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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.
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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
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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.
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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.
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Biswas A, Wong OY, Aygun B, Gore S, Mankad K. Extraocular Orbital and Peri-Orbital Masses. Neuroimaging Clin N Am 2023; 33:643-659. [PMID: 37741663 DOI: 10.1016/j.nic.2023.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
In this article, we will describe relevant anatomy and imaging findings of extraocular and orbital rim pathologic conditions. We will highlight important clinical and imaging pearls that help in differentiating these lesions from one another, and provide a few practical tips for challenging cases.
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Affiliation(s)
- Asthik Biswas
- Department of Neuroradiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK.
| | - Oi Yean Wong
- Department of Neuroradiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK
| | - Berna Aygun
- Department of Neuroradiology, UK Kings College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Sri Gore
- Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kshitij Mankad
- Department of Neuroradiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK; UCL GOS Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
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Joseph AK, Guerin JB, Eckel LJ, Dalvin LA, Keating GF, Liebo GB, Benson JC, Brinjikji W, Laack NN, Silvera VM. Imaging Findings of Pediatric Orbital Masses and Tumor Mimics. Radiographics 2022; 42:880-897. [PMID: 35245105 DOI: 10.1148/rg.210116] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pediatric orbital masses are not common but encompass a wide spectrum of benign and malignant entities that range from developmental anomalies to primary and secondary orbital malignancies and metastatic disease. Certain orbital tumors are unique to pediatric patients, such as retinoblastoma and neuroblastoma. Clinical symptoms and signs are often insufficient to differentiate between orbital lesions, and imaging is essential for narrowing the diagnostic considerations and determining the most appropriate management strategy. MRI is the primary imaging modality for evaluating orbital masses in children, with US and CT playing complementary roles. The authors review a spectrum of masses and tumor mimics that affect the pediatric globe and orbit. The shared and differentiating characteristics of pediatric orbital lesions are reviewed. Emphasis is placed on utilizing an orbital compartment-based approach to narrow the differential diagnosis. By using this organizational scheme, the authors describe intraocular processes (retinoblastoma, persistent fetal vasculature, and Coats disease), intraconal lesions (lymphatic malformation, schwannoma, optic nerve sheath meningioma, and optic pathway glioma), extraconal lesions (infantile hemangioma, rhabdomyosarcoma, idiopathic orbital inflammation, lymphoma, venous varix, plexiform neurofibroma, and pleomorphic adenoma of the lacrimal gland), and lesions involving the bony orbit (dermoid cyst, metastatic neuroblastoma, and Langerhans cell histiocytosis). The authors describe the basic management of each entity. Orbital infections and traumatic lesions are beyond the scope of this article. ©RSNA, 2022.
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Affiliation(s)
- Annie K Joseph
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Julie B Guerin
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Laurence J Eckel
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Lauren A Dalvin
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Gesina F Keating
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Greta B Liebo
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - John C Benson
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Waleed Brinjikji
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Nadia N Laack
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - V Michelle Silvera
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
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Langerhans Cell Histiocytosis of the Orbit: Spectrum of Clinical and Imaging Findings. J Pediatr 2021; 230:174-181.e1. [PMID: 33157073 DOI: 10.1016/j.jpeds.2020.10.056] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/03/2020] [Accepted: 10/22/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the clinical and imaging characteristics of orbital lesions of pediatric Langerhans cell histiocytosis (LCH). STUDY DESIGN A retrospective analysis of clinical data and central review of magnetic resonance imaging scans in patients with LCH, enrolled into one of the consecutive international trials LCH I-III, or submitted for a second opinion between 1994 and 2015. RESULTS Data from 31 children (34 involved orbits) were analyzed. Orbital LCH was the only disease manifestation in 15, part of a multifocal skeletal in 5, or a multisystem LCH in 11 patients. Orbital LCH was part of the initial disease presentation in 23 or developed at relapse in 8 cases. Orbital involvement was unilateral in 28 and bilateral in 3 patients (34 affected orbits). Proptosis was present in 9 patients. Frontal and zygomatic bone were most commonly affected. All orbital lesions were extraconal. Associated extraorbital imaging findings were dural tail sign in 19, neurodegeneration in 8, and hypothalamic-pituitary mass in 3 patients. Sixteen patients (52%) had at least 1 documented disease relapse. Permanent consequences were prominent proptosis in 1, diabetes insipidus in 8, growth hormone deficiency in 2, radiologic neurodegeneration in 8, and clinical neurodegeneration in 3 patients. CONCLUSIONS Predominantly unilateral orbital LCH can be the only disease manifestation or part of a disseminated disease. Orbital lesions in LCH are exclusively extraconal, typically located at the roof and the lateral wall of the orbit. The optimal treatment approach of unifocal LCH of the orbit remains controversial and warrants a prospective evaluation.
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Singh J, Rajakulasingam R, Saifuddin A. Langerhans cell histiocytosis of the shoulder girdle, pelvis and extremities: a review of radiographic and MRI features in 85 cases. Skeletal Radiol 2020; 49:1925-1937. [PMID: 32451558 DOI: 10.1007/s00256-020-03472-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To describe the radiographic and MRI features of histologically proven Langerhans cell histiocytosis (LCH) of the bone. MATERIALS AND METHODS A retrospective review of the radiographic and MRI features of 85 histologically proven cases of skeletal LCH over a 12-year period. Clinical data recorded included age, gender and location. Radiographic features evaluated included Lodwick grading, cortical/periosteal response and matrix mineralisation. MRI features assessed included lesion size and T1-weighted signal intensity (T1W SI), nature of margin, hypointense rim, enhancement pattern, bone marrow and soft tissue oedema, soft tissue mass, fluid-fluid levels, the penumbra sign and the budding and bulging signs. RESULTS The study included 85 patients, 54 males and 31 females with mean age of 13 years (range 1-76 years). The femur was the commonest bone involved (38.8%), followed by the scapula (9.4%), clavicle (8.2%), ilium (8.2%) and ischium (8.2%). The mean maximal lesion size was 40 mm (range 16-85 mm). The commonest radiographic appearance was of a lytic lesion with no appreciable sclerotic rim, an intact expanded cortex and either absent or laminated periosteal response. MRI demonstrated a hypointense rim (41.5%), the budding (31.7%) and bulging (36.6%) signs, eccentric extra-osseous mass (42.7%), prominent bone marrow (95.3%) and soft tissue oedema (84.1%). Rarer features included haemorrhage (2.4%), the penumbra sign (3.5%) and fluid-fluid levels (2.4%). Thirteen of 25 post-contrast studies showed peripheral/rim enhancement with central necrosis. CONCLUSIONS LCH classically presents as a moderately aggressive lytic bone lesion on radiography, with prominent reactive bone and soft tissue oedema being a characteristic feature on MRI.
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Affiliation(s)
- J Singh
- Department of Medical Imaging, Guru Nanak Dev Superspeciality hospital, Goindwal Sahib Road, Taran Sahib, Punjab, 143401, India
| | - R Rajakulasingam
- Department of Medical Imaging, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK.
| | - A Saifuddin
- Department of Medical Imaging, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
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