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Lin H, Cao XX. Current State of Targeted Therapy in Adult Langerhans Cell Histiocytosis and Erdheim-Chester Disease. Target Oncol 2024; 19:691-703. [PMID: 38990463 DOI: 10.1007/s11523-024-01080-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [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.
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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.
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Wang XZ, Gao XM, Wang JM, Cai H, Li J, Cao XX. Co-occurrence of Erdheim-Chester disease and clonally evolving acute myeloid leukemia with FLT3-ITD and PTPN11 mutations. Ann Hematol 2024; 103:3229-3233. [PMID: 38879649 DOI: 10.1007/s00277-024-05842-5] [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: 03/20/2024] [Accepted: 06/09/2024] [Indexed: 07/28/2024]
Abstract
Erdheim-Chester disease (ECD) is a rare histiocytosis that tends to co-exist with other myeloid malignancies. Here, we use genetic and transcriptomic sequencing to delineate a case of co-occurring BRAFV600E-mutated ECD and acute myeloid leukemia (AML), followed by AML remission and relapse. The AML relapse involved the extinction of clones with KMT2A-AFDN and FLT3-ITD, and the predominance of PTPN11-mutated subclones with distinct transcriptomic features. This case report has highlighted the screening for other myeloid malignancies at the diagnosis of ECD and the clinical significance of PTPN11-mutated AML subclones that require meticulous monitoring.
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Affiliation(s)
- Xue-Zhu Wang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Xue-Min Gao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Jun-Mei Wang
- Neuropathological Department, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing Neurosurgical Institute, Beijing, China
| | - Hao Cai
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Jian Li
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Xin-Xin Cao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
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3
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Prieto-Torres L, Requena L, Rodríguez-Pinilla SM. Clinical, Histopathological and Molecular Spectrum of Cutaneous Lesions in Myelodysplastic Syndrome and Myeloproliferative Neoplasms (MDS/MPN): An Integrative Review. Cancers (Basel) 2023; 15:5888. [PMID: 38136431 PMCID: PMC10742063 DOI: 10.3390/cancers15245888] [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: 11/10/2023] [Revised: 12/07/2023] [Accepted: 12/16/2023] [Indexed: 12/24/2023] Open
Abstract
Myeloid neoplasms and acute leukemias include different entities that have been recently re-classified taking into account molecular and clinicopathological features. The myelodysplastic syndrome/myeloproliferative neoplasm (MDS/MPN) category comprises a heterogeneous group of hybrid neoplastic myeloid diseases characterized by the co-occurrence of clinical and pathological features of both myelodysplastic and myeloproliferative neoplasms. The most frequent entity in this category is chronic myelomonocytic leukemia (CMML) which is, after acute myeloid leukemia (AML), the main myeloid disorder prone to develop cutaneous manifestations. Skin lesions associated with myelodysplastic and myeloproliferative neoplasms include a broad clinical, histopathological and molecular spectrum of lesions, poorly understood and without a clear-cut classification in the current medical literature. The aim of this review is to describe and classify the main clinical, histopathological and molecular patterns of cutaneous lesions in the setting of MDS/MPN in order to improve the diagnostic skills of the dermatologists, hematologists and pathologists who deal with these patients.
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Affiliation(s)
- Lucía Prieto-Torres
- Department of Dermatology, Hospital Clínico Universitario Lozano Blesa, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, 28040 Madrid, Spain;
| | - Socorro Maria Rodríguez-Pinilla
- Department of Pathology, Fundación Jiménez Díaz, Universidad Autónoma, 50019 Zaragoza, Spain;
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28040 Madrid, Spain
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Lang M, Zhou DB, Cao XX. [Mutation pedigree and treatment selection of Erdheim-Chester disease]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:876-880. [PMID: 38049347 PMCID: PMC10694082 DOI: 10.3760/cma.j.issn.0253-2727.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Indexed: 12/06/2023]
Affiliation(s)
- M Lang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - D B Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - X X Cao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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Silveira LDHJ, Nogueira CD, Costa CT, de Azevedo PT, Magalhães SMM, Pinheiro RF. Erdheim-Chester disease after Essential Thrombocythemia: coincidence or not? Hematol Transfus Cell Ther 2023; 45:90-94. [PMID: 34034993 PMCID: PMC9938459 DOI: 10.1016/j.htct.2021.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/13/2021] [Accepted: 01/27/2021] [Indexed: 02/06/2023] Open
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Machan S, Alonso-Dominguez JM, Sánchez García FJ, Nieves Salgado R, Soto C, Castro Y, Pajares R, Manso R, Santonja C, Serrano Del Castillo C, Piris MA, Requena L, Rodríguez Pinilla SM. Plasmacytoid Dendritic Cell Dermatosis Associated to Myeloproliferative/Myelodysplastic Neoplasms. Am J Surg Pathol 2022; 46:1623-1632. [PMID: 36001453 DOI: 10.1097/pas.0000000000001960] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cutaneous lesions in the setting of myeloproliferative neoplasms and myelodysplastic syndromes are poorly understood. We report 6 patients with pruritic papular eruptions composed of mature T-lymphocytes with large clusters of CD123-positive cells. Double immunohistochemical studies demonstrated a lack of myeloid cell nuclear differentiation antigen in the CD123-positive cells, which expressed SPIB, confirming that they were mature plasmacytoid dendritic cells. Four patients were diagnosed with chronic myelomonocytic leukemia and 2 with myelodysplastic syndromes (AREB-I and myelodysplastic syndromes with 5q deletion, respectively). All patients had a long history of hematological alterations, mainly thrombocytopenia, preceding the cutaneous disorder. Nevertheless, the skin lesions developed in all cases coincidentally with either progression or full-establishment of their hematological disease. Most cutaneous lesions disappeared spontaneously or after corticosteroid treatment. Molecular studies performed in both bone marrow and cutaneous lesions in 2 patients demonstrated the same mutational profile, confirming the specific, neoplastic nature of these mature plasmacytoid dendritic cells-composed cutaneous lesions.
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Affiliation(s)
| | | | | | | | | | - Yolanda Castro
- Pathology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Raquel Pajares
- Pathology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Rebeca Manso
- Pathology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Carlos Santonja
- Pathology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
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Kazama S, Yokoyama K, Ueki T, Kazumoto H, Satomi H, Sumi M, Ito I, Yusa N, Kasajima R, Shimizu E, Yamaguchi R, Imoto S, Miyano S, Tanaka Y, Denda T, Ota Y, Tojo A, Kobayashi H. Case report: Common clonal origin of concurrent langerhans cell histiocytosis and acute myeloid leukemia. Front Oncol 2022; 12:974307. [PMID: 36185232 PMCID: PMC9523168 DOI: 10.3389/fonc.2022.974307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) and acute myeloid leukemia (AML) are distinct entities of blood neoplasms, and the exact developmental origin of both neoplasms are considered be heterogenous among patients. However, reports of concurrent LCH and AML are rare. Herein we report a novel case of concurrent LCH and AML which shared same the driver mutations, strongly suggesting a common clonal origin.An 84-year-old female presented with cervical lymphadenopathy and pruritic skin rash on the face and scalp. Laboratory tests revealed pancytopenia with 13% of blasts, elevated LDH and liver enzymes, in addition to generalised lymphadenopathy and splenomegaly by computed tomography. Bone marrow specimens showed massive infiltration of MPO-positive myeloblasts, whereas S-100 and CD1a positive atypical dendritic cell-like cells accounted for 10% of the atypical cells on bone marrow pathology, suggesting a mixture of LCH and AML. A biopsy specimen from a cervical lymph node and the skin demonstrated the accumulation of atypical cells which were positive for S-100 and CD1a. LCH was found in lymph nodes, skin and bone marrow; AML was found in peripheral blood and bone marrow (AML was predominant compared with LCH in the bone marrow).Next generation sequencing revealed four somatic driver mutations (NRAS-G13D, IDH2-R140Q, and DNMT3A-F640fs/-I715fs), equally shared by both the lymph node and bone marrow, suggesting a common clonal origin for the concurrent LCH and AML. Prednisolone and vinblastine were initially given with partial response in LCH; peripheral blood blasts also disappeared for 3 months. Salvage chemotherapy with low dose cytarabine and aclarubicin were given for relapse, with partial response in both LCH and AML. She died from pneumonia and septicemia on day 384. Our case demonstrates a common cell of origin for LCH and AML with a common genetic mutation, providing evidence to support the proposal to classify histiocytosis, including LCH, as a myeloid/myeloproliferative malignancy.
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Affiliation(s)
- Shintaro Kazama
- Department of Hematology, Nagano Red Cross Hospital, Nagano, Japan
| | - Kazuaki Yokoyama
- Division of Molecular Therapy, Institute of Medical Science, Advanced Clinical Research Center, The University of Tokyo, Tokyo, Japan
- *Correspondence: Kazuaki Yokoyama, ; Arinobu Tojo,
| | - Toshimitsu Ueki
- Department of Hematology, Nagano Red Cross Hospital, Nagano, Japan
| | - Hiroko Kazumoto
- Department of Hematology, Nagano Red Cross Hospital, Nagano, Japan
| | - Hidetoshi Satomi
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Masahiko Sumi
- Department of Hematology, Nagano Red Cross Hospital, Nagano, Japan
| | - Ichiro Ito
- Department of Pathology, Nagano Red Cross Hospital, Nagano, Japan
| | - Nozomi Yusa
- Department of Applied Genomics, Research Hospital, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Rika Kasajima
- Molecular Pathology and Genetics Division, Kanagawa Cancer Center Research Institute, Yokohama, Japan
| | - Eigo Shimizu
- Division of Health Medical Data Science, Health Intelligence Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Rui Yamaguchi
- Division of Cancer Systems Biology, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Seiya Imoto
- Division of Health Medical Data Science, Health Intelligence Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Satoru Miyano
- Department of Integrated Data Science, Medical and Dental Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yukihisa Tanaka
- Department of Diagnostic Pathology, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Tamami Denda
- Department of Diagnostic Pathology, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Yasunori Ota
- Department of Diagnostic Pathology, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Arinobu Tojo
- Department of Data Science and Faculty Affairs, Tokyo Medical and Dental University, Tokyo, Japan
- *Correspondence: Kazuaki Yokoyama, ; Arinobu Tojo,
| | - Hikaru Kobayashi
- Department of Hematology, Nagano Red Cross Hospital, Nagano, Japan
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Erdheim-Chester disease collides with myelodysplastic neoplasm in bone marrow. Ann Diagn Pathol 2022; 58:151928. [DOI: 10.1016/j.anndiagpath.2022.151928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 02/02/2022] [Accepted: 02/11/2022] [Indexed: 11/22/2022]
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Martin de Frémont G, Hirsch P, Gimenez de Mestral S, Moguelet P, Ditchi Y, Emile JF, Senet P, Georgin-Lavialle S, Hanslik T, Maurier F, Adedjouma A, Abisror N, Mahevas T, Malard F, Adès L, Fenaux P, Fain O, Chasset F, Mekinian A. Myeloid Clonal Infiltrate Identified With Next-Generation Sequencing in Skin Lesions Associated With Myelodysplastic Syndromes and Chronic Myelomonocytic Leukemia: A Case Series. Front Immunol 2021; 12:715053. [PMID: 34671345 PMCID: PMC8521190 DOI: 10.3389/fimmu.2021.715053] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background Myelodysplastic syndromes (MDS) and chronic myelomonocytic leukemia (CMML) are associated with cutaneous manifestations. Next-generation sequencing (NGS) is a tool capable of identifying clonal myeloid cells in the skin infiltrate and thus better characterize the link between hematological diseases and skin lesions. Objective To assess whether skin lesions of MDS/CMML are clonally related to blood or bone marrow cells using NGS. Methods Comparisons of blood or bone marrow and skin samples NGS findings from patients presenting with MDS/CMML and skin lesions in three French hospitals. Results Among the 14 patients recruited, 12 patients (86%) had mutations in the skin lesions biopsied, 12 patients (86%) had a globally similar mutational profile between blood/bone marrow and skin, and 10 patients (71%) had mutations with a high variant allele frequency (>10%) found in the myeloid skin infiltrate. Mutations in TET2 and DNMT3A, both in four patients, were the most frequent. Two patients harbored a UBA1 mutation on hematopoietic samples. Limitations Limited number of patients and retrospective collection of the data. Blood and skin sampling were not performed at the exact same time point for two patients. Conclusion Skin lesions in the setting of MDS/CMML are characterized by a clonal myeloid infiltrate in most cases.
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Affiliation(s)
- Grégoire Martin de Frémont
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Médecine Interne et Inflammation-[Département Médico-Universitaire (DMU)-i3], Université Paris 06, Paris, France
| | - Pierre Hirsch
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine, AP-HP, Hôpital Saint-Antoine, Service d'Hématologie Biologique, Université Paris 06, Paris, France
| | - Santiago Gimenez de Mestral
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service d'Anatomopathologie, Université Paris 06, Paris, France
| | - Philippe Moguelet
- Service d'Anatomopathologie, Hôpital Ambroise Paré, Assistance Publique Hôpitaux de Paris (APHP) and Université de Versailles Saint Quentin en Yvelines, Boulogne Billancourt, France
| | - Yoan Ditchi
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service d'Anatomopathologie, Université Paris 06, Paris, France
| | - Jean-François Emile
- Sorbonne Université, AP-HP, Hôpital Tenon, Service d'Anatomopathologie, Université Paris 06, Paris, France
| | - Patricia Senet
- Sorbonne Université, AP-HP, Hôpital Tenon, Service de Dermatologie, Université Paris 06, Paris, France
| | - Sophie Georgin-Lavialle
- Sorbonne Université, AP-HP, Hôpital Tenon, Service de Médecine Interne, Université Paris 06, Paris, France
| | - Thomas Hanslik
- Service de Médecine Interne, Hôpital Ambroise Paré, Assistance Publique Hôpitaux de Paris (APHP) and Université de Versailles Saint Quentin en Yvelines, Boulogne Billancourt, France
| | - François Maurier
- Service de Médecine Interne et Immunologie Clinique, Groupe Hospitalier UNEOS, Metz, France
| | - Amir Adedjouma
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Médecine Interne et Inflammation-[Département Médico-Universitaire (DMU)-i3], Université Paris 06, Paris, France
| | - Noémie Abisror
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Médecine Interne et Inflammation-[Département Médico-Universitaire (DMU)-i3], Université Paris 06, Paris, France
| | - Thibault Mahevas
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Médecine Interne et Inflammation-[Département Médico-Universitaire (DMU)-i3], Université Paris 06, Paris, France
| | - Florent Malard
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service d'Hématologie Clinique, Université Paris 06, Paris, France
| | - Lionel Adès
- Service d'Hématologie-Sénior, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP) and Université de Paris, Paris, France
| | - Pierre Fenaux
- Service d'Hématologie-Sénior, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP) and Université de Paris, Paris, France
| | - Olivier Fain
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Médecine Interne et Inflammation-[Département Médico-Universitaire (DMU)-i3], Université Paris 06, Paris, France
| | - François Chasset
- Sorbonne Université, AP-HP, Hôpital Tenon, Service de Dermatologie, Université Paris 06, Paris, France
| | - Arsène Mekinian
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Médecine Interne et Inflammation-[Département Médico-Universitaire (DMU)-i3], Université Paris 06, Paris, France
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Kanakis M, Petrou P, Lourida G, Georgalas I. Erdheim-Chester disease: a comprehensive review from the ophthalmologic perspective. Surv Ophthalmol 2021; 67:388-410. [PMID: 34081930 DOI: 10.1016/j.survophthal.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 01/18/2023]
Abstract
Erdheim-Chester disease (ECD) is a rare clonal histiocytic neoplasm with less than 1200 documented cases to date. The disease is life-threatening and difficult to recognize, although increasing awareness as well as the integration of clinical, imaging, pathology information , and genetic studies have led to a recent exponential increase in new reported cases. ECD affects multiple organs and systems, including skeletal, neurologic, and cardiovascular. Pulmonary, retroperitoneal, and cutaneous lesions have also been reported in various combinations. Until the discovery that more than half of ECD patients harbor the BRAF-V600E mutation or other mutations in the mitogen-activated protein kinase (MAPK) and RAS pathways, Interferon-a was the first-line treatment. Nowadays BRAF and MEK-inhibitors targeted therapies are the mainstay of treatment. Ophthalmologic involvement occurs in 25% -30% of ECD cases, usually in the form of orbital involvement presenting with exophthalmos and ophthalmoplegia. Other ophthalmologic manifestations include palpebral xanthelasmas, anterior uveitis and vitritis, optic disk edema, choroidal infiltration, recurrent serous retinal detachment, retinal drusen-like deposits and retinal pigment epithelial changes. ECD patients can also present with ocular symptoms as a result of adverse effects of the treatment regimens. In some cases with smoldering or protean symptoms, the emergence of eye manifestations triggered the diagnosis. Ophthalmologists have to be aware of the disease, recognize the constellation of ECD symptoms, and contribute to the diagnosis, treatment, and follow-up of ECD patients.
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Affiliation(s)
| | - Petros Petrou
- G. Genimatas General Hospital, National and Kapodistrian University of Athens, 1st University Eye Clinic, Athens, Greece
| | - Giota Lourida
- Department of Internal Medicine and Infectious Disease, Sotiria Hospital, Athens, Greece
| | - Ilias Georgalas
- G. Genimatas General Hospital, National and Kapodistrian University of Athens, 1st University Eye Clinic, Athens, Greece.
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11
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Cohen-Aubart F, Ungureanu I, Razanamahery J, Charlotte F, Valmary-Degano S, Hélias-Rodzewicz Z, Cazals-Hatem D, Dartigues P, Delage-Corre M, Selves J, Tas P, Humbert S, Malakhia A, Kunnamo M, Veresezan L, Prokopiou C, Seeber A, Tazi A, Donadieu J, Lucidarme O, Haroche J, Emile JF. Peritoneal or mesenteric tumours revealing histiocytosis. BMJ Open Gastroenterol 2021; 8:bmjgast-2021-000622. [PMID: 34020934 PMCID: PMC8144026 DOI: 10.1136/bmjgast-2021-000622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/13/2021] [Accepted: 05/01/2021] [Indexed: 01/31/2023] Open
Abstract
Objective Peritoneal or mesenteric tumours may correspond to several tumour types or tumour-like conditions, some of them being represented by histiocytosis. This rare condition often poses diagnostic difficulties that can lead to important time delay in targeted therapies. Our aim was to describe main features of histiocytoses with mesenteric localisation that can improve the diagnostic process. Design We performed a retrospective study on 22 patients, whose peritoneal/mesenteric biopsies were infiltrated by histiocytes. Results Abdominal pain was the revealing symptom in 10 cases, and 19 patients underwent surgical biopsies. The diagnosis of histiocytosis was proposed by initial pathologists in 41% of patients. The other initial diagnoses were inflammation (n=7), sclerosing mesenteritis (n=4) and liposarcoma (n=1). The CD163/CD68+CD1a- histiocytes infiltrated subserosa and/or deeper adipose tissues in 16 and 14 cases, respectively. A BRAFV600E mutation was detected within the biopsies in 11 cases, and two others were MAP2K1 mutated. The final diagnosis was histiocytosis in 18 patients, 15 of whom had Erdheim-Chester disease. The median diagnostic delay of histiocytosis was 9 months. Patients treated with BRAF or MEK inhibitors showed a partial response or a stable disease. One patient died soon after surgery, and five died by the progression of the disease. Conclusion Diagnosis of masses arising in the mesentery should be carefully explored as one of the possibilities in histiocytosis. This diagnosis is frequently missed on mesenteric biopsies. Molecular biology for detecting the mutations in BRAF or in genes of the MAP kinase pathway is a critical diagnostic tool.
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Affiliation(s)
- Fleur Cohen-Aubart
- Sorbonne University, Paris, Île-de-France, France.,Service de Médecine Interne et Centre National de Référence Maladies Systémiques Rares et Histiocytoses, University Hospital Pitié Salpêtrière, Paris, Île-de-France, France
| | - Irena Ungureanu
- Department of Pathology, Hôpital Ambroise-Pare, Boulogne-Billancourt, Île-de-France, France.,Department of Pathology, University Emergency Hospital Bucharest, Bucharest, Romania
| | - Jerome Razanamahery
- Department of Internal Medicine and Clinical Immunology, University Hospital Centre Dijon, Dijon, France
| | - Frédéric Charlotte
- Department of Pathology, University Hospital Pitié Salpêtrière, Paris, Île-de-France, France
| | - Séverine Valmary-Degano
- Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, University Grenoble Alpes, Grenoble, Rhône-Alpes, France
| | - Zofia Hélias-Rodzewicz
- Department of Pathology, Hôpital Ambroise-Pare, Boulogne-Billancourt, Île-de-France, France.,EA4340-BECCOH, Versailles Saint-Quentin-en-Yvelines University, Versailles, Île-de-France, France
| | | | - Peggy Dartigues
- Department of Pathology, Gustave Roussy Institute, Villejuif, Île-de-France, France
| | | | - Janick Selves
- Department of Pathology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, Occitanie, France
| | - Patrick Tas
- Department of Pathology, CHU Pontchaillou, Rennes, Bretagne, France
| | - Sebastien Humbert
- Department of Internal Medicine and Clinical Immunology, University Hospital Centre Dijon, Dijon, France
| | - Alexandre Malakhia
- Department of Radiology, University Hospital Centre Besancon, Besancon, France
| | - Merja Kunnamo
- Department of Medicine, Central Finland Central Hospital, Jyvaskyla, Central Finland, Finland
| | - Liana Veresezan
- Department of Pathology, Centre Henri Becquerel, Rouen, Haute-Normandie, France
| | | | - Andreas Seeber
- Medical University of Innsbruck, Innsbruck, Austria.,Department of Hematology and Oncology, Comprehensive Cancer Center Innsbruck, Innsbruck, Austria
| | - Abdellatif Tazi
- Centre National de Référence des Histiocytoses, Department of Pneumology, Hospital Saint-Louis, Paris, Île-de-France, France.,FR-75006, Université de Paris, Paris, Île-de-France, France
| | - Jean Donadieu
- EA4340-BECCOH, Versailles Saint-Quentin-en-Yvelines University, Versailles, Île-de-France, France.,Department of Pediatric Hematology and Oncology, Centre de Référence des Histiocytoses, Hôpital Armand-Trousseau, Paris, Île-de-France, France
| | - Olivier Lucidarme
- Department of Radiology, University Hospital Pitié Salpêtrière, Paris, Île-de-France, France.,CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Sorbonne University, Paris, Île-de-France, France
| | - Julien Haroche
- Sorbonne University, Paris, Île-de-France, France.,Service de Médecine Interne et Centre National de Référence Maladies Systémiques Rares, University Hospital Pitié Salpêtrière, Paris, Île-de-France, France
| | - Jean-François Emile
- Department of Pathology, Hôpital Ambroise-Pare, Boulogne-Billancourt, Île-de-France, France .,EA4340-BECCOH, Versailles Saint-Quentin-en-Yvelines University, Versailles, Île-de-France, France
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12
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Li JJ, Talam S, Star P, Getta B. Atypical cutaneous histiocytic eruption in a patient with chronic myelomonocytic leukemia: A case report. J Cutan Pathol 2021; 48:680-688. [PMID: 33416192 DOI: 10.1111/cup.13957] [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: 08/27/2020] [Revised: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 11/27/2022]
Abstract
Chronic myelomonocytic leukemia (CMML) is a clonal hematopoietic stem cell malignancy with features of both a myeloproliferative neoplasm and a myelodysplastic syndrome. We present a case of 72-year-old man with CMML who presented with generalized hemorrhagic papules and plaques which on histopathology showed a peculiar infiltrate of atypical mature histiocytes. The immunohistochemical markers for Langerhans cells, indeterminate dendritic cells, and plasmacytoid dendritic cells were negative. Next generation sequencing performed on the paraffin block of the leg biopsy specimen revealed identical ASXL1, SRSF2, and KRAS mutations as seen in the CMML clone of the peripheral blood. Along with recent literature, this case illustrates the spectrum of histiocytic and dendritic cell proliferations in CMML, many of which may be clonally related to the hematopoietic malignancy.
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Affiliation(s)
- Jing Jing Li
- Department of Anatomical Pathology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Stephanie Talam
- Department of Hematology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Phoebe Star
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Bartlomiej Getta
- Department of Hematology, Liverpool Hospital, Liverpool, New South Wales, Australia
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13
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Kemps PG, Hebeda KM, Pals ST, Verdijk RM, Lam KH, Bruggink AH, de Lil HS, Ruiterkamp B, de Heer K, van Laar JAM, Valk PJM, Mutsaers P, Levin M, Hogendoorn PCW, van Halteren AGS. Spectrum of histiocytic neoplasms associated with diverse haematological malignancies bearing the same oncogenic mutation. J Pathol Clin Res 2021; 7:10-26. [PMID: 32852896 PMCID: PMC7737785 DOI: 10.1002/cjp2.177] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/18/2020] [Accepted: 06/25/2020] [Indexed: 12/14/2022]
Abstract
Histiocytic disorders are a spectrum of rare diseases characterised by the accumulation of macrophage-, dendritic cell-, or monocyte-differentiated cells in various tissues and organs. The discovery of recurrent genetic alterations in many of these histiocytoses has led to their recognition as clonal neoplastic diseases. Moreover, the identification of the same somatic mutation in histiocytic lesions and peripheral blood and/or bone marrow cells from histiocytosis patients has provided evidence for systemic histiocytic neoplasms to originate from haematopoietic stem/progenitor cells (HSPCs). Here, we investigated associations between histiocytic disorders and additional haematological malignancies bearing the same genetic alteration(s) using the nationwide Dutch Pathology Registry. By searching on pathologist-assigned diagnostic terms for the various histiocytic disorders, we identified 4602 patients with a putative histopathological diagnosis of a histiocytic disorder between 1971 and 2019. Histiocytosis-affected tissue samples of 187 patients had been analysed for genetic alterations as part of routine molecular diagnostics, including from nine patients with an additional haematological malignancy. Among these patients, we discovered three cases with different histiocytic neoplasms and additional haematological malignancies bearing identical oncogenic mutations, including one patient with concomitant KRAS p.A59E mutated histiocytic sarcoma and chronic myelomonocytic leukaemia (CMML), one patient with synchronous NRAS p.G12V mutated indeterminate cell histiocytosis and CMML, and one patient with subsequent NRAS p.Q61R mutated Erdheim-Chester disease and acute myeloid leukaemia. These cases support the existence of a common haematopoietic cell-of-origin in at least a proportion of patients with a histiocytic neoplasm and additional haematological malignancy. In addition, they suggest that driver mutations in particular genes (e.g. N/KRAS) may specifically predispose to the development of an additional clonally related haematological malignancy or secondary histiocytic neoplasm. Finally, the putative existence of derailed multipotent HSPCs in these patients emphasises the importance of adequate (bone marrow) staging, molecular analysis and long-term follow-up of all histiocytosis patients.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/genetics
- Erdheim-Chester Disease/genetics
- Erdheim-Chester Disease/pathology
- Erdheim-Chester Disease/therapy
- Fatal Outcome
- GTP Phosphohydrolases/genetics
- Genetic Predisposition to Disease
- Histiocytic Sarcoma/genetics
- Histiocytic Sarcoma/pathology
- Histiocytic Sarcoma/therapy
- Humans
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/pathology
- Leukemia, Myeloid, Acute/therapy
- Leukemia, Myelomonocytic, Chronic/genetics
- Leukemia, Myelomonocytic, Chronic/pathology
- Leukemia, Myelomonocytic, Chronic/therapy
- Male
- Membrane Proteins/genetics
- Middle Aged
- Mutation
- Phenotype
- Proto-Oncogene Proteins p21(ras)/genetics
- Retrospective Studies
- Treatment Outcome
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Affiliation(s)
- Paul G Kemps
- Department of PaediatricsLeiden University Medical CenterLeidenThe Netherlands
| | - Konnie M Hebeda
- Department of PathologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Steven T Pals
- Department of PathologyAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Robert M Verdijk
- Department of PathologyErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
- Department of PathologyLeiden University Medical CenterLeidenThe Netherlands
| | - King H Lam
- Department of PathologyErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
| | - Annette H Bruggink
- PALGA Foundation (Nationwide Network and Registry of Histopathology and Cytopathology)HoutenThe Netherlands
| | - Heleen S de Lil
- Department of HaematologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Bart Ruiterkamp
- Department of HaematologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Koen de Heer
- Department of HaematologyAmsterdam University Medical CentersAmsterdamThe Netherlands
- Department of HaematologyFlevoziekenhuisAlmereThe Netherlands
| | - Jan AM van Laar
- Department of Internal MedicineErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
- Department of ImmunologyErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
| | - Peter JM Valk
- Department of HaematologyErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
| | - Pim Mutsaers
- Department of HaematologyErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
| | - Mark‐David Levin
- Department of Internal MedicineAlbert Schweitzer ZiekenhuisDordrechtThe Netherlands
| | | | - Astrid GS van Halteren
- Department of PaediatricsLeiden University Medical CenterLeidenThe Netherlands
- Princess Máxima Center for Paediatric OncologyUtrechtThe Netherlands
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14
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Papageorgiou SG, Divane A, Roumelioti M, Kottaridi C, Bouchla A, Georgakopoulos A, Ieremiadou F, Daraki A, Bazani E, Thomopoulos TP, Chatziioannou S, Mavrogenis A, Panayiotidis P, Panayiotides IG, Pappa V, Foukas PG. Erdheim-Chester Disease and Acute Myeloid Leukemia with Mutated NPM1 in a Patient with Clonal Hematopoiesis: A Case Report. Onco Targets Ther 2020; 13:11689-11695. [PMID: 33235460 PMCID: PMC7678692 DOI: 10.2147/ott.s276497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/20/2020] [Indexed: 12/02/2022] Open
Abstract
Background Erdheim–Chester Disease (ECD) is a clonal non-Langerhans histiocytosis, classified as a macrophage-dendritic cell neoplasm in the 2016 WHO classification. The exact cell of origin of ECD is unknown, although some limited evidence suggests that it arises from myeloid progenitors. Case Presentation A 43-year-old patient, diagnosed with BRAFV600E mutated ECD, developed NPM1+/FLT3+ acute myeloid leukemia (AML) with wild-type BRAF, 15 months after the initial ECD diagnosis. The patient received intensive chemotherapy plus midostaurin, followed by midostaurin maintenance. Six months into maintenance, the patient remains in complete remission with low-level measurable residual disease, whereas ECD shows a sustained partial metabolic response. Molecular karyotype at several distinct timepoints, namely ECD diagnosis, AML diagnosis, and following treatment of AML, highlighted a molecular signature, indicative of a persistent, underlying clonal hematopoiesis. Conclusion This case report suggests that ECD and AML might represent an expansion of two distinct clones in a background of clonal hematopoiesis, indicating their shared origin. Moreover, molecular karyotype might serve as a strong, inexpensive tool for revealing clonal hematopoiesis in cases of negative targeted next-generation sequencing. Finally, the moderate response of ECD to midostaurin suggests that kinase inhibition might have a potential role in ECD treatment.
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Affiliation(s)
- Sotirios G Papageorgiou
- 2nd Department of Internal Medicine and Research Unit, Hematology Unit, University General Hospital "Attikon", Haidari, Athens, Greece
| | - Aspasia Divane
- "LIFE CODE" Private Diagnostic Laboratory, Medical Ltd., Athens, Greece
| | - Maria Roumelioti
- 1st Department of Propaedeutic Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christine Kottaridi
- 2nd Department of Pathology, National and Kapodistrian University of Athens, Medical School, University General Hospital "Attikon", Haidari, Athens, Greece
| | - Anthi Bouchla
- 2nd Department of Internal Medicine and Research Unit, Hematology Unit, University General Hospital "Attikon", Haidari, Athens, Greece
| | - Alexandros Georgakopoulos
- 2nd Department of Radiology, Nuclear Medicine Section, National and Kapodistrian University of Athens, University General Hospital "Attikon", Haidari, Athens, Greece
| | - Fotini Ieremiadou
- "LIFE CODE" Private Diagnostic Laboratory, Medical Ltd., Athens, Greece
| | - Aggeliki Daraki
- "LIFE CODE" Private Diagnostic Laboratory, Medical Ltd., Athens, Greece
| | - Efthymia Bazani
- 2nd Department of Internal Medicine and Research Unit, Hematology Unit, University General Hospital "Attikon", Haidari, Athens, Greece
| | - Thomas P Thomopoulos
- 2nd Department of Internal Medicine and Research Unit, Hematology Unit, University General Hospital "Attikon", Haidari, Athens, Greece
| | - Sofia Chatziioannou
- 2nd Department of Radiology, Nuclear Medicine Section, National and Kapodistrian University of Athens, University General Hospital "Attikon", Haidari, Athens, Greece.,Nuclear Medicine Section, Biomedical Research Foundation Academy of Athens, BRFAA, Athens, Greece
| | - Andreas Mavrogenis
- 1st Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, University General Hospital "Attikon", Haidari, Athens, Greece
| | - Panayiotis Panayiotidis
- 1st Department of Propaedeutic Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis G Panayiotides
- 2nd Department of Pathology, National and Kapodistrian University of Athens, Medical School, University General Hospital "Attikon", Haidari, Athens, Greece
| | - Vasiliki Pappa
- 2nd Department of Internal Medicine and Research Unit, Hematology Unit, University General Hospital "Attikon", Haidari, Athens, Greece
| | - Periklis G Foukas
- 2nd Department of Pathology, National and Kapodistrian University of Athens, Medical School, University General Hospital "Attikon", Haidari, Athens, Greece
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15
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Konstantinou MP, Lucas P, Uthurriague C, Severino-Freire M, Spenatto N, Gaudin C, Lamant L, Tournier E, Bulai-Livideanu C, Meyer N, Paul C. Langerhans cell histiocytosis associated with chronic myelomonocytic leukaemia both harbouring the same BRAF V600E mutation: efficacy of vemurafenib. J Eur Acad Dermatol Venereol 2020; 35:e120-e121. [PMID: 32757402 DOI: 10.1111/jdv.16850] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/22/2020] [Accepted: 07/30/2020] [Indexed: 01/09/2023]
Affiliation(s)
- M P Konstantinou
- Dermatology Department, Paul Sabatier University, University Hospital of Toulouse, Toulouse, France
| | - P Lucas
- Dermatology Department, Paul Sabatier University, University Hospital of Toulouse, Toulouse, France
| | - C Uthurriague
- Dermatology Department, Paul Sabatier University, University Hospital of Toulouse, Toulouse, France
| | - M Severino-Freire
- Dermatology Department, Paul Sabatier University, University Hospital of Toulouse, Toulouse, France
| | - N Spenatto
- Center of Sexually Transmitted Diseases, Dermatology department and social medicine, University Hospital of Toulouse, Toulouse, France
| | - C Gaudin
- Geriatrics Department, University Hospital of Toulouse, Toulouse, France
| | - L Lamant
- Pathology Department, University Institute of Cancer Toulouse Oncopole and University Hospital of Toulouse, Toulouse, France
| | - E Tournier
- Pathology Department, University Institute of Cancer Toulouse Oncopole and University Hospital of Toulouse, Toulouse, France
| | - C Bulai-Livideanu
- Dermatology Department, Paul Sabatier University, University Hospital of Toulouse, Toulouse, France
| | - N Meyer
- Dermatology Department, IUC and CHU de Toulouse, Toulouse, France
| | - C Paul
- Dermatology Department, Paul Sabatier University, University Hospital of Toulouse, Toulouse, France
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16
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Abstract
Erdheim-Chester disease (ECD) is a rare but increasingly recognized multi-system disorder. Its diagnosis and treatment require integration of clinical information, imaging studies, and pathology studies. Of note, ECD can now be defined as a clonal myeloid disorder due to mutations which activate mitogen-activated protein kinase (MAPK) pathways and where an inflammatory milieu is important in the pathogenesis and clinical manifestations of the disease. Biopsy demonstrating characteristic histopathologic features in addition to clinical and radiographic features, most often sclerosing long bone involvement, is required to establish a diagnosis. Detection of somatic MAPK pathway mutations can also assist in the differential diagnosis of ECD and related histiocytic neoplasms. Also, genetic analysis establishing BRAF and RAS mutational status is critical in all ECD patients, as these features will impact therapy with MAPK inhibition. Therapy is recommended at diagnosis in all patients, except for those patients with minimally symptomatic disease. Prospective therapeutic trials are essential to furthering therapeutic progress in ECD.
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Affiliation(s)
- Gordon Starkebaum
- University of Washington, Division of Rheumatology, 1959 NE Pacific St., Box 356428, Seattle, WA, 98195-6428, USA.
| | - Paul Hendrie
- Division of Hematology, University of Washington, 1959 NE Pacific St., Box 358081, Seattle, WA, 98195-6428, USA.
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17
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Cavalli G, Dagna L, Biavasco R, Villa A, Doglioni C, Ferrero E, Ferrarini M. Erdheim-Chester disease: An in vivo human model of Mϕ activation at the crossroad between chronic inflammation and cancer. J Leukoc Biol 2020; 108:591-599. [PMID: 32056262 DOI: 10.1002/jlb.3mr0120-203rr] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/16/2020] [Accepted: 01/20/2020] [Indexed: 12/13/2022] Open
Abstract
Erdheim-Chester disease (ECD) is a rare histiocytosis characterized by infiltration of multiple tissues by CD68+ foamy Mϕs (or 'histiocytes'). Clinical manifestations arise from mass-forming lesions or from tissue and systemic inflammation. ECD histiocytes harbor oncogenic mutations along the MAPK-kinase signaling pathway (BRAFV600E in more than half of the patients), and secrete abundant pro-inflammatory cytokines and chemokines. Based on these features, ECD is considered an inflammatory myeloid neoplasm, and is accordingly managed with targeted kinase inhibitors or immunosuppressive and cytokine-blocking agents. Evidence is emerging that maladaptive metabolic changes, particularly up-regulated glycolysis, represent an additional, mutation-driven feature of ECD histiocytes, which sustains deregulated and protracted pro-inflammatory activation and cytokine production. Besides translational relevance to the management of ECD patients and to the development of new therapeutic approaches, recognition of ECD as a natural human model of chronic, maladaptive Mϕ activation instructs the understanding of Mϕ dysfunction in other chronic inflammatory conditions.
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Affiliation(s)
- Giulio Cavalli
- Vita-Salute San Raffaele University, Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Dagna
- Vita-Salute San Raffaele University, Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Biavasco
- Vita-Salute San Raffaele University, Milan, Italy.,San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), San Raffaele Scientific Institute, Milan, Italy
| | | | - Claudio Doglioni
- Vita-Salute San Raffaele University, Milan, Italy.,Pathology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Ferrero
- Division of Experimental Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Marina Ferrarini
- Division of Experimental Oncology, San Raffaele Scientific Institute, Milan, Italy
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18
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Goyal G, Ravindran A, Liu Y, He R, Shah MV, Bennani NN, Patnaik MM, Rech KL, Go RS. Bone marrow findings in Erdheim-Chester disease: increased prevalence of chronic myeloid neoplasms. Haematologica 2020; 105:e84-e86. [PMID: 31624111 DOI: 10.3324/haematol.2019.234187] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
| | | | - Yuanhang Liu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Rong He
- Department of Laboratory Medicine and Pathology, Mayo Clinic
| | | | | | | | - Karen L Rech
- Department of Laboratory Medicine and Pathology, Mayo Clinic
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19
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Goyal G, Liu Y, Ravindran A, Al‐Kali A, Go RS, Patnaik MM, Rech KL. Concomitant Erdheim‐Chester disease and chronic myelomonocytic leukaemia: genomic insights into a common clonal origin. Br J Haematol 2019; 187:e51-e54. [DOI: 10.1111/bjh.16177] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Gaurav Goyal
- Division of Hematology Mayo Clinic Rochester MN USA
| | - Yuanhang Liu
- Department of Health Sciences Research Mayo Clinic Rochester MN USA
| | - Aishwarya Ravindran
- Department of Laboratory Medicine and Pathology Mayo Clinic Rochester MN USA
| | - Aref Al‐Kali
- Division of Hematology Mayo Clinic Rochester MN USA
| | - Ronald S. Go
- Division of Hematology Mayo Clinic Rochester MN USA
| | | | - Karen L. Rech
- Department of Laboratory Medicine and Pathology Mayo Clinic Rochester MN USA
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