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Gru AA, Horacio Maluf MD. Contributions of Dr. Louis "Pepper" Dehner to the art of cutaneous pathology, the first pediatric dermatopathologist. Semin Diagn Pathol 2016; 33:441-449. [PMID: 27720563 DOI: 10.1053/j.semdp.2016.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Dr. Louis "Pepper" Dehner has been one of the most influential surgical pathologists of the last century. Authoring more than 450 publications, he is the premier modern pediatric pathologist. Perhaps, an area that he is less recognized and in which we would like to describe his contributions, is his role as a creator of the art of pediatric dermatopathology. Dr. Dehner has had at least 50 major publications describing, discovering, and orienting the discipline in the fields of fibrohistiocytic disorders of childhood, vascular tumors, and histiocytosis among many others. Dr. Dehner has clearly manifested that while many similarities between adult and pediatric surgical pathology exist, "children get different diseases." It is because of his mindful analysis and translation of the clinico-pathologic and biologic correlative between specific entities and advances in the field he has made that we are honored to describe some of his contributions to this particular area.
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Affiliation(s)
- Alejandro A Gru
- Department of Pathology, University of Virginia, Charlottesville, Virginia.
| | - M D Horacio Maluf
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
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Abstract
Two hundred eight neonates with malignant tumors and cutaneous metastases were reviewed. Malignancies most often associated with cutaneous metastases, in order of rank, were leukemia, multisystem Langerhans cell histiocytosis, neuroblastoma, rhabdoid tumor, rhabdomyosarcoma, primitive neuroectodermal tumor, choriocarcinoma, and adrenocortical carcinoma. Bluish skin nodules producing the "blueberry muffin baby"-like appearance were the most common dermatologic finding in 171, or 82% of 208 neonates. The tendency of newborns to present with skin nodules is one of the significant differences between malignancies in younger and older children. Patients with rhabdoid tumor and rhabdomyosarcoma had the lowest survival rates, 4% and 15%, respectively, compared with leukemia, 37.5%, and neuroblastoma, 58%. Overall survival was 39%.
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Affiliation(s)
- Hart Isaacs
- Department of Pathology, Rady Children's Hospital San Diego, San Diego, California 92123, USA.
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Nezelof C, Basset F. Langerhans cell histiocytosis research. Past, present, and future. Hematol Oncol Clin North Am 1998; 12:385-406. [PMID: 9561908 DOI: 10.1016/s0889-8588(05)70518-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This article reviews the various investigative events that led to the endorsement of the term Langerhans cell histiocytosis for the various clinicopathologic conditions previously called Hand-Schüller-Christian disease, Abt-Letterer-Siwe disease, eosinophilic granuloma of bone, and histiocytosis X. The different denominations reflect the changing conceptual approaches to the so-called reticuloendothelial system and the successive acquisition of new ultrastructural and immunocytochemical data.
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Affiliation(s)
- C Nezelof
- Department of Pathology, Faculté de Médecine de Paris, France
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Hamre M, Hedberg J, Buckley J, Bhatia S, Finlay J, Meadows A, Nesbit M, Smithson A, Robison L. Langerhans cell histiocytosis: an exploratory epidemiologic study of 177 cases. MEDICAL AND PEDIATRIC ONCOLOGY 1997; 28:92-7. [PMID: 8986144 DOI: 10.1002/(sici)1096-911x(199702)28:2<92::aid-mpo2>3.0.co;2-n] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
There is little information available regarding epidemiologic risk factors for Langerhans cell histiocytosis (LCH). An exploratory investigation was conducted using information obtained from parents of 177 cases of LCH diagnosed before 21 years of age (median 2 years). Utilizing data available from the Children's Cancer Group, LCH cases were compared to two matched control groups including 614 patients diagnosed with a variety of childhood cancers and 318 community controls. Questionnaire data included information on demographics, prenatal and perinatal factors, complications in the neonatal period, environmental exposures, family medical history, and childhood exposures. Factors found to be statistically significantly associated with an increased risk of LCH included: maternal urinary tract infection during the index pregnancy, feeding problems during infancy, and blood transfusions during infancy. Use of supplemental vitamins was associated with a significantly decreased risk of LCH. Results from this exploratory study provide a basis for speculation on potential etiologic risk factors for LCH. Future epidemiologic investigations of LCH need to consider the presenting disease characteristics in assessing possible etiologic factors.
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Affiliation(s)
- M Hamre
- Division of Hematology and Oncology, Children's Memorial Hospital, Chicago, Illinois, USA
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Bernstein EF, Resnik KS, Loose JH, Halcin C, Kauh YC. Solitary congenital self-healing reticulohistiocytosis. Br J Dermatol 1993; 129:449-54. [PMID: 8217762 DOI: 10.1111/j.1365-2133.1993.tb03175.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Congenital self-healing reticulohistiocytosis (CSHR) was first described in 1973 by Hashimoto and Pritzker. Since then, both multiple and solitary forms have been described. We report a further case of solitary congenital self-healing reticulohistiocytosis. CSHR is a rare disorder which frequently presents a diagnostic dilemma in the newborn. Nodular forms of systemic Langerhans cell histiocytosis may present in a manner similar to CSHR. Because their differentiation on histopathological grounds is impossible, physical examination, laboratory investigations, and follow-up are necessary to ensure a lack of systemic involvement. Although previously thought to represent a rare variant of CSHR, solitary lesions of CSHR account for almost 25% of reported cases. A review of the literature relating to solitary CSHR, and a consideration of the differential diagnosis of a solitary congenital nodule, are also presented.
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Affiliation(s)
- E F Bernstein
- Thomas Jefferson University, Department of Dermatology, Philadelphia, PA 19107-5541
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Abstract
Congenital histiocytosis X involving multiple organs is a rare disease that causes rapid mortality in intrauterine and neonatal life. The diagnosis of histiocytosis X (Letterer-Siwe disease) should be considered in a neonate with vesiculated crusting skin lesions. We present clinical, radiographic and histopathological findings in a neonate with congenital histiocytosis who died of respiratory failure due to diffuse infiltration of lungs with histiocytic cells.
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Affiliation(s)
- A Vade
- Department of Radiology, Loyola University Medical Center, Maywood, Illinois 60153
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Hashimoto K, Kagetsu N, Taniguchi Y, Weintraub R, Chapman-Winokur RL, Kasiborski A. Immunohistochemistry and electron microscopy in Langerhans cell histiocytosis confined to the skin. J Am Acad Dermatol 1991; 25:1044-53. [PMID: 1687409 DOI: 10.1016/0190-9622(91)70305-l] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Four cases of benign Langerhans cell histiocytosis limited to the skin were studied. In all three self-healing cases (cases 2, 3, and 4) many dense bodies, myelin bodies, and worm bodies were found. In one chronic case (case 1) none of these was identified. In all four cases, in addition to CD1, HLA-DR, and S-100 stains, interferon-gamma and S-100 beta-subunit were positive in the dermal tumor cells. Both interferon-gamma and S-100 beta-subunits were negative in the normal epidermal Langerhans cells. A comprehensive literature review yielded 87 cases of skin-limited Langerhans cell histiocytosis. These cases could be subgrouped into three categories: (1) those that resolved spontaneously, (2) those that responded to therapy and had no recurrence, and (3) those with persistent or recurrent lesions, not responding to therapy but still limited to the skin.
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Affiliation(s)
- K Hashimoto
- Department of Dermatology and Syphilology, Wayne State University School of Medicine, Detroit, MI
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Kodet R, Elleder M, De Wolf-Peeters C, Mottl H. Congenital histiocytosis. A heterogeneous group of diseases, one presenting as so-called congenital self-healing histiocytosis. Pathol Res Pract 1991; 187:458-66. [PMID: 1908575 DOI: 10.1016/s0344-0338(11)80007-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Three cases of congenital histiocytic disorders--generalized Langerhans cell histiocytosis, generalized juvenile xanthogranuloma and so-called congenital self-healing histiocytosis are compared using histiochemical, immunohistochemical and ultrastructural methods. The results showed a typical morphological pattern of Langerhans cell histiocytosis (S 100+, CD 1+, alpha-mannosidase +) with an unusual self-healing cutaneous phenomenon. The congenital self-healing histiocytosis showed a non-Langerhans cell immunophenotype (CD 14+, CD 1-, S 100-) and morphological appearance resembling the evolutive "early" stage of juvenile xanthogranuloma. A diffuse cellular positivity of alpha-mannosidase in juvenile xanthogranuloma and congenital self-healing histiocytosis differed from a typical perinuclear globular positivity of this enzyme in Langerhans cell histiocytosis. It is concluded that congenital self-healing histiocytosis may in some cases be of non-Langerhans cell type and under this term a clinically characteristic syndrome of histiocytic proliferation of Langerhans cells or tissue histiocytes may be included.
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Affiliation(s)
- R Kodet
- Department of Pathology, Faculty of Paediatric Medicine, Charles' University, Prague, Czechoslovakia
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Timpatanapong P, Rochanawutanon M, Siripoonya P, Nitidandhaprabhas P. Congenital self-healing reticulohistiocytosis: report of a patient with a strikingly large tumor mass. Pediatr Dermatol 1989; 6:28-32. [PMID: 2704660 DOI: 10.1111/j.1525-1470.1989.tb00263.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A newborn male Thai infant had numerous brownish red nodules of various sizes scattered over both palms and soles, left thigh, abdomen, chin, and left upper eyelid. An extremely large tumor mass was present on the right sole. Many lesions showed spontaneous ulceration. No extracutaneous involvement was found. All lesions involuted spontaneously within two to three months, some with scar formation. Histology showed large numbers of mononucleated and multinucleated histiocytic cell infiltrations, 10% of which contained Birbeck's granules. Areas of necrosis and calcification were also seen in the largest tumor. No recurrence was observed after follow-up for three years.
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Affiliation(s)
- P Timpatanapong
- Department of Medicine, Mahidol University, Bangkok, Thailand
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Dehner LP. Allogeneic bone marrow transplantation in a patient with chemotherapy-resistant progressive histiocytosis X. N Engl J Med 1987; 317:773-4. [PMID: 3306383 DOI: 10.1056/nejm198709173171221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Abstract
A 38-month-old boy presented with nodules in the skin of the genital region present for 2 1/2 years. These later spread to the skin of the trunk, head, and extremities. A complete clinical workup could not reveal involvement in any other organ sites and biopsy of one of the cutaneous lesions was diagnosed as histiocytosis X. Because the child was in generally good condition, no treatment was given. Follow-up revealed that the disease had remained limited to the skin, where 15% of the lesions disappeared spontaneously.
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Esterly NB, Maurer HS, Gonzalez-Crussi F. Histiocytosis X: a seven-year experience at a children's hospital. J Am Acad Dermatol 1985; 13:481-96. [PMID: 3877082 DOI: 10.1016/s0190-9622(85)70192-2] [Citation(s) in RCA: 99] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Thirty-two patients with histiocytosis X were evaluated and treated at Children's Memorial Hospital, Chicago, during the years 1978 to 1984. Twelve patients (38%) had solitary or multifocal bone lesions, three (9%) had bone lesions and diabetes insipidus, and seventeen (53%) had cutaneous and/or multisystem involvement. Age at diagnosis ranged from 2 days to 15 years. Fifteen patients were 2 years of age or younger at the time of diagnosis. Sixteen patients (50%) had skin infiltrates, of whom seven (43%) had cutaneous lesions documented at birth. Cutaneous lesions included vesicopustules, erythematous papules, nodules, eczematous dermatitis, granulomatous ulcerative lesions, petechiae, and hemorrhagic lesions. Xanthomas and nail dystrophy were not observed. The therapeutic regimen chosen was based on extent of involvement and location of infiltrates. Only two of the thirty-two patients died; both had multisystem disease.
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Isaacs H. Perinatal (congenital and neonatal) neoplasms: a report of 110 cases. PEDIATRIC PATHOLOGY 1985; 3:165-216. [PMID: 3879355 DOI: 10.3109/15513818509078782] [Citation(s) in RCA: 89] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
One hundred ten congenital and neonatal tumors encompassing a 25-year period are described and compared with similar published cases. Forty percent are classified as histologically malignant, and 65% of neonates with malignancies died. The types, frequency, and clinical features of neoplasms encountered in the perinatal period are markedly different from those observed in older children and adolescents. Their biological behavior and response to therapy are also dissimilar. Leukemia was responsible for the largest number of deaths followed by neuroblastoma and brain tumors.
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Ornvold K, Vidar Jacobsen S, Nielsen MH. Congenital self-healing reticulohistiocytoma. A clinical, histological and ultrastructural study. ACTA PAEDIATRICA SCANDINAVICA 1985; 74:143-7. [PMID: 3984719 DOI: 10.1111/j.1651-2227.1985.tb10938.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A 2 300 g male infant presented at birth with multiple, firm, bluish skin nodules, petechiae and thrombocytopenia. Physical examination was otherwise normal and no biochemical signs of organ dysfunction were found. A skin biopsy, done on the second day of life, was consistent with self-healing reticulohistiocytoma by light and electron microscopy. The nodules spontaneously resolved during the following months. At one year follow-up, he was without evidence of disease, the only sequelae being occasional discrete scarring. The major problem with this rare entity lies in its dramatic presentation and the chance of possible hazardous "overtreatment".
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Valderrama E, Kahn LB, Festa R, Lanzkowsky P. Benign isolated histiocytosis mimicking chicken pox in a neonate: report of two cases with ultrastructural study. PEDIATRIC PATHOLOGY 1985; 3:103-13. [PMID: 4034439 DOI: 10.3109/15513818509068840] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Two cases of benign isolated cutaneous histiocytosis X in newborn infants are reported. Clinically, the lesions mimicked chicken pox, and the histologic findings in skin biopsies were indistinguishable from those described in infantile Letterer-Siwe disease. Electron microscopy showed Langerhans' cells with the classical trilaminar, racket-shaped granules. Our cases a well as 10 of the 21 previously reported cases showed spontaneous resolution of the skin lesions. Since this is a benign spontaneous resolving histiocytosis, we recommend that no therapy be given provided that no other signs of systemic involvement are found.
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Abstract
The histiocytoses represent a heterogeneous group of conditions. Their common denominator is the proliferation and the activation of the mononuclear phagocyte system (MPS). On the basis of recent advances in the knowledge of the distribution, biology, and behavior of the MPS, the following classification is proposed. Reactive and secondary histiocytoses related either to a chronic parasitic intracellular infection or to a patent or latent immunodeficiency state. Some well-established conditions belong to this category--i.e., familial lympho-histiocytosis, cytophagic sinus histiocytosis, Omenn's reticulosis. The dystrophic histiocytoses associated with the storage of either exogenous or endogenous material. It is prudent to separate the storages of homogeneous and chemically defined lipid material (such as cerebroside, sphingomyelin, etc.) from those of heterogeneous lipid material. Proliferative histiocytoses: it is crucial to distinguish the malignant histiocytosis from the histiocytosis X, which seems to be associated with a nonmalignant proliferation of a subpopulation of the MPS, the Langerhans cell system.
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