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Neckel N, Lissat A, von Stackelberg A, Thieme N, Doueiri MS, Spors B, Beck-Broichsitter B, Heiland M, Raguse JD. Primary oral manifestation of Langerhans cell histiocytosis refractory to conventional therapy but susceptible to BRAF-specific treatment: a case report and review of the literature. Ther Adv Med Oncol 2019; 11:1758835919878013. [PMID: 31666812 PMCID: PMC6801882 DOI: 10.1177/1758835919878013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 08/30/2019] [Indexed: 12/17/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a diagnostic and therapeutic challenge. We
report on a rare case of its primary oral manifestation that was treated
successfully with the BRAF-specific agent, vemurafenib, after insufficient
standard LCH treatment. This case underlines the importance of proper diagnosis
and the evaluation of targeted therapy as a valuable tool in LCH treatment.
Furthermore, the close collaboration of surgeons, oncologists, and dentists is
mandatory to ensure adequate treatment, restore the stomatognathic system in
debilitating post-treatment situations, improve quality of life, and ensure
effective disease control in infants and young patients.
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Affiliation(s)
- Norbert Neckel
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13351 Berlin 13353, Germany
| | - Andrej Lissat
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Paediatrics, Division of Oncology and Haematology, Berlin, Germany
| | - Arendt von Stackelberg
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Paediatrics, Division of Oncology and Haematology, Berlin, Germany
| | - Nadine Thieme
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Berlin, Germany
| | - Mohemed-Salim Doueiri
- Charité - Universitätsmedizin Berlin, Centre for Dental and Craniofacial Sciences, Department of Orthodontics, Dentofacial Orthopaedics and Paedodontics, Berlin, Germany
| | - Birgit Spors
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Paediatric Radiology, Berlin, Germany
| | - Benedicta Beck-Broichsitter
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Berlin, Germany
| | - Max Heiland
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Berlin, Germany
| | - Jan-Dirk Raguse
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Berlin, Germany
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Atarbashi-Moghadam S, Lotfi A, Atarbashi-Moghadam F. Gingival recessions and ulcerations in association with pruritic papules of the scalp, hands, and trunk in a young adult female. Int J Dermatol 2019; 58:1253-1254. [PMID: 31183852 DOI: 10.1111/ijd.14482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 03/27/2019] [Accepted: 04/24/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Saede Atarbashi-Moghadam
- Department of Oral and Maxillofacial Pathology, Dental School of Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Lotfi
- Department of Oral and Maxillofacial Pathology, Dental School of Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fazele Atarbashi-Moghadam
- Department of Periodontics, Dental School of Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Nangalia R, Chatterjee RP, Kundu S, Pal M. Langerhans Cell Histiocytosis in an Adult with Oral Cavity Involvement: Posing a Diagnostic Challenge. Contemp Clin Dent 2019; 10:154-157. [PMID: 32015659 PMCID: PMC6974994 DOI: 10.4103/ccd.ccd_432_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare hematological disorder characterized by local or generalized, uncontrolled proliferation and infiltration of Langerhans type of histiocytic cells. It represents a spectrum of clinicopathologic disorders, ranging from a highly aggressive and frequently fatal multisystem disease to an easily cured solitary lesion of bone. Involvement of children and the younger age group is more common than the adults. Oral cavity involvement occurs early in LCH, but the initial symptoms are generally nonspecific, often causing misdiagnosis. This report describes a rare case of chronic localized LCH in an adult patient, with involvement of oral cavity. A 34-year-old male patient presented with multiple nodulo-papular, ulcerated lesions in gingiva involving both the jaws (primarily mandible) and the left buccal mucosa, in addition to regional teeth mobility. The most striking feature was that even after extraction of mobile teeth, the lesions persisted. After recording proper history, performing clinical and radiological evaluation, an incisional biopsy was performed followed by histopathology and immunohistochemistry to reach a confirmatory diagnosis of LCH, thereby implementing early and appropriate initiation of treatment.
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Affiliation(s)
- Richa Nangalia
- Department of Oral and Maxillofacial Pathology, Guru Nanak Institute of Dental Sciences and Research, Kolkata, West Bengal, India
| | | | - Sanchita Kundu
- Department of Oral and Maxillofacial Pathology, Guru Nanak Institute of Dental Sciences and Research, Kolkata, West Bengal, India
| | - Mousumi Pal
- Department of Oral and Maxillofacial Pathology, Guru Nanak Institute of Dental Sciences and Research, Kolkata, West Bengal, India
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Raviraj J, Venkata S, Shaik S, Kodadala A, Kakarla P. Multifocal Eosinophilic Granuloma of Jaws and Skull with Classical and Unusual Radiographic/Imaging Findings. J Clin Diagn Res 2017; 11:ZD09-ZD11. [PMID: 28274065 DOI: 10.7860/jcdr/2017/23732.9154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 10/19/2016] [Indexed: 12/23/2022]
Abstract
Eosinophilic granuloma is basically a disorder of reticuloendothelial system and is one of the variants of langerhans cell histiocytosis. Multifocal eosinophilic granuloma affecting jaws and skull is relatively a rare disorder. We hereby report a case of multifocal eosinophilic granuloma involving mandible, maxilla and several skull bones. The present case has mixture of classical floating teeth appearance and an unusual radiographic/imaging finding of periosteal remodeling, which is rarely seen in adult patients of eosinophilic granuloma and pseudo-multilocular appearance in anterior mandibular region in coronal sections and moth-eaten appearance of skull was appreciated in axial slices of Computed Tomography (CT).
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Affiliation(s)
- Jayam Raviraj
- Professor, Department of Oral Medicine and Radiology, CKS Teja Institute of Dental Sciences and Research , Tirupati, Andhra Pradesh, India
| | - Suman Venkata
- Reader, Department of Oral Medicine and Radiology, CKS Teja Institute of Dental Sciences and Research , Tirupati, Andhra Pradesh, India
| | - Sameulla Shaik
- Senior Lecturer, Department of Oral Medicine and Radiology, CKS Teja Institute of Dental Sciences and Research , Tirupati, Andhra Pradesh, India
| | - Amrutha Kodadala
- Ex-Postgraduate Student, Department of Oral Medicine and Radiology, CKS Teja Institute of Dental Sciences and Research , Tirupati, Andhra Pradesh, India
| | - Prashanti Kakarla
- Senior Lecturer, Department of Oral Medicine and Radiology, CKS Teja Institute of Dental Sciences and Research , Tirupati-Andhra Pradesh, India
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Shen J, Feng S. Bone Langerhans cell histiocytosis with pulmonary involvement in an adult non-smoker: A case report and brief review of the literature. Mol Clin Oncol 2016; 6:67-70. [PMID: 28123731 DOI: 10.3892/mco.2016.1077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 07/27/2016] [Indexed: 11/05/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare disease of unknown cause, which encompasses a set of disorders of multiple organs with various clinical presentations that share the common characteristic of sizeable Langerhans cell infiltration. The clinical spectrum of LCH ranges from solitary bone lesions to involvement of other organs. lung involvement in LCH may be part of a multisystem disease, which almost exclusively occurs in adult smokers, while it is overlooked or misdiagnosed in the majority of non-smokers. High-resolution computed tomography (HRCT) of the chest is crucial for diagnosis; however, the treatment and prognosis of this disease have not been clearly determined. We herein present the case of a non-smoking adult patient who presented with lower limb pain and was diagnosed via biopsy with lch with multisystem involvement, including the bone and lungs. Lytic lesions in the corpus of the sacroiliac joint, sacrum, acetabulum and femoral head by a soft tissue mass were observed on diagnostic CT. In addition, chest HRCT revealed multiple cysts in the bilateral lungs, predominantly in the upper lobes. The final diagnosis of LCH was confirmed by histopathological examination and immunohistochemical staining for CD1a and S-100. Corticosteroid treatment alleviated lower limb pain and improved the patient's quality of life; thus, corticosteroids may be considered as a potential treatment option for patients with LCH.
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Affiliation(s)
- Jie Shen
- Department of Imaging, Nanjing Chest Hospital, Medical School of Southeast University, Nanjing, Jiangsu 210009, P.R. China
| | - Shicheng Feng
- Department of Oncology, Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu 210009, P.R. China
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