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Chen Y, Gao A, Tian X. Bilateral Adult-Onset Orbital Xanthogranuloma: A Case Report. Clin Cosmet Investig Dermatol 2023; 16:3575-3580. [PMID: 38111909 PMCID: PMC10725833 DOI: 10.2147/ccid.s437616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/14/2023] [Indexed: 12/20/2023]
Abstract
Adult-onset xanthogranuloma (AOX) is one of the four rare syndromes collectively referred to as adult xanthogranulomatous disease (AXD). It primarily occurs in the orbit and ocular adnexa and displays distinctive histopathological features, characterized by the infiltration of non-Langerhans-derived foam-like histiocytes and Touton giant cells. The presence of diffuse yellow plaques on the eyelids serves as a highly indicative feature. In this report, we present a compelling case of bilateral periorbital AOX. Initially, the patient received a diagnosis of necrotizing xanthogranuloma (NBX) and underwent treatment with dapsone, which yielded a poor response. Subsequently, through repeated biopsy, immunoprotein electrophoresis, and high-throughput sequencing, the diagnosis was revised to AOX. Subsequently, the patient's treatment was modified to include oral hormone therapy, and no further progression of the periorbital plaque was observed. Notably, the patient's sister was diagnosed with xanthelasma palpebrarum (XP), suggesting a potential genetic association between AOX and XP. Unfortunately, the sister declined further histologic examination and genetic sequencing of her skin lesions, impeding the acquisition of additional evidence regarding the genetic link between these two disorders. Despite the divergent pathological features, pathogenesis, and clinical presentation of AOX and xanthelasma palbrarum, clinicians should remain cognizant of the plausible genetic correlation between these two conditions and pursue further investigations when feasible.
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Affiliation(s)
- Yue Chen
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People’s Republic of China
| | - Aili Gao
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People’s Republic of China
| | - Xin Tian
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People’s Republic of China
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2
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Setoguchi N, Nakayama Y, Amiya E, Takeda N, Komuro I. A long-term follow-up of necrobiotic xanthogranuloma with concomitant large-vessel vasculitis and heart failure with reduced ejection fraction: a case report. Eur Heart J Case Rep 2023; 7:ytad469. [PMID: 37811154 PMCID: PMC10552582 DOI: 10.1093/ehjcr/ytad469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 08/25/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023]
Abstract
Background Necrobiotic xanthogranuloma (NXG) is a non-Langerhans cell histiocytosis and multisystem disorder. Low level of HDL cholesterol associated with a systemic inflammatory profile, which may result from the interaction of monoclonal immunoglobulin and lipoproteins, is a characteristic feature. There is no evidence of NXG-associated large-vessel vasculitis, nor are there any established treatments, although chemotherapy for comorbid multiple myeloma is most often administered. Case summary We describe a case of a 53-year-old male with a first history of heart failure with impaired systolic function. He presented with orbital xanthomas and multiple subcutaneous nodules, and laboratory examination showed elevated levels of C-reactive protein, low HDL, and paraproteinemia. A constellation of these clinical features and pathological findings of skin biopsy led to the diagnosis of NXG. 18F-Fluorodeoxyglucose positron emission tomography (PET)/computed tomography (CT) confirmed increased uptake in the aorta and bilateral common carotid arteries. He began prednisolone treatment with reference to treatment for large-vessel vasculitis. After the treatment, C-reactive protein immediately decreased with markedly increased levels of apolipoprotein A1 (Apo-A1) and HDL. Systolic dysfunction was restored at 6-month follow-up. The patient has not experienced heart failure for 5 years after treatment, and the follow-up PET/CT demonstrated resolution of vascular inflammation. Discussion This is the first report of NXG-associated large-vessel vasculitis. Low-dose prednisolone may benefit for NXG-associated vasculitis and cardiomyopathy. HDL, Apo-A1, and C-reactive protein levels may be useful for monitoring the activity of NXG, and PET/CT was a valuable diagnostic tool for NXG-associated vasculitis.
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Affiliation(s)
- Naoto Setoguchi
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukiteru Nakayama
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- International University of Health and Welfare, Tokyo, Japan
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3
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Momin ZK, Patel SJ, Gordon K. Diffuse planar xanthomas on the bilateral breasts. JAAD Case Rep 2023; 40:77-79. [PMID: 37731674 PMCID: PMC10507047 DOI: 10.1016/j.jdcr.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Affiliation(s)
- Zoha K. Momin
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Swapneel J. Patel
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Katherine Gordon
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
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4
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Varghese KJ, Singh SP, Qureshi FM, Shreekumar S, Ramprasad A, Qureshi F. Digital Patient Education on Xanthelasma Palpebrarum: A Content Analysis. Clin Pract 2023; 13:1207-1214. [PMID: 37887084 PMCID: PMC10605081 DOI: 10.3390/clinpract13050108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023] Open
Abstract
Patient education has been transformed using digital media and online repositories which disseminate information with greater efficiency. In dermatology, this transformation has allowed for patients to gain education on common cutaneous conditions and improve health literacy. Xanthelasma palpebrarum is one of the most common cutaneous conditions, yet there is a poor understanding of how digital materials affect health literacy on this condition. Our study aimed to address this paucity of literature utilizing Brief DISCERN, Rothwell's Classification of Questions, and six readability calculations. The findings of this study indicate a poor-quality profile (Brief DISCERN < 16) regarding digital materials and readability scores which do not meet grade-level recommendations in the United States. This indicates a need to improve the current body of educational materials used by clinicians for diagnosing and managing xanthelasma palpebrarum.
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Affiliation(s)
- Kevin J. Varghese
- Department of Biomedical Sciences, University of Missouri Kansas City School of Medicine, Kansas City, MO 64108, USA; (F.M.Q.); (S.S.); (A.R.)
| | - Som P. Singh
- Department of Biomedical Sciences, University of Missouri Kansas City School of Medicine, Kansas City, MO 64108, USA; (F.M.Q.); (S.S.); (A.R.)
| | - Fahad M. Qureshi
- Department of Biomedical Sciences, University of Missouri Kansas City School of Medicine, Kansas City, MO 64108, USA; (F.M.Q.); (S.S.); (A.R.)
| | - Shreevarsha Shreekumar
- Department of Biomedical Sciences, University of Missouri Kansas City School of Medicine, Kansas City, MO 64108, USA; (F.M.Q.); (S.S.); (A.R.)
| | - Aarya Ramprasad
- Department of Biomedical Sciences, University of Missouri Kansas City School of Medicine, Kansas City, MO 64108, USA; (F.M.Q.); (S.S.); (A.R.)
| | - Fawad Qureshi
- Department of Nephrology, Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA;
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5
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Oganesyan A, Gregory A, Malard F, Ghahramanyan N, Mohty M, Kazandjian D, Mekinian A, Hakobyan Y. Monoclonal gammopathies of clinical significance (MGCS): In pursuit of optimal treatment. Front Immunol 2022; 13:1045002. [PMID: 36505449 PMCID: PMC9728929 DOI: 10.3389/fimmu.2022.1045002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022] Open
Abstract
Monoclonal gammopathy of clinical significance (MGCS) represents a new clinical entity referring to a myriad of pathological conditions associated with the monoclonal gammopathy of undetermined significance (MGUS). The establishment of MGCS expands our current understanding of the pathophysiology of a range of diseases, in which the M protein is often found. Aside from the kidney, the three main organ systems most affected by monoclonal gammopathy include the peripheral nervous system, skin, and eye. The optimal management of these MGUS-related conditions is not known yet due to the paucity of clinical data, the rarity of some syndromes, and limited awareness among healthcare professionals. Currently, two main treatment approaches exist. The first one resembles the now-established therapeutic strategy for monoclonal gammopathy of renal significance (MGRS), in which chemotherapy with anti-myeloma agents is used to target clonal lesion that is thought to be the culprit of the complex clinical presentation. The second approach includes various systemic immunomodulatory or immunosuppressive options, including intravenous immunoglobulins, corticosteroids, or biological agents. Although some conditions of the MGCS spectrum can be effectively managed with therapies aiming at the etiology or pathogenesis of the disease, evidence regarding other pathologies is severely limited to individual patient data from case reports or series. Future research should pursue filling the gap in knowledge and finding the optimal treatment for this novel clinical category.
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Affiliation(s)
- Artem Oganesyan
- Department of Hematology and Transfusion Medicine, National Institute of Health, Yerevan, Armenia,Department Of Adult Hematology, Hematology Center after Prof. R. Yeolyan, Yerevan, Armenia,*Correspondence: Artem Oganesyan,
| | - Andrew Gregory
- Wayne State University School of Medicine, Detroit, MI, United States
| | - Florent Malard
- Department of Clinical Hematology and Cellular Therapy, INSERM, Saint-Antoine Research Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Paris, France
| | - Nerses Ghahramanyan
- Department Of Adult Hematology, Hematology Center after Prof. R. Yeolyan, Yerevan, Armenia
| | - Mohamad Mohty
- Department of Clinical Hematology and Cellular Therapy, INSERM, Saint-Antoine Research Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Paris, France
| | - Dickran Kazandjian
- Myeloma Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
| | - Arsène Mekinian
- Department of Internal Medicine (DMU i3), Sorbonne University, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Paris, France,French-Armenian Clinical Research Center, National Institute of Health, Yerevan, Armenia
| | - Yervand Hakobyan
- Department of Hematology and Transfusion Medicine, National Institute of Health, Yerevan, Armenia,Department Of Adult Hematology, Hematology Center after Prof. R. Yeolyan, Yerevan, Armenia
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6
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Marinkovic A, Zypchen LN, Chan J, Chen LY, Parkin S. Monoclonal gammopathy of clinical significance: what the rheumatologist needs to know. THE LANCET. RHEUMATOLOGY 2022; 4:e362-e373. [PMID: 38294033 DOI: 10.1016/s2665-9913(21)00348-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/29/2021] [Accepted: 10/18/2021] [Indexed: 02/01/2024]
Abstract
Monoclonal proteins can provide important information on the diagnosis of several non-malignant systemic inflammatory disorders. At low concentration, they most commonly represent monoclonal gammopathy of undetermined significance (MGUS), whereas high concentrations often signify plasma cell myeloma or B-cell lymphoma. However, several rare inflammatory conditions associated with variable concentrations of monoclonal proteins, systemic symptoms, and organ dysfunction also exist. These conditions are termed monoclonal gammopathies of clinical significance (MGCS). Patients with MGCS might present to rheumatologists with undiagnosed systemic inflammatory disorders and the monoclonal protein provides an important, underappreciated clue for diagnosis. In this Review, we provide an approach to distinguishing MGCS from MGUS and lymphoid neoplasms, focusing on four rare MGCS that rheumatologists must recognise: scleromyxedema, Schnitzler's syndrome, idiopathic systemic capillary leak syndrome (also known as Clarkson's disease), and telangiectasias, elevated erythropoietin and erythrocytosis, monoclonal gammopathy, perinephric fluid collections, and intrapulmonary shunting (known as TEMPI) syndrome.
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Affiliation(s)
- Angelina Marinkovic
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Leslie N Zypchen
- Division of Hematology, University of British Columbia, Vancouver, BC, Canada
| | - Jonathan Chan
- Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada
| | - Luke Yc Chen
- Division of Hematology, University of British Columbia, Vancouver, BC, Canada; Centre for Health Education Scholarship, University of British Columbia, Vancouver, BC, Canada
| | - Stephen Parkin
- Division of Hematology, University of British Columbia, Vancouver, BC, Canada; Vancouver General Hospital, Vancouver, BC, Canada.
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7
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Cho H. Diagnosis and management of monoclonal gammopathy of clinical significance. Blood Res 2022; 57:20-26. [PMID: 35483921 PMCID: PMC9057659 DOI: 10.5045/br.2022.2022035] [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: 02/05/2022] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/17/2022] Open
Abstract
The term "monoclonal gammopathy of clinical significance" (MGCS) refers to any plasma cell or B-cell clonal disorder that does not meet the current criteria for malignant disorders but produces a monoclonal protein that directly or indirectly results in organ damage. The most commonly affected organs are the kidneys, nerves, and skin. This review summarizes the current classification of MGCS and its diagnostic and treatment approaches.
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Affiliation(s)
- Hyungwoo Cho
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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8
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Cutaneous manifestations of monoclonal gammopathy. Blood Cancer J 2022; 12:58. [PMID: 35411042 PMCID: PMC9001632 DOI: 10.1038/s41408-022-00661-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/17/2022] [Accepted: 02/23/2022] [Indexed: 12/29/2022] Open
Abstract
Monoclonal gammopathy associated with dermatological manifestations are a well-recognized complication. These skin disorders can be associated with infiltration and proliferation of a malignant plasma cells or by a deposition of the monoclonal immunoglobulin in a nonmalignant monoclonal gammopathy. These disorders include POEMS syndrome, light chain amyloidosis, Schnitzler syndrome, scleromyxedema and TEMPI syndrome. This article provides a review of clinical manifestations, diagnostics criteria, natural evolution, pathogenesis, and treatment of these cutaneous manifestations.
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9
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Zhao L, Chen H. Xanthoma Disseminatum Mimicking Peritoneal Carcinomatosis from Hilar Cholangiocarcinoma. Radiology 2021; 301:547. [PMID: 34519574 DOI: 10.1148/radiol.2021210984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Liang Zhao
- From the Department of Nuclear Medicine and Minnan PET Center, Xiamen Cancer Center, First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen 361003, China
| | - Haojun Chen
- From the Department of Nuclear Medicine and Minnan PET Center, Xiamen Cancer Center, First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen 361003, China
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10
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Iglesias-Girard L, Roy SF, Chapdelaine H, Désy D, Bouffard D, Funaro D. Disseminated Xanthosiderohistiocytosis With Monoclonal Gammopathy-A Rare Form of Xanthoma Disseminatum. JAMA Dermatol 2021; 156:1270-1272. [PMID: 32520307 DOI: 10.1001/jamadermatol.2020.1579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Laura Iglesias-Girard
- Department of Dermatology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Simon F Roy
- Department of Pathology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Hugo Chapdelaine
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,Institut de Recherches Cliniques de Montreal, Montreal, Quebec, Canada
| | - Delphine Désy
- Department of Pathology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Danielle Bouffard
- Department of Pathology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Deana Funaro
- Department of Dermatology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
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11
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Dispenzieri A. Monoclonal gammopathies of clinical significance. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2020; 2020:380-388. [PMID: 33275738 PMCID: PMC7727544 DOI: 10.1182/hematology.2020000122] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
"Monoclonal gammopathy of clinical significance" (MGCS) is the term used to describe nonmalignant monoclonal gammopathies causing important disease. MGCS is the differential diagnosis for any patient presenting with what appears to be a monoclonal gammopathy of undetermined significance but is also experiencing other unexplained symptoms. Broadly, these conditions can be separated into symptoms and signs referable to the nerves, the kidneys, and the skin. The first step in making these diagnoses is to consider them. With a particular condition in mind, the next step is to order those tests that can help confirm or dismiss a particular diagnosis. Nearly all of the renal and dermatologic conditions are diagnosed by renal and skin biopsies, respectively. The importance of a highly competent renal pathologist and dermatopathologist cannot be underestimated. Biopsy is less specific for the neuropathic conditions. Because several of the MGCSs are syndromes, recognizing other manifestations is also key. Treatment recommendations for many of these conditions are anecdotal because of their rarity, but for several of the conditions, IV immunoglobulin, rituximab, and plasma cell-directed therapy are the best options.
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Affiliation(s)
- Angela Dispenzieri
- Division of Hematology and Division of Clinical Chemistry, Mayo Clinic, Rochester, MN
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12
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Liang D, Liu J, Liang S, Xu F, Cheng Z, Huang X, Zeng C, Liu Z. Types of M protein and clinicopathological profiles in patients with monoclonal gammopathy of renal significance. J Nephrol 2020; 34:1137-1146. [PMID: 32725498 DOI: 10.1007/s40620-020-00817-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/22/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The development of renal disease in patients with monoclonal gammopathy of renal significance (MGRS) depends on the pathogenicity of the secreted monoclonal protein (M protein). However, the correlation between the types of M proteins and clinical and renal pathological features is still unclear. METHODS A total of 148 patients with detectable serum M protein and biopsy-proven MGRS were recruited. The patients were categorized according to the heavy and light chain types of M protein in the serum. RESULTS Among 148 patients, the most common M protein was IgGλ, followed by IgAλ and IgGκ. According to the type of heavy chain, patients with IgM-MGRS were more likely to have renal dysfunction, anemia and hypocomplementemia than patients with IgG-MGRS and IgA-MGRS. The λ light chain was predominant in patients with IgG-MGRS and IgA-MGRS, whereas the κ light chain was predominant in patients with IgM-MGRS. The most common renal lesion was amyloidosis in patients with IgG-MGRS and IgA-MGRS, while it was cryoglobulinemic glomerulonephritis in patients with IgM-MGRS. According to the type of light chain, patients with κ light chain were more likely to be male and to have renal dysfunction, anemia and hypocomplementemia than those with λ light chain. The types of heavy chain and light chain of M protein were not associated with patient or renal survival. CONCLUSION The clinicopathological features were distinct in patients with different types of M protein. Integration of the types of M protein and renal pathologic findings may shed light on individual management of patients with MGRS.
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Affiliation(s)
- Dandan Liang
- National Clinical Research Center of Kidney Diseases, Jinling Clinical Medical College of Nanjing Medical University, 305 East Zhongshan Road, Nanjing, China
| | - Jing Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Shaoshan Liang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Feng Xu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Zhen Cheng
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Xianghua Huang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Caihong Zeng
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Zhihong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Clinical Medical College of Nanjing Medical University, 305 East Zhongshan Road, Nanjing, China. .,National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
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Nelson CA, Zhong CS, Hashemi DA, Ashchyan HJ, Brown-Joel Z, Noe MH, Imadojemu S, Micheletti RG, Vleugels RA, Wanat KA, Rosenbach M, Mostaghimi A. A Multicenter Cross-Sectional Study and Systematic Review of Necrobiotic Xanthogranuloma With Proposed Diagnostic Criteria. JAMA Dermatol 2020; 156:270-279. [PMID: 31940000 PMCID: PMC6990734 DOI: 10.1001/jamadermatol.2019.4221] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 11/07/2019] [Indexed: 11/14/2022]
Abstract
Importance Necrobiotic xanthogranuloma (NXG) is a non-Langerhans cell histiocytosis classically associated with paraproteinemia attributable to plasma-cell dyscrasias or lymphoproliferative disorders. Despite the morbidity of NXG, the literature is limited to case reports and small studies, and diagnostic criteria are lacking. Objective To evaluate the characteristics of NXG and propose diagnostic criteria. Design, Setting, and Participants This multicenter cross-sectional study was conducted at tertiary academic referral centers and followed by a systematic review and a consensus exercise. The multicenter cohort included patients with NXG diagnosed at the Brigham and Women's and Massachusetts General Hospitals (2000-2018), the University of Iowa Hospitals and Clinics (2000-2018), and the University of Pennsylvania Health System (2008-2018). The systematic review was conducted in 2018 and included patients with NXG identified in the Cochrane, Ovid EMBASE, PubMed, and Web of Science databases. The consensus exercise was conducted by 8 board-certified dermatologists to identify diagnostic criteria. Main Outcomes and Measures Demographic factors, comorbidities, clinical features, and treatment response. Results Of 235 included patients with NXG (34 from the multicenter cohort and 201 from the systematic review results), the mean (SD) age at presentation was 61.6 (14.2) years; 147 (62.6%) were female. Paraproteinemia was detected in 193 patients (82.1%), most often IgG-κ (117 patients [50.0%]). A malignant condition was detected in 59 patients (25.1%), most often multiple myeloma (33 patients [14.0%]). The overall rate of paraproteinemia and/or a malignant condition was 83.8% (197 patients). In the multicenter cohort, evolution of paraproteinemia into multiple myeloma was observed up to 5.7 years (median [range], 2.4 [0.1-5.7] years) after NXG presentation. Cutaneous lesions consisted of papules, plaques, and/or nodules, typically yellow or orange in color (113 of 187 [60.4%]) with a periorbital distribution (130 of 219 [59.3%]). The eye was the leading site of extracutaneous involvement (34 of 235 [14.5%]). In the multicenter cohort, intravenous immunoglobulin had the best treatment response rate (9 of 9 patients [100%]), followed by antimalarial drugs (4 of 5 patients [80%]), intralesional triamcinolone (6 of 8 patients [75%]), surgery (3 of 4 patients [75%]), chemotherapy (8 of 12 patients [67%]), and lenalidomide or thalidomide (5 of 8 patients [63%]). The consensus exercise yielded 2 major criteria, which were (1) clinical and (2) histopathological features consistent with NXG, and 2 minor criteria, consisting of (1) paraproteinemia, plasma-cell dyscrasia, and/or other associated lymphoproliferative disorder and (2) periorbital distribution of cutaneous lesions. In the absence of foreign body, infection, or another identifiable cause, fulfillment of both major and at least 1 minor criterion were proposed to establish the diagnosis of NXG. Conclusions and Relevance Necrobiotic xanthogranuloma is a multisystem disorder associated with paraproteinemia and malignant conditions. The proposed diagnostic criteria may advance clinical research and should be validated.
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Affiliation(s)
- Caroline A. Nelson
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - David A. Hashemi
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Hovik J. Ashchyan
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Zoe Brown-Joel
- University of Iowa Carver College of Medicine, Iowa City
| | - Megan H. Noe
- Perelman School of Medicine at the University of Pennsylvania, Department of Dermatology, Philadelphia
| | - Sotonye Imadojemu
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert G. Micheletti
- Perelman School of Medicine at the University of Pennsylvania, Department of Dermatology, Philadelphia
- Perelman School of Medicine at the University of Pennsylvania, Department of Medicine, Philadelphia
| | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Karolyn A. Wanat
- Department of Dermatology, University of Iowa Carver College of Medicine, Iowa City
| | - Misha Rosenbach
- Perelman School of Medicine at the University of Pennsylvania, Department of Dermatology, Philadelphia
- Perelman School of Medicine at the University of Pennsylvania, Department of Medicine, Philadelphia
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Lin X, Hu H, Qian Y, Jie X, Nie B, Zhao YZ, Wang H, Jiang H. Intralesional injection of bleomycin in the treatment of xanthelasma palpebrarum: A clinical study. J Cosmet Dermatol 2020; 19:2125-2130. [PMID: 31930760 DOI: 10.1111/jocd.13258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/14/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Xanthelasma palpebrarum (XP) is the most common type of cutaneous xanthoma and has been treated with intralesional injection of pingyangmycin effectively. However, bleomycin, which has the same effect in antitumor activity as pingyangmycin, has not been applied in the treatment of XP. AIMS To explore and assess the treatment of xanthelasma by intralesional injection of bleomycin, which has been widely used as an antitumor antibiotic, for the replacement of pingyangmycin. METHODS Intralesional injection of different concentrations of bleomycin was administered to 44 xanthelasma lesions of 24 patients who have never been treated before, divided into two groups according to age. Photographs were taken and analyzed to assess the therapeutic efficiency. Patients were then followed up for 6-24 months. RESULTS All the lesions resolved after 1 month of treatment with the intralesional injection of different concentrations of bleomycin. There was no significant difference observed between the two groups. No severe complications had occurred. CONCLUSION The treatment of XP with intralesional injection of bleomycin is minimally invasive, safe, and effective. Consequently, it also has good cosmetic outcome with no adverse effects.
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Affiliation(s)
- Xianzheng Lin
- Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Navy Medical University (Second Military Medical University), Shanghai, China
| | - Hao Hu
- Postdoctoral Station of Clinical Medicine, East Hospital, Tongji University School of Medicine, Shanghai, China.,Department of Plastic and Reconstructive Surgery, East Hospital, Tongji University, Shanghai, China
| | - Yuxin Qian
- Department of Plastic and Reconstructive Surgery, East Hospital, Tongji University, Shanghai, China
| | - Xiang Jie
- Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Navy Medical University (Second Military Medical University), Shanghai, China
| | - Bing Nie
- Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Navy Medical University (Second Military Medical University), Shanghai, China
| | - Yao-Zhong Zhao
- Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Navy Medical University (Second Military Medical University), Shanghai, China
| | - Hui Wang
- Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Navy Medical University (Second Military Medical University), Shanghai, China.,Department of Plastic and Reconstructive Surgery, East Hospital, Tongji University, Shanghai, China
| | - Hua Jiang
- Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Navy Medical University (Second Military Medical University), Shanghai, China.,Department of Plastic and Reconstructive Surgery, East Hospital, Tongji University, Shanghai, China
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15
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Kim JG, Kim HR, You MH, Shin DH, Choi JS, Bae YK. Necrobiotic Xanthogranuloma Coexists with Diffuse Normolipidemic Plane Xanthoma and Multiple Myeloma. Ann Dermatol 2019; 32:53-56. [PMID: 33911709 PMCID: PMC7992639 DOI: 10.5021/ad.2020.32.1.53] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 10/10/2018] [Accepted: 10/26/2018] [Indexed: 11/28/2022] Open
Abstract
Necrobiotic xanthogranuloma (NXG), is a rare multisystem disease that manifests as cutaneous inflammatory lesions, and is commonly associated with lymphoproliferative disease. Diffuse normolipemic plane xanthoma (NX), is also a rare, acquired disease that is often associated with systemic diseases such as lymphoproliferative disease. Both of these diseases have been reported to be associated with monoclonal gammopathy (MG). However, there are few cases in which these diseases co-exist. A 78-year-old female, who had a known case of NX on the neck and axillary area, presented with an asymptomatic erythematous plaque on her left supraclavicular area. Histopathological examination showed lymphoid aggregates, necrobiotic areas, and granulomatous inflammation in the dermis. Numerous foreignbody and Touton type giant cells were noticed. Serum protein immunoelectrophoresis showed an IgG kappa type MG. Lipid profile of the patient was normal. Bone marrow examination showed plasma cell myeloma. Based on these histologic and laboratory results, we diagnosed this lesion as NXG coexisting with NX and multiple myeloma. She was started on treatment with bortezomib and melphalan for multiple myeloma, and high-dose systemic corticosteroid and triamcinolone intralesional injection for the skin lesion. After 3 months of treatment, the NXG skin lesion and MG improved.
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Affiliation(s)
- Joon Goon Kim
- Department of Dermatology, Yeungnam University College of Medicine, Daegu, Korea
| | - Hye Ri Kim
- Department of Dermatology, Yeungnam University College of Medicine, Daegu, Korea
| | - Moon Hyung You
- Department of Dermatology, Yeungnam University College of Medicine, Daegu, Korea
| | - Dong Hoon Shin
- Department of Dermatology, Yeungnam University College of Medicine, Daegu, Korea
| | - Jong Soo Choi
- Department of Dermatology, Yeungnam University College of Medicine, Daegu, Korea
| | - Young Kyung Bae
- Department of Pathology, Yeungnam University College of Medicine, Daegu, Korea
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16
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Lopez-Trujillo E, Pedro C, March-Rodriguez A, Pujol RM. Necrobiotic xanthogranuloma developing in a patient with diffuse normolipemic plane xanthoma: association of two monoclonal gammopathy-related disorders. Australas J Dermatol 2019; 61:e245-e247. [PMID: 31736053 DOI: 10.1111/ajd.13198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Emilio Lopez-Trujillo
- Department of Dermatology, Hospital del Mar, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carme Pedro
- Department of Hematology, Hospital del Mar, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alvaro March-Rodriguez
- Department of Dermatology, Hospital del Mar, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ramon M Pujol
- Department of Dermatology, Hospital del Mar, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
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17
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Wetzel M, Owen CE, Callen JP. Paraneoplastic Syndromes for the Inpatient Dermatologist. CURRENT DERMATOLOGY REPORTS 2019. [DOI: 10.1007/s13671-019-00277-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Morsink LM, Nijhof IS. Diffuse plane normolipaemic xanthomatosis as a manifestation of monoclonal gammopathy. Br J Haematol 2019; 187:411. [PMID: 31407310 PMCID: PMC6900145 DOI: 10.1111/bjh.16141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Linde M Morsink
- Department of Haematology, University Medical Centre Groningen, Groningen, the Netherlands
| | - Inger S Nijhof
- Department of Haematology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
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19
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Abstract
The colors reflected from the skin are important indicators of dermatologic and systemic disorders. Incident light is subject to absorption by chromophores in the skin and scattering. Chromophores associated with yellow light reflection include the carotenoids and bilirubin. Various pathophysiologic mechanisms associated with these and other chromophores manifest with a yellow hue on examination. This review describes these mechanisms and the clinical features of yellow skin disorders by morphology. A brief summary of the differential diagnosis, laboratory investigations, and treatments are presented. Yellow skin disorders are a heterogenous group composed of abnormalities in keratin, elastic and connective tissue, lipid metabolism, and other states of metabolic, inflammatory, or organ dysfunction. Patients will present through different routes, and skin disease may precede or follow systemic disease. Dermatologists have an essential role in identifying those with malignant or systemic associations to ensure early diagnosis and treatment.
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Affiliation(s)
- Ian T Logan
- Department of Dermatology, Addenbrooke's Hospital, Cambridge, England, United Kingdom.
| | - Richard A Logan
- Department of Dermatology, Princess of Wales Hospital, Bridgend, Wales, United Kingdom
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20
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Legrand A, Jullie ML, Ly S, Beylot-Barry M, Viallard JF, Calonje J, Bureau-Lenoir C, Doutre MS. Extrafacial necrobiotic xanthogranuloma and monoclonal gammopathy: two cases. Int J Dermatol 2019; 58:e112-e114. [PMID: 30883695 DOI: 10.1111/ijd.14416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/23/2019] [Accepted: 02/05/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Adeline Legrand
- Dermatology Department, University Hospital of Bordeaux, Bordeaux, France
| | | | - Sandra Ly
- Dermatology Department, University Hospital of Bordeaux, Bordeaux, France
| | - Marie Beylot-Barry
- Dermatology Department, University Hospital of Bordeaux, Bordeaux, France
| | | | - Jaime Calonje
- Dermatopathology Laboratory, St John's Institute of Dermatology, St Thomas' Hospital, London, UK
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21
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Lee WI, Calma A, Drummond C, Cook MC. Xanthoma and paraproteinaemia: a spot diagnosis. BMJ Case Rep 2019; 12:12/2/bcr-2018-227884. [PMID: 30824465 DOI: 10.1136/bcr-2018-227884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Wei-I Lee
- Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Aicee Calma
- Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | | | - Matthew C Cook
- Immunology, Canberra Hospital, Canberra, Australian Capital Territory, Australia.,Australian National University, Canberra, Australian Capital Territory, Australia
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22
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Falk L, Dyall-Smith D, Stolz W, Coras-Stepanek B. Diffuse plane xanthoma developing in association with prior monoclonal gammopathy. BMJ Case Rep 2019; 12:12/2/e229164. [PMID: 30765451 DOI: 10.1136/bcr-2018-229164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Lorena Falk
- Department of Dermatology, Stadtisches Klinikum Muenchen GmbH, Muenchen, Germany
| | | | - Wilhelm Stolz
- Department of Dermatology, Stadtisches Klinikum Muenchen GmbH, Muenchen, Germany
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23
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Chung YH, Kang SY, Choi WS. A case of intramuscular xanthelasma palpebrarum found during blepharoplasty. Arch Craniofac Surg 2019; 19:296-299. [PMID: 30613094 PMCID: PMC6325326 DOI: 10.7181/acfs.2018.02068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/24/2018] [Indexed: 12/04/2022] Open
Abstract
Xanthelasma palpebrarum is the most common cutaneous xanthoma found on the medial side of the eyelid. The typical lesion is usually a flat and yellowish plaque on the skin. However, we report on a unique case of intramuscular xanthoma found during blepharoplasty for the correction of ptosis. A 53-year-old male patient visited our department with a complaint of a ptotic eyelid. He was concerned about the cosmetic appearance and the uncomfortable feeling while opening his eyes, and wanted these problems to be solved. A yellowish plaque of about 0.3 × 0.3 cm in size was found in the orbicularis oculi muscle during the surgery. The lesion was excised and xanthelasma was confirmed with biopsy. We have found this specific case of xanthelasma palpebrarum in the only muscle. Therefore, a careful approach to clinical and histologic examination and imaging is required for patients with these lesions.
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Affiliation(s)
- Young Hun Chung
- Department of Plastic Surgery, Graduate School, Kyung Hee University, Seoul, Korea
| | - Sang Yoon Kang
- Department of Plastic Surgery, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
| | - Woo Suk Choi
- Department of Radiology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
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24
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Normolipemic eruptive xanthoma in a patient with monoclonal gammopathy of undetermined significance. Med Clin (Barc) 2018; 151:507-508. [PMID: 29731133 DOI: 10.1016/j.medcli.2018.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/08/2018] [Accepted: 03/15/2018] [Indexed: 11/22/2022]
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25
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Monoclonal gammopathy of clinical significance: a novel concept with therapeutic implications. Blood 2018; 132:1478-1485. [DOI: 10.1182/blood-2018-04-839480] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 06/22/2018] [Indexed: 12/12/2022] Open
Abstract
Abstract
Monoclonal gammopathy is a common condition, particularly in the elderly. It can indicate symptomatic multiple myeloma or another overt malignant lymphoid disorder requiring immediate chemotherapy. More frequently, it results from a small and/or quiescent secreting B-cell clone, is completely asymptomatic, and requires regular monitoring only, defining a monoclonal gammopathy of unknown significance (MGUS). Sometimes, although quiescent and not requiring any treatment per se, the clone is associated with potentially severe organ damage due to the toxicity of the monoclonal immunoglobulin or to other mechanisms. The latter situation is increasingly observed but still poorly recognized and frequently undertreated, although it often requires rapid specific intervention to preserve involved organ function. To improve early recognition and management of these small B-cell clone–related disorders, we propose to introduce the concept of monoclonal gammopathy of clinical significance (MGCS). This report identifies the spectrum of MGCSs that are classified according to mechanisms of tissue injury. It highlights the diversity of these disorders for which diagnosis and treatment are often challenging in clinical practice and require a multidisciplinary approach. Principles of management, including main diagnostic and therapeutic procedures, are also described. Importantly, efficient control of the underlying B-cell clone usually results in organ improvement. Currently, it relies mainly on chemotherapy and other anti–B-cell/plasma cell agents, which should aim at rapidly producing the best hematological response.
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26
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Roupie AL, Battistella M, Talbot A, Jachiet M, Bouaziz JD, Vignon-Pennamen MD, Royer B, Fermand JP, Arnulf B, Harel S. Coexisting cutaneous macroglobulinosis and scleredema of Buschke in a patient with a Waldenström Macroglobulinemia. J Eur Acad Dermatol Venereol 2018; 33:e104-e106. [PMID: 30267590 DOI: 10.1111/jdv.15268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A L Roupie
- Department of Immuno-Hematology, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - M Battistella
- Department of Pathology, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France.,Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale (GEDIM), Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - A Talbot
- Department of Immuno-Hematology, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France.,Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale (GEDIM), Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - M Jachiet
- Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale (GEDIM), Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France.,Department of Dermatology, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - J D Bouaziz
- Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale (GEDIM), Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France.,Department of Dermatology, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - M D Vignon-Pennamen
- Department of Pathology, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France.,Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale (GEDIM), Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - B Royer
- Department of Immuno-Hematology, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France.,Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale (GEDIM), Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - J P Fermand
- Department of Immuno-Hematology, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France.,Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale (GEDIM), Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - B Arnulf
- Department of Immuno-Hematology, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France.,Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale (GEDIM), Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - S Harel
- Department of Immuno-Hematology, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France.,Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale (GEDIM), Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France
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27
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Soran H, Ho JH, Durrington PN. Acquired low cholesterol: diagnosis and relevance to safety of low LDL therapeutic targets. Curr Opin Lipidol 2018; 29:318-326. [PMID: 29746303 DOI: 10.1097/mol.0000000000000526] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Acquired hypocholesterolaemia occurs more commonly than inherited hypocholesterolaemia but has received little attention in the literature. In this review, we discuss the causes and underlying mechanisms of acquired hypocholesterolaemia and its relevance to safety of therapeutically induced decreased LDL cholesterol levels. RECENT FINDINGS Hypocholesterolaemia is increasingly identified as cholesterol testing becomes more widespread in the assessment of cardiovascular risk. Lower therapeutic targets for LDL cholesterol are also being achieved more regularly with the introduction of more intensive cholesterol-lowering regimens. Acquired hypocholesterolaemia may be the presenting feature of treatable diseases. Understanding its mechanisms may also provide new treatment approaches for neoplastic disease, such as breast cancer, and infections, such as tuberculosis. SUMMARY When hypocholesterolaemia is discovered, it is important to identify its cause. Further research into the pathogenesis of hypocholesterolaemia may provide new therapies for primary diseases underlying it.
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Affiliation(s)
- Handrean Soran
- Lipoprotein Research Group, Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester
- Department of Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jan Hoong Ho
- Lipoprotein Research Group, Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester
- Department of Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Paul N Durrington
- Lipoprotein Research Group, Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester
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28
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Patel N, Norberg A, Hogeling M. Planar xanthomas secondary to post-transplantation cholangiopathy in a 16-month-old boy. Pediatr Dermatol 2018; 35:e163-e164. [PMID: 29575286 DOI: 10.1111/pde.13463] [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] [Indexed: 11/29/2022]
Abstract
Planar xanthomas in children represent rare dermatologic findings associated with abnormalities in lipid metabolism. While planar xanthomas in Alagille's syndrome have been well described in the literature, there have been no cases reported of eruptive xanthomas in pediatric liver transplant patients. Herein we report a case of a 16-month-old boy status post-liver transplantation who presents with planar xanthomas secondary to cholangiopathy. A brief review of xanthomas and the related literature is also provided.
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Affiliation(s)
- Nirali Patel
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Adam Norberg
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Marcia Hogeling
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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29
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Olson RM, Harrison AR, Maltry A, Mokhtarzadeh A. Periorbital Necrobiotic Xanthogranuloma Successfully Treated with Intravenous Immunoglobulin. Case Rep Ophthalmol 2018; 9:70-75. [PMID: 29643785 PMCID: PMC5892313 DOI: 10.1159/000485913] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/29/2017] [Indexed: 11/19/2022] Open
Abstract
Background Necrobiotic xanthogranuloma (NXG) is a rare non-Langerhans histiocytosis with cutaneous manifestations, most commonly of the periorbital skin, and is often associated with hematologic disorders such as monoclonal gammopathy. Treatment of NXG is notoriously difficult, and fraught with recurrence and progression. Case Presentation The authors describe a case of NXG with periorbital involvement in a patient with a complex autoimmune and hematologic medical history. The biopsy of this rare lesion prompted subsequent evaluation for an underlying disorder, which led to the diagnosis of multiple myeloma. Her NXG lesions demonstrated remarkable clinical improvement after treatment with intravenous immunoglobulin (IVIG). Conclusions This case demonstrates the ophthalmologist's critical role in the diagnosis and management of NXG, as early detection cannot only prevent ophthalmic consequences such as ocular perforation and blindness, but also prompt further investigation that may reveal an underlying disorder or systemic involvement, including hematologic malignancy as in this case. NXG has been effectively treated with IVIG in a handful of reported cases. To the author's knowledge, this is the third case of periorbital NXG successfully treated with IVIG, and the first in the ophthalmic literature.
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Affiliation(s)
- Rose M Olson
- University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Andrew R Harrison
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Ophthalmology and Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Amanda Maltry
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ali Mokhtarzadeh
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA
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30
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Wollina U, Schönlebe J, Tchernev G, Lotti T. Diffuse Normolipemic Plane Xanthoma (DNPX) of the Neck without Xanthelasma Palpebrum. Open Access Maced J Med Sci 2018; 6:123-125. [PMID: 29484006 PMCID: PMC5816280 DOI: 10.3889/oamjms.2018.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 11/05/2022] Open
Abstract
Diffuse normolipemic plane xanthoma (DNPX) is an uncommon subtype of non-Langerhans histiocytosis. DNPX is characterised by xanthelasma palpebrarum, diffuse plane xanthoma of the head, neck, trunk, or extremities, and normal plasma lipid levels. The neck is the most common site. We report about a 62-year-old female Caucasian patient, who developed an asymptomatic fine wrinkling and loose skin on the neck and décolleté about three years ago. The skin colour became yellowish. Xanthelasma was absent. Histopathology of a skin biopsy confirmed the diagnosis of DNPX. The patient had a medical history of chronic myeloblastic leukaemia. No other laboratory abnormalities were found. Laser treatment was offered but opposed by the patient.
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Affiliation(s)
- Uwe Wollina
- Städtisches Klinikum Dresden - Department of Dermatology and Allergology, Dresden, Sachsen, Germany
| | - Jacqueline Schönlebe
- Städtisches Klinikum Dresden - Institute of Pathology "Georg Schmorl", Dresden, Germany
| | - Georgi Tchernev
- Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior, Sofia, Bulgaria.,Onkoderma, Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
| | - Torello Lotti
- University G. Marconi of Rome - Dermatology and Venereology, Rome, Italy
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31
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Melguizo Moya I, Navarro Puerto MA, Grilo Reina A. Necrobiotic xanthogranuloma associated with monoclonal gammopathy of unknown significance. Med Clin (Barc) 2017; 149:509-510. [PMID: 28736067 DOI: 10.1016/j.medcli.2017.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 05/28/2017] [Accepted: 06/01/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Isabel Melguizo Moya
- Unidad de Gestión Clínica de Medicina Interna, Hospital Universitario de Valme, Sevilla, España.
| | | | - Antonio Grilo Reina
- Unidad de Gestión Clínica de Medicina Interna, Hospital Universitario de Valme, Sevilla, España
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32
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Mastrolorenzo A, D’Errico A, Pierotti P, Vannucchi M, Giannini S, Fossi F. Pleomorphic cutaneous xanthomas disclosing homozygous familial hypercholesterolemia. World J Dermatol 2017; 6:59-65. [DOI: 10.5314/wjd.v6.i4.59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 08/30/2017] [Accepted: 11/10/2017] [Indexed: 02/06/2023] Open
Abstract
Homoxygous Familial Hypercholesterolemia is characterized by a presence of several types of cutaneous xanthomas with an abnormal lipid profile. Some of these could be pathognomonic. Although these could be initially interpreted as isolated and localized benign disorders and offered surgical treatment, it has become increasingly clear that they could be a part of a systemic pathology. Here we describe a case of this rare disorder in a 19 years old non-obese young man who presented multiple, intertriginous, tuberous and tendinous xanthomas and had an associated abnormal lipid profile with elevated low-density lipoprotein cholesterol levels. A detailed history with clinical assessment in the differential diagnosis and laboratory investigations led to a precise diagnosis.
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Affiliation(s)
- Antonio Mastrolorenzo
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Public Hospital Piero Palagi, Florence 50125, Italy
| | - Antonietta D’Errico
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Public Hospital Piero Palagi, Florence 50125, Italy
| | - Piera Pierotti
- Azienda Sanitaria di Firenze, Department of Infectious Diseases, Ospedale SM Annunziata, Florence 50012, Italy
| | - Margherita Vannucchi
- Histopathology and Molecular Diagnostics Institute, Careggi University Hospital, Florence 50134, Italy
| | - Stefano Giannini
- Diabetes and Metabolic Disease Agency, Careggi University Hospital, Florence 50134, Italy
| | - Fiammetta Fossi
- SODc of Transfusion Medicine and Cell Therapy, Careggi University Hospital, Florence 50134, Italy
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33
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Sidana S, Rajkumar SV, Dispenzieri A, Lacy MQ, Gertz MA, Buadi FK, Hayman SR, Dingli D, Kapoor P, Gonsalves WI, Go RS, Hwa YL, Leung N, Fonder AL, Hobbs MA, Zeldenrust SR, Russell SJ, Lust JA, Kyle RA, Kumar SK. Clinical presentation and outcomes of patients with type 1 monoclonal cryoglobulinemia. Am J Hematol 2017; 92:668-673. [PMID: 28370486 DOI: 10.1002/ajh.24745] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 03/26/2017] [Accepted: 03/27/2017] [Indexed: 11/10/2022]
Abstract
We describe a series of 102 patients diagnosed from January 1, 1990 to December 31, 2015 with Type 1 monoclonal cryoglobulinemia (MoC). Symptoms were seen in 89 (87%) patients, including: cutaneous symptoms in 64 (63%) patients, with purpura (n = 43, 42%) and ulcers/gangrene (n = 35, 34%) being most common; neurological findings in 33 (32%) patients, most frequently sensory neuropathy (n = 24, 24%); vasomotor symptoms, mainly Raynaud's phenomenon in 25 (25%); arthralgias in 24 (24%); and renal manifestations, primarily glomerulonephritis in 14 (14%) patients. An underlying lymphoproliferative disorder was identified in 94 (92%) subjects; MGUS-39, myeloma-20, lymphoplasmacytic lymphoma-21 and others-14. Treatment was initiated in 73 (72%) patients, primarily for cryoglobulinemia-related symptoms in 57. Treatment regimens consisted of: steroids ± alkylating agents in 29 (40%), novel myeloma therapies in 16 (22%), rituximab with alkylating agents in 12 (16%) and rituximab ± steroids in 11 (15%) patients; 22 patients received plasmapheresis. Six patients underwent autologous stem cell transplant. Cryocrit at treatment initiation, change in cryocrit and time to nadir cryocrit were predictive of symptom improvement. Treatment directed toward the underlying clonal disorder resulted in improvement (n = 47) or stabilization (n = 16) of symptoms in the majority of patients and disappearance of cryoglobulin in over one-half.
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Affiliation(s)
- Surbhi Sidana
- Division of Hematology; Department of Internal Medicine, Mayo Clinic; Rochester Minnesota USA
| | - S. Vincent Rajkumar
- Division of Hematology; Department of Internal Medicine, Mayo Clinic; Rochester Minnesota USA
| | - Angela Dispenzieri
- Division of Hematology; Department of Internal Medicine, Mayo Clinic; Rochester Minnesota USA
| | - Martha Q. Lacy
- Division of Hematology; Department of Internal Medicine, Mayo Clinic; Rochester Minnesota USA
| | - Morie A. Gertz
- Division of Hematology; Department of Internal Medicine, Mayo Clinic; Rochester Minnesota USA
| | - Francis K. Buadi
- Division of Hematology; Department of Internal Medicine, Mayo Clinic; Rochester Minnesota USA
| | - Suzanne R. Hayman
- Division of Hematology; Department of Internal Medicine, Mayo Clinic; Rochester Minnesota USA
| | - David Dingli
- Division of Hematology; Department of Internal Medicine, Mayo Clinic; Rochester Minnesota USA
| | - Prashant Kapoor
- Division of Hematology; Department of Internal Medicine, Mayo Clinic; Rochester Minnesota USA
| | - Wilson I. Gonsalves
- Division of Hematology; Department of Internal Medicine, Mayo Clinic; Rochester Minnesota USA
| | - Ronald S. Go
- Division of Hematology; Department of Internal Medicine, Mayo Clinic; Rochester Minnesota USA
| | - Yi Lisa Hwa
- Division of Hematology; Department of Internal Medicine, Mayo Clinic; Rochester Minnesota USA
| | - Nelson Leung
- Division of Hematology; Department of Internal Medicine, Mayo Clinic; Rochester Minnesota USA
- Division of Nephrology; Department of Internal Medicine, Mayo Clinic; Rochester Minnesota USA
| | - Amie L. Fonder
- Division of Hematology; Department of Internal Medicine, Mayo Clinic; Rochester Minnesota USA
| | - Miriam A. Hobbs
- Division of Hematology; Department of Internal Medicine, Mayo Clinic; Rochester Minnesota USA
| | - Steven R. Zeldenrust
- Division of Hematology; Department of Internal Medicine, Mayo Clinic; Rochester Minnesota USA
| | - Stephen J. Russell
- Division of Hematology; Department of Internal Medicine, Mayo Clinic; Rochester Minnesota USA
| | - John A. Lust
- Division of Hematology; Department of Internal Medicine, Mayo Clinic; Rochester Minnesota USA
| | - Robert A. Kyle
- Division of Hematology; Department of Internal Medicine, Mayo Clinic; Rochester Minnesota USA
| | - Shaji K. Kumar
- Division of Hematology; Department of Internal Medicine, Mayo Clinic; Rochester Minnesota USA
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34
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Adult Xanthogranulomatous Disease of the Orbit: Clinical Presentations, Evaluation, and Management. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2017.03.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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35
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Vu K, Gupta R, Frater J, Atkinson J, Ranganathan P. A 55-Year-Old Man With Periorbital and Inguinal Masses, Pericarditis, and Pleuritis. Arthritis Care Res (Hoboken) 2017; 69:730-736. [PMID: 26815130 DOI: 10.1002/acr.22843] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 12/11/2015] [Accepted: 01/12/2016] [Indexed: 12/24/2022]
Affiliation(s)
- Khoan Vu
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Richa Gupta
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - John Frater
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - John Atkinson
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Prabha Ranganathan
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
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36
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Comparative Study of Clinical, Pathological, Radiological, and Genetic Features of Patients With Adult Ocular Adnexal Xanthogranulomatous Disease, Erdheim-Chester Disease, and IgG4-Related Disease of the Orbit/Ocular Adnexa. Ophthalmic Plast Reconstr Surg 2017; 33:112-119. [PMID: 26882062 DOI: 10.1097/iop.0000000000000661] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To compare and contrast the clinical, radiologic, pathologic, and genetic features of patients with ocular adnexal IgG4-related disease (IgG4-RD) and patients with adult ocular adnexal xanthogranulomatous disease (XG). METHODS This retrospective review study identified patients with histological evidence of either disease from records of the pathology department of our hospital from 1996 to 2014. Clinical, imaging, and a variety of histopathologic features were collected for 23 patients with IgG4-RD and 13 patients with XG. Next generation sequencing with a 50-gene cancer screening panel was performed on biopsy tissues from 10 patients in each group. RESULTS Statistical differences between the 2 groups include eyelid (67%; p = 0.0002) and anterior orbital (75%; p = 0.0352) predilection for XG except for Erdheim-Chester disease subgroup which was more posterior and diffuse. Eyelid involvement was rare (4%) for IgG4-RD. Involvement of orbital nerves was seen in 30% of IgG4-RD and 0% in XG (p = 0.0695). Five patients with IgG4-RD developed malignancy (4 lymphoma, 1 leiomyosarcoma), but none of XG patients. Discriminating pathological features were the presence of any IgG4+ plasma cells (p = 0.0121) and the ratio of IgG4+/IgG+ plasma cells (p =0.0294) for IgG4-RD. Five of 12 (42%) patients with XG had sufficient numbers of IgG4+ plasma cells/high power field to fulfill published diagnostic criteria for IgG4-RD, and 5 (42%) had a ratio of IgG4+/IgG+ plasma cells over 40%, but the numbers overall were less than seen in the IgG4-RD patients. The only genetic difference between the 2 groups was that BRAF V600E mutation was found in 1 of the 2 Erdheim-Chester disease patients, which form a subgroup of XG. CONCLUSIONS IgG4-RD and XG share clinical, imaging, and histopathological features including IgG4+ plasma cells. Significant differences were the eyelid involvement in XG, orbital nerve involvement, and an elevated IgG4+/IgG+ ratio in IgG4-RD and the only genetic abnormality found was BRAF V600E mutation in the Erdheim-Chester disease subgroup of XG.
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37
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Vignon M, Placais L, Malphettes M, Bouaziz JD, Asli B, Bedossa P, Rivet J, Szalat R, Zagdanski AM, Rybojad M, Fermand JP, Baron M, Rautou PE, Arnulf B. Non-cirrhotic portal hypertension in necrobiotic xanthogranuloma associated with monoclonal gammopathy. J Eur Acad Dermatol Venereol 2017; 31:e403-e405. [PMID: 28295661 DOI: 10.1111/jdv.14213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- M Vignon
- Department of Clinical Immunology, Saint-Louis Hospital, 75010, Paris, France.,Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale, 75010, Paris, France
| | - L Placais
- Department of Clinical Immunology, Saint-Louis Hospital, 75010, Paris, France
| | - M Malphettes
- Department of Clinical Immunology, Saint-Louis Hospital, 75010, Paris, France.,Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale, 75010, Paris, France
| | - J D Bouaziz
- Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale, 75010, Paris, France.,Department of Dermatology, Saint-Louis Hospital, 75010, Paris, France
| | - B Asli
- Department of Clinical Immunology, Saint-Louis Hospital, 75010, Paris, France.,Department of Dermatology, Saint-Louis Hospital, 75010, Paris, France
| | - P Bedossa
- Department of Pathology, Beaujon Hospital, 75010, Paris, France
| | - J Rivet
- Department of Pathology, Saint-Louis Hospital, 75010, Paris, France
| | - R Szalat
- Department of Clinical Immunology, Saint-Louis Hospital, 75010, Paris, France.,Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale, 75010, Paris, France
| | - A M Zagdanski
- Department of Radiology, Saint Louis Hospital, 75010, Paris, France
| | - M Rybojad
- Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale, 75010, Paris, France.,Department of Dermatology, Saint-Louis Hospital, 75010, Paris, France
| | - J P Fermand
- Department of Clinical Immunology, Saint-Louis Hospital, 75010, Paris, France
| | - M Baron
- Department of Clinical Immunology, Saint-Louis Hospital, 75010, Paris, France
| | - P E Rautou
- Department of Hepatology, Beaujon Hospital, 92110, Clichy, France
| | - B Arnulf
- Department of Clinical Immunology, Saint-Louis Hospital, 75010, Paris, France.,Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale, 75010, Paris, France
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38
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Ortiz Salvador JM, Subiabre Ferrer D, Pérez Ferriols A. Adult Xanthogranulomatous Disease of the Orbit: Clinical Presentations, Evaluation, and Management. ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:400-406. [PMID: 28262109 DOI: 10.1016/j.ad.2016.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 11/10/2016] [Accepted: 12/02/2016] [Indexed: 01/18/2023] Open
Abstract
Adult xanthogranulomatous disease of the orbit refers to a heterogeneous group of clinical syndromes with differing degrees of systemic involvement and distinct prognoses. The different syndromes all present clinically with progressively enlarging, yellowish lesions of the orbit. Histologically, the lesions are characterized by an inflammatory infiltrate of foam cells and Touton-type multinucleated giant cells. The xanthomatized histiocytes are CD68+, S100-, and CD1a-. There are 4 clinical forms of xanthogranulomatous disease of the orbit: adult xanthogranulomatous disease of the orbit, adult onset asthma and periocular xanthogranuloma, necrobiotic xanthogranuloma, and Erdheim-Chester disease. The treatment of local lesions are treated with systemic corticosteroids and other immunosuppressors. Vemurafenib, tocilizumab, and sirolimus have shown promising results in systemic disease.
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Affiliation(s)
- J M Ortiz Salvador
- Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, España.
| | - D Subiabre Ferrer
- Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, España
| | - A Pérez Ferriols
- Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, España
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39
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Wruhs M, Feldmann R, Sawetz I, Breier F, Steiner A. Necrobiotic Xanthogranuloma in a Patient with Multiple Myeloma. Case Rep Dermatol 2016; 8:350-353. [PMID: 28101022 PMCID: PMC5216253 DOI: 10.1159/000452826] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 10/25/2016] [Indexed: 11/25/2022] Open
Abstract
An 82-year-old woman presented with a 9-month history of multiple, well-defined skin lesions on her neck and upper chest, progressively increasing in size. Histological examination of a skin biopsy showed a regular epidermis. In the dermis, granulomatous changes with central necrobiosis were found which extended focally into the subcutaneous fat. The necrobiotic areas were surrounded by Touton cells and foreign-body giant cells. Laboratory analysis revealed leucopenia. Serum electrophoresis and immunofixation disclosed the presence of an IgG-λ paraprotein. Bone marrow aspiration cytology showed 20% plasmatic cells. The skeletal X-ray revealed frontal and occipital osteolytic skull lesions as well as pubic osteolysis. Urinalysis was unremarkable without proteinuria. Based on the clinical, laboratory, and histological findings, necrobiotic xanthogranuloma in association with multiple myeloma was diagnosed. The patient was treated with bortezomib combined with oral dexamethasone. Follow-up at week 13 revealed the complete disappearance of the IgG paraproteinemia. However, the skin lesions remained unchanged. Therefore, bortezomib treatment was discontinued, and systemic corticosteroids were continued at a higher dosage. After the steroid treatment, the lesions markedly flattened.
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Affiliation(s)
- Marlies Wruhs
- Department of Dermatology, Municipal Hospital Hietzing, Vienna, Austria
| | - Robert Feldmann
- Department of Dermatology, Municipal Hospital Hietzing, Vienna, Austria
| | - Isabelle Sawetz
- Department of Dermatology, Municipal Hospital Hietzing, Vienna, Austria
| | - Friedrich Breier
- Department of Dermatology, Municipal Hospital Hietzing, Vienna, Austria
| | - Andreas Steiner
- Department of Dermatology, Municipal Hospital Hietzing, Vienna, Austria
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40
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Zhao C, Kong M, Cao L, Zhang Q, Fang Y, Ruan W, Dou X, Gu X, Bi Q. Multiple large xanthomas: A case report. Oncol Lett 2016; 12:4327-4332. [PMID: 28101197 PMCID: PMC5228295 DOI: 10.3892/ol.2016.5282] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 03/22/2016] [Indexed: 02/06/2023] Open
Abstract
A 23-year-old male patient presented with multiple large masses in his elbows, buttocks, knees, Achilles tendons, feet, shoulders and hands. The large masses in the elbows and buttocks measured ~6×5×5 cm and ~7×5×4 cm, respectively. The patient presented with an elevated level of low-density lipoprotein cholesterol, and had been previously diagnosed with homozygous familial hypercholesterolemia (FH) and multiple xanthomas. Local surgical excisions were performed to remove the massive xanthomas from the elbows and buttocks, and histological analysis of the surgical specimens confirmed the previous diagnosis of homozygous FH (HoFH). The aim of the present study was to report a rare case of HoFH coinciding with multiple, large and widely-distributed xanthomas and to discuss the clinical characteristics, in order to provide a better understanding of xanthomas and FH.
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Affiliation(s)
- Chen Zhao
- Department of Orthopedics and Joint Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, P.R. China
| | - Mingxiang Kong
- Department of Orthopedics, The Second Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Li Cao
- Department of Orthopedics and Joint Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, P.R. China
| | - Qiong Zhang
- Operating Room, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, P.R. China
| | - Yong Fang
- Department of Orthopedics, The Second Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Weiwei Ruan
- Department of Orthopedics, The Second Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Xiaofan Dou
- Department of Orthopedics and Joint Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, P.R. China
| | - Xiaohui Gu
- Department of Orthopedics and Joint Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, P.R. China
| | - Qing Bi
- Department of Orthopedics, The Second Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
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41
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Kusumgar P, Vijaya PH, Monappa V. Adult-onset asthma and periocular xanthogranuloma: A rare case report. Can J Ophthalmol 2016; 51:e168-e171. [PMID: 27938975 DOI: 10.1016/j.jcjo.2016.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/25/2016] [Accepted: 05/25/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Pallak Kusumgar
- Department of Ophthalmology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Pai H Vijaya
- Department of Ophthalmology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.
| | - Vidya Monappa
- Department of Pathology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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42
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Lipsker D. Monoclonal gammopathy of cutaneous significance: review of a relevant concept. J Eur Acad Dermatol Venereol 2016; 31:45-52. [PMID: 27501129 DOI: 10.1111/jdv.13847] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/09/2016] [Indexed: 11/28/2022]
Abstract
Some dermatologic entities are strongly associated with the presence of a monoclonal gammopathy. They should be referred to as monoclonal gammopathy of cutaneous significance (MGCS). A short review of the main entities that fit into the spectrum of MGCS is provided. Amyloidosis, macroglobulinoderma and follicular hyperkeratotic spicules result from extravascular immunoglobulin or immunoglobulin-related protein deposition. Skin findings include papules and plaques, follicular spicules, purpura, haemorrhagic bullae, macroglossia and nail changes. The skin findings in cryoglobulinemia (CG) result from vascular immunoglobulin deposition, either as immune complexes within the vessel walls in mixed CG or within the lumina of small vessels in monoclonal CG. Mixed CG manifests as palpable purpura of leukocytoclastic vasculitis, and monoclonal CG as stellar and/or retiform purpura that can evolve into extensive skin necrosis. In some rare instances, immunoglobulins have a specific biological activity. This is, for example, the case when they bind lipoproteins that precipitate and induce hypocomplementemic xanthomas. Xanthoderma related to antiflavin activity of the monoclonal component or acquired angioedema related to anti-C1INH activity is other example. Abnormal cytokine secretion is the hallmark of some entities. High vascular endothelial growth factor levels correlate with some of the skin manifestations of the Polyneuropathy organomegaly endocrinopathy monoclonal component skin changes syndrome, such as hypertrichosis or the adenopathy and extensive skin patch overlying plasmacytoma syndrome. All the clinical manifestations of the Schnitzler syndrome are IL-1 mediated. In other MGCS, such as scleromyxedema, Clarkson syndrome, TEMPI syndrome, cutis laxa and the neutrophilic dermatoses, the link between the monoclocal component and the entity is clearly established, but not understood so far.
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Affiliation(s)
- D Lipsker
- Faculté de Médecine, Université de Strasbourg et Clinique Dermatologique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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43
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Higgins LS, Go RS, Dingli D, Kumar SK, Rajkumar SV, Dispenzieri A, Buadi FK, Lacy MQ, Lust JA, Kapoor P, Leung N, Lin Y, Kourelis TV, Gertz MA, Kyle RA, Gonsalves WI. Clinical Features and Treatment Outcomes of Patients With Necrobiotic Xanthogranuloma Associated With Monoclonal Gammopathies. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:447-52. [DOI: 10.1016/j.clml.2016.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 03/29/2016] [Accepted: 04/26/2016] [Indexed: 10/21/2022]
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44
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Miguel D, Lukacs J, Illing T, Elsner P. Treatment of necrobiotic xanthogranuloma - a systematic review. J Eur Acad Dermatol Venereol 2016; 31:221-235. [DOI: 10.1111/jdv.13786] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 05/02/2016] [Indexed: 01/25/2023]
Affiliation(s)
- D. Miguel
- Department of Dermatology; University Hospital; Jena Germany
| | - J. Lukacs
- Department of Dermatology; University Hospital; Jena Germany
| | - T. Illing
- Department of Dermatology; University Hospital; Jena Germany
| | - P. Elsner
- Department of Dermatology; University Hospital; Jena Germany
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45
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AlGain M, Szalat R, Vignon-Pennamen MD, Malphettes M, Vignon M, de Masson A, Bagot M, Rybojad M, Asli B, Arnulf B, Bouaziz JD. A rare case of disseminated skin and mucosal necrobiotic xanthogranuloma and xanthoma. J Eur Acad Dermatol Venereol 2016; 31:e3-e5. [PMID: 26810089 DOI: 10.1111/jdv.13577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M AlGain
- Department of Dermatology, Saint-Louis Hospital, Paris, France.,Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France
| | - R Szalat
- Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France.,Department of Clinical Immunology, Saint-Louis Hospital, Paris, France.,Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale, Paris, France
| | - M D Vignon-Pennamen
- Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France.,Department of Clinical Immunology, Saint-Louis Hospital, Paris, France.,Department of Pathology, Saint-Louis Hospital, Paris, France
| | - M Malphettes
- Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France.,Department of Clinical Immunology, Saint-Louis Hospital, Paris, France.,Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale, Paris, France
| | - M Vignon
- Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France.,Department of Clinical Immunology, Saint-Louis Hospital, Paris, France.,Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale, Paris, France
| | - A de Masson
- Department of Dermatology, Saint-Louis Hospital, Paris, France.,Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France
| | - M Bagot
- Department of Dermatology, Saint-Louis Hospital, Paris, France.,Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France
| | - M Rybojad
- Department of Dermatology, Saint-Louis Hospital, Paris, France.,Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France.,Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale, Paris, France
| | - B Asli
- Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France.,Department of Clinical Immunology, Saint-Louis Hospital, Paris, France.,Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale, Paris, France
| | - B Arnulf
- Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France.,Department of Clinical Immunology, Saint-Louis Hospital, Paris, France.,Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale, Paris, France
| | - J-D Bouaziz
- Department of Dermatology, Saint-Louis Hospital, Paris, France.,Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France.,Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale, Paris, France
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46
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Glavey SV, Leung N. Monoclonal gammopathy: The good, the bad and the ugly. Blood Rev 2015; 30:223-31. [PMID: 26732417 DOI: 10.1016/j.blre.2015.12.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 12/04/2015] [Accepted: 12/08/2015] [Indexed: 12/13/2022]
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) is a condition characterized by the presence of a monoclonal gammopathy (MG) in which the clonal mass has not reached a predefined state in which the condition is considered malignant. It is a precursor to conditions such as multiple myeloma or lymphoma at a rate of ~1%/year. Thus, from a hematologic standpoint, MGUS is a fairly benign condition. However, it is now recognized that organ damage resulting from just the MG without the need MM or lymphoma can occur. One of the most recognized is nephropathy secondary to monoclonal gammopathy of renal significance (MGRS). Other well-recognized conditions include neuropathies, oculopathies and dermopathies. Some conditions such as autoimmune diseases and coagulopathies are less common and recognized. Finally, systemic involvement of multiple organs is well described in several entities. In all of these conditions, the role of the MG is no longer insignificant. Thus, the term MGUS should be avoided when describing these entities.
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Affiliation(s)
- Siobhan V Glavey
- Department of Hematology, National University of Ireland, Galway, Ireland
| | - Nelson Leung
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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Zinoun M, Hali F, Marnissi F, Lazaar S, Benchikhi H. [Xanthoma disseminatum with asymptomatic multisystem involvement]. Ann Dermatol Venereol 2015; 142:276-80. [PMID: 25626620 DOI: 10.1016/j.annder.2014.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 10/04/2014] [Accepted: 11/13/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Xanthogranulomas belong to non-Langerhans histiocytosis of the second group in the Histiocyte Society classification. They comprise a heterogeneous group of rare entities frequently involving cutaneous tropism. Xanthoma disseminatum belongs to this group of non-Langerhans histiocytosis. We report a case of xanthoma disseminatum (XD) in which localized skin and mucous impairment revealed multisystem involvement. PATIENTS AND METHODS A 28-year-old man presented with a two-year history of progressive yellow-orange and infiltrated xanthomatous papulonodular lesions of the face. Lesions of the oral mucosa and genital region were seen, with no functional repercussions. No ophthalmic or other complications were found. Histopathology showed a dense histiocytic infiltrate within the dermis with Touton giant cells, foamy multinucleated giant cells and inflammatory cells, without necrobiosis. Histiocytes were positive for CD68 but negative for CD1a. Gastric and lung involvement was seen and was confirmed at histology. Bone scintigraphy showed suspicious left ulnar hyperfixation suggesting bone involvement. No monoclonal gammopathy or diabetes insipidus was seen. Our patient was treated with corticosteroids 1mg/kg/day and thalidomide 100 mg/day. The outcome was marked by regression and exfiltration of the cutaneous lesions from the second week of treatment, with subsidence continuing at 3 months. DISCUSSION This case involves a very rare form of xanthoma disseminatum. The localized facial skin lesions revealed multifocal non-Langerhans histiocytosis that was in fact asymptomatic. The diagnosis of XD was based on clinical, histological and immunohistochemical criteria. Xanthoma disseminatum is a non-Langerhans histiocytic proliferation first described by Montgomery in 1938. This rare entity is characterized by skin and mucous membrane xanthomatosis in which the facial involvement is common, together with diabetes insipidus and normal lipid metabolism. The prognosis is determined by the presence of mucosal xanthomas and visceral involvement. Thus, all xanthogranulomas involving multiple lesions warrant screening for visceral involvement. Diagnosis of this entity can be difficult and is usually based on clinical and histopathological findings. In addition, treatment is complex and non-consensual.
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Affiliation(s)
- M Zinoun
- Service de dermatologie-vénéréologie, CHU Ibn Rochd, 1, quartier des Hôpitaux, Casablanca, Maroc.
| | - F Hali
- Service de dermatologie-vénéréologie, CHU Ibn Rochd, 1, quartier des Hôpitaux, Casablanca, Maroc
| | - F Marnissi
- Service d'anatomopathologie, CHU Ibn Rochd, 1, quartier des Hôpitaux, Casablanca, Maroc
| | - S Lazaar
- Service de radiologie, CHU Ibn Rochd, 1, quartier des Hôpitaux, Casablanca, Maroc
| | - H Benchikhi
- Service de dermatologie-vénéréologie, CHU Ibn Rochd, 1, quartier des Hôpitaux, Casablanca, Maroc
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Szalat R, Pirault J, Fermand JP, Carrié A, Saint-Charles F, Olivier M, Robillard P, Frisdal E, Villard EF, Cathébras P, Bruckert E, Chapman MJ, Giral P, Guerin M, Lesnik P, Le Goff W. Physiopathology of necrobiotic xanthogranuloma with monoclonal gammopathy. J Intern Med 2014; 276:269-84. [PMID: 24428816 PMCID: PMC4279948 DOI: 10.1111/joim.12195] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
RATIONALE Xanthomatosis associated with monoclonal gammopathy includes hyperlipidaemic xanthoma (HX), normolipidaemic xanthoma (NX) and necrobiotic xanthogranuloma (NXG). All three pathologies are characterized by skin or visceral lesions related to cholesterol accumulation, monoclonal immunoglobulin (MIg) and hypocomplementemia. The pathophysiology underlying NXG remains unknown although the involvement of MIg is suspected. OBJECTIVE To provide further insights into the pathophysiology of NXG, we evaluated the plasma lipid phenotype, mechanisms involved in cellular cholesterol accumulation and role of MIg in an analysis of blood and plasma markers of inflammation in 16 patients with xanthomatosis [NXG (n = 8) and NX (n = 8)] associated with monoclonal IgG relative to the relevant controls. RESULTS The lipid profile of patients with NXG was characterized by a low HDL-C phenotype and an abnormal distribution of HDL particles. Sera from patients with NXG induced cholesterol accumulation in human macrophages. This accumulation was due in part to a significant reduction in the HDL capacity to promote cholesterol efflux from macrophages, which was not found in the case of NX. The MIg of NXG and NX patients was tested positively by ELISA to recognize a large spectrum of lipoproteins. High plasma levels of pro-inflammatory cytokines (TNFα and IL-6), soluble cytokine receptors (sIL-6R, sTNFRI and sTNFRII), adhesion molecules (VCAM-1 and ICAM-1) and chemokines (MCP-1, IL-8 and MIP-1α) were observed in both patients with NXG and NX, revealing a specific xanthoma inflammatory signature which was inversely correlated with plasma levels of anti-inflammatory HDL. However, patients with NXG were distinguished by elevated levels of IL-15 and a marked increase in the rate of intermediate CD14++CD16+ monocytes. CONCLUSION This study revealed that NXG is characterized by impaired macrophage lipid homeostasis associated with a systemic inflammatory profile that may result from the interaction of MIg and lipoproteins.
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Affiliation(s)
- R Szalat
- Département d'immunologie Clinique, Hôpital Saint Louis, Paris, France; EA3963, Université Paris 7 Denis Diderot, INSERM, IFR105, Institut Universitaire d'Hématologie, Paris, France
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Adult Orbital Xanthogranuloma Successfully Treated with Rituximab. Ophthalmology 2014; 121:1664-5.e1-3. [DOI: 10.1016/j.ophtha.2014.02.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 01/25/2014] [Accepted: 02/20/2014] [Indexed: 11/23/2022] Open
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Liszewski W, Wisniewski JD, Safah H, Boh EE. Treatment of refractory necrobiotic xanthogranulomas with extracorporeal photopheresis and intravenous immunoglobulin. Dermatol Ther 2014; 27:268-71. [DOI: 10.1111/dth.12135] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Walter Liszewski
- Tulane University School of Medicine; Tulane University; New Orleans Louisiana
| | | | - Hana Safah
- Division of Hematology and Medical Oncology; Tulane University; New Orleans Louisiana
| | - Erin E. Boh
- Department of Dermatology; Tulane University; New Orleans Louisiana
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