1
|
Yuan CY, Zhang ZR, Guo MF, Zhang N. Recurrent multisystem Langerhans cell histiocytosis involving the female genitalia: A case report. World J Clin Cases 2024; 12:6222-6229. [DOI: 10.12998/wjcc.v12.i28.6222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 05/20/2024] [Accepted: 06/20/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a histiocytic proliferative disease caused by clonal proliferation of Langerhans cells, which is currently defined as an inflammatory myeloid tumor. It is rare in adults, with an incidence of 1–2 per million, and is highly heterogeneous in clinical presentation, with unpredictable disease progression and outcome.
CASE SUMMARY A 52-year-old postmenopausal female patient presented to the gynecology department in July 2023 with bilateral vulvar masses. She was diagnosed with recurrent multisystem LCH. The patient had previously been diagnosed with a single-system and single-focal LCH in October 2021 due to a right maxillofacial mass, which resolved after surgical treatment. A chemotherapy regimen was developed after multidisciplinary consultation. Six cycles of chemotherapy resulted in partial remission, and maintenance chemotherapy is currently being administered.
CONCLUSION Recurrent LCH involving the bilateral vulva has been poorly reported. Comprehensive imaging and pathological evaluation is important for diagnosis. The model of joint multidisciplinary specialist diagnosis and treatment is worthy of clinical application.
Collapse
Affiliation(s)
- Chun-Yan Yuan
- Department of Gynaecology, Fengdu People's Hospital, Chongqing 408200, China
| | - Zhi-Rong Zhang
- Department of Gynaecology, Fengdu People's Hospital, Chongqing 408200, China
| | - Ming-Fang Guo
- Department of Gynecologic Oncology, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing 400030, China
| | - Na Zhang
- Department of Gynecologic Oncology, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing 400030, China
| |
Collapse
|
2
|
Aswani Y, Patel A, Zhan X, Ansari S, Marcelino LG, Aswani N, Patel DD, Kandemirli S, Averill S, Bhatt S. Imaging in Erdheim-Chester Disease. Radiographics 2024; 44:e240011. [PMID: 39172709 DOI: 10.1148/rg.240011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
Erdheim-Chester disease (ECD) is a rare, multisystemic, inflammatory, non-Langerhans cell histiocytic neoplasm. The discovery of recurrent and somatic mutations in the mitogen-activated protein kinase signaling pathway, most commonly BRAFV600E, has led to a reclassification of ECD from an inflammatory disorder to a neoplastic process. It is now included in the revised 2016 World Health Organization classification of hematopoietic tumors and in the Langerhans group in the revised 2016 Histiocytosis Classification of the Histiocyte Society. When symptomatic, ECD most commonly manifests with bone pain and fatigue. Also, neurologic manifestations, central diabetes insipidus, exophthalmos, and periorbital xanthelasma-like lesions are frequently encountered. Pathologic findings may vary depending on the site of biopsy and may display a spectrum of features. Thus, due to the diverse clinical presentation and variable histologic findings, imaging can often show the first sign of the disease. Radiologic findings are, however, interpreted in conjunction with clinical and histologic findings to establish the diagnosis of ECD. From providing classic findings that facilitate diagnosis to helping radiologists determine the extent of disease and predicting a prognosis, the role of radiology in ECD has evolved with the understanding of the disease itself. Insights into the molecular pathogenesis and the development of targeted therapeutic agents along with approval of vemurafenib and cobimetinib have necessitated revision of the guidelines for the management of ECD. The authors discuss various radiologic findings of ECD and differential diagnoses by using an organ system-based approach and briefly describe the revised consensus recommendations for evaluation, diagnosis, and treatment based on the International Medical Symposia on ECD from a radiologist's perspective. ©RSNA, 2024 Supplemental material is available for this article. The full digital presentation is available online.
Collapse
Affiliation(s)
- Yashant Aswani
- From the Department of Radiology, University of Iowa Hospitals & Clinics, 200 Hawkins Dr, 3882 John Pappajohn Pavilion, Iowa City, IA 52242 (Y.A., A.P., X.Z., S.K., S. Averill); Department of Radiology, Rush University Medical Center, Chicago, Ill (S. Ansari); Department of Radiology, Radiology Institute of University of São Paulo, São Paulo, Brazil (L.G.M.); Department of Neurology, Geetanjali Medical College and Hospital, Udaipur, India (N.A.); Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India (D.D.P.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Aditi Patel
- From the Department of Radiology, University of Iowa Hospitals & Clinics, 200 Hawkins Dr, 3882 John Pappajohn Pavilion, Iowa City, IA 52242 (Y.A., A.P., X.Z., S.K., S. Averill); Department of Radiology, Rush University Medical Center, Chicago, Ill (S. Ansari); Department of Radiology, Radiology Institute of University of São Paulo, São Paulo, Brazil (L.G.M.); Department of Neurology, Geetanjali Medical College and Hospital, Udaipur, India (N.A.); Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India (D.D.P.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Xin Zhan
- From the Department of Radiology, University of Iowa Hospitals & Clinics, 200 Hawkins Dr, 3882 John Pappajohn Pavilion, Iowa City, IA 52242 (Y.A., A.P., X.Z., S.K., S. Averill); Department of Radiology, Rush University Medical Center, Chicago, Ill (S. Ansari); Department of Radiology, Radiology Institute of University of São Paulo, São Paulo, Brazil (L.G.M.); Department of Neurology, Geetanjali Medical College and Hospital, Udaipur, India (N.A.); Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India (D.D.P.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Shehbaz Ansari
- From the Department of Radiology, University of Iowa Hospitals & Clinics, 200 Hawkins Dr, 3882 John Pappajohn Pavilion, Iowa City, IA 52242 (Y.A., A.P., X.Z., S.K., S. Averill); Department of Radiology, Rush University Medical Center, Chicago, Ill (S. Ansari); Department of Radiology, Radiology Institute of University of São Paulo, São Paulo, Brazil (L.G.M.); Department of Neurology, Geetanjali Medical College and Hospital, Udaipur, India (N.A.); Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India (D.D.P.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Leonardo Gomes Marcelino
- From the Department of Radiology, University of Iowa Hospitals & Clinics, 200 Hawkins Dr, 3882 John Pappajohn Pavilion, Iowa City, IA 52242 (Y.A., A.P., X.Z., S.K., S. Averill); Department of Radiology, Rush University Medical Center, Chicago, Ill (S. Ansari); Department of Radiology, Radiology Institute of University of São Paulo, São Paulo, Brazil (L.G.M.); Department of Neurology, Geetanjali Medical College and Hospital, Udaipur, India (N.A.); Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India (D.D.P.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Nishant Aswani
- From the Department of Radiology, University of Iowa Hospitals & Clinics, 200 Hawkins Dr, 3882 John Pappajohn Pavilion, Iowa City, IA 52242 (Y.A., A.P., X.Z., S.K., S. Averill); Department of Radiology, Rush University Medical Center, Chicago, Ill (S. Ansari); Department of Radiology, Radiology Institute of University of São Paulo, São Paulo, Brazil (L.G.M.); Department of Neurology, Geetanjali Medical College and Hospital, Udaipur, India (N.A.); Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India (D.D.P.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Dhrumil Deveshkumar Patel
- From the Department of Radiology, University of Iowa Hospitals & Clinics, 200 Hawkins Dr, 3882 John Pappajohn Pavilion, Iowa City, IA 52242 (Y.A., A.P., X.Z., S.K., S. Averill); Department of Radiology, Rush University Medical Center, Chicago, Ill (S. Ansari); Department of Radiology, Radiology Institute of University of São Paulo, São Paulo, Brazil (L.G.M.); Department of Neurology, Geetanjali Medical College and Hospital, Udaipur, India (N.A.); Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India (D.D.P.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Sedat Kandemirli
- From the Department of Radiology, University of Iowa Hospitals & Clinics, 200 Hawkins Dr, 3882 John Pappajohn Pavilion, Iowa City, IA 52242 (Y.A., A.P., X.Z., S.K., S. Averill); Department of Radiology, Rush University Medical Center, Chicago, Ill (S. Ansari); Department of Radiology, Radiology Institute of University of São Paulo, São Paulo, Brazil (L.G.M.); Department of Neurology, Geetanjali Medical College and Hospital, Udaipur, India (N.A.); Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India (D.D.P.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Sarah Averill
- From the Department of Radiology, University of Iowa Hospitals & Clinics, 200 Hawkins Dr, 3882 John Pappajohn Pavilion, Iowa City, IA 52242 (Y.A., A.P., X.Z., S.K., S. Averill); Department of Radiology, Rush University Medical Center, Chicago, Ill (S. Ansari); Department of Radiology, Radiology Institute of University of São Paulo, São Paulo, Brazil (L.G.M.); Department of Neurology, Geetanjali Medical College and Hospital, Udaipur, India (N.A.); Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India (D.D.P.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Shweta Bhatt
- From the Department of Radiology, University of Iowa Hospitals & Clinics, 200 Hawkins Dr, 3882 John Pappajohn Pavilion, Iowa City, IA 52242 (Y.A., A.P., X.Z., S.K., S. Averill); Department of Radiology, Rush University Medical Center, Chicago, Ill (S. Ansari); Department of Radiology, Radiology Institute of University of São Paulo, São Paulo, Brazil (L.G.M.); Department of Neurology, Geetanjali Medical College and Hospital, Udaipur, India (N.A.); Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India (D.D.P.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| |
Collapse
|
3
|
Correia Marques M, Ombrello MJ, Schulert GS. New discoveries in the genetics and genomics of systemic juvenile idiopathic arthritis. Expert Rev Clin Immunol 2024; 20:1053-1064. [PMID: 38641907 PMCID: PMC11303111 DOI: 10.1080/1744666x.2024.2345868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/17/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION Systemic juvenile idiopathic arthritis (sJIA) is a severe inflammatory condition with onset in childhood. It is sporadic, but elements of its stereotypical innate immune responses are likely genetically encoded by both common variants with small effect sizes and rare variants with larger effects. AREAS COVERED Genomic investigations have defined the unique genetic architecture of sJIA. Identification of the class II HLA locus as the strongest sJIA risk factor for the first time brought attention to T lymphocytes and adaptive immune mechanisms in sJIA. The importance of the human leukocyte antigen (HLA) locus was reinforced by recognition that HLA-DRB1*15 alleles are strongly associated with development of drug reactions and sJIA-associated lung disease (sJIA-LD). At the IL1RN locus, genetic variation relates to both risk of sJIA and may also predict non-response to anakinra. Finally, rare genetic variants may have critical roles in disease complications, such as homozygous LACC1 mutations in families with an sJIA-like illness, and hemophagocytic lymphohistiocytosis (HLH) gene variants in some children with macrophage activation syndrome (MAS). EXPERT OPINION Genetic and genomic analysis of sJIA holds great promise for both basic discovery of the course and complications of sJIA, and may help guide personalized medicine and therapeutic decision-making.
Collapse
Affiliation(s)
- Mariana Correia Marques
- Translational Genetics and Genomics Section, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, USA
| | - Michael J Ombrello
- Translational Genetics and Genomics Section, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, USA
| | - Grant S Schulert
- Division of Rheumatology, Cincinnati Children's Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
4
|
Xiang Z. Lesion on the right temporal region. Int J Dermatol 2024. [PMID: 39169504 DOI: 10.1111/ijd.17450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 07/30/2024] [Accepted: 08/06/2024] [Indexed: 08/23/2024]
Affiliation(s)
- Zhang Xiang
- Department of Dermatology, Second Affiliated Hospital of Wannan Medical College, Wuhu, China
| |
Collapse
|
5
|
Wongpattaraworakul W, Krongbaramee T, Lanzel EA, Hellstein JW, Teixeira FB. Hematolymphoid neoplasm mimicking endodontic lesions: case series and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2024:S2212-4403(24)00406-1. [PMID: 39179451 DOI: 10.1016/j.oooo.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/16/2024] [Accepted: 07/20/2024] [Indexed: 08/26/2024]
Abstract
Hematolymphoid neoplasms originating in the periapical region of a tooth are rare occurrences. Their signs, symptoms, and radiographic findings can also mimic lesions of endodontic origin. History-taking and clinical examination provide clues to determine the possibility of a non-endodontic lesion, although the definitive diagnosis can only be rendered based on histologic examination. In our case series, we present four cases of hematolymphoid neoplasms that radiographically mimicked endodontic lesions. All the cases initially underwent endodontic treatment, but the lesions failed to resolve. In one case, the clinician suspected a diagnosis of lymphoma based on the patient's history. In the other cases, the clinicians' impression was that the lesions originated from endodontic issues. We present two cases of diffuse large B-cell lymphoma, a case of a plasma cell neoplasm, and a case of Langerhans cell histiocytosis, along with a literature review of three entities when found in the oral cavity as well as review of hematolymphoid neoplasm mimicking endodontic lesion previously reported in literature.
Collapse
Affiliation(s)
- Wattawan Wongpattaraworakul
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA; Division of Oral Diagnostic Sciences, Faculty of Dentistry, Thammasat University, Pathumthani, Thailand
| | - Tadkamol Krongbaramee
- Division of Endodontics, Department of Restorative Dentistry & Periodontology, Chiang Mai University, Chiang Mai, Thailand
| | - Emily A Lanzel
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA
| | - John W Hellstein
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA
| | - Fabricio B Teixeira
- Department of Endodontics, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA.
| |
Collapse
|
6
|
Detiger SE, Paridaens D, Kemps PG, van Halteren AGS, van Hagen PM, van Laar JAM, Verdijk RM. Histological evidence of MAPK pathway activation across subtypes of adult orbital xanthogranulomatous disease irrespective of the detection of oncogenic mutations. Clin Immunol 2024; 265:110299. [PMID: 38936524 DOI: 10.1016/j.clim.2024.110299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/19/2024] [Accepted: 06/21/2024] [Indexed: 06/29/2024]
Abstract
Adult orbital xanthogranulomatous disease (AOXGD) is a spectrum of histiocytoses with four subtypes. Mitogen-activated protein kinase (MAPK) pathway mutations have been detected in various histiocytic neoplasms, little is known about this in AOXGD. Targeted regions of cancer- and histiocytosis-related genes were analyzed and immunohistochemical staining of phosphorylated ERK (pERK), cyclin D1 and PU.1 was performed in 28 AOXGD and 10 control xanthelasma biopsies to assess MAPK pathway activation. Mutations were detected in 7/28 (25%) patients. Positive staining for pERK and/or cyclin D1 was found across all subtypes in 17/27 (63%) patients of whom 12/17 (71%) did not harbour a mutation. Xanthelasma tissue stained negative for pERK and cyclin D1. Relapse occurred in 5/7 (71%) patients with a MAPK pathway mutation compared to 8/21 (38%) patients in whom no mutation could be detected. Molecular analysis and evaluation for systemic disease is warranted to identify patients at risk of recurrent xanthomatous disease.
Collapse
Affiliation(s)
- S E Detiger
- The Rotterdam Eye Hospital, Rotterdam, the Netherlands
| | - D Paridaens
- The Rotterdam Eye Hospital, Department of Oculoplastic, Orbital and Lacrimal Surgery, Rotterdam, the Netherlands; Department of Ophthalmology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - P G Kemps
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - A G S van Halteren
- Department of Internal Medicine, section Clinical Immunology & Allergology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; On behalf of the HOVON Histiocytic and Lymphocytic Diseases Working Group
| | - P M van Hagen
- Department of Internal Medicine, section Clinical Immunology & Allergology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Immunology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J A M van Laar
- Department of Internal Medicine, section Clinical Immunology & Allergology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Immunology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands; On behalf of the HOVON Histiocytic and Lymphocytic Diseases Working Group
| | - R M Verdijk
- The Rotterdam Eye Hospital, Rotterdam, the Netherlands; Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands; Department of Pathology, section Ophthalmic Pathology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.
| |
Collapse
|
7
|
Riddle N, Parkash V, Guo CC, Shen SS, Perincheri S, Ramirez AS, Auerbach A, Belchis D, Humphrey PA. Recent Advances in Genitourinary Tumors: Updates From the 5th Edition of the World Health Organization Blue Book Series. Arch Pathol Lab Med 2024; 148:952-964. [PMID: 38031818 DOI: 10.5858/arpa.2022-0509-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 12/01/2023]
Abstract
CONTEXT.— Urinary and Male Genital Tumours is the 8th volume of the World Health Organization Classification of Tumours series, 5th edition. Released in hard copy in September 2022, it presents an update to the classification of male genital and urinary tumors in the molecular age. Building upon previous volumes in this series, significant effort has been made to harmonize terminology across organ systems for biologically similar tumors (eg, neuroendocrine tumors). Genomic terminology has been standardized and genetic syndromes covered more comprehensively. This review presents a concise summary of this volume, highlighting new entities, notable modifications relative to the 4th edition, and elements of relevance to routine clinical practice. OBJECTIVE.— To provide a comprehensive update on the World Health Organization classification of urinary and male genital tumors, highlighting updated diagnostic criteria and terminology. DATA SOURCES.— The 4th and 5th editions of the World Health Organization Classification of Tumours: Urinary and Male Genital Tumours. CONCLUSIONS.— The World Health Organization has made several changes in the 5th edition of the update on urinary and male genital tumors that pathologists need to be aware of for up-to-date clinical practice.
Collapse
Affiliation(s)
- Nicole Riddle
- From the Department of Pathology, Tampa General Hospital, Tampa, Florida (Riddle)
- Pathology and Laboratory Medicine, Ruffolo, Hooper, and Associates, University of South Florida Health, Tampa (Riddle)
| | - Vinita Parkash
- the Department of Pathology, Yale University School of Medicine, New Haven, Connecticut (Parkash, Perincheri, Humphrey)
| | - Charles C Guo
- the Department of Pathology, University of Texas MD Anderson Cancer Center, Houston (Guo)
| | - Steven S Shen
- the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Shen)
| | - Sudhir Perincheri
- the Department of Pathology, Yale University School of Medicine, New Haven, Connecticut (Parkash, Perincheri, Humphrey)
| | | | - Aaron Auerbach
- the Department of Hematopathology, The Joint Pathology Center, Silver Spring, Maryland (Auerbach)
| | - Deborah Belchis
- the Department of Pathology, Luminis Health, Baltimore, Maryland (Belchis)
| | - Peter A Humphrey
- the Department of Pathology, Yale University School of Medicine, New Haven, Connecticut (Parkash, Perincheri, Humphrey)
| |
Collapse
|
8
|
Chalard F, Nguyen T, Morel B, Leiber LM, Roux CJ, Petit P, Soto Ares G, Donadieu J, Ducou le Pointe H. Juvenile Xanthogranuloma of the Head and Neck: Imaging Findings in 11 Cases. J Pediatr Hematol Oncol 2024; 46:e368-e380. [PMID: 38832444 PMCID: PMC11268553 DOI: 10.1097/mph.0000000000002872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 04/01/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Juvenile Xanthogranuloma (JXG) is a non-Langerhans cell histiocytosis, occurring mainly in infancy. With an extracutaneous lesion, its diagnosis is difficult, because of a wide clinical spectrum. Here we demonstrate and characterize imaging features of 11 patients with JXG of the head and neck in various locations. MATERIAL AND METHODS We recorded clinical data and reviewed all imaging studies of 11 patients with JXG of the head and neck. Ultrasonography (US) alone was performed in 1 patient; MRI alone in 6 patients; US and MRI in 1 patient; and US, CT, and MRI in 3 patients. We evaluated the following characteristics in all studies: location and number of lesions, echogenicity and vascularization on US, density on CT, signal intensity on T 1 - and T 2 -weighted images, ADC and enhancement on MRI, and tumor boundaries and bone involvement. RESULTS Lesions were well-defined in 9 cases, and bone erosion was present in 2. On US, lesions were hypoechoic or hyperechoic and with or without vascularization. On CT, lesions were hyper-dense, with no calcification. On MRI, lesions were mildly hyper-intense or iso-intense on T 1 -weighted images in 8 of 9 patients, hypo-intense on T2-weighted images in 7 of 10, low ADC in 7 of 9, and enhancement in 7 of 7. CONCLUSIONS The diagnosis of extra cutaneous JXG may be proposed, with the following suggestive criteria: age < 1 year, well-defined lesion, mild hyper-intensity on T 1 -weighted images, hypo-intensity on T 2 -weighted images, low ADC, enhancement, and possible adjacent bone involvement.
Collapse
Affiliation(s)
| | - Toan Nguyen
- Radiologie pédiatrique, hôpital Armand Trousseau, Paris
| | - Baptiste Morel
- Radiologie pédiatrique, hôpital Gatien de Clocheville, Tours
| | | | | | - Philippe Petit
- Radiologie pédiatrique, hôpital de la Timone Enfants, Marseille
| | | | - Jean Donadieu
- Onco-hématologie pédiatrique, hôpital Armand Trousseau, Paris, France
| | | |
Collapse
|
9
|
Vicario R, Fragkogianni S, Pokrovskii M, Mayer C, Lopez-Rodrigo E, Hu Y, Ogishi M, Alberdi A, Baako A, Ay O, Plu I, Sazdovitch V, Heritier S, Cohen-Aubart F, Shor N, Miyara M, Nguyen-Khac F, Viale A, Idbaih A, Amoura Z, Rosenblum MK, Zhang H, Karnoub ER, Sashittal P, Jakatdar A, Iacobuzio-Donahue CA, Abdel-Wahab O, Tabar V, Socci ND, Elemento O, Diamond EL, Boisson B, Casanova JL, Seilhean D, Haroche J, Donadieu J, Geissmann F. Mechanism of neurodegeneration mediated by clonal inflammatory microglia. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.07.30.605867. [PMID: 39131366 PMCID: PMC11312538 DOI: 10.1101/2024.07.30.605867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Langerhans cell Histiocytosis (LCH) and Erdheim-Chester disease (ECD) are clonal myeloid disorders, associated with MAP-Kinase activating mutations and an increased risk of neurodegeneration. Surprisingly, we found pervasive PU.1+ microglia mutant clones across the brain of LCH and ECD patients with and without neurological symptoms, associated with microgliosis, reactive astrocytosis, and neuronal loss. The disease predominated in the grey nuclei of the rhombencephalon, a topography attributable to a local proliferative advantage of mutant microglia. Presence of clinical symptoms was associated with a longer evolution of the disease and a larger size of PU.1+ clones (p= 0.0003). Genetic lineage tracing of PU.1+ clones suggest a resident macrophage lineage or a bone marrow precursor origin depending on patients. Finally, a CSF1R-inhibitor depleted mutant microglia and limited neuronal loss in mice suggesting an alternative to MAPK inhibitors. These studies characterize a progressive neurodegenerative disease, caused by clonal proliferation of inflammatory microglia (CPIM), with a decade(s)-long preclinical stage of incipient disease that represent a therapeutic window for prevention of neuronal death.
Collapse
Affiliation(s)
- Rocio Vicario
- Immunology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York 10065, USA
| | - Stamatina Fragkogianni
- Immunology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York 10065, USA
| | - Maria Pokrovskii
- Immunology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York 10065, USA
| | - Carina Mayer
- Immunology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York 10065, USA
| | - Estibaliz Lopez-Rodrigo
- Immunology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York 10065, USA
| | - Yang Hu
- Department of Physiology and Biophysics, Institute for Computational Biomedicine, Weill Cornell New York, NY 10021, USA
| | - Masato Ogishi
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, 10065 NY, USA
| | - Araitz Alberdi
- Immunology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York 10065, USA
| | - Ann Baako
- Immunology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York 10065, USA
| | - Oyku Ay
- Immunology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York 10065, USA
| | - Isabelle Plu
- Department of Neuropathology, Pitié-Salpêtrière Hospital, APHP-Sorbonne Université, Paris, France
| | - Véronique Sazdovitch
- Department of Neuropathology, Pitié-Salpêtrière Hospital, APHP-Sorbonne Université, Paris, France
| | - Sebastien Heritier
- French Langerhans cell histiocytosis registry, Department of Pediatric Hematology and Oncology, Trousseau Hospital, AP-HP, Paris, France
| | - Fleur Cohen-Aubart
- Department of Internal Medicine & Institut E3M, Pitié-Salpêtrière Hospital, APHP-Sorbonne Université, Paris, France
| | - Natalia Shor
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, APHP-Sorbonne Université, Paris, France
| | - Makoto Miyara
- Center for Immunology and Infectious Diseases (CIMI-PARIS), Pitié-Salpêtrière Hospital, APHP-Sorbonne Université, Paris, France
| | - Florence Nguyen-Khac
- Department of Hematology, Pitié-Salpêtrière Hospital, APHP-Sorbonne Université, Paris, France
| | - Agnes Viale
- Marie-Josée & Henry R. Kravis Center for Molecular Oncology, MSKCC, New York, New York 10065, USA
| | - Ahmed Idbaih
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, F-75013, Paris, France
| | - Zahir Amoura
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, APHP-Sorbonne Université, Paris, France
| | | | - Haochen Zhang
- Human Oncology and Pathogenesis Program, MSKCC, New York, NY, USA)
| | | | | | | | - Christine A. Iacobuzio-Donahue
- Department of Pathology, MSKCC, New York, New York 10065, USA
- Human Oncology and Pathogenesis Program, MSKCC, New York, NY, USA)
| | - Omar Abdel-Wahab
- Human Oncology and Pathogenesis Program, MSKCC, New York, NY, USA)
| | - Viviane Tabar
- Department of Neurosurgery, and Center for Stem Cell Biology, MSKCC, New York, NY, USA
- Department of Neurology, MSKCC, New York, New York 10065, USA
| | - Nicholas D. Socci
- Marie-Josée & Henry R. Kravis Center for Molecular Oncology, MSKCC, New York, New York 10065, USA
| | - Olivier Elemento
- Department of Physiology and Biophysics, Institute for Computational Biomedicine, Weill Cornell New York, NY 10021, USA
| | - Eli L Diamond
- Department of Neurosurgery, and Center for Stem Cell Biology, MSKCC, New York, NY, USA
| | - Bertrand Boisson
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, 10065 NY, USA
| | - Jean-Laurent Casanova
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, 10065 NY, USA
| | - Danielle Seilhean
- Department of Neuropathology, Pitié-Salpêtrière Hospital, APHP-Sorbonne Université, Paris, France
| | - Julien Haroche
- Department of Internal Medicine & Institut E3M, Pitié-Salpêtrière Hospital, APHP-Sorbonne Université, Paris, France
| | - Jean Donadieu
- French Langerhans cell histiocytosis registry, Department of Pediatric Hematology and Oncology, Trousseau Hospital, AP-HP, Paris, France
| | - Frederic Geissmann
- Immunology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York 10065, USA
| |
Collapse
|
10
|
M’hango H, Chirwa U, Muhimba Z, Chilufya R, Mulopwe J, Mumba C, Mpabalwani E. An Unusual Cause of Lymphadenopathy: Rosai Dorfman Disease in a 7-Year-Old Female Zambian Child: Case Report and Literature Review. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2024; 17:11795476241265279. [PMID: 39086600 PMCID: PMC11289797 DOI: 10.1177/11795476241265279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/11/2024] [Indexed: 08/02/2024]
Abstract
Rosai Dorfman disease (RDD) is a rare non-Langerhans histiocytic disorder, which belongs to the R group of the 2016 revised histiocytic classification. It's characterized by the accumulation of activated histiocytes in the sinusoids of lymph nodes and/or extranodal tissues. Herein, we report a 7-year-old female who was initially suspected to have a lymphoma but was later identified as having RDD. She presented with a history of fever, night sweats, and weight loss, and on physical examination had bilateral cervical lymphadenopathy. Histologic examination of the biopsied cervical lymph nodes showed distended sinuses with S100 and CD68 immunoreactive histiocytes demonstrating emperipolesis, confirming a diagnosis of RDD. The condition is known to be self-limiting. However, evidence from literature and our case management shows that medical therapy can hasten remission in pediatric cases.
Collapse
Affiliation(s)
- Hellen M’hango
- University Teaching Hospital-Children’s Hospital, Lusaka, Zambia
| | - Uzima Chirwa
- University Teaching Hospital-Children’s Hospital, Lusaka, Zambia
| | - Zoran Muhimba
- Department of Pathology and Microbiology, University Teaching Hospital-Adult Hospitals, Lusaka, Zambia
| | - Rose Chilufya
- University Teaching Hospital-Children’s Hospital, Lusaka, Zambia
| | - Juliet Mulopwe
- University Teaching Hospital-Radiology Department, Adult Hospitals, Lusaka, Zambia
| | - Chibamba Mumba
- Department of Pathology and Microbiology, University Teaching Hospital-Adult Hospitals, Lusaka, Zambia
- Department of Pathology and Microbiology, University of Zambia School of Medicine, Lusaka, Zambia
| | - Evans Mpabalwani
- University Teaching Hospital-Children’s Hospital, Lusaka, Zambia
- Department of Paediatric and Child Health, University of Zambia, School of Medicine, Lusaka, Zambia
| |
Collapse
|
11
|
Chang L, Cai HC, Lang M, Lin H, Luo YP, Duan MH, Zhou DB, Goyal G, Cao XX. Liver involvement with Langerhans cell histiocytosis in adults. Oncologist 2024:oyae175. [PMID: 39066586 DOI: 10.1093/oncolo/oyae175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND AND AIMS Liver involvement portends poor prognosis in adults. We aimed to characterize the clinical features, liver function tests, radiologic findings, molecular profiles, therapeutic approaches and outcomes of adults patients with Langerhans cell histiocytosis (LCH) with liver involvement. METHODS We conducted a retrospective analysis of all adults with LCH (≥ 18 years) seen at Peking Union Medical College Hospital (Beijing, China) between January 2001 and December 2022. RESULTS Among the 445 newly diagnosed adults with LCH, 90 patients had liver involvement at diagnosis and 22 patients at relapse. The median age was 32 years (range, 18-66 years). Of 112 evaluable patients, 108 had full liver function testing, including alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase (ALP), γ-glutamyl transpeptidase (GGT), and total bilirubin and albumin. Elevated ALP was seen in 63.0% and GGT in 86.1%; 14.8% had elevated bilirubin. Next-generation sequencing of 54 patients revealed frequent BRAFN486_P490 (29.6%), BRAFV600E (18.5%), and MAP2K1 (14.8%). OUTCOMES After a median 40 months' follow-up (range 1-168 months), 3-year progression-free survival (PFS) and overall survival were 49.7% and 86.6% respectively. In multivariable analyses, ≥3 abnormal liver function tests (HR 3.384, 95% CI 1.550-7.388, P = .002) associated with inferior PFS; immunomodulatory drug therapy (HR 0.073, 95% CI, 0.010-0.541, P = .010) correlated with superior PFS versus chemotherapy. CONCLUSIONS In summary, elevated GGT and ALP were common in adults with LCH liver involvement. Greater than equal to 3 abnormal liver function tests predicted poor outcomes. Immunomodulatory drug therapy was associated with favorable progression-free survival compared to chemotherapy.
Collapse
Affiliation(s)
- Long Chang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, People's Republic of China
| | - Hua-Cong Cai
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, People's Republic of China
| | - Min Lang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, People's Republic of China
| | - He Lin
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, People's Republic of China
| | - Ya-Ping Luo
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, People's Republic of China
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ming-Hui Duan
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, People's Republic of China
| | - Dao-Bin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, People's Republic of China
| | - Gaurav Goyal
- Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Xin-Xin Cao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, People's Republic of China
| |
Collapse
|
12
|
Lin H, Cao XX. Current State of Targeted Therapy in Adult Langerhans Cell Histiocytosis and Erdheim-Chester Disease. Target Oncol 2024:10.1007/s11523-024-01080-x. [PMID: 38990463 DOI: 10.1007/s11523-024-01080-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/12/2024]
Abstract
The mitogen-activated protein kinase (MAPK) pathway is a key driver in many histiocytic disorders, including Langerhans cell histiocytosis (LCH) and Erdheim-Chester disease (ECD). This has led to successful and promising treatment with targeted therapies, including BRAF inhibitors and MEK inhibitors. Additional novel inhibitors have also demonstrated encouraging results. Nevertheless, there are several problems concerning targeted therapy that need to be addressed. These include, among others, incomplete responsiveness and the emergence of resistance to BRAF inhibition as observed in other BRAF-mutant malignancies. Drug resistance and relapse after treatment interruption remain problems with current targeted therapies. Targeted therapy does not seem to eradicate the mutated clone, leading to inevitable relapes, which is a huge challenge for the future. More fundamental research and clinical trials are needed to address these issues and to develop improved targeted therapies that can overcome resistance and achieve long-lasting remissions.
Collapse
Affiliation(s)
- He Lin
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Xin-Xin Cao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China.
| |
Collapse
|
13
|
Chen Y, Deng H, Zhou R, Jiang X, Wang H, Xin S, Mo W, Wang S, Liu Y. Comprehensive mapping of immune perturbations associated with secondary hemophagocytic lymphohistiocytosis. J Leukoc Biol 2024:qiae138. [PMID: 38973235 DOI: 10.1093/jleuko/qiae138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/02/2024] [Accepted: 06/13/2024] [Indexed: 07/09/2024] Open
Abstract
Secondary hemophagocytic lymphohistiocytosis (sHLH) is a hyperinflammatory syndrome characterized by immune disorders. It is imperative to elucidate the immunophenotypic panorama and the interactions among these cells in patients. Human peripheral blood mononuclear cells were collected from healthy donors and sHLH patients and tested using multicolor flow cytometry. We used FlowSOM to explore and visualize the immunophenotypic characteristics of sHLH. By demonstrating the phenotypes of immune cells, we discovered that sHLH patients had significantly higher levels of CD56+ monocytes, higher levels of myeloid-derived suppressor cells, low-density neutrophil-to-T cell ratio, and higher heterogeneous T cell activation than healthy donors. However, natural killer cell cytotoxicity and function were impaired. We then assessed the correlations among 30 immune cell types and evaluated metabolic analysis. Our findings demonstrated polymorphonuclear myeloid-derived suppressor cells, CD56+ monocytes, and neutrophil-to-T cell ratio were elevated abnormally in sHLH patients, which may indicate an association with immune overactivation and inflammatory response. We are expected to confirm that they are involved in the occurrence of the disease through further in-depth research.
Collapse
Affiliation(s)
- Yinchun Chen
- Department of Hematology, The Second Affiliated Hospital, School of Medicine, South China University of Technology, No. 1 Panfu Road, Guangzhou 510180, China
- Department of Hematology, Guangzhou First People's Hospital, No. 1 Panfu Road, Guangzhou 510180, China
| | - Haimei Deng
- Department of Hematology, The Seventh Affiliated Hospital of Sun Yat-Sen University, No. 628, Zhenyuan Road, Xinhuling Street, Shenzhen 518118, China
| | - Ruiqing Zhou
- Department of Hematology, The Second Affiliated Hospital, School of Medicine, South China University of Technology, No. 1 Panfu Road, Guangzhou 510180, China
- Department of Hematology, Guangzhou First People's Hospital, No. 1 Panfu Road, Guangzhou 510180, China
| | - Xiaotao Jiang
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 16 Airport Road, Guangzhou 510400, China
| | - Huijuan Wang
- Center for Medical Research on Innovation and Translation, Guangzhou First People's Hospital, No. 10 Huan Yu Second Road, Guangzhou 510180, China
| | - Songqing Xin
- Changan Hospital of Dongguan, No. 171 Changqing South Road, Dongguan 523850, China
| | - Wenjian Mo
- Department of Hematology, Guangzhou First People's Hospital, No. 1 Panfu Road, Guangzhou 510180, China
| | - Shunqing Wang
- Department of Hematology, The Second Affiliated Hospital, School of Medicine, South China University of Technology, No. 1 Panfu Road, Guangzhou 510180, China
- Department of Hematology, Guangzhou First People's Hospital, No. 1 Panfu Road, Guangzhou 510180, China
| | - Yufeng Liu
- Department of Hematology, The Second Affiliated Hospital, School of Medicine, South China University of Technology, No. 1 Panfu Road, Guangzhou 510180, China
- Department of Hematology, Guangzhou First People's Hospital, No. 1 Panfu Road, Guangzhou 510180, China
- Center for Medical Research on Innovation and Translation, Guangzhou First People's Hospital, No. 10 Huan Yu Second Road, Guangzhou 510180, China
| |
Collapse
|
14
|
Koh KN, Yoon SH, Kang SH, Kim H, Im HJ. Advancements in the understanding and management of histiocytic neoplasms. Blood Res 2024; 59:22. [PMID: 38963520 PMCID: PMC11224208 DOI: 10.1007/s44313-024-00022-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 06/12/2024] [Indexed: 07/05/2024] Open
Abstract
Histiocytic neoplasms are rare diseases involving macrophages, dendritic cells, and monocytes. They include Langerhans cell histiocytosis (LCH), Erdheim-Chester disease (ECD), Rosai-Dorfman disease (RDD), juvenile xanthogranuloma (JXG), and histiocytic sarcoma. Histiocytic neoplasms are characterized by varied clinical courses and prognoses, necessitating a nuanced understanding of their classification, epidemiology, and clinical manifestations. Genetic studies have revealed somatic mutations, predominantly in the MAPK pathway, suggesting a clonal neoplastic nature. This review covers the current understanding of histiocytic neoplasms, molecular pathophysiology, with a particular focus on mutations in genes such as BRAF, MAP2K1, and the PI3K-AKT signaling pathways, and evolving treatment strategies, especially focusing on LCH, ECD, RDD, and JXG. The treatment landscape has evolved with advancements in targeted therapies. BRAF inhibitors, such as vemurafenib and dabrafenib, have shown efficacy, especially in high-risk LCH cases; however, challenges remain, including relapse post-treatment discontinuation, and adverse effects. MEK inhibitors have also demonstrated effectiveness, and cobimetinib has recently been approved for use in adults. Further research is required to determine the optimal treatment duration and strategies for managing therapy interruptions. Advancements in molecular genetics and targeted therapies have revolutionized the management of histiocytic neoplasms. However, ongoing research is crucial for optimizing patient outcomes.
Collapse
Affiliation(s)
- Kyung-Nam Koh
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Su Hyun Yoon
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Sung Han Kang
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Hyery Kim
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Ho Joon Im
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| |
Collapse
|
15
|
Daifu T, Umeda K, Yokoyama A, Yoshida T, Saida S, Kato I, Hiramatsu H, Kudo K, Higuchi Y, Takita J. Juvenile xanthogranuloma manifesting with LCH-associated neurodegenerative disease-like radiological findings. Pediatr Blood Cancer 2024; 71:e31043. [PMID: 38679849 DOI: 10.1002/pbc.31043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/05/2024] [Accepted: 04/12/2024] [Indexed: 05/01/2024]
Abstract
Here, we describe two patients with juvenile xanthogranuloma (JXG) manifesting with Langerhans cell histiocytosis (LCH)-associated neurodegenerative disease (ND)-like radiological findings. One patient showed typical radiological abnormalities at onset, which worsened with progressing central nervous system symptoms 7 years after LCH-oriented chemotherapy. Another showed spontaneous regression of clinical symptoms, with a transient radiological change 1 year after salvage chemotherapy for recurrence of JXG. These data regarding JXG-associated ND will facilitate future investigation of the disease, as well as development of therapeutic interventions.
Collapse
Affiliation(s)
- Tomoo Daifu
- Department of Pediatrics, Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Katsutsugu Umeda
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Atsushi Yokoyama
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Yoshida
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Saida
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Itaru Kato
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hidefumi Hiramatsu
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ko Kudo
- Department of Pediatrics, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yoshihisa Higuchi
- Department of Pediatrics, Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Junko Takita
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
16
|
Kulkarni AM, Gayam PKR, Aranjani JM. Advances in Understanding and Management of Erdheim-Chester Disease. Life Sci 2024; 348:122692. [PMID: 38710283 DOI: 10.1016/j.lfs.2024.122692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/13/2024] [Accepted: 05/03/2024] [Indexed: 05/08/2024]
Abstract
Erdheim Chester Disease (ECD) is a rare histiocytic disorder marked by infiltration of organs with CD68+ histiocytes. ECD stems from mutations of BRAF and MAP2K1 in hematopoietic stem and progenitor cells (HSPCs), which further differentiate into monocytes and histiocytes. Histopathology reveals lipid-containing histiocytes, which test positive for CD68 and CD133 in immunohistochemistry. Signs and symptoms vary and depend on the organ/s of manifestation. Definitive radiological results associated with ECD include hairy kidney, coated aorta, and cardiac pseudotumor. Treatment options primarily include anti-cytokine therapy and inhibitors of BRAF and MEK signaling.
Collapse
Affiliation(s)
- Aniruddha Murahar Kulkarni
- Department of Pharmaceutical Biotechnology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Prasanna Kumar Reddy Gayam
- Department of Pharmaceutical Biotechnology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Jesil Mathew Aranjani
- Department of Pharmaceutical Biotechnology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| |
Collapse
|
17
|
Suster DI, Ronen S, Suster S. Selected Case From the Arkadi M. Rywlin International Pathology Slide Seminar: Involvement of Skin and Soft Tissue by Erdheim-Chester Disease. Adv Anat Pathol 2024; 31:271-274. [PMID: 38180007 DOI: 10.1097/pap.0000000000000429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Erdheim-Chester disease is a rare form of non-Langerhans cell histiocytosis that preferentially involves long bones but can affect a variety of other organs. Initial presentation with extraskeletal involvement is not unusual and is most commonly observed in the central nervous system, heart, retroperitoneum, lungs, and skin. Initial presentation of the disease as a subcutaneous soft tissue mass is exceedingly rare and may pose difficulties for diagnosis. We describe a case of Erdheim-Chester disease that initially presented as a cutaneous and subcutaneous soft tissue mass in the right posterior shoulder of a 52-year-old man.
Collapse
Affiliation(s)
- David I Suster
- Department of Pathology, Rutgers New Jersey Medical School, Newark, NJ
| | - Shira Ronen
- Department of Pathology, Cleveland Clinic Foundation, Cleveland, OH
| | - Saul Suster
- Department of Pathology, Rutgers New Jersey Medical School, Newark, NJ
| |
Collapse
|
18
|
Shin H, Naros A, Kieninger S, Polligkeit J, Fend F, Milla J. [Rare differential diagnosis of an osteolytic lesion of the mandible in a young adult]. PATHOLOGIE (HEIDELBERG, GERMANY) 2024; 45:284-289. [PMID: 38602523 PMCID: PMC11199283 DOI: 10.1007/s00292-024-01321-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/12/2024]
Abstract
We report a rarely occurring hematologic neoplasm in a young adult. Hematologic neoplasms were first described in 2008 and are now included in both accepted tumor classification systems, i.e., International Consensus Classification and World Health Organization. This hematologic neoplasm shows a characteristic ALK positivity in immunohistochemical examination and correspondingly, ALK fusion genes in the molecular analysis. Pathologists should be aware of this entity, particularly as it is challenging to differentiate from other more frequent neoplasms of the same disease group or mesenchymal neoplasm with ALK aberration.
Collapse
Affiliation(s)
- Hyunkyu Shin
- Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Andreas Naros
- Klinik und Poliklinik für Mund‑, Kiefer- und Gesichtschirurgie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Sinja Kieninger
- Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Joachim Polligkeit
- Klinik und Poliklinik für Mund‑, Kiefer- und Gesichtschirurgie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Falko Fend
- Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Jakob Milla
- Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Tübingen, Deutschland.
| |
Collapse
|
19
|
Pegoraro F, Papo M, Cohen-Aubart F, Peyronel F, Lugli G, Trambusti I, Baulier G, de Menthon M, Le Scornet T, Oziol E, Ferreira-Maldent N, Hermine O, Faucher B, Koschel D, Straetmans N, Abisror N, Terrier B, Lifermann F, Razanamahery J, Allenbach Y, Keraen J, Bulifon S, Hervier B, Buccoliero A, Charlotte F, Monzani Q, Boussouar S, Shor N, Tondo A, Barete S, Idbaih A, Tazi A, Sieni E, Amoura Z, Emile JF, Vaglio A, Haroche J. Long-term outcome and prognosis of mixed histiocytosis (Erdheim-Chester disease and Langerhans Cell Histiocytosis). EClinicalMedicine 2024; 73:102658. [PMID: 38841707 PMCID: PMC11152896 DOI: 10.1016/j.eclinm.2024.102658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 06/07/2024] Open
Abstract
Background Erdheim-Chester disease (ECD) is a rare histiocytosis that may overlap with Langerhans Cell Histiocytosis (LCH). This "mixed" entity is poorly characterized. We here investigated the clinical phenotype, outcome, and prognostic factors of a large cohort of patients with mixed ECD-LCH. Methods This retrospective study was performed at two referral centers in France and Italy (Pitié-Salpêtrière Hospital, Paris; Meyer Children's Hospital, Florence). We included children and adults with ECD diagnosed in 2000-2022 who had biopsy-proven LCH, available data on clinical presentation, treatment and outcome, and a minimum follow-up of one year. Outcomes included differences in clinical presentation and survival between mixed ECD-LCH and isolated ECD; we also investigated response to treatments and predictors of survival in the mixed cohort. Survival was analyzed using the Kaplan-Maier method and differences in survival with the long-rank test. Cox regression models were used to evaluate the potential impact of age and gender on survival and to identify predictors of non-response and survival. Findings Out of a cohort of 502 ECD patients, 69 (14%) had mixed ECD-LCH. Compared to isolated ECD, mixed ECD-LCH occurred more frequently in females (51 vs. 26%, p < 0.001) and in patients with multisystem disease (≥4 sites). Mixed ECD-LCH more frequently involved long bones (91 vs. 79%, p = 0.014), central nervous system (51 vs. 34%, p = 0.007), facial/orbit (52 vs. 38%, p = 0.031), lungs (43 vs. 28%, p = 0.009), hypothalamic/pituitary axis (51 vs. 26%, p < 0.001), skin (61 vs. 29%, p < 0.001), and lymph nodes (15 vs. 7%, p = 0.028); the BRAFV600E mutation was also more frequent in mixed ECD-LCH (81 vs. 59%, p < 0.001). Targeted treatments (BRAF and/or MEK inhibitors) induced response more frequently than conventional therapies (interferon-α, chemotherapy), either as first-line (77 vs. 29%, p < 0.001) or as any line (75 vs. 24%, p < 0.001). After a median follow-up of 71 months, 24 patients (35%) died. Survival probability was comparable between ECD alone and mixed ECD-LCH (log-rank p = 0.948). At multivariable analysis, age at diagnosis (HR 1.052, 95% CI 1.008-1.096), associated hematologic conditions (HR 3.030, 95% CI 1.040-8.827), and treatment failure (HR 9.736, 95% CI 2.919-32.481) were associated with an increased risk of death, while lytic bone lesions with a lower risk (HR 0.116, 95% CI 0.031-0.432). Interpretation Mixed ECD-LCH is a multisystem disease driven by the BRAFV600E mutation and targeted treatments are effective. Age at diagnosis, bone lesion patterns, associated hematologic conditions, and treatment failure are the main predictors of death in mixed ECD-LCH. Funding None.
Collapse
Affiliation(s)
- Francesco Pegoraro
- Sorbonne University, Internal Medicine Department 2, Institut E3M, French Reference Centre for Histiocytosis, Pitié-Salpȇtrière Hospital, CIMI INSERM-UMRS 1135, Assistance Publique-Hôpitaux de Paris, Paris, France
- Hematology and Oncology Department, Meyer Children’s Hospital IRCCS, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Matthias Papo
- Sorbonne University, Internal Medicine Department 2, Institut E3M, French Reference Centre for Histiocytosis, Pitié-Salpȇtrière Hospital, CIMI INSERM-UMRS 1135, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fleur Cohen-Aubart
- Sorbonne University, Internal Medicine Department 2, Institut E3M, French Reference Centre for Histiocytosis, Pitié-Salpȇtrière Hospital, CIMI INSERM-UMRS 1135, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Francesco Peyronel
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Nephrology and Dialysis Unit, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Gianmarco Lugli
- Rare Disease Center, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Irene Trambusti
- Hematology and Oncology Department, Meyer Children’s Hospital IRCCS, Florence, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gildas Baulier
- Internal Medicine and Clinical Immunology Department, Périgueux University Hospital, Périgueux, France
| | - Mathilde de Menthon
- Paris-Saclay University, Internal Medicine and Clinical Immunology Department, Bicetre Hospital, Assistance Publique - Hôpitaux de Paris, Le Kremlin Bicêtre, France
| | - Tanguy Le Scornet
- Internal Medicine Department, Hotel Dieu, Nantes University Hospital, Nantes, France
| | - Eric Oziol
- Internal Medicine Department, Béziers Hospital, Béziers, France
| | | | - Olivier Hermine
- Hematology Department, Hôpital Necker - Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benoit Faucher
- Internal Medicine Department, La Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Dirk Koschel
- Internal Medicine and Pneumology Department, Fachkrankenhaus Coswig, Lung Center, Coswig and Medical Department I, Division of Pneumology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Nicole Straetmans
- Hematology Department, University Hospital Saint-Luc, Brussels, Belgium
| | - Noémie Abisror
- Internal Medicine Department, Saint Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benjamin Terrier
- Internal Medicine Department, Referral Center for Rare Autoimmune and Systemic Diseases, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Jerome Razanamahery
- Internal Medicine and Clinical Immunology Department, Dijon University Hospital, Dijon, France
| | - Yves Allenbach
- Internal Medicine Department, Sorbonne University, INSERM UMRS 974, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jeremy Keraen
- Internal Medicine and Immunology Department, Cornouaille Hospital Center, Quimper, France
| | - Sophie Bulifon
- Paris-Saclay University, Faculty of Medicine, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, Le Kremlin-Bicêtre, France
- Respiratory and Intensive Care Medicine Department, Pulmonary Hypertension National Referral Center, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Baptiste Hervier
- Internal Medicine Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Frederic Charlotte
- Pathology Department, Pitié-Salpêtrière Hospital, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Quentin Monzani
- Polyvalent and Oncologic Radiology Department–Musculoskeletal Unit, Pitié-Salpêtrière Hospital, Paris, France
| | - Samia Boussouar
- Cardiovascular and Thoracic Imaging Unit, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Natalia Shor
- Neuro-Radiology Department, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Annalisa Tondo
- Hematology and Oncology Department, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Stephane Barete
- Sorbonne University, Dermatology Unit, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ahmed Idbaih
- Sorbonne University, Neuro-Oncology Department, Paris Brain Institute - ICM, Inserm, CNRS, Pitié-Salpêtrière Hospital, DMU Neurosciences, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Abdellatif Tazi
- UFR de Médecine, Paris Cité University, Paris, France
- INSERM UMR 976 Saint Louis Research Institute, Paris, France
- Pneumology Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Elena Sieni
- Hematology and Oncology Department, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Zahir Amoura
- Sorbonne University, Internal Medicine Department 2, Institut E3M, French Reference Centre for Histiocytosis, Pitié-Salpȇtrière Hospital, CIMI INSERM-UMRS 1135, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-François Emile
- EA4340 BECCOH, Versailles SQY University, Pathology Department, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne, France
| | - Augusto Vaglio
- Nephrology and Dialysis Unit, Meyer Children’s Hospital IRCCS, Florence, Italy
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Julien Haroche
- Sorbonne University, Internal Medicine Department 2, Institut E3M, French Reference Centre for Histiocytosis, Pitié-Salpȇtrière Hospital, CIMI INSERM-UMRS 1135, Assistance Publique-Hôpitaux de Paris, Paris, France
| |
Collapse
|
20
|
Mandić JJ, Bakula M, Šklebar LK, Jakovčević A, Mandić K, Petrović Jurčević J, Padjen I. Histiocytosis and adult-onset orbital xanthogranuloma in 2023: a review of the literature and mini case series. Int Ophthalmol 2024; 44:301. [PMID: 38951425 DOI: 10.1007/s10792-024-03181-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/15/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE Within the large umbrella of histiocytosis are a few similar yet heterogenous entities involving the orbit and periocular tissues with or without systemic infiltration, termed adult onset xanthogranuloma or orbital xanthogranuloma. Due to rarity of these conditions, different classifications in use, diverse clinical presentations and still unknown etiology, the aim of this paper was to provide an up-to-date literature review of the actual understanding of histiocytosis and its subgroups involving the orbit and periocular area, diagnostic strategies and therapeutic modalities. METHODS We present a review of literature and small case series comprising four patients diagnosed and treated in the period from 2001 until 2023 in our hospital. Clinical files of 4 patients with adult-onset xanthogranulomatous disease of the orbit and ocular adnexa (AOXGD) were reviewed retrospectively. Clinical, laboratory, radiological, histopathological, and immunohistochemical findings were reexamined. RESULTS Reviewing medical records of our patients with AOXGD, we found significant overlap between histiocytosis and different immune disorders. A broad workup should be considered in these patients as they can harbour severe immune disfunctions and hematologic disorders. Preferred treatment modality depends on a histopathologic type of AOXGD, clinical presentation and systemic involvement and should be conducted multidisciplinary. CONCLUSION The diagnosis is often delayed because of its rarity and diverse clinical findings. Development of molecular genetic tests, detection of BRAF V600E mutation and different types of kinase mutations, mutations in transcriptional regulatory genes as well as tyrosine kinase receptors have shed a new light on the etiopathogenesis and potential targeted treatment of histiocytosis.
Collapse
Affiliation(s)
- Jelena Juri Mandić
- School of Medicine, University of Zagreb, Šalata 3B, Zagreb, Croatia.
- Department of Ophthalmology, University Hospital Center Zagreb, Kišpatićeva 12, Zagreb, Croatia.
| | - Maja Bakula
- School of Medicine, University of Zagreb, Šalata 3B, Zagreb, Croatia
- Department of Ophthalmology, University Hospital Center Zagreb, Kišpatićeva 12, Zagreb, Croatia
| | - Lorena Karla Šklebar
- School of Medicine, University of Zagreb, Šalata 3B, Zagreb, Croatia
- Department of Ophthalmology, University Hospital Center Zagreb, Kišpatićeva 12, Zagreb, Croatia
| | - Antonia Jakovčević
- Department of Pathology, University Hospital Center Zagreb, Kišpatićeva 12, Zagreb, Croatia
| | - Krešimir Mandić
- School of Medicine, University of Zagreb, Šalata 3B, Zagreb, Croatia
- Department of Ophthalmology, University Hospital Center Zagreb, Kišpatićeva 12, Zagreb, Croatia
| | | | - Ivan Padjen
- School of Medicine, University of Zagreb, Šalata 3B, Zagreb, Croatia
- Division of Clinical Immunology and Rheumatology, Referral Centre for Systemic Lupus Erythematosus and Related Disorders, Department of Internal Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb, Croatia
| |
Collapse
|
21
|
Li MS, Wu XL, Huang A, Wang H. Langerhans cell histiocytosis in sphenoid sinus with vision impairment: Case report and literature review. Sci Prog 2024; 107:368504241257129. [PMID: 39196602 PMCID: PMC11363225 DOI: 10.1177/00368504241257129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
Langerhans cell histiocytosis (LCH) is a neoplastic disease characterized by aberrant proliferation of the mononuclear phagocyte system, predominantly affecting children under the age of 3 years. Although LCH can affect almost all organs, sinus involvement is rare. This case report documents a 9-year-old boy presented with vision impairment and intermittent headache on the right side. The CT scan and MRI examination revealed the presence of a soft mass in the right atrium of sphenoid sinus, which impacted the right optic canal. Biopsy results confirmed the presence of LCH. Considering the involvement of optic canal and vision impairment, meticulous debridement was performed followed by a 12-month standard chemotherapy. After 2 years of follow-up, the patient showed significant improvement, despite the presence of an encapsulated cyst in the right sphenoid sinus. This case highlights the importance of considering LCH when encountering an isolated soft mass accompanied by decreased vision in the sphenoid sinus. A thorough physical examination, laboratory tests, and imaging methods should be performed, with a biopsy being necessary to confirm the type of lesion and guide the appropriate treatment.
Collapse
Affiliation(s)
- Min-Shan Li
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Allergy and Clinical Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Clinical Research Center for Nasal Inflammatory Diseases, Wuhan, China
| | - Xing-Liang Wu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Allergy and Clinical Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Clinical Research Center for Nasal Inflammatory Diseases, Wuhan, China
| | - Ao Huang
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Allergy and Clinical Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Clinical Research Center for Nasal Inflammatory Diseases, Wuhan, China
| | - Heng Wang
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Allergy and Clinical Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Clinical Research Center for Nasal Inflammatory Diseases, Wuhan, China
| |
Collapse
|
22
|
Aslam Z, Chowdhary O, Razik A, Negmeldin M. Rosai-Dorfman Disease in a Middle-Aged Man With Recurrent Pleural Effusions and Lymphadenopathy. Cureus 2024; 16:e64825. [PMID: 39156344 PMCID: PMC11330195 DOI: 10.7759/cureus.64825] [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] [Accepted: 07/18/2024] [Indexed: 08/20/2024] Open
Abstract
Rosai-Dorfman disease (RDD) is a rare benign condition that presents most commonly with lymphadenopathy and skin lesions and is characterized by infiltration of histiocytes into the skin and soft tissues. We present a case of RDD in an Afro-Caribbean male in his 50s who presented to our chest clinic with shortness of breath, cough, and weight loss of 15 kg over one year. CT scan showed evidence of right pleural effusion, mediastinal and hilar lymphadenopathy, and bony lesions in the spine. Cytology from multiple pleural effusions and endobronchial ultrasound-guided fine needle aspiration from lymph nodes did not show any malignancy. Left axillary excisional biopsy showed a pattern consistent with RDD. The patient was started on interferon therapy by the hematologist and pleurodesis after repeated pleural taps failed to relieve recurrent right pleural effusions. This case emphasizes the importance of tissue diagnosis to avoid misdiagnosis and unnecessary treatment.
Collapse
Affiliation(s)
- Zaheer Aslam
- Respiratory Medicine, Bedford Hospital NHS Trust, Bedford, GBR
| | - Omer Chowdhary
- Respiratory Medicine, Luton and Dunstable University Hospital, Luton, GBR
| | - Anjana Razik
- General Internal Medicine, Bedford Hospital NHS Trust, Bedford, GBR
| | | |
Collapse
|
23
|
Friedman JS, Durham BH, Reiner AS, Yabe M, Petrova-Drus K, Dogan A, Pulitzer M, Busam KJ, Francis JH, Rampal RK, Ulaner GA, Reddy R, Yeh R, Hatzoglou V, Lacouture ME, Rotemberg V, Mazor RD, Hershkovitz-Rokah O, Shpilberg O, Goyal G, Go RS, Abeykoon JP, Rech K, Morlote D, Fidai S, Gannamani V, Zia M, Abdel-Wahab O, Panageas KS, Rosenblum MK, Diamond EL. Mixed histiocytic neoplasms: A multicentre series revealing diverse somatic mutations and responses to targeted therapy. Br J Haematol 2024; 205:127-137. [PMID: 38613141 PMCID: PMC11245369 DOI: 10.1111/bjh.19462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/14/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024]
Abstract
Histiocytic neoplasms are diverse clonal haematopoietic disorders, and clinical disease is mediated by tumorous infiltration as well as uncontrolled systemic inflammation. Individual subtypes include Langerhans cell histiocytosis (LCH), Rosai-Dorfman-Destombes disease (RDD) and Erdheim-Chester disease (ECD), and these have been characterized with respect to clinical phenotypes, driver mutations and treatment paradigms. Less is known about patients with mixed histiocytic neoplasms (MXH), that is two or more coexisting disorders. This international collaboration examined patients with biopsy-proven MXH with respect to component disease subtypes, oncogenic driver mutations and responses to conventional (chemotherapeutic or immunosuppressive) versus targeted (BRAF or MEK inhibitor) therapies. Twenty-seven patients were studied with ECD/LCH (19/27), ECD/RDD (6/27), RDD/LCH (1/27) and ECD/RDD/LCH (1/27). Mutations previously undescribed in MXH were identified, including KRAS, MAP2K2, MAPK3, non-V600-BRAF, RAF1 and a BICD2-BRAF fusion. A repeated-measure generalized estimating equation demonstrated that targeted treatment was statistically significantly (1) more likely to result in a complete response (CR), partial response (PR) or stable disease (SD) (odds ratio [OR]: 17.34, 95% CI: 2.19-137.00, p = 0.007), and (2) less likely to result in progression (OR: 0.08, 95% CI: 0.03-0.23, p < 0.0001). Histiocytic neoplasms represent an entity with underappreciated clinical and molecular diversity, poor responsiveness to conventional therapy and exquisite sensitivity to targeted therapy.
Collapse
Affiliation(s)
- Joshua S Friedman
- Departments of Neurology, Neurosurgery, and Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Benjamin H Durham
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Molecular Pharmacology, Sloan Kettering Institute, New York, New York, USA
| | - Anne S Reiner
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mariko Yabe
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kseniya Petrova-Drus
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ahmet Dogan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Melissa Pulitzer
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Klaus J Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jasmine H Francis
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Raajit K Rampal
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gary A Ulaner
- Molecular Imaging and Therapy, Hoag Family Cancer Institute, Newport Beach, California, USA
- Molecular Imaging and Therapy, University of Southern California, Los Angeles, California, USA
| | - Ryan Reddy
- Molecular Imaging and Therapy, Hoag Family Cancer Institute, Newport Beach, California, USA
- Molecular Imaging and Therapy, University of Southern California, Los Angeles, California, USA
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Randy Yeh
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vaios Hatzoglou
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mario E Lacouture
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Veronica Rotemberg
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Roei D Mazor
- Clinic of Histiocytic Neoplasms, Institute of Hematology, Assuta Medical Center, Tel-Aviv, Israel
| | - Oshrat Hershkovitz-Rokah
- Department of Molecular Biology, Faculty of Natural Sciences, Ariel University, Ariel, Israel
- Translational Research Lab, Assuta Medical Centers, Tel-Aviv, Israel
| | - Ofer Shpilberg
- Clinic of Histiocytic Neoplasms, Institute of Hematology, Assuta Medical Center, Tel-Aviv, Israel
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Gaurav Goyal
- Department of Hematology Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Rare Histiocytic Disorders Steering Committee of the Histiocyte Society
| | - Ronald S Go
- Rare Histiocytic Disorders Steering Committee of the Histiocyte Society
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Karen Rech
- Department of Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Rare Histiocytic Disorders Steering Committee of the Histiocyte Society
| | - Diana Morlote
- Department of Hematology Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Shiraz Fidai
- Department of Pathology, John H. Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Vedavyas Gannamani
- Department of Pathology, John H. Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Maryam Zia
- Department of Pathology, John H. Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Omar Abdel-Wahab
- Department of Molecular Pharmacology, Sloan Kettering Institute, New York, New York, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Katherine S Panageas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Marc K Rosenblum
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Eli L Diamond
- Rare Histiocytic Disorders Steering Committee of the Histiocyte Society
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| |
Collapse
|
24
|
Ren H, Zhang H, Wan Q, Pang Y, Tian H, Ren Z, Cai Y. Case report: Uncommon manifestations of Rosai-Dorfman disease in the liver mimicking HCC. Front Oncol 2024; 14:1408353. [PMID: 39007098 PMCID: PMC11239378 DOI: 10.3389/fonc.2024.1408353] [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: 04/28/2024] [Accepted: 06/17/2024] [Indexed: 07/16/2024] Open
Abstract
Rosai-Dorfman-Destombes disease (RDD) is a rare non-Langerhans cell histiocytosis (LCH) disorder characterized by systemic extranodal lesions. Common cases include skin lesions, whereas liver lesions are rare. This study presents a case of a 66-year-old woman with a solitary extranodal liver lesion who underwent successful surgical treatment followed by glucocorticoid therapy. The patient did not experience any symptoms before surgery. The liver lesion was incidentally discovered during a routine ultrasound examination. Enhanced CT scan revealed the lesion with the characteristic of washout, similar to primary hepatic cancer (HCC). CT scans of the head, neck, chest, and abdominal pelvis revealed no lymph node or other organ lesions. After surgery, the liver lesion was diagnosed as RDD, and subsequent whole-body examinations did not reveal any skin lesions. The definitive diagnosis was solid liver RDD in adults. Although there were no typical cases of bilateral cervical lymph node lesions, ultrasound and CT examinations promptly detected liver lesions, leading to the correct diagnosis through surgical resection. The findings from this case indicate that RDD can occur in rare extrasegmental areas, and the imaging characteristics of liver lesions are not specific, indicating the importance of avoiding delayed diagnosis.
Collapse
Affiliation(s)
- Huipeng Ren
- Department of Medical Imaging, Baoji Central Hospital, Baoji, China
| | - Hao Zhang
- Department of Pathology, Baoji Central Hospital, Baoji, China
| | - Qinyun Wan
- Department of Medical Ultrasonics, Baoji Central Hospital, Baoji, China
| | - Yuhui Pang
- Department of Medical Imaging, Baoji Central Hospital, Baoji, China
| | - Hongzhe Tian
- Department of Medical Imaging, Baoji Central Hospital, Baoji, China
| | - Zhuanqin Ren
- Department of Medical Imaging, Baoji Central Hospital, Baoji, China
| | - Yuan Cai
- Department of Pathology, Baoji Central Hospital, Baoji, China
| |
Collapse
|
25
|
Rajabi MT, Abdol Homayuni MR, Samiee R, Mobader Sani S, Aghajani AH, Rafizadeh SM, Amanollahi M, Pezeshgi S, Hosseini SS, Rajabi MB, Sadeghi R. Orbital histiocytosis; From A to Z. Int Ophthalmol 2024; 44:236. [PMID: 38902584 DOI: 10.1007/s10792-024-03179-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/15/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE Histiocytosis is one of the most challenging diseases in medical practice. Because of the broad spectrum of clinical manifestations, systemic involvements, unknown etiology, and complex management, different types of histiocytosis are still a big question mark for us. Orbital histiocytosis is characterized by the abnormal proliferation of histiocytes in orbital tissues. It could affect the orbit, eyelid, conjunctiva, and uveal tract. Orbital histiocytosis can cause limited eye movement, proptosis, decreased visual acuity, and epiphora. In this study, we review the novel findings regarding the pathophysiology, diagnosis, and treatment of different types of histiocytosis, focusing on their orbital manifestations. METHOD This review was performed based on a search of the PubMed, Scopus, and Embase databases or relevant published papers regarding orbital histiocytosis on October 9th, 2023. No time restriction was proposed, and articles were excluded if they were not referenced in English. RESULTS 391 articles were screened, most of them being case reports. The pathophysiology of histiocytosis is still unclear. However, different mutations are found to be prevalent in most of the patients. The diagnostic path can be different based on various factors such as age, lesion site, type of histiocytosis, and the stage of the disease. Some modalities, such as corticosteroids and surgery, are used widely for treatment. On the other hand, based on some specific etiological factors for each type, alternative treatments have been proposed. CONCLUSION Significant progress has been made in the detection of somatic molecular changes. Many case studies describe various disease patterns influencing the biological perspectives on different types of histiocytosis. It is necessary to continue investigating and clustering data from a broad range of patients with histiocytosis in children and adults to define the best ways to diagnose and treat these patients.
Collapse
Affiliation(s)
- Mohammad Taher Rajabi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
| | - Mohammad Reza Abdol Homayuni
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- NCweb Association, Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Samiee
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sheida Mobader Sani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- NCweb Association, Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Aghajani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
| | - Seyed Mohsen Rafizadeh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
| | - Mobina Amanollahi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Saharnaz Pezeshgi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Simindokht Hosseini
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
| | - Mohammad Bagher Rajabi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
| | - Reza Sadeghi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran.
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
26
|
Al-Haddab M, Al Muqarrab FJ, Alhumidi A, Alkofide M. Clinical Progression and Manifestations of H Syndrome: A Case Report of Failed Treatment Option. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e944198. [PMID: 38850017 PMCID: PMC11176275 DOI: 10.12659/ajcr.944198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/16/2024] [Accepted: 04/09/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND H syndrome is an autosomal recessive disorder of histiocytic proliferation with clinical spectrum of unique cutaneous and systemic manifestations. There is no consistent treatment for the disease, and all available options are based on case reports. Here, we present the chronological progression of a case of H syndrome with typical cutaneous manifestations that was misdiagnosed early as meningitis-induced sensorineural hearing loss and later as a non-defined autoimmune connective tissue disease. A new tried, although failed, treatment option is described as well. CASE REPORT A 31-year-old Saudi woman born of a consanguineous marriage presented to our dermatology clinic with symmetrical indurated hyperpigmented to violaceous plaques over the medial thighs, upper legs, lower back, volar wrists, and upper arms, associated with hypertrichosis. Hallux valgus of the big toes was clinically detected as well. She had a history of sensorineural deafness, diabetes mellitus, chronic anemia, and hypothyroidism. Genetic analysis of the patient showed a homozygous frameshift pathogenic variant of the SLC29A3 gene, c.243del p.(Lys81Asnfs*20). Systemic treatments in the form of methotrexate and imatinib had been tried; however, both failed to control her sclerotic cutaneous changes. CONCLUSIONS Knowing the early life presentation and the variable clinical symptoms of H syndrome is crucial in early intervention and further prevention of the non-reversible changes. Moreover, avoiding unnecessary immunosuppressive medication use is warranted in certain circumstances.
Collapse
Affiliation(s)
- Mohammed Al-Haddab
- Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fatimah J. Al Muqarrab
- Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Alhumidi
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Maha Alkofide
- Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
27
|
Orth P, Stahl PR, Tränkenschuh W, Baumhoer D, Kehl T, Lehnhof HP, Schneider G, Meese E, Madry H, Fischer U. A novel entity of massive multifocal osteolyses in the elderly. Bone Rep 2024; 21:101765. [PMID: 38681749 PMCID: PMC11052910 DOI: 10.1016/j.bonr.2024.101765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/03/2024] [Accepted: 04/16/2024] [Indexed: 05/01/2024] Open
Abstract
Osteolyses are common findings in elderly patients and most frequently represent malignant or locally aggressive bone tumors, infection, inflammatory and endocrine disorders, histiocytoses, and rare diseases such as Gorham-Stout syndrome. We here report on a novel entity of massive multifocal osteolyses in both shoulders, the right hip and left knee joint and the dens of an 83-year-old patient not relatable to any previously known etiopathology of bone disorders. The soft tissue mass is of myxoid stroma with an unspecific granulomatous inflammatory process, aggressively destroying extensive cortical and cancellous bone segments and encroaching on articulating bones in diarthrodial large joints. Radiological, nuclear medical, serological, histological, and immunohistochemical analyses were incapable of further classifying the disease pattern within the existing scheme of pathology. Quantitative polymerase chain reaction and next generation sequencing revealed that mutations are not suggestive of any known hereditary or acquired bone disease. Possible treatment options include radionuclide therapy for pain palliation and percutaneous radiation to arrest bone resorption while surgical treatment is inevitable for pathological fractures. This case study shall increase the awareness of the musculoskeletal community and motivate to collect further information on this rare but mutilating disorder.
Collapse
Affiliation(s)
- Patrick Orth
- Department of Orthopaedic Surgery, Saarland University Medical Center, D-66421 Homburg, Germany
- Center of Experimental Orthopaedics, Saarland University, D-66421 Homburg, Germany
| | - Phillip Rolf Stahl
- Department of Pathology, MSB Medical School Berlin, D-14197 Berlin, Germany
| | - Wolfgang Tränkenschuh
- Department of Pathology, Saarland University Medical Center, D-66421 Homburg, Germany
| | - Daniel Baumhoer
- Bone Tumor Reference Center, Institute of Pathology, University Hospital Basel, CH-4031 Basel, Switzerland
| | - Tim Kehl
- Center for Bioinformatics, Saarland Informatics Campus, D-66123 Saarbrücken, Germany
| | - Hans-Peter Lehnhof
- Center for Bioinformatics, Saarland Informatics Campus, D-66123 Saarbrücken, Germany
| | - Günther Schneider
- Department of Radiology, Saarland University Medical Center, D-66421 Homburg, Germany
| | - Eckart Meese
- Institute of Human Genetics, Saarland University, D-66421 Homburg, Germany
| | - Henning Madry
- Center of Experimental Orthopaedics, Saarland University, D-66421 Homburg, Germany
| | - Ulrike Fischer
- Institute of Human Genetics, Saarland University, D-66421 Homburg, Germany
| |
Collapse
|
28
|
Alradhi SI, Almanjomi F, Alamr F, Alwakid I, Alrashidi M, Alkhelaif M. Clinical Presentations, Diagnosis, and Genetic Features of Hemophagocytic Lymphohistiocytosis: A Single Institutional Experience With the Saudi Population. Cureus 2024; 16:e61879. [PMID: 38978926 PMCID: PMC11228410 DOI: 10.7759/cureus.61879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2024] [Indexed: 07/10/2024] Open
Abstract
Background Hemophagocytic lymphohistiocytosis (HLH) is an uncommon, potentially fatal condition caused by high immune activation. The present study aimed to identify the clinical manifestations, geographic distribution, and associated pathogenic genetic mutations of HLH in Saudi Arabia. Method A retrospective cross-sectional study was conducted at King Fahad Medical City (KFMC), with a total of 59 patients diagnosed with HLH in the period between 2006 and 2018. All genetic results and clinical and biochemical data were retrieved and statistically analyzed using IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States). Results The results revealed that 48 patients (81.4%) had 15 pathogenic mutations of primary HLH whereas 8 (13.6%) patients had no genetic mutation. The most common variant mutation identified was c.1430C>T of the STXBP2 gene (42.4% of total patients), followed by c.1122G>A of the PRF1 gene (10.2% of patients), which demonstrated a distinctive geographic and tribal association. Patients with RAB27A mutation tend to present at an older age than the others with a median age of presentation of 5.5 months vs 2 months for patients with PRF1 mutations. No significant differences in clinical features were observed among the various groups. Conclusion This study highlights the incidence of genetic mutations among the Saudi population with HLH. The STXBP2 is the most common mutation followed by PRF1 mutations, many mutation variants are associated with a distinctive tribal and geographic association.
Collapse
Affiliation(s)
- Sami I Alradhi
- Pediatric Hematology and Oncology, Maternity and Children Hospital, Dammam, SAU
| | | | - Fahad Alamr
- College of Medicine, Al-Baha University, Al-Baha, SAU
| | | | | | | |
Collapse
|
29
|
Al-Hashemi RW, Aldarraji SS, Abdalla T, Hasnah S, Abu-Dayeh A, Telfah HK. The Lone Lump: Cutaneous Rosai-Dorfman Disease as an Isolated Upper Arm Lesion. Cureus 2024; 16:e63542. [PMID: 39086775 PMCID: PMC11289357 DOI: 10.7759/cureus.63542] [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] [Accepted: 06/30/2024] [Indexed: 08/02/2024] Open
Abstract
Rosai-Dorfman disease (RDD) is a rare disorder characterized by excessive growth of histiocytes. We present a case of a 14-year-old female with cutaneous RDD who had a subcutaneous lump on her left arm for three years. The lump became tender and progressively larger over the past year. She had no systemic symptoms, and her physical examination revealed a mobile, tender lump. Laboratory tests were normal. Surgical excision of the lump was performed, and histopathological examination confirmed RDD with the presence of epithelioid histiocytes with eosinophilic and clear cytoplasm, along with emperipolesis and positive staining for CD68, CD163, S100, and OCT2. The patient was referred for follow-up and required no further treatment. RDD can present with subcutaneous masses without systemic symptoms, and it is important to consider RDD in the differential diagnosis of such cases. Surgical excision is the main treatment, and long-term monitoring is necessary due to the potential for disease recurrence. Awareness of cutaneous RDD presentations is crucial for accurate diagnosis and management.
Collapse
Affiliation(s)
| | | | - Tasnim Abdalla
- Family Medicine Residency Program, Medical Education, Hamad Medical Corporation, Doha, QAT
| | - Sham Hasnah
- Family Medicine Residency Program, Medical Education, Hamad Medical Corporation, Doha, QAT
| | - Ala Abu-Dayeh
- Pathology and Laboratory Medicine, Hamad Medical Corporation, Doha, QAT
| | | |
Collapse
|
30
|
Rabha KD, Barman H, Kumar SA, Mishra J, Kynta RL, Lynser D, Kalita P. Rosai-Dorfman Disease as Constrictive Pericarditis: An Unusual Childhood Presentation. Cureus 2024; 16:e62062. [PMID: 38989342 PMCID: PMC11235087 DOI: 10.7759/cureus.62062] [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] [Accepted: 06/07/2024] [Indexed: 07/12/2024] Open
Abstract
Rosai-Dorfman disease (RDD) is a rare, multisystemic, histiocytic disorder that usually presents with painless cervical lymphadenopathy. We describe a case of constrictive effusive pericarditis with congestive cardiac failure in a six-year-old child as an initial presentation of RDD. The child underwent pericardiectomy and was treated with steroids, following which the symptoms resolved entirely. While tuberculosis accounts for the majority of cases presenting with constrictive pericarditis in developing countries, the presentation of RDD can be easily missed if not kept in mind as a possibility. This case report documents the unique presentation of a rare disease.
Collapse
Affiliation(s)
- Kapil Dev Rabha
- Pediatrics and Neonatology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Himesh Barman
- Pediatrics, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Shakthi A Kumar
- Pediatrics, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Jaya Mishra
- Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Reuben L Kynta
- Cardiothoracic and Vascular Surgery, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Donboklang Lynser
- Radiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Pranjal Kalita
- Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| |
Collapse
|
31
|
Mousselli M, Brien E. Treatment of histiocytic neoplasms with intralesional steroids: A case series report. Int J Surg Case Rep 2024; 119:109719. [PMID: 38733665 PMCID: PMC11101882 DOI: 10.1016/j.ijscr.2024.109719] [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: 11/20/2023] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Rosai-Dorfman disease was first described in the 1960s and is characterized by hyperproliferation of histiocytes, which presents as painless lymphadenopathy with fever, night sweats, and weight loss. This disease often affects young adults and children of African descent. Different types of RDD exist, including familial, classical (nodal), extranodal, neoplasia-associated, and immune-associated. While this disease can cause significant pain, there is currently no consensus on treatment. CASE PRESENTATION This case series outlines three cases of bony involvement of histiocytic neoplasms and our technique for intralesionoal steroid injections. Two cases were successfully treated with intralesional steroid injections and one patient was treated with oral steroids. CLINICAL DISCUSSION Histiocytic neoplasms can cause significant pain for patients and there is no standardized treatment as of yet. An interesting finding on MRI was a characteristic peripheral edema we termed the "Halo Sign". Steroids are believed to exert their benefit in treating this disease by apoptosis and reducing tumoral swelling. CONCLUSION This case series demonstrates the successful management of bony involvement of RDD with intralesional steroids similar to eosinophilic granuloma. While intralesional steroid injection has previously been described for other types of RDD, this is the first description of bony RDD treated with this technique to our knowledge.
Collapse
Affiliation(s)
- Michael Mousselli
- Community Memorial Hospital, 147 Brent St., Ventura, CA 93003, United States of America.
| | - Earl Brien
- Cedars Sinai, 127 S San Vicente Blvd 7th Floor, Los Angeles, CA 90048, United States of America
| |
Collapse
|
32
|
Alsharif MT, Badr F, Mair Y, Komo H, Alkeheli M, Binmadi N. Spontaneous pathological mandibular fracture in a 48-year-old patient. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:566-572. [PMID: 38508905 DOI: 10.1016/j.oooo.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/18/2024] [Accepted: 02/26/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Maha T Alsharif
- Department of Oral Diagnostic Sciences, King Abdulaziz University Faculty of Dentistry, Jeddah, Saudi Arabia.
| | - Fatma Badr
- Department of Oral Diagnostic Sciences, King Abdulaziz University Faculty of Dentistry, Jeddah, Saudi Arabia
| | - Yasmin Mair
- Department of Oral Diagnostic Sciences, King Abdulaziz University Faculty of Dentistry, Jeddah, Saudi Arabia
| | - Hisham Komo
- Department of Oral and Maxillofacial Surgery, King Abdulaziz University Faculty of Dentistry, Jeddah, Saudi Arabia
| | - Madawi Alkeheli
- Department of Oral Diagnostic Sciences, King Abdulaziz University Faculty of Dentistry, Jeddah, Saudi Arabia
| | - Nada Binmadi
- Department of Oral Diagnostic Sciences, King Abdulaziz University Faculty of Dentistry, Jeddah, Saudi Arabia
| |
Collapse
|
33
|
Mavromati M, Caironi V, Saiji E, Vargas MI, Momjian S, Andrade-Lopes S, Gubert C, Demarchi MS, Mainta I, Jornayvaz FR, Samii K, Stalder G, Leboulleux S. Langerhans cell histiocytosis of the suprasellar region: diagnosis based on thyroid cytology. Eur Thyroid J 2024; 13:e240011. [PMID: 38718824 PMCID: PMC11227055 DOI: 10.1530/etj-24-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/07/2024] [Indexed: 06/04/2024] Open
Abstract
Langerhans cell histiocytosis (LCH) may present as unifocal disease of the suprasellar region, with symptoms and signs of hypopituitarism, arginine vasopressin deficiency (AVP-D), and weight gain. Transcranial biopsy is necessary to define diagnosis and guide treatment decisions, but it is associated with significant morbidity. We describe a patient with Hashimoto thyroiditis and a single hypothalamic mass in whom LCH diagnosis was made by thyroid fine-needle aspiration cytology (FNAC) performed despite nonspecific findings in thyroid imaging, on the basis of a slightly elevated [18F]-fluorodeoxyglucose (FDG) avidity on PET/CT and volume increase during follow-up.
Collapse
Affiliation(s)
- Maria Mavromati
- Department of Endocrinology, Diabetology, Nutrition and Therapeutic Education, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil, Geneva, Switzerland
- University of Geneva, Faculty of Medicine, Rue Michel Servet, Geneva, Switzerland
| | - Verdiana Caironi
- Department of Internal Medicine, Lugano Regional Hospital, Ente Ospedaliero Cantonale, Via Tesserete Lugano, Switzerland
| | - Essia Saiji
- University of Geneva, Faculty of Medicine, Rue Michel Servet, Geneva, Switzerland
- Department of Pathology, Geneva University Hospitals, University of Geneva, Rue Gabrielle-Perret-Gentil, Geneva, Switzerland
| | - Maria-Isabel Vargas
- University of Geneva, Faculty of Medicine, Rue Michel Servet, Geneva, Switzerland
- Department of Neuroradiology, Geneva University Hospitals, University of Geneva, Rue Gabrielle-Perret-Gentil, Geneva, Switzerland
| | - Shahan Momjian
- University of Geneva, Faculty of Medicine, Rue Michel Servet, Geneva, Switzerland
- Department of Neurosurgery, Geneva University Hospitals, University of Geneva, Rue Gabrielle-Perret-Gentil, Geneva, Switzerland
| | - Stephanie Andrade-Lopes
- Department of Endocrinology, Diabetology, Nutrition and Therapeutic Education, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil, Geneva, Switzerland
| | - Capucine Gubert
- Department of Internal Medicine, Geneva University Hospitals, University of Geneva, Rue Gabrielle-Perret-Gentil, Geneva, Switzerland
| | - Marco Stefano Demarchi
- Department of Thoracic and Endocrine Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil, Geneva, Switzerland
| | - Ismini Mainta
- Department of Nuclear Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil, Geneva, Switzerland
| | - François R Jornayvaz
- Department of Endocrinology, Diabetology, Nutrition and Therapeutic Education, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil, Geneva, Switzerland
- University of Geneva, Faculty of Medicine, Rue Michel Servet, Geneva, Switzerland
| | - Kaveh Samii
- University of Geneva, Faculty of Medicine, Rue Michel Servet, Geneva, Switzerland
- Department of Hematology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil, Geneva, Switzerland
| | - Grégoire Stalder
- Service and Central Laboratory of Hematology, Lausanne University Hospital, rue du Bugnon Lausanne, Switzerland.
- Service of Hematology and Laboratory of Hematology, Institut Central des Hôpitaux, Hôpital du Valais, Av. du Grand-Champsec, Sion, Switzerland
| | - Sophie Leboulleux
- Department of Endocrinology, Diabetology, Nutrition and Therapeutic Education, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil, Geneva, Switzerland
- University of Geneva, Faculty of Medicine, Rue Michel Servet, Geneva, Switzerland
| |
Collapse
|
34
|
de Mello Heliodoro TL, Ribeiro PRJ, Salustiano LX, de Camargo LA, Bahmad F. Langerhans Cell Histiocytosis in Sphenoid Sinus: Uncommon Bone Involvement. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e942681. [PMID: 38764221 PMCID: PMC11117437 DOI: 10.12659/ajcr.942681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 04/02/2024] [Accepted: 01/25/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a rare and uncontrolled proliferation of dendritic cells of myeloid origin. The incidence of LHC was estimated at 5 cases per million children ages 0-15 years old. The most common places for this tumor are the jaw, vertebra, pelvis, and the extremities. The disease with multisystem involvement can present a mortality rate of 20% and one-third of children have multisystem involvement. We present a case with unusual bone involvement of the anterior cranial base with a challenging diagnosis and a complex surgical approach. CASE REPORT We report the case of a 6-year-old boy who manifested the disease with daily holocranial headache, worse in the frontal region and refractory to analgesia for 10 days, strabismus homonymous, diplopia, and right palpebral ptosis. The tumor affected the sphenoid sinus, internal carotid artery, and sella turcica, and made contact with the pituitary gland. A joint surgery with Otorhinolaryngology and Neurosurgery was performed by nasal endoscopic access to the skull base by means of the right medial turbinectomy (for the access) and right sphenoid opening, septectomy and opening of the left sphenoid to work with 4 hands and, after resection of lesion, inside the sphenoid. CONCLUSIONS This patient had rare bone involvement from LCH and atypical clinical presentation next to the important and delicate structures of the anterior skull base, but had a satisfactory outcome.
Collapse
Affiliation(s)
- Taynara Luisa de Mello Heliodoro
- Faculty of Health Sciences, University of Brasília, Brasília, DF, Brazil
- Department of Otolaryngology, Brasiliense Institute of Otorhinolaryngology, Brasília, DF, Brazil
| | | | | | | | - Fayez Bahmad
- Faculty of Health Sciences, University of Brasília, Brasília, DF, Brazil
- Department of Otolaryngology, Brasiliense Institute of Otorhinolaryngology, Brasília, DF, Brazil
| |
Collapse
|
35
|
Ge X, Ou W, Wei A, Lian H, Ma H, Cui L, Wang D, Zhang L, Wang X, He L, Zhang R, Wang T. Clinical features and treatment outcomes of liver involvement in paediatric Langerhans cell histiocytosis. BMC Pediatr 2024; 24:316. [PMID: 38714959 PMCID: PMC11077857 DOI: 10.1186/s12887-024-04764-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Abstract
Langerhans cell histiocytosis (LCH) is the most common histiocytic disorder in children, and liver involvement in LCH is rare. This retrospective study reported the clinical features and prognosis of patients with hepatic LCH. Liver involvement was defined by histopathological findings, liver dysfunction or abnormalities, or ultrasound imaging. A total of 130 patients (14.5%) with hepatic LCH out of 899 in the LCH population were enrolled. Patients with liver involvement had greater frequencies of skin, lung, hearing system, and haematologic system involvement, and hemophagocytic lymphohistiocytosis (P<0.001, 0.001, 0.002, 0.009, and <0.001, respectively). Overall survival and progression-free survival were lower in LCH patients with liver involvement than in those without liver involvement (P<0.001 and <0.001). In patients with liver involvement, the overall survival (OS) and progression-free survival (PFS) rates were lower in patients with cholangitis than in those without cholangitis (P<0.020 and 0.030). For the treatment response, the response rate of hepatic LCH patients to initial first-line therapy (n=89) was 22.5%. However, there was no significant difference in the response rate or recurrence rate between patients who shifted from first-line treatment to second-line treatment (n=29) or to targeted therapy (n=13) (P=0.453 and 1.000). The response rate of hepatic LCH patients who received initial second-line therapy (n=13) was 38.5%. Two of these patients subsequently experienced bone recurrence. The response rate of hepatic LCH patients who received initial targeted therapy (n=16) was 75.0%. Three patients subsequently experienced recurrence, including 2 in the bone and 1 in the liver and skin. A total of 39.3% of patients who received second-line treatment had severe myelosuppression (grade III-IV), and 50.8% had varying degrees of gastrointestinal events, whereas there was no severe toxicity in patients who received first-line treatment and targeted therapy. Four patients underwent liver transplantation because of liver cirrhosis. The patients' liver disease improved within a follow-up period of 18-79 months. This study demonstrated that LCH with liver involvement, especially cholangitis, indicates a poor prognosis. Targeted therapy provides a good treatment response and less toxicity. However, it may relapse after withdrawal. Liver transplantation is still a reliable salvage option for patients with end-stage liver disease.
Collapse
Affiliation(s)
- Xinshun Ge
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Disease in Children, Ministry of Education; Department of Hematology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nanlishi Road No. 56, Xicheng District, Beijing, 100045, P.R. China
| | - Wenxin Ou
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Disease in Children, Ministry of Education; Department of Hematology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nanlishi Road No. 56, Xicheng District, Beijing, 100045, P.R. China
| | - Ang Wei
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Disease in Children, Ministry of Education; Department of Hematology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nanlishi Road No. 56, Xicheng District, Beijing, 100045, P.R. China
| | - Hongyun Lian
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Disease in Children, Ministry of Education; Department of Hematology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nanlishi Road No. 56, Xicheng District, Beijing, 100045, P.R. China
| | - Honghao Ma
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Disease in Children, Ministry of Education; Department of Hematology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nanlishi Road No. 56, Xicheng District, Beijing, 100045, P.R. China
| | - Lei Cui
- Hematologic Disease Laboratory, Beijing Pediatric Research Institute; Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Disease in Children, Ministry of Education; Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, P. R. China
| | - Dong Wang
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Disease in Children, Ministry of Education; Department of Hematology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nanlishi Road No. 56, Xicheng District, Beijing, 100045, P.R. China
| | - Liping Zhang
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Disease in Children, Ministry of Education; Department of Hematology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nanlishi Road No. 56, Xicheng District, Beijing, 100045, P.R. China
| | - Xiaoman Wang
- Department of Ultrasonography, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nanlishi Road No. 56, Xicheng District, Beijing, 100045, P.R. China.
| | - Lejian He
- Department of Pathology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nanlishi Road No. 56, Xicheng District, Beijing, 100045, P.R. China.
| | - Rui Zhang
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Disease in Children, Ministry of Education; Department of Hematology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nanlishi Road No. 56, Xicheng District, Beijing, 100045, P.R. China.
| | - Tianyou Wang
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Disease in Children, Ministry of Education; Department of Hematology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nanlishi Road No. 56, Xicheng District, Beijing, 100045, P.R. China.
| |
Collapse
|
36
|
Yoon SO. Pathologic characteristics of histiocytic and dendritic cell neoplasms. Blood Res 2024; 59:18. [PMID: 38713245 PMCID: PMC11076448 DOI: 10.1007/s44313-024-00015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/05/2024] [Indexed: 05/08/2024] Open
Abstract
Histiocytic and dendritic cell neoplasms comprise diverse tumors originating from the mononuclear phagocytic system, which includes monocytes, macrophages, and dendritic cells. The 5th edition of the World Health Organization (WHO) classification updating the categorization of these tumors, reflecting a deeper understanding of their pathogenesis.In this updated classification system, tumors are categorized as Langerhans cell and other dendritic cell neoplasms, histiocyte/macrophage neoplasms, and plasmacytoid dendritic cell neoplasms. Follicular dendritic cell neoplasms are classified as mesenchymal dendritic cell neoplasms within the stroma-derived neoplasms of lymphoid tissues.Each subtype of histiocytic and dendritic cell neoplasms exhibits distinct morphological characteristics. They also show a characteristic immunophenotypic profile marked by various markers such as CD1a, CD207/langerin, S100, CD68, CD163, CD4, CD123, CD21, CD23, CD35, and ALK, and hematolymphoid markers such as CD45 and CD43. In situ hybridization for EBV-encoded small RNA (EBER) identifies a particular subtype. Immunoprofiling plays a critical role in determining the cell of origin and identifying the specific subtype of tumors. There are frequent genomic alterations in these neoplasms, especially in the mitogen-activated protein kinase pathway, including BRAF (notably BRAF V600E), MAP2K1, KRAS, and NRAS mutations, and ALK gene translocation.This review aims to offer a comprehensive and updated overview of histiocytic and dendritic cell neoplasms, focusing on their ontogeny, morphological aspects, immunophenotypic profiles, and molecular genetics. This comprehensive approach is essential for accurately differentiating and classifying neoplasms according to the updated WHO classification.
Collapse
Affiliation(s)
- Sun Och Yoon
- Department of Pathology, Yonsei University College of Medicine, Severance Hospital, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, South Korea.
| |
Collapse
|
37
|
Ruan GJ, Zanwar S, Ravindran A, Schram S, Abeykoon JP, Hazim A, Young JR, Shah MV, Bennani NN, Jiang L, Morlote D, Rech KL, Goyal G, Go RS. Clinical characteristics, molecular aberrations, treatments, and outcomes of malignant histiocytosis. Am J Hematol 2024; 99:871-879. [PMID: 38409747 PMCID: PMC11038892 DOI: 10.1002/ajh.27263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/28/2024]
Abstract
Malignant histiocytosis (MH) is an extremely rare neoplasm of the macrophage-dendritic cell lineage. We report the clinical characteristics, molecular aberrations, treatments, and outcomes of patients with MH seen at two referral centers from January 2000 to May 2023. We identified 43 patients with MH, of which 26 had histiocytic sarcoma (MH-H), 9 interdigitating dendritic cell sarcoma (MH-IDC), and 8 Langerhans cell sarcoma (MH-LC). The median age at diagnosis was 61 years (range, 3-83). Thirty-three patients (77%) had multifocal disease, while 10 had unifocal involvement. Tumor specimens from 22 patients (51%) underwent targeted next generation sequencing, and 19 of 22 (86%) had at least one pathogenic mutation, including mutations in MAPK pathway genes (73%). The median overall survival (OS) among the entire cohort was 16 months (95% CI: 8-50). The outcomes of those with multifocal disease were significantly shorter than their unifocal counterpart: median OS of 10 months versus 50 months (p = .07). Patients with risk organ involvement (bone marrow, spleen, or liver) had significantly inferior outcomes. Chemotherapy and surgery were the most common first-line treatments for multifocal and unifocal disease, respectively. While the outcome for patients with multifocal disease was poor, there was a subset of patients who had durable responses to treatment. Our study highlights that MH has heterogeneous clinical presentation, frequent oncogenic mutations, and prognosis, which is strongly tied to disease extent and type of organ involvement.
Collapse
Affiliation(s)
- Gordon J Ruan
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Saurabh Zanwar
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Aishwarya Ravindran
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Laboratory Medicine-Hematopathology, Department of Pathology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Susan Schram
- Sawtooth Epidemiology & Infectious Diseases, Boise, Idaho, USA
| | | | - Antonious Hazim
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jason R Young
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Mithun V Shah
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - N Nora Bennani
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Liuyan Jiang
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida, USA
| | - Diana Morlote
- Division of Laboratory Medicine-Hematopathology, Department of Pathology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Karen L Rech
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Gaurav Goyal
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Hematology-Oncology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
38
|
Cravero JC, Ibrahim S. Recurrent Soft Tissue Rosai Dorfman Disease of Right Medial Thigh Lipoma With Lymph Node Involvement. Fed Pract 2024; 41:S20-S23. [PMID: 38813251 PMCID: PMC11132110 DOI: 10.12788/fp.0475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Background Rosai Dorfman disease is a rare non-Langerhans cell histiocytosis that affects lymph nodes, soft tissues, and other organs. The etiology of Rosai Dorfman disease is poorly understood, though it may involve an immunologic processes or infection. Treatment varies according to the disease presentation. Case Presentation A male aged 56 years was evaluated for a cutaneous mass on his right medial thigh. Initially, the patient received surgical debulking with subsequent observation and no systemic therapy. However, the mass recurred, prompting another surgical removal 9 years after the initial surgery. A mass biopsy showed infiltration of plasma cells, lymphocytes, histiocytes, and occasional neutrophils with noted reactivity of S-100 protein and CD163, but not CD1a. No systemic therapy was initiated, and the patient agreed to a period of watchful waiting. Conclusions Rosai Dorfman disease of soft tissue occurs in older adults and is often associated with soft tissue abnormalities, and more rarely, in lipomas. Multidisciplinary management of the disease and research for mutations and microenvironment of RDD is needed to better understand its clinicopathological nature and improve novel therapies.
Collapse
|
39
|
Schubert C, Schiffmann I, Farschtschi SC, Emile JF, Friese MA. Treatment of Cerebral Histiocytosis With Low Dose of Cobimetinib: A Report of 2 Cases. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200233. [PMID: 38588479 PMCID: PMC11010243 DOI: 10.1212/nxi.0000000000200233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/05/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVES Histiocytic disorders are pathologic expansions of myeloid cells in multiple organs, including the CNS. They share activation of the MAP kinase pathway due to either BRAFV600E variant or other variants in the RAS-RAF-MEK-ERK pathway. The rarity and heterogeneity of the disease only enable therapy through pathophysiologic considerations. METHODS We present 2 histiocytosis cases without BRAF sequence variants that affect the CNS, one with Erdheim-Chester disease and the other with an unspecified histiocytosis, and their diagnostic and therapeutic challenges. RESULTS In both cases, comprehensive analysis of the RAS-RAF-MEK-ERK signaling pathway secured the diagnosis. Treatment with the MEK inhibitor cobimetinib brought the disease to a complete halt. However, side effects such as thrombosis and serous macular edema made it necessary to reduce cobimetinib dosage. Low-dose cobimetinib maintenance medication was successful in preventing recurrence of histiocytic disease. DISCUSSION CNS involvement of histiocytic disorders can lead to detrimental neurologic symptoms. MEK inhibitors are effective treatment options for some of these patients. Since side effects are common, according to our cases we propose a low-dose treatment of 20 mg per day to balance treatment effects with side effects. CLASSIFICATION OF EVIDENCE This case report provides Class IV evidence. This is a single observational study without controls.
Collapse
Affiliation(s)
- Charlotte Schubert
- From the Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (C.S., I.S., M.A.F.); Department of Neurology (C.S., I.S., S.C.F., M.A.F.), University Medical Center Hamburg-Eppendorf, Germany; and Pathology Department (J.-F.E.), Paris-Saclay University, Versailles SQY University (UVSQ), EA4340-BECCOH, Assistance Publique-Hôpitaux de Paris (APHP), Ambroise-Paré Hospital, Boulogne-Billancourt, France
| | - Insa Schiffmann
- From the Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (C.S., I.S., M.A.F.); Department of Neurology (C.S., I.S., S.C.F., M.A.F.), University Medical Center Hamburg-Eppendorf, Germany; and Pathology Department (J.-F.E.), Paris-Saclay University, Versailles SQY University (UVSQ), EA4340-BECCOH, Assistance Publique-Hôpitaux de Paris (APHP), Ambroise-Paré Hospital, Boulogne-Billancourt, France
| | - Said C Farschtschi
- From the Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (C.S., I.S., M.A.F.); Department of Neurology (C.S., I.S., S.C.F., M.A.F.), University Medical Center Hamburg-Eppendorf, Germany; and Pathology Department (J.-F.E.), Paris-Saclay University, Versailles SQY University (UVSQ), EA4340-BECCOH, Assistance Publique-Hôpitaux de Paris (APHP), Ambroise-Paré Hospital, Boulogne-Billancourt, France
| | - Jean-François Emile
- From the Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (C.S., I.S., M.A.F.); Department of Neurology (C.S., I.S., S.C.F., M.A.F.), University Medical Center Hamburg-Eppendorf, Germany; and Pathology Department (J.-F.E.), Paris-Saclay University, Versailles SQY University (UVSQ), EA4340-BECCOH, Assistance Publique-Hôpitaux de Paris (APHP), Ambroise-Paré Hospital, Boulogne-Billancourt, France
| | - Manuel A Friese
- From the Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (C.S., I.S., M.A.F.); Department of Neurology (C.S., I.S., S.C.F., M.A.F.), University Medical Center Hamburg-Eppendorf, Germany; and Pathology Department (J.-F.E.), Paris-Saclay University, Versailles SQY University (UVSQ), EA4340-BECCOH, Assistance Publique-Hôpitaux de Paris (APHP), Ambroise-Paré Hospital, Boulogne-Billancourt, France
| |
Collapse
|
40
|
Abreu AFTD, Amorim RPD, Oliveira PMD, Moraes MPDT, Marques SA. Benign cephalic histiocytosis: exuberant manifestation in an infant. An Bras Dermatol 2024; 99:451-454. [PMID: 38443301 DOI: 10.1016/j.abd.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/02/2022] [Accepted: 11/08/2022] [Indexed: 03/07/2024] Open
Affiliation(s)
- Ana Flávia Teixeira de Abreu
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil.
| | - Rebecca Perez de Amorim
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Pedro Marciano de Oliveira
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Marcelo Padovani de Toledo Moraes
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Silvio Alencar Marques
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil
| |
Collapse
|
41
|
Ham SD, Desai P, Wertenteil S, Levy CF. A Newborn with Blueberry Muffin Lesions. Neoreviews 2024; 25:e299-e302. [PMID: 38688891 DOI: 10.1542/neo.25-5-e299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Affiliation(s)
- Steven D Ham
- Department of Pediatrics, Cohen Children's Medical Center/Northwell Health, New Hyde Park, NY
| | - Pooja Desai
- Department of Pediatrics, Cohen Children's Medical Center/Northwell Health, New Hyde Park, NY
| | - Sara Wertenteil
- Department of Dermatology, Northwell Health, New Hyde Park, NY
| | - Carolyn Fein Levy
- Department of Pediatrics, Cohen Children's Medical Center/Northwell Health, New Hyde Park, NY
| |
Collapse
|
42
|
Dai S, Su X, Liu WP, Wu Y. Multisystem Erdheim-Chester disease presenting with pericardial effusion confirmed by the effusion cytology specimen. Cardiovasc Pathol 2024; 70:107625. [PMID: 38417471 DOI: 10.1016/j.carpath.2024.107625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/01/2024] Open
Abstract
Erdheim-Chester disease (ECD) is a rare histiocytosis characterized by the foamy CD68+CD1a- histiocytes infiltrating multiple organs and tissues. ECD might be asymptomatic or present with variable manifestations. The diagnosis of ECD requires characteristic radiological findings and pathological features. Herein, we described a 52-year-old female patient who was admitted to our hospital for recurrent pericardial effusion for two months. She has a medical history of papillary thyroid carcinoma (PTC) and underwent a total thyroidectomy two years before admission. The radiological findings suggested a potential diagnosis of ECD. Cytological analysis of the effusion cytology specimen revealed CD68+CD1a- histiocytes, confirming the ECD diagnosis. The BRAF V600E mutation was identified in the histiocytes, prompting the administration of vemurafenib, a BRAF inhibitor. After two months of standard-dose vemurafenib treatment, the disease was well controlled with pericardial effusion regression.
Collapse
Affiliation(s)
- Shishuo Dai
- Department of Clinical Medicine, West China School of Medicine/West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan 610041, China
| | - Xueying Su
- Department of Clinical Medicine, West China School of Medicine/West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan 610041, China; Department of Pathology, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan 610041, China
| | - Wei-Ping Liu
- Department of Clinical Medicine, West China School of Medicine/West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan 610041, China; Department of Pathology, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan 610041, China
| | - Yu Wu
- Department of Clinical Medicine, West China School of Medicine/West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan 610041, China; Department of Hematology, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan 610041, China.
| |
Collapse
|
43
|
Guja KE, Behr G, Bedmutha A, Kuhn M, Nadel HR, Pandit-Taskar N. Molecular Imaging with PET-CT and PET-MRI in Pediatric Musculoskeletal Diseases. Semin Nucl Med 2024; 54:438-455. [PMID: 38688770 DOI: 10.1053/j.semnuclmed.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 05/02/2024]
Abstract
Molecular imaging has emerged as an integral part of oncologic imaging. Given the physiologic changes that precede anatomic changes, molecular imaging can enable early detection of disease and monitoring of response. [18F] Fluorodeoxyglucose (FDG) Positron emission tomography (PET) is the predominant molecular imaging modality used in oncologic assessment and can be performed using PET/CT or PET/MR. In pediatric patients, PET/MRI imaging is generally preferred due to low radiation exposure and PET/MRI is particularly advantageous for imaging musculoskeletal (MSK) diseases, as MRI provides superior characterization of tissue changes as compared to CT. In this article, we provide an overview of the typical role of PET CT/MRI in assessment of some common pediatric malignancies and benign MSK diseases with case examples. We also discuss the relative advantages of PET/MRI compared to PET/CT, and review published data with a primary focus on the use of PET/MR.
Collapse
Affiliation(s)
- Kip E Guja
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Gerald Behr
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; Weil Cornell Medical College, New York, New York
| | - Akshay Bedmutha
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marlena Kuhn
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Helen R Nadel
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Neeta Pandit-Taskar
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; Weil Cornell Medical College, New York, New York.
| |
Collapse
|
44
|
Lee MHH, Smith EJ, Hardy TG, Graf N, Tumuluri K. Paediatric Orbital Juvenile Xanthogranuloma: A Case Series and Review of the Literature. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00389. [PMID: 38687290 DOI: 10.1097/iop.0000000000002696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
PURPOSE Juvenile xanthogranuloma (JXG) is a subtype of histiocytosis characterised histologically by foamy non-Langerhan cells with Touton giant cells. It typically manifests as a single self-limiting cutaneous nodule in the paediatric population. Orbital JXG is extremely rare, and its clinical course and management are not well understood or defined. Herein we present 3 cases of orbital JXG and provide a detailed literature review. METHODS Review of 3 cases with orbital JXG and literature review of all published cases. RESULTS Three presented cases demonstrate the heterogeneous clinical course of orbital JXG. Although centred around the use of steroids, there is neither robust evidence nor consensus on its management. The wider JXG literature is currently concentrated around the classification of JXG with respect to histiocytosis, especially the exclusion of extracutaneous JXG as separate diseases. This separation is based on clinical, histopathological, and molecular findings. It is unclear where orbital JXG best fits in this emerging classification of JXG. CONCLUSION Our review of the cases and literature on orbital JXG show that it may manifest with variable clinical course and its molecular pathogenic mechanism may be different to that of the cutaneous JXG.
Collapse
Affiliation(s)
- Ming-Han H Lee
- Department of Ophthalmology, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead
- School of Medicine, The University of Sydney
- Save Sight Institute, Sydney, New South Wales
| | - Ebony J Smith
- Department of Ophthalmology, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead
- Department of Ophthalmology, Sunshine Coast University Hospital, Queensland
| | - Thomas G Hardy
- Orbital, Plastic and Lacrimal Service (OPAL), Royal Victorian Eye and Ear Hospital, Melbourne
- Department of Ophthalmology, Royal Children's Hospital
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria
| | - Nicole Graf
- School of Medicine, The University of Sydney
- Department of Histology, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead
- School of Medicine, Western Sydney University, Campbelltown, Sydney, New South Wales, Australia
| | - Krishna Tumuluri
- Department of Ophthalmology, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead
- School of Medicine, The University of Sydney
- Save Sight Institute, Sydney, New South Wales
| |
Collapse
|
45
|
Gagliardo CM, Giammanco A, Vaglio A, Pegoraro F, Cefalù AB, Averna M, Noto D. Erdheim-Chester disease as complex clinical presentation and diagnosis: A case report and concise review of literature. Medicine (Baltimore) 2024; 103:e37870. [PMID: 38669404 PMCID: PMC11049690 DOI: 10.1097/md.0000000000037870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
RATIONALE Erdheim-Chester disease (ECD) is a rare multisystemic disease characterized by the infiltration of multiple organs by foamy CD68 + CD1a-histiocytes. The genetic background consists of gain-of-function somatic mutations in the mitogen-activated protein kinase pathway. The purpose of the present paper is to make a contribution to the scientific literature on ECD by reporting our experience with a complex clinical case report, along with a concise review of the literature. We discussed the unusual clinical presentation, the complex diagnostic process and the comparison with other published cases. PATIENT CONCERNS A 70-year-old man presented with arthralgia due to multiple bone areas of sclerosis, first diagnosed with metastases of a prostatic neoplasm. Sequential thorax-abdomen, femoral and homer contrast-enhanced computed tomography (CT) showed pericardial effusion, pulmonary fibrosis, and perirenal fibrous tissue as "hairy kidneys." He underwent. Three bone biopsies were unsuccessful to reach diagnosis. DIAGNOSES A xanthelasma biopsy showed histopathological signs compatible with ECD; genetic analysis showed the mutation BRAFV600E. INTERVENTIONS The patient underwent targeted therapy with vemurafenib (BRAF-inhibitor), discontinued 2 weeks later due to the onset of a diffuse erythematous papular rash on the trunk and limbs. OUTCOMES At the 1-year follow-up, there was only progression of chronic kidney disease (CKD). LESSONS The present case report describes how ECD diagnosis could represent a challenge for clinicians, owing to its heterogeneous clinical presentation. Early diagnosis followed by prompt therapy is essential for modifying the natural history of the disease.
Collapse
Affiliation(s)
- Carola M. Gagliardo
- Department of Health Promotion, Maternal and Child Health, Internal and Specialized Medicine of Excellence “G. D. Alessandro” (PROMISE), University of Palermo, Palermo, Italy
| | - Antonina Giammanco
- Department of Health Promotion, Maternal and Child Health, Internal and Specialized Medicine of Excellence “G. D. Alessandro” (PROMISE), University of Palermo, Palermo, Italy
| | - Augusto Vaglio
- Nephrology and Dialysis Unit, Meyer Children’s Hospital IRCCS, Florence, Italy
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | - Francesco Pegoraro
- Department of Health Science, University of Florence, Florence, Italy
- Pediatric Hematology and Oncology Unit, Meyer Children’s University Hospital IRCCS, Florence, Italy
| | - Angelo B. Cefalù
- Department of Health Promotion, Maternal and Child Health, Internal and Specialized Medicine of Excellence “G. D. Alessandro” (PROMISE), University of Palermo, Palermo, Italy
| | - Maurizio Averna
- Department of Health Promotion, Maternal and Child Health, Internal and Specialized Medicine of Excellence “G. D. Alessandro” (PROMISE), University of Palermo, Palermo, Italy
| | - Davide Noto
- Department of Health Promotion, Maternal and Child Health, Internal and Specialized Medicine of Excellence “G. D. Alessandro” (PROMISE), University of Palermo, Palermo, Italy
| |
Collapse
|
46
|
King HL, Benedetti GB, Keller JJ, DeLoughery TG, Shatzel JJ, Martens KL. Dermatologic manifestations of hematologic disorders. Ann Hematol 2024:10.1007/s00277-024-05761-5. [PMID: 38662204 DOI: 10.1007/s00277-024-05761-5] [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: 02/13/2024] [Accepted: 04/14/2024] [Indexed: 04/26/2024]
Abstract
Distinguishing key morphologic features and understanding the pathophysiology of common cutaneous manifestations of hematologic disorders is essential to ensure prompt and appropriate treatment. In fact, classic cutaneous signs may provide the first clue to the diagnosis of an underlying hematologic disease. Disorders of coagulation, vascular abnormalities, or cutaneous infiltration and deposition are responsible for the underlying pathophysiology of cutaneous manifestations in the majority of cases. Hematologists often feel ill-equipped in identifying morphologic changes in the skin. Thus, the purpose of this review is to provide a comprehensive overview of classic cutaneous manifestations and diagnostic considerations of the associated hematologic conditions. Though there is a specific focus on non-malignant disorders, those straddling the spectrum of malignancy are also discussed. In many disease states, the skin may serve as an important marker of an emerging hematologic disorder, so close collaboration and multidisciplinary input remain essential to provide optimal and timely care for these patients.
Collapse
Affiliation(s)
- Hannah L King
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | | | - Jesse J Keller
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | - Thomas G DeLoughery
- Division of Hematology and Medical Oncology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road Mail Code: OC14HO, 97239, Portland, OR, USA
| | - Joseph J Shatzel
- Division of Hematology and Medical Oncology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road Mail Code: OC14HO, 97239, Portland, OR, USA
| | - Kylee L Martens
- Division of Hematology and Medical Oncology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road Mail Code: OC14HO, 97239, Portland, OR, USA.
| |
Collapse
|
47
|
Aromolo IF, Moltrasio C, Maronese CA, Campochiaro C, Bonometti A, Berti E, Passoni E, Marzano A. Successful treatment of cutaneous-onset Erdheim-Chester disease with cobimetinib and anakinra. Clin Exp Dermatol 2024; 49:523-525. [PMID: 38231013 DOI: 10.1093/ced/llae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/08/2023] [Accepted: 01/02/2024] [Indexed: 01/18/2024]
Abstract
Erdheim–Chester disease is a rare multisystem non-Langerhans cell histiocytosis. We report the case of a patient with BRAF wildtype Erdheim–Chester disease presenting with facial nodular xanthomas and developing systemic involvement 10 years later. The patient was successfully treated with a combination of anakinra and cobimetinib.
Collapse
Affiliation(s)
| | - Chiara Moltrasio
- Dermatology Unit, IRCCS Foundation Maggiore Policlinico Hospital, Lombardia, Milan, Italy
- Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Friuli-Venezia Giulia, Italy
| | | | | | | | - Emilio Berti
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Emanuela Passoni
- Dermatology Unit, IRCCS Foundation Maggiore Policlinico Hospital, Lombardia, Milan, Italy
| | - Angelo Marzano
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Dermatology Unit, IRCCS Foundation Maggiore Policlinico Hospital, Lombardia, Milan, Italy
| |
Collapse
|
48
|
Palmeiro AG, Pimentel B, Castro CG, Claro C, Viana I. Hypopigmented white patches in a newborn. Clin Exp Dermatol 2024; 49:537-539. [PMID: 38123493 DOI: 10.1093/ced/llad448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 11/18/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
A newborn developed multiple hyperkeratotic erythematous papules, some with central erosions, mainly located on her scalp and trunk. Histopathology revealed a dense infiltrate of monotonous mononuclear cells with pale pink cytoplasm and reniform nuclei, positive for CD1a, S100 protein and langerin.
Collapse
Affiliation(s)
| | | | | | - Cristina Claro
- Department of Dermatology, Hospital Egas Moniz, Lisbon, Portugal
| | - Isabel Viana
- Department of Dermatology, Hospital Egas Moniz, Lisbon, Portugal
| |
Collapse
|
49
|
Gazik FK, Gookizadeh P, Khadivi M, Mehrjardi AZ, Iranmehr A. A rare presentation of Rosai-Dorfman disease as a single dural-based lumbar intradural lesion: A case report. Heliyon 2024; 10:e28542. [PMID: 38689968 PMCID: PMC11059540 DOI: 10.1016/j.heliyon.2024.e28542] [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: 10/16/2023] [Revised: 03/08/2024] [Accepted: 03/20/2024] [Indexed: 05/02/2024] Open
Abstract
Central nervous system Rosai Dorfman disease (RDD) is a rare condition and it is just reported in 5% of 600 registered RDD cases. In previously reported patients, the intradural extramedullary spinal lesion is extremely rare. In this article, we aim to report a case of intradural extramedullary Rosai-Dorfman lesion of the lumbar spine which was managed with gross total resection. Lumbar meningioma was the pre-operative diagnosis for this patient, the final correct diagnosis of Rosai-Dorfman disease was made after histological examination. RDD should be considered in the differential diagnosis of single intradural extramedullary lesions of the lumbar spine.
Collapse
Affiliation(s)
- Farid Kazemi Gazik
- Department of Neurosurgery, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Peyman Gookizadeh
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Khadivi
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Zare Mehrjardi
- Department of Pathology, Iran University of Medical Sciences, Tehran, Iran
| | - Arad Iranmehr
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Gamma-Knife Radiosurgery Center, Yas Hospital, Tehran University of Medical Sciences, Iran
| |
Collapse
|
50
|
Shi C, Lytle A, Milman T, Penne R, Bagg A. Composite Histiocytic Sarcoma and Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma of the Ocular Adnexa. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00377. [PMID: 38624159 DOI: 10.1097/iop.0000000000002670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Histiocytic sarcoma (HS) is a rare and aggressive hematologic neoplasm characterized by the proliferation of malignant histiocytes. It infrequently presents with periorbital involvement. Here we present the first documented case of ocular adnexal histiocytic sarcoma composite with chronic lymphocytic leukemia/small lymphocytic lymphoma and provide compelling evidence for the transdifferentiation of chronic lymphocytic leukemia/small lymphocytic lymphoma to histiocytic sarcoma in an 80-year-old woman. Comprehending the clinicopathological characteristics of histiocytic sarcoma and various other histiocytic proliferations and neoplasms affecting orbital and ocular structures is imperative for ophthalmic surgeons and pathologists.
Collapse
Affiliation(s)
- Chenxu Shi
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Andrew Lytle
- Centre for Lymphoid Cancer, BC Cancer and Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Tatyana Milman
- Department of Ophthalmology Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Robert Penne
- Department of Ophthalmology Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
- Department of Oculoplastic and Orbital Surgery, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Adam Bagg
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| |
Collapse
|