. [PMID: 33774864 DOI: 10.1111/1346-8138.15857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/17/2021] [Accepted: 03/04/2021] [Indexed: 01/15/2023]
Abstract
Indeterminate cell histiocytosis (ICH) and Langerhans cell histiocytosis (LCH) are rare histiocyte proliferating disorders with unknown etiologies. However, both tumor cells immunophenotypically share some features of Langerhans cells (LC), thereby expressing CD1a. Recent transcriptome analysis revealed that circulating CD1c+ myeloid dendritic cells are the potential precursor of LCH tumor cells. LC express CD1a as well as CD1c, but not CD1b. We discovered that both tumor cells express CD1c, but not CD1b, similar to LC. Moreover, like LC, both tumor cells express colony-stimulating factor 1 receptor (CSF-1R). Considering the crucial role of the interleukin (IL)-34/CSF-1R axis for the development and survival of LC, CSF-1R on both tumor cells might facilitate their survival and proliferation in situ. These data provide additional evidence to support the fact that ICH and LCH share immunophenotypical features with LC. In addition, we hypothesized that tumor cells in ICH and LCH survive and proliferate through IL-34-mediated CSF-1R signaling.
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Affiliation(s)
- Manao Kinoshita
- Department of Dermatology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Youichi Ogawa
- Department of Dermatology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Akiko Honobe
- Department of Dermatology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Ozumi Tomita
- Department of Dermatology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Naoki Oishi
- Department of Pathology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Shinji Shimada
- Department of Dermatology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Tetsuo Kondo
- Department of Pathology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Tatsuyoshi Kawamura
- Department of Dermatology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
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18
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A mutation in POLR3E impairs antiviral immune response and RNA polymerase III. Proc Natl Acad Sci U S A 2020; 117:22113-22121. [PMID: 32843346 DOI: 10.1073/pnas.2009947117] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
RNA polymerase (Pol) III has a noncanonical role of viral DNA sensing in the innate immune system. This polymerase transcribes viral genomes to produce RNAs that lead to induction of type I interferons (IFNs). However, the genetic and functional links of Pol III to innate immunity in humans remain largely unknown. Here, we describe a rare homozygous mutation (D40H) in the POLR3E gene, coding for a protein subunit of Pol III, in a child with recurrent and systemic viral infections and Langerhans cell histiocytosis. Fibroblasts derived from the patient exhibit impaired induction of type I IFN and increased susceptibility to human cytomegalovirus (HCMV) infection. Cultured cell lines infected with HCMV show induction of POLR3E expression. However, induction is not restricted to DNA virus, as sindbis virus, an RNA virus, enhances the expression of this protein. Likewise, foreign nonviral DNA elevates the steady-state level of POLR3E and elicits promoter-dependent and -independent transcription by Pol III. Remarkably, the molecular mechanism underlying the D40H mutation of POLR3E involves the assembly of defective initiation complexes of Pol III. Our study links mutated POLR3E and Pol III to an innate immune deficiency state in humans.
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19
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Polyzos SA, Makras P, Tournis S, Anastasilakis AD. Off-label uses of denosumab in metabolic bone diseases. Bone 2019; 129:115048. [PMID: 31454537 DOI: 10.1016/j.bone.2019.115048] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 08/14/2019] [Accepted: 08/23/2019] [Indexed: 01/16/2023]
Abstract
Denosumab (Dmab), a monoclonal antibody against the receptor activator of nuclear factor-κB (RANK) ligand (RANKL) which substantially suppresses osteoclast activity, has been approved for the treatment of common metabolic bone diseases, including postmenopausal osteoporosis, male osteoporosis, and glucocorticoid-induced osteoporosis, in which the pathway of the RANK/RANKL/osteoprotegerin is dysregulated. However, the imbalance of RANKL/RANK/osteoprotegerin is also implicated in the pathogenesis of several other rare metabolic bone diseases, including Juvenile Paget disease, fibrous dysplasia, Hajdu Cheney syndrome and Langerhans cell histiocytosis, thus rendering Dmab a potential treatment option for these diseases. Dmab has been also administered off-label in selected patients (e.g., with Paget's disease, osteogenesis imperfecta, aneurysmal bone cysts) due to contraindications or unresponsiveness to standard treatment, such as bisphosphonates. Moreover, Dmab was administered to improve hypercalcemia induced by various diseases, including primary hyperparathyroidism, tuberculosis and immobilization. The aim of this review is to summarize existing evidence on off-label uses of Dmab in metabolic bone diseases and provide opinion for or against its use, which should be always considered on an individual basis.
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Affiliation(s)
- Stergios A Polyzos
- First Department of Pharmacology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Polyzois Makras
- Department of Endocrinology and Diabetes and Department of Medical Research, 251 Hellenic Air Force General Hospital, Athens, Greece
| | - Symeon Tournis
- Laboratory for Research of the Musculoskeletal System "Th. Garofalidis", National and Kapodistrian University of Athens, KAT Hospital, Athens, Greece
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20
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Karamova AE, Chikin VV, Znamenskaya LF, Nefedova MA, Mikhina VA, Battalova NS. Langerhans cell histiocytosis in an adult patient. VESTNIK DERMATOLOGII I VENEROLOGII 2019. [DOI: 10.25208/0042-4609-2019-95-4-57-66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Aim: to present a clinical case of a rare dermatosis — Langerhans cell histiocytosis (LCH) in an adult patient.Materials and methods. A clinical and laboratory examination of a 64-year-old woman who had complained of rashes on the skin of the scalp, neck, trunk and lower extremities accompanied by itching was carried out. A histological study of skin biopsy samples from the lesion area, as well as an immunohistochemical study of Langerhans cell markers — langerin and S-100 protein — were performed.Results. Clinical manifestations of the disease, the presence of histiocytic infiltrate in the epidermis and dermis during the histological study and immunohistochemical detection of langerin infiltrate cells and S-100 protein were all consistent with the diagnosis of LCH. The therapy with methotrexate subcutaneously significantly improved the patient’s condition.Conclusion. Verification of the LCH diagnosis requires a histological study of skin biopsy samples and an immunohistochemical study of Langerhans cell markers. The efficacy of methotrexate in the treatment of this disease has been confirmed.
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Affiliation(s)
- A. E. Karamova
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
| | - V. V. Chikin
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
| | - L. F. Znamenskaya
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
| | - M. A. Nefedova
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
| | - V. A. Mikhina
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
| | - N. S. Battalova
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
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21
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Mendonça-Sanches M, Rolim I, Costa-Rosa J, Caldas G, Moura C. Eruptive Junctional Nevi Appearing During Langerhans Cell Histiocytosis Treatment. Eur J Case Rep Intern Med 2019; 6:001088. [PMID: 31293989 PMCID: PMC6601688 DOI: 10.12890/2019_001088] [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: 04/14/2019] [Accepted: 04/28/2019] [Indexed: 11/20/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a multisystemic disorder that results from the clonal proliferation of immunophenotypically and functionally immature Langerhans cells (LC). The detection of the V600E mutation in the BRAF oncogene in LCH biopsy specimens supports previous evidence that LCH is a neoplastic disorder. This mutation is present in other cutaneous lesions including malignant melanoma and benign nevi. Single case reports of a correlation between LCH and the appearance of eruptive nevi limited to the inguinal folds after chemotherapy have previously been described in the literature. This suggested that LCH could be an additional cause of eruptive melanocytic nevi, with a specific distribution mimicking that of LCH cutaneous lesions. We present the case of a 6-year-old boy, previously treated with chemotherapy for Langerhans cell histiocytosis, with disseminated junctional nevi. Although this co-occurrence may be coincidental, the skin involvement is distinct from other previously reported clinical cases. It would be interesting to evaluate whether the BRAF mutation described in LCH cells might in fact support a genetic background for the development of nevi in these patients.
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Affiliation(s)
| | - Inês Rolim
- Pathology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Joaninha Costa-Rosa
- Pathology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Gabriela Caldas
- Pediatrics Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Cecília Moura
- Dermatology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
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22
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Kim JE, Yi WJ, Heo MS, Lee SS, Choi SC, Huh KH. Langerhans cell histiocytosis of the jaw, a mimicker of osteomyelitis on CT and MR images: A retrospective analysis. Medicine (Baltimore) 2019; 98:e16331. [PMID: 31277182 PMCID: PMC6635274 DOI: 10.1097/md.0000000000016331] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Differential diagnosis of Langerhans Cell Histiocytosis (LCH) in the jaw is essential for early treatment including systemic therapy. Records of 17 patients (6 men and 11 women; mean age, 14 years) with histologically confirmed LCH were reviewed. All the lesions occurred in the mandible. Most of the cases (n=12) were intraosseous type LCH, only 5 patients had alveolar type LCH. Patients complained of facial swelling and pain most likely. In the 14 patients who underwent CT and/or MR imaging, all LCH lesions were osteolytic, with a mean size of 23 mm. LCH presented as expansile lesions with periosteal new bone formation, perilesional sclerosis, fluid attenuation/signal within the lesion, and inflammatory changes in adjacent soft tissues on CT/MR images. Considering the major symptoms of LCH were swelling and pain, the differential diagnosis of LCH from osteomyelitis might be more difficult. The differential diagnosis for osteolytic lesions of the jaw with surrounding inflammatory changes should include LCH, especially in young patients.
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Affiliation(s)
- Jo-Eun Kim
- Department of Oral and Maxillofacial Radiology, Seoul National University Dental Hospital
| | - Won-Jin Yi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University
| | - Min-Suk Heo
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University
| | - Sam-Sun Lee
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University
| | - Soon-Chul Choi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University
| | - Kyung-Hoe Huh
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
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23
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Liu X, Zhang Y, Zhou CX. High Prevalence of BRAF V600E Mutations in Langerhans Cell Histiocytosis of Head and Neck in Chinese Patients. Int J Surg Pathol 2019; 27:836-843. [PMID: 31203679 DOI: 10.1177/1066896919855774] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Langerhans cell histiocytosis (LCH) is characterized by clonal proliferation of Langerhans cells and has been classified as a hematolymphoid tumor. BRAF V600E mutation was found to be frequent in LCH; however, it has also been reported that Asia patients with LCH tend to show a lower rate of BRAF V600E mutation. In this study, we found LCH from the head and neck region often involved bone especially the posterior of the mandible and presented a high prevalence of BRAF V600E mutation in Chinese patients. Our findings also showed immunohistochemical detection correlated very well to DNA sequencing of BRAF alterations, which may be useful in the diagnosis of LCH, especially in cases with a low proportion of Langerhans cells, and BRAF inhibitors might be a treatment option for patients with LCH harboring BRAF V600E mutation.
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Affiliation(s)
- Xiaoxiao Liu
- Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
| | - Ye Zhang
- Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
| | - Chuan-Xiang Zhou
- Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
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24
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Borch WR, Aguilera NS, Brissette MD, O'Malley DP, Auerbach A. Practical Applications in Immunohistochemistry: An Immunophenotypic Approach to the Spleen. Arch Pathol Lab Med 2019; 143:1093-1105. [PMID: 30917045 DOI: 10.5858/arpa.2018-0211-cp] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Even though immunohistochemistry is routinely used by pathologists, evaluation of immunohistochemistry in splenic lesions remains difficult for many. Classification of benign and splenic lesions often requires a combination of hematoxylin-eosin evaluation, immunophenotyping, and sometimes molecular testing. Immunohistochemical staining is essential in evaluating many splenic lesions, and requires an understanding of the normal compartments of the spleen. OBJECTIVE.— To address different immunohistochemical features used for identification and subclassification of different lesions of the spleen, as well as in the normal compartments of the spleen. DATA SOURCES.— The information outlined in this review article is based on our experiences with a variety of spleen cases, on the current World Health Organization classification of hematopoietic and lymphoid tumors, and on a review of English-language articles published during 2018. CONCLUSIONS.— Features for phenotyping normal spleen as well as a variety of splenic lesions, including littoral cell angioma and splenic marginal zone lymphoma, are discussed. Suggested immunopanels are provided to assist in the diagnosis of different lesions of the spleen.
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Affiliation(s)
- William R Borch
- From the Department of Pathology, Walter Reed National Military Medical Center, Bethesda Maryland (Dr Borch); the Department of Hematopathology, University of Virginia, Charlottesville (Dr Aguilera); the Department of Hematopathology, Joint Pathology Center, Silver Spring, Maryland (Drs Brissette and Auerbach); and the Department of Hematopathology, NeoGenomics, Aliso Viejo, California (Dr O'Malley)
| | - Nadine S Aguilera
- From the Department of Pathology, Walter Reed National Military Medical Center, Bethesda Maryland (Dr Borch); the Department of Hematopathology, University of Virginia, Charlottesville (Dr Aguilera); the Department of Hematopathology, Joint Pathology Center, Silver Spring, Maryland (Drs Brissette and Auerbach); and the Department of Hematopathology, NeoGenomics, Aliso Viejo, California (Dr O'Malley)
| | - Mark D Brissette
- From the Department of Pathology, Walter Reed National Military Medical Center, Bethesda Maryland (Dr Borch); the Department of Hematopathology, University of Virginia, Charlottesville (Dr Aguilera); the Department of Hematopathology, Joint Pathology Center, Silver Spring, Maryland (Drs Brissette and Auerbach); and the Department of Hematopathology, NeoGenomics, Aliso Viejo, California (Dr O'Malley)
| | - Dennis P O'Malley
- From the Department of Pathology, Walter Reed National Military Medical Center, Bethesda Maryland (Dr Borch); the Department of Hematopathology, University of Virginia, Charlottesville (Dr Aguilera); the Department of Hematopathology, Joint Pathology Center, Silver Spring, Maryland (Drs Brissette and Auerbach); and the Department of Hematopathology, NeoGenomics, Aliso Viejo, California (Dr O'Malley)
| | - Aaron Auerbach
- From the Department of Pathology, Walter Reed National Military Medical Center, Bethesda Maryland (Dr Borch); the Department of Hematopathology, University of Virginia, Charlottesville (Dr Aguilera); the Department of Hematopathology, Joint Pathology Center, Silver Spring, Maryland (Drs Brissette and Auerbach); and the Department of Hematopathology, NeoGenomics, Aliso Viejo, California (Dr O'Malley)
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25
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Flores-Terry M, Sanz-Trenado J, García-Arpa M, Cortina-de la Calle M. Cutaneous Langerhans Cell Histiocytosis Presenting in Adulthood. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2018.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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26
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Gottumukkala RV, Gee MS, Hampilos PJ, Greer MLC. Current and Emerging Roles of Whole-Body MRI in Evaluation of Pediatric Cancer Patients. Radiographics 2019; 39:516-534. [DOI: 10.1148/rg.2019180130] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Ravi V. Gottumukkala
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.V.G., M.S.G., P.J.H.); Department of Diagnostic Imaging, the Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8 (M.L.C.G.); and Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (M.L.C.G.)
| | - Michael S. Gee
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.V.G., M.S.G., P.J.H.); Department of Diagnostic Imaging, the Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8 (M.L.C.G.); and Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (M.L.C.G.)
| | - Perry J. Hampilos
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.V.G., M.S.G., P.J.H.); Department of Diagnostic Imaging, the Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8 (M.L.C.G.); and Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (M.L.C.G.)
| | - Mary-Louise C. Greer
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.V.G., M.S.G., P.J.H.); Department of Diagnostic Imaging, the Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8 (M.L.C.G.); and Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (M.L.C.G.)
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27
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Nakashima K, Koga Y, Sakai Y, Takada H, Harimaya K, Ohga S, Taguchi T, Oda Y, Honda H, Ohga S. Radiotherapy for Langerhans cell histiocytosis with paraplegia: A rare oncologic emergency case report in infancy and literature review. Brain Dev 2018; 40:952-955. [PMID: 29907475 DOI: 10.1016/j.braindev.2018.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/02/2018] [Accepted: 05/22/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a clonal disease with focal or disseminated lesions that may compress the surrounding tissues, including the spinal cord. Because few reports have described the spinal symptoms as the first manifestation of pediatric LCH, the long-term neurological outcomes remain unclear. CASE REPORT AND LITERATURE REVIEW We report a 21-month-old boy who presented with sudden-onset paraplegia. Imaging analyses revealed that osteolytic lesions and epidural tumors compressing the spinal cord at the T7-9 vertebrae. Twelve days after he developed leg weakness, emergency radiotherapy was started after a tumor biopsy. During the course of radiotherapy, paralysis steadily ameliorated. After we excluded infections and determined the pathological diagnosis of LCH, multi-drug chemotherapy was started. Apparent improvement in his complete paraplegia was observed after a total 15 Gy of radiotherapy and subsequent chemotherapy, leaving no neurological sequelae at 4 years of age. Through a literature search of studies published from 1980 to 2017, we found that children with LCH showed a generally favorable recovery from neurological dysfunction after the acute phase of spinal symptoms. CONCLUSION This report underscores the utility of emergency radiotherapy for the neurological recovery of spinal LCH in infants. Our long-term observation further denotes the value of this treatment in terms of the intact survival with preserved motor functions and physical growth.
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Affiliation(s)
- Kentaro Nakashima
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuhki Koga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Hidetoshi Takada
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Perinatal and Pediatric Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Katsumi Harimaya
- Department of Orthopedic Surgery, Kyushu University, Fukuoka, Japan
| | - Saiji Ohga
- Department of Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoaki Taguchi
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinao Oda
- Department of Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Honda
- Department of Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Tamura S, Kawamoto K, Miyoshi H, Suzuki T, Katagiri T, Kasami T, Nemoto H, Miyakoshi S, Kobayashi H, Shibasaki Y, Masuko M, Takeuchi K, Ohshima K, Sone H, Takizawa J. Cladribine treatment for Erdheim-Chester disease involving the central nervous system and concomitant polycythemia vera: A case report. J Clin Exp Hematop 2018; 58:161-165. [PMID: 30305475 PMCID: PMC6407475 DOI: 10.3960/jslrt.18015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Erdheim–Chester disease (ECD), a rare form of non-Langerhans cell histiocytosis, is
characterized by the infiltration of foamy CD68+ and CD1a-
histiocytes into multiple organ systems. Central nervous system (CNS) involvement has
recently been reported to be a poor prognostic factor when treating ECD with interferon
alpha. We report the case of a 66-year-old Japanese patient with ECD involving the CNS who
harbored the BRAF V600E mutation and also concomitantly developed
polycythemia vera with the JAK2 V617F mutation. We confirmed
2-chlorodeoxyadenosine (cladribine) therapy to be effective for the patient in this
case.
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Schwentner R, Jug G, Kauer MO, Schnöller T, Waidhofer-Söllner P, Holter W, Hutter C. JAG2 signaling induces differentiation of CD14 + monocytes into Langerhans cell histiocytosis-like cells. J Leukoc Biol 2018; 105:101-111. [PMID: 30296338 DOI: 10.1002/jlb.1a0318-098r] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 08/12/2018] [Accepted: 09/17/2018] [Indexed: 12/26/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a MAPK pathway-driven disease characterized by the accumulation of CD1a+ langerin+ cells of unknown origin. We have previously reported that the Notch signaling pathway is active in LCH lesions and that the Notch ligand Jagged2 (JAG2) induces CD1a and langerin expression in monocytes in vitro. Here we show that Notch signaling induces monocytes to acquire an LCH gene signature and that Notch inhibition suppresses the LCH phenotype. In contrast, while also CD1c+ dendritic cells or IL-4-stimulated CD14+ monocytes acquire CD1a and langerin positivity in culture, their gene expression profiles and surface phenotypes are more different from primary LCH cells. We propose a model where CD14+ monocytes serve as LCH cell precursor and JAG2-mediated activation of the Notch signaling pathway initiates a differentiation of monocytes toward LCH cells in selected niches and thereby contributes to LCH pathogenesis.
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Affiliation(s)
- Raphaela Schwentner
- Children´s Cancer Research Institute, St. Anna Kinderkrebsforschung, Vienna, Austria
| | - Gunhild Jug
- Children´s Cancer Research Institute, St. Anna Kinderkrebsforschung, Vienna, Austria
| | - Maximilian O Kauer
- Children´s Cancer Research Institute, St. Anna Kinderkrebsforschung, Vienna, Austria
| | - Thomas Schnöller
- Children´s Cancer Research Institute, St. Anna Kinderkrebsforschung, Vienna, Austria
| | | | - Wolfgang Holter
- Children´s Cancer Research Institute, St. Anna Kinderkrebsforschung, Vienna, Austria.,St. Anna Children's Hospital, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Caroline Hutter
- Children´s Cancer Research Institute, St. Anna Kinderkrebsforschung, Vienna, Austria.,St. Anna Children's Hospital, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
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Flores-Terry MA, Sanz-Trenado JL, García-Arpa M, Cortina-de la Calle MP. Cutaneous Langerhans Cell Histiocytosis Presenting in Adulthood. ACTAS DERMO-SIFILIOGRAFICAS 2018; 110:167-169. [PMID: 30270145 DOI: 10.1016/j.ad.2017.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/16/2017] [Accepted: 12/26/2017] [Indexed: 10/28/2022] Open
Affiliation(s)
- M A Flores-Terry
- Servicio de Dermatología, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
| | - J L Sanz-Trenado
- Servicio de Anatomía Patológica, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - M García-Arpa
- Servicio de Dermatología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - M P Cortina-de la Calle
- Servicio de Dermatología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
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Kulker D, Queiros C, Kun-Darbois JD, François P, Goga D, Paré A. Orbitofrontal pseudotumour in young adult. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 119:529-531. [PMID: 30031893 DOI: 10.1016/j.jormas.2018.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/11/2018] [Accepted: 07/15/2018] [Indexed: 11/19/2022]
Affiliation(s)
- D Kulker
- Department of maxillofacial and facial plastic surgery, Trousseau hospital, 37000 Tours, France; University of François-Rabelais, school of medicine, 37000 Tours, France.
| | - C Queiros
- Department of maxillofacial and facial plastic surgery, Trousseau hospital, 37000 Tours, France; University of François-Rabelais, school of medicine, 37000 Tours, France
| | - J D Kun-Darbois
- Department of maxillofacial surgery, hospital of Angers, university of Angers, 49100 Angers, France
| | - P François
- University of François-Rabelais, school of medicine, 37000 Tours, France; Department of neurosurgery, Bretonneau hospital, 37000 Tours, France
| | - D Goga
- Department of maxillofacial and facial plastic surgery, Trousseau hospital, 37000 Tours, France; University of François-Rabelais, school of medicine, 37000 Tours, France
| | - A Paré
- Department of maxillofacial and facial plastic surgery, Trousseau hospital, 37000 Tours, France; University of François-Rabelais, school of medicine, 37000 Tours, France
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Anastasilakis AD, Tsoli M, Kaltsas G, Makras P. Bone metabolism in Langerhans cell histiocytosis. Endocr Connect 2018; 7:R246-R253. [PMID: 29967185 PMCID: PMC6063875 DOI: 10.1530/ec-18-0186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 07/02/2018] [Indexed: 12/18/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a rare disease of not well-defined etiology that involves immune cell activation and frequently affects the skeleton. Bone involvement in LCH usually presents in the form of osteolytic lesions along with low bone mineral density. Various molecules involved in bone metabolism are implicated in the pathogenesis of LCH or may be affected during the course of the disease, including interleukins (ILs), tumor necrosis factor α, receptor activator of NF-κB (RANK) and its soluble ligand RANKL, osteoprotegerin (OPG), periostin and sclerostin. Among them IL-17A, periostin and RANKL have been proposed as potential serum biomarkers for LCH, particularly as the interaction between RANK, RANKL and OPG not only regulates bone homeostasis through its effects on the osteoclasts but also affects the activation and survival of immune cells. Significant changes in circulating and lesional RANKL levels have been observed in LCH patients irrespective of bone involvement. Standard LCH management includes local or systematic administration of corticosteroids and chemotherapy. Given the implication of RANK, RANKL and OPG in the pathogenesis of the disease and the osteolytic nature of bone lesions, agents aiming at inhibiting the RANKL pathway and/or osteoclastic activation, such as bisphosphonates and denosumab, may have a role in the therapeutic approach of LCH although further clinical investigation is warranted.
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Affiliation(s)
| | - Marina Tsoli
- 1st Propaedeutic Department of Internal MedicineNational and Kapodistrian University of Athens, Athens, Greece
| | - Gregory Kaltsas
- 1st Propaedeutic Department of Internal MedicineNational and Kapodistrian University of Athens, Athens, Greece
| | - Polyzois Makras
- Department of Endocrinology and Diabetes251 Hellenic Air Force & VA General Hospital, Athens, Greece
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Montefusco L, Harari S, Elia D, Rossi A, Specchia C, Torre O, Adda G, Arosio M. Endocrine and metabolic assessment in adults with Langerhans cell histiocytosis. Eur J Intern Med 2018; 51:61-67. [PMID: 29198444 DOI: 10.1016/j.ejim.2017.11.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 11/26/2017] [Accepted: 11/27/2017] [Indexed: 12/22/2022]
Abstract
CONTEXT Diabetes insipidus (DI) is one of most common complications of Langerhans cell histiocytosis (LCH) but prevalence of anterior pituitary deficiencies and metabolic alterations have not been clearly defined yet. OBJECTIVES Evaluate prevalence of endocrine and metabolic manifestations in a cohort of patients affected by Pulmonary LCH. METHODS Observational cross-sectional study on 18 adults (7 M/11 F, 42±12years) studied for complete basal and dynamic endocrine lab tests and glucose metabolism. RESULTS Hypothalamic-pituitary endocrine alterations were found in 9 patients: 9 had DI, 5 Growth Hormone Deficiency (GHD), 5 central hypogonadism, 3 central hypothyroidism and 1 central hypoadrenalism. Hyperprolactinemia and hypothalamic syndrome were found in 2 patients each. All these central endocrine alterations were always associated to DI. Five of the 10 MRI performed showed abnormalities. Prevalence of obesity and glucose alterations (either DM or IFG/IGT) were respectively 39% and 33%, higher than expected basing on epidemiological data on general Italian population. Multi-system-LCH without risk-organ involvement (LCH MS-RO-) seems to have slightly higher prevalence of insulin resistance, glucose alterations and metabolic syndrome than LCH with isolated lung involvement (LCH SS lung+). A papillary BRAFV600E positive thyroid carcinoma was diagnosed in one patient. CONCLUSIONS The presence of anterior pituitary deficiencies should be systematically sought in all LCH patients with DI both at diagnosis and during the follow-up by basal and dynamic hormonal assessment. Patients with pulmonary LCH, particularly those with MS disease, have a worse metabolic profile than general population. Occurrence of papillary thyroid carcinoma has been reported.
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Affiliation(s)
- L Montefusco
- U.O. di Malattie Endocrine e Diabetologia, Ospedale San Giuseppe Multimedica, Milan, Italy; MultiMedica IRCCS, Milan, Italy
| | - S Harari
- MultiMedica IRCCS, Milan, Italy; U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria - Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe Multimedica, Milan, Italy.
| | - D Elia
- MultiMedica IRCCS, Milan, Italy; U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria - Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe Multimedica, Milan, Italy
| | - A Rossi
- U.O. di Malattie Endocrine e Diabetologia, Ospedale San Giuseppe Multimedica, Milan, Italy; MultiMedica IRCCS, Milan, Italy
| | - C Specchia
- MultiMedica IRCCS, Milan, Italy; Dipartimento di Medicina Molecolare e Traslazionale, Università di Brescia, Italy
| | - O Torre
- MultiMedica IRCCS, Milan, Italy; U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria - Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe Multimedica, Milan, Italy
| | - G Adda
- U.O. di Malattie Endocrine e Diabetologia, Ospedale San Giuseppe Multimedica, Milan, Italy; MultiMedica IRCCS, Milan, Italy
| | - M Arosio
- U.O. di Endocrinologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Milan, Italy
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Tang X, Guo X, Sun LY, Ai Y, Yang X, Sun JJ, Wu JR, Gao J. [BRAF-V600E mutation and its clinical significance in children with Langerhans cell histiocytosis]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2018; 20:290-294. [PMID: 29658453 PMCID: PMC7390037 DOI: 10.7499/j.issn.1008-8830.2018.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 02/26/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the clinical significance of BRAF-V600E mutation in children with Langerhans cell histiocytosis (LCH). METHODS Real-time fluorescence quantitative PCR was used to detect BRAF-V600E mutation in paraffin-embedded tissue samples from 26 children with LCH. A retrospective analysis was performed for the association of BRAF-V600E mutation with clinical features and prognosis of children with LCH. RESULTS Of the 26 children, 25 received standard chemotherapy, with a 2-year overall survival (OS) rate of 100% and a 2-year event-free survival (EFS) rate of 88%. Of the 26 pathological samples, 18 (70%) came from bone tissue, and the positive rate of BRAF-V600E mutation reached 50% (13/26). The positive rate of BRAF-V600E gene mutation was not associated with age, sex, affected organ, clinical classification, early treatment response, recurrence, and 2-year OS and EFS rates of the children with LCH (P>0.05), but it was associated with clinical grouping of LCH (P<0.05). CONCLUSIONS Children with LCH tend to have a high OS rate and a high incidence rate of BRAF-V600E mutation. BRAF-V600E mutation is associated with clinical grouping of LCH.
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Affiliation(s)
- Xue Tang
- Department of Pediatrics, West China Second University Hospital, Sichuan University/Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China.
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Zhang X, Zhou J, Chai X, Chen G, Guo B, Ni L, Wu P. The application of x-ray, computed tomography, and magnetic resonance imaging on 22 pediatric Langerhans cell histiocytosis patients with long bone involvement: A retrospective analysis. Medicine (Baltimore) 2018; 97:e0411. [PMID: 29702989 PMCID: PMC5944563 DOI: 10.1097/md.0000000000010411] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The studies focusing on x-ray, computed tomography (CT), and magnetic resonance imaging (MRI) in pediatric Langerhans cell histiocytosis (LCH) patients were still rare. Therefore, we aimed to evaluate the application of x-ray, CT, and MRI in pediatric LCH patients with long bone involvement.Total 22 pediatric LCH patients were included in this study. The diagnosis of LCH was confirmed by pathological examination. All patients were followed up for 3 years. X-ray, CT, or MRI was performed and the results were recorded for further analyses.Among 22 pediatric patients, x-ray (n = 20), CT (n = 18), or MRI (n = 12) were used to scan the lesion on long bones affected by LCH. Femurs (n = 13, 38.24%), tibia (n = 11, 32.35%), humerus (n = 5, 14.71%), and radius (n = 4, 11.76%) were the most frequently affected anatomic sites. Ovoid or round radiolucent lesions, aggressive periosteal reaction, and swelling of surrounding soft tissues were characteristic image of long bones on x-ray, CT, and MRI in pediatric LCH.Femurs, tibia, humerus, and radius were the most commonly affected long bones of pediatric LCH. The application of x-ray, CT, and MRI on long bones could help with the diagnosis of pediatric LCH.
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Affiliation(s)
| | - Jing Zhou
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine
| | | | | | | | | | - Peng Wu
- Department of Hematology, Children's Hospital of Nanjing Medical University, Nanjing, China
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Abstract
This article focuses on cutaneous hematopoietic neoplasms that are more likely to be encountered in the pediatric age-group and includes both lymphoproliferative and histiocytic disorders. The cutaneous hematologic disorders in children have a different epidemiologic profile to what is seen during adulthood. Although mycosis fungoides is the most frequent form of cutaneous lymphoma in adults, it is very rare in children. Because lymphoblastic leukemias and lymphomas are more frequent in the pediatric setting, cutaneous leukemic infiltrates are relatively common in this age-group. Similarly, histiocytic disorders are more common in children, particularly Langerhans cell histiocytosis and juvenile xanthogranuloma. Notably, the histiocytic disorders have undergone significant modifications on their nomenclature in the basis of the molecular characteristics that are present in them. A summary of the most frequent cutaneous hematopoietic disorders in children will be discussed further in this review.
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Affiliation(s)
- Alejandro A Gru
- 1 Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Louis P Dehner
- 2 Lauren V. Ackerman Laboratory of Surgical Pathology, St. Louis Children's Hospital and Dermatopathology, Washington University Medical Center, St. Louis, Missouri
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Papadopoulou M, Panagopoulou P, Papadopoulou A, Hatzipantelis E, Efstratiou I, Galli-Tsinopoulou A, Papadopoulou-Alataki E. The multiple faces of Langerhans cell histiocytosis in childhood: A gentle reminder. Mol Clin Oncol 2018; 8:489-492. [PMID: 29468064 DOI: 10.3892/mco.2017.1539] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 12/13/2017] [Indexed: 11/06/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare hematologic disorder that results from the clonal multiplication and accumulation of immature dendritic Langerhans cells. Its reported incidence rate varies, but is considered to be 2.6-8.9 per million children who are <15 years of age each year. It may affect any system or organ. The present study reported 4 pediatric LCH cases in order to highlight the heterogeneity of the initial presentation, and the pitfalls that may mislead clinicians and delay diagnosis. The clinical features, as well as the pathognomonic imaging, pathology findings and treatment options were presented. LCH may be rare, but it should always be included in the differential diagnosis of persistent eczema, unexplained skin lesions, diabetes insipidus and persistent bone pain, among others. While the debate on pathogenesis and treatment is ongoing, high index of suspicion among pediatricians, pediatric oncologists and other specialists (pathologists, dermatologists, orthopaedic surgeons, general practitioners or family physicians) is essential for early diagnosis, and optimal outcome.
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Affiliation(s)
- Maria Papadopoulou
- Fourth Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 56403 Thessaloniki, Greece
| | - Paraskevi Panagopoulou
- Fourth Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 56403 Thessaloniki, Greece
| | - Anastasia Papadopoulou
- Fourth Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 56403 Thessaloniki, Greece
| | - Emmanuel Hatzipantelis
- Second Department of Pediatrics, Aristotle University of Thessaloniki, AHEPA General Hospital, 56403 Thessaloniki, Greece
| | - Ioannis Efstratiou
- Pathology Department, Papageorgiou General Hospital, 56403 Thessaloniki, Greece
| | - Assimina Galli-Tsinopoulou
- Fourth Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 56403 Thessaloniki, Greece
| | - Efimia Papadopoulou-Alataki
- Fourth Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 56403 Thessaloniki, Greece
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Cazzolla AP, Testa NF, Favia G, Lacaita MG, Ciavarella D, Zhurakivska K, Troiano G, Lo Muzio L. Multidisciplinary approach in a case of Hand-Schüller-Christian disease with maxillary involvement. SPECIAL CARE IN DENTISTRY 2018; 38:107-111. [DOI: 10.1111/scd.12273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | - Domenico Ciavarella
- Department of Clinical and Experimental Medicine; University of Foggia; Foggia Italy
| | - Khrystyna Zhurakivska
- Department of Clinical and Experimental Medicine; University of Foggia; Foggia Italy
| | - Giuseppe Troiano
- Department of Clinical and Experimental Medicine; University of Foggia; Foggia Italy
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine; University of Foggia; Foggia Italy
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Lan ZG, Richard SA, Lei C, Ju Y. Thoracolumbar Langerhans cell histiocytosis in a toddler. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2017.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Gündüz AK, Temel E. Histiocytic lesions of the orbit: A study of 9 cases. Saudi J Ophthalmol 2018; 32:40-44. [PMID: 29755270 PMCID: PMC5943821 DOI: 10.1016/j.sjopt.2018.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 03/07/2018] [Accepted: 03/07/2018] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To describe the clinical presentation, treatment, and outcome of patients with histiocytic lesions of the orbit. METHODS Retrospective study of 9 patients treated and followed up between October 2001 and January 2018. RESULTS Eight patients in our series were males and one patient was female. The mean age at presentation was 16.8 years (range, 1 to 42 years). All patients had unilateral disease. The most common presenting complaint was upper eyelid swelling in 8 of 9. All patients underwent preoperative computed tomography (CT) and magnetic resonance imaging (MRI). Eight of 9 patients demonstrated orbital bone erosion with adjacent soft tissue mass. Destruction of the orbital roof and contrast enhancement of dura were detected in 3 cases. All cases underwent orbitotomy and subtotal tumor excision with additional bone curettage (4 cases) and intraorbital steroid (40 mg triamcinolone acetonide) injection (3 cases). Adjuvant systemic chemotherapy consisting of vinblastine and prednisone was administered in 3 cases with dural involvement. External radiotherapy (1000 cGy) was applied in one case because of widespread disease. Histopathologic diagnoses were eosinophilic granuloma (7 cases), necrotic xanthogranuloma (1 case), and Langerhans cell sarcoma (1 case). The mean follow-up period after diagnosis was 19.7 months (range, 1-96 months). There was no systemic or multifocal bone involvement in eosinophilic granuloma cases at initial presentation and follow-up. None of these patients developed diabetes insipidus or neurologic symptoms. The patient with Langerhans cell sarcoma died from systemic disease 1 month after diagnosis of the orbital tumor. The patient with necrotic xanthogranuloma did not develop any malignancy at 9 months follow-up. CONCLUSIONS Eosinophilic granuloma was the most frequently encountered orbital histiocytic lesion in our series. Eosiophilic granuloma usually responded well to subtotal tumor excision, bone curettage, and intraorbital corticosteroid injections. Systemic chemotherapy was used in cases with full thickness bone destruction and adjacent dural enhancement in an effort to prevent the development of central nervous system disease.
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Affiliation(s)
- A. Kaan Gündüz
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
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Zhang L, Pacheco-Rodriguez G, Steagall WK, Kato J, Colby TV, Haughey M, Moss J. BRAF and NRAS mutations in circulating Langerhans-like CD1a + cells in a patient with pulmonary Langerhans' cell histiocytosis. Eur Respir J 2017; 50:50/4/1700521. [PMID: 29025887 DOI: 10.1183/13993003.00521-2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/11/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Li Zhang
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Gustavo Pacheco-Rodriguez
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Wendy K Steagall
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jiro Kato
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Thomas V Colby
- Dept of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ, USA
| | - Mary Haughey
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Joel Moss
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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CD207 +CD1a + cells circulate in pediatric patients with active Langerhans cell histiocytosis. Blood 2017; 130:1898-1902. [PMID: 28847997 DOI: 10.1182/blood-2017-05-782730] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/16/2017] [Indexed: 01/16/2023] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare disease with an unknown etiology characterized by heterogeneous lesions containing CD207+CD1a+ cells that can arise in almost any tissue and cause significant morbidity and mortality. Precursors of pathological Langerhans cells have yet to be defined. Our aim was to identify circulating CD207+CD1a+ cells and their inducers in LCH. Expression of CD207 and CD1a in the blood myeloid compartment as well as thymic stromal lymphopoietin (TSLP) and transforming growth factor β (TGF-β) plasma levels were measured in 22 pediatric patients with active disease (AD) or nonactive disease (NAD). In patients with AD vs those with NAD, the myeloid compartment showed an increased CD11b (CD11bhigh plus CD11b+) fraction (39.7 ± 3.6 vs 18.6 ± 1.9), a higher percentage of circulating CD11bhighCD11c+CD207+ cells (44.5 ± 11.3 vs 3.2 ± 0.5), and the presence of CD11chighCD207+CD1a+ cells (25.0 ± 9.1 vs 2.3 ± 0.5). Blood CD207+CD1a+ cells were not observed in adult controls or umbilical cord. Increased TSLP and TGF-β levels were detected in patients with AD. Interestingly, plasma from patients with AD induces CD207 expression on CD14+ monocytes. We conclude that CD207+CD1a+ cells are circulating in patients with active LCH, and TSLP and TGF-β are potential drivers of Langerhans-like cells in vivo.
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Wieland R, Flanagan J, Everett E, Mount S. Langerhans cell histiocytosis limited to the female genital tract: A review of literature with three additional cases. Gynecol Oncol Rep 2017; 22:4-8. [PMID: 28932806 PMCID: PMC5596262 DOI: 10.1016/j.gore.2017.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 08/17/2017] [Accepted: 08/24/2017] [Indexed: 11/18/2022] Open
Abstract
LCH of the female reproductive tract has four patterns of involvement. A comprehensive literature review revealed 35 cases of pure genital LCH. We report two new cases of pure LCH lesions of the vulva and one of the cervix. Treatment of LCH varies and there is no standard for pure genital involvement. Prognosis of LCH confined to the gynecologic tract appears to be favorable.
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Affiliation(s)
- Rebekah Wieland
- College of Medicine, University of Vermont, Burlington, VT, USA
- Department of Pathology and Laboratory Medicine, The University of Vermont Medical Center, Burlington, VT, USA
- Corresponding author at: College of Medicine, University of Vermont, Burlington, VT, USA.College of MedicineUniversity of VermontBurlingtonVTUSA
| | - Jenna Flanagan
- Gynecological Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, The University of Vermont Medical Center, Burlington, VT, USA
| | - Elise Everett
- Gynecological Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, The University of Vermont Medical Center, Burlington, VT, USA
| | - Sharon Mount
- Department of Pathology and Laboratory Medicine, The University of Vermont Medical Center, Burlington, VT, USA
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Lee SW, Kim H, Suh JK, Koh KN, Im HJ, Yoon HM, Seo JJ. Long-term clinical outcome of spinal Langerhans cell histiocytosis in children. Int J Hematol 2017; 106:441-449. [DOI: 10.1007/s12185-017-2252-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 05/04/2017] [Accepted: 05/09/2017] [Indexed: 11/29/2022]
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Cazzolla AP, Troiano G, Zhurakivska K, Maiorano E, Favia G, Lacaita MG, Marzo G, Dicuonzo F, Andresciani S, Muzio LL. Langerhans cell histiocytosis of the maxillae in a child treated only with chemotherapy: a case report. J Med Case Rep 2017; 11:130. [PMID: 28482919 PMCID: PMC5422897 DOI: 10.1186/s13256-017-1286-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 03/30/2017] [Indexed: 12/29/2022] Open
Abstract
Background Langerhans cell histiocytosis is a sporadic disease caused by an uncontrolled pathogenic clonal proliferation of dendritic cells that have Langerhans cell characteristics. New treatment protocols provided by the HISTSOC-LCH-III (NCT00276757) trial show an improvement in the survival of children with langerhans cell histiocytosis. Case presentation We report a case of Langerhans cell histiocytosis, which presented as an osteolytic lesion of the left pre-maxillae enclosing the deciduous incisor and canine in a 7-month-old white Italian boy. He was treated with chemotherapy. He achieved complete remission after 7 months and after 24 months no signs of recurrence were observed. Conclusions As a result of this treatment, anesthetic sequelae and loss of teeth were avoided; in addition, we prevented a loss of the vertical dimension of occlusion.
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Affiliation(s)
| | - Giuseppe Troiano
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Khrystyna Zhurakivska
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy. .,Clinica Odontoiatrica, Via Rovelli 50, 71122, Foggia, Italy.
| | - Eugenio Maiorano
- Department of Pathological Anatomy, University of Bari, Bari, Italy
| | - Gianfranco Favia
- Department of Translational Medicine, University of Bari, Bari, Italy
| | | | - Giuseppe Marzo
- Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Franca Dicuonzo
- Department of Neuroradiology, Policlinico of Bari, Bari, Italy
| | | | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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Elkin VD, Sedova TG, Kopytova EA, Plotnikova EV. Langerhans cell histiocytosis: Skin diseases and visceral lesions. TERAPEVT ARKH 2017; 89:115-120. [DOI: 10.17116/terarkh2017894115-120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a rare clonal proliferative disorder that belongs to class I histiocytoses and is characterized by infiltration of one or many organs by Langerhans cells to form granulomas. The literature analysis could identify a lot of etiological, pathogenetic, and trigger factors and mechanisms for LCH development, which determine the diversity of the clinical picture and course of the disease. The clinical manifestations of LCH are very variable and depend on the severity of lesions and the age of patients. In addition to skin lesions, there is involvement of one or more visceral organs. Difficulties in diagnosing the disease lead to statistical variations of LCH in different countries of the world and require more attention by physicians of all specialties.
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Makras P, Tsoli M, Anastasilakis AD, Thanou M, Kaltsas G. Denosumab for the treatment of adult multisystem Langerhans cell histiocytosis. Metabolism 2017; 69:107-111. [PMID: 28285639 DOI: 10.1016/j.metabol.2017.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 01/05/2017] [Accepted: 01/06/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE An etiological treatment is currently lacking for Langerhans Cell Histiocytosis (LCH). Receptor activator of nuclear factor κB ligand (RANKL) appears to play a central role in the lesional immunological process inducing compensatory osteoprotegerin (OPG) activation. In a preliminary study we aimed to evaluate for the first time the use of denosumab, a RANKL inhibitor, as a targeted treatment strategy in LCH in order to support and enhance endogenous OPG action in order to control or alter the lesional immunological process. PROCEDURES Two adult female patients with painful osteolytic bone lesions and concomitant pulmonary involvement received bimonthly denosumab 120mg in a total of 4 doses. RESULTS Both patients reported an immediate pain relief within the first two weeks following the 1st dose of denosumab. One month following the last dose an almost full remission of the initial osteolytic and lung lesions was observed, although an apparent new bone lesion was detected in one patient that was treated with a single intralesional steroid injection. No adverse events were recorded throughout the treatment period. Both patients have no active disease 6months following the last denosumab dose. CONCLUSIONS Denosumab could be considered an effective treatment option in adults with multisystem LCH also exerting a significant analgesic effect in bone lesions, warranting further investigation.
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Affiliation(s)
- Polyzois Makras
- Department of Endocrinology and Diabetes, 251 Hellenic Air Force General Hospital, 3 Kanellopoulou St., 11525, Athens, Greece.
| | - Marina Tsoli
- Department of Pathophysiology, National University of Athens, 75 Mikras Asias St., 11527, Athens, Greece
| | | | - Maria Thanou
- REA Maternity Hospital, 383 A. Singrou Ave., P. Faliro, 17564, Athens, Greece
| | - Gregory Kaltsas
- Department of Pathophysiology, National University of Athens, 75 Mikras Asias St., 11527, Athens, Greece
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Ballester LY, Cantu MD, Lim KPH, Sarabia SF, Ferguson LS, Renee Webb C, Allen CE, McClain KL, Mohila CA, Punia JN, Roy A, López-Terrada DH, John Hicks M, Fisher KE. The use of BRAF V600E mutation-specific immunohistochemistry in pediatric Langerhans cell histiocytosis. Hematol Oncol 2017; 36:307-315. [PMID: 28219109 PMCID: PMC6886693 DOI: 10.1002/hon.2388] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/09/2017] [Accepted: 01/10/2017] [Indexed: 01/01/2023]
Abstract
BRAF p.V600E mutations are detected in greater than 50% of pediatric Langerhans cell histiocytosis (LCH) lesions. However, the use of mutation-specific BRAF V600E immunohistochemistry (IHC) as a surrogate for molecular testing in pediatric LCH is unknown. We tested the mutation-specific BRAF V600E monoclonal antibody (clone VE1) in formalin-fixed, paraffin-embedded LCH samples from 26 pediatric patients (14 males and 12 females, ages 7 mo-17 y) using allele-specific real-time polymerase chain reaction (PCR) with a limit of detection of 0.5% as the comparative gold standard. BRAF VE1 staining was scored for both intensity (0-3+) and percentage of immunoreactive tumor cells (0%-100%). BRAF VE1 immunoreactivity was determined using both lenient (≥1+, ≥1%) and stringent (≥2+, ≥10%) scoring criteria. Using lenient-scoring criteria, we found that the sensitivity and specificity of IHC compared with allele-specific real-time PCR were 100.0% and 18.2%, respectively. The poor specificity of lenient IHC analysis was attributable to weak, 1+ staining in both BRAF-mutated and wild-type LCH. Using stringent-scoring criteria, we found that specificity improved to 100.0% at the expense of sensitivity that decreased to 80.0%. Stringent scoring generated 3 false-negative results, but in all cases, neoplastic tissue comprised less than 5% of the stained section and/or the specimen was decalcified. In conclusion, highly sensitive molecular assays remain the gold standard for BRAF mutation analysis in LCH paraffin-embedded lesions. To avoid false-positive results, unequivocal VE1 staining of 2+ intensity in greater than or equal to 10% neoplastic histiocytes is required. However, negative VE1 results require additional studies to exclude false-negatives, and stringent-scoring criteria may not be optimal for scant or decalcified specimens.
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Affiliation(s)
- Leomar Y Ballester
- Department of Pathology, Texas Children's Hospital, Houston, TX, USA.,Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
| | - Miguel D Cantu
- Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA.,Division of Hematology and Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Karen P H Lim
- Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA.,Division of Hematology and Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Stephen F Sarabia
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
| | | | - C Renee Webb
- Department of Pathology, Texas Children's Hospital, Houston, TX, USA
| | - Carl E Allen
- Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA.,Division of Hematology and Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Kenneth L McClain
- Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA.,Division of Hematology and Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Carrie A Mohila
- Department of Pathology, Texas Children's Hospital, Houston, TX, USA.,Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
| | - Jyotinder N Punia
- Department of Pathology, Texas Children's Hospital, Houston, TX, USA.,Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
| | - Angshumoy Roy
- Department of Pathology, Texas Children's Hospital, Houston, TX, USA.,Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA.,Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - Dolores H López-Terrada
- Department of Pathology, Texas Children's Hospital, Houston, TX, USA.,Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA.,Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - M John Hicks
- Department of Pathology, Texas Children's Hospital, Houston, TX, USA.,Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA.,Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - Kevin E Fisher
- Department of Pathology, Texas Children's Hospital, Houston, TX, USA.,Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
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Ruiz Beguerie J, Fernández J, Stringa MF, Anaya J. Vulvar Langerhans cell histiocytosis and thalidomide: an effective treatment option. Int J Dermatol 2016; 56:324-326. [PMID: 27778317 DOI: 10.1111/ijd.13377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 01/29/2016] [Accepted: 05/10/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Julieta Ruiz Beguerie
- Department of Dermatology, Austral University Hospital, Austral University, Buenos Aires, Argentina.,Research Committee, Austral University Hospital, Austral University, Buenos Aires, Argentina
| | - Julia Fernández
- Department of Dermatology, Austral University Hospital, Austral University, Buenos Aires, Argentina
| | - Matías F Stringa
- Department of Dermatology, Austral University Hospital, Austral University, Buenos Aires, Argentina
| | - Javier Anaya
- Department of Dermatology, Austral University Hospital, Austral University, Buenos Aires, Argentina.,Department of Pathology, Austral University Hospital, Austral University, Buenos Aires, Argentina
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Monsereenusorn C, Minkov M, Rodriguez-Galindo C. Current treatment of Langerhans cell histiocytosis. Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2016.1230058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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