1
|
Serrallach BL, Kralik SF, Tran BH, Huisman TAGM, Patel RP, Allen CE, McClain KL, Gulati N, Dillard-Ilboudo CQ, Hicks MJ, Mohila CA, Desai NK. Neuroimaging in Pediatric Patients with Juvenile Xanthogranuloma of the CNS. AJNR Am J Neuroradiol 2022; 43:1667-1673. [PMID: 36265894 PMCID: PMC9731252 DOI: 10.3174/ajnr.a7683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Juvenile xanthogranuloma is a rare clonal, myeloid, neoplastic disorder. Typically, juvenile xanthogranuloma is a self-limited disorder of infancy, often presenting as a solitary red-brown or yellow skin papule/nodule. A small subset of patients present with extracutaneous, systemic juvenile xanthogranuloma, which may include the CNS. The goal of this retrospective study was to evaluate and categorize the neuroimaging findings in a representative cohort of pediatric patients with CNS juvenile xanthogranuloma. MATERIALS AND METHODS The brain and/or spine MR imaging data of 14 pediatric patients with pathology-proven juvenile xanthogranuloma were categorized and evaluated for the location; the signal intensity of xanthogranulomas on T1WI, T2WI, DWI, and a matching ADC map for the pattern and degree of contrast enhancement; and the presence of perilesional edema, cysts, or necrosis. RESULTS Fourteen pediatric patients (8 girls, 6 boys; mean age, 84 months) were included in the study. Patients presented with a wide variety of different symptoms, including headache, seizure, ataxia, strabismus, hearing loss, facial paresis, and diabetes insipidus. Juvenile xanthogranuloma lesions were identified in a number of different sites, including supra- and infratentorial as well as intracranial and spinal leptomeningeal. Five patients were categorized into the neuroradiologic pattern unifocal CNS juvenile xanthogranuloma; 8, into multifocal CNS juvenile xanthogranuloma; and 1, into multifocal CNS juvenile xanthogranuloma with intracranial and spinal leptomeningeal disease. In most cases, xanthogranulomas were small-to-medium intra-axial masses with isointense signal on T1WI (compared with cortical GM), iso- or hyperintense signal on T2WI, had restricted diffusion and perilesional edema. Almost all xanthogranulomas showed avid contrast enhancement. However, we also identified less common patterns with large lesions, nonenhancing lesions, or leptomeningeal disease. Four cases had an additional CT available. On CT, all xanthogranulomas were homogeneously hyperdense (solid component) without evident calcifications. CONCLUSIONS CNS juvenile xanthogranuloma may demonstrate heterogeneous neuroimaging appearances potentially mimicking other diseases, such as primary brain neoplasms, metastatic disease, lymphoma and leukemia, other histiocytic disorders, infections, or granulomatous diseases.
Collapse
Affiliation(s)
- B L Serrallach
- From the Edward B. Singleton Department of Radiology (B.L.S., S.F.K., B.H.T., T.A.G.M.H., R.P.P., N.K.D.)
| | - S F Kralik
- From the Edward B. Singleton Department of Radiology (B.L.S., S.F.K., B.H.T., T.A.G.M.H., R.P.P., N.K.D.)
| | - B H Tran
- From the Edward B. Singleton Department of Radiology (B.L.S., S.F.K., B.H.T., T.A.G.M.H., R.P.P., N.K.D.)
| | - T A G M Huisman
- From the Edward B. Singleton Department of Radiology (B.L.S., S.F.K., B.H.T., T.A.G.M.H., R.P.P., N.K.D.)
| | - R P Patel
- From the Edward B. Singleton Department of Radiology (B.L.S., S.F.K., B.H.T., T.A.G.M.H., R.P.P., N.K.D.)
| | - C E Allen
- Department of Pediatrics (C.E.A., K.L.M., N.G., C.Q.D.-I.), Section of Hematology-Oncology
| | - K L McClain
- Department of Pediatrics (C.E.A., K.L.M., N.G., C.Q.D.-I.), Section of Hematology-Oncology
| | - N Gulati
- Department of Pediatrics (C.E.A., K.L.M., N.G., C.Q.D.-I.), Section of Hematology-Oncology
| | - C Q Dillard-Ilboudo
- Department of Pediatrics (C.E.A., K.L.M., N.G., C.Q.D.-I.), Section of Hematology-Oncology
| | - M J Hicks
- Department of Pathology and Immunology (M.J.H., C.A.M.), Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - C A Mohila
- Department of Pathology and Immunology (M.J.H., C.A.M.), Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - N K Desai
- From the Edward B. Singleton Department of Radiology (B.L.S., S.F.K., B.H.T., T.A.G.M.H., R.P.P., N.K.D.)
| |
Collapse
|
2
|
Siddaiahgari S, Lingappa L, Penmetcha C. Ten-year outcome in disseminated juvenile xanthogranuloma with central nervous system involvement: A case report. Pediatr Blood Cancer 2022; 69:e29448. [PMID: 34957667 DOI: 10.1002/pbc.29448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/16/2021] [Accepted: 10/19/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Sirisharani Siddaiahgari
- Department of Pediatric Hematology Oncology and Bone Marrow Transplantation, Rainbow Children's Hospital, Hyderabad, India
| | - Lokesh Lingappa
- Department of Pediatric Neurosciences, Rainbow Children's Hospital, Hyderabad, India
| | | |
Collapse
|
3
|
Nasany RA, Reiner AS, Francis JH, Abla O, Panageas KS, Diamond EL. Rosai-Dorfman-Destombes disease of the nervous system: a systematic literature review. Orphanet J Rare Dis 2022; 17:92. [PMID: 35236371 PMCID: PMC8889645 DOI: 10.1186/s13023-022-02220-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 02/06/2022] [Indexed: 12/28/2022] Open
Abstract
Background Rosai–Dorfman–Destombes disease (RDD) is a rare histiocytic disorder with heterogeneous clinical manifestations and rare neurologic involvement. The existing clinical literature about neurologic RDD has yet to be critically examined.
Methods We performed a four-database English-language systematic literature search for cases of RDD neurohistiocytosis, excluding secondary literature. Individual patient data for neurologic symptoms, disease sites, treatments, and responses were captured. Responses to first-line and second-line surgical interventions, post-surgical radiotherapy, and systemic therapies were analyzed. Results Among 4769 articles yielded by literature search, 154 articles were fully reviewed, containing data on 224 patients with neurologic RDD. 128 (83.1%) articles were single case reports. 149 (66.5%) patients were male, 74 (33.5%) female, with a median age of 37.6 years (range 2–79). Presenting neurologic symptoms included headache (45.1%), focal neurological deficits (32.6%), visual symptoms (32.1%), and seizures (24.6%). RDD involvement was multifocal in 32 (14.3%) cases. First-line treatment involved resection in 200 (89.6%) patients, with subsequent progression in 52 (26%), including 41 (78.8%) with unifocal disease. No difference was observed in progression-free survival comparing post-operative radiotherapy to no radiotherapy following partial resection. Chemotherapy given alone as first-line treatment led to complete or partial response in 3/7(43%) patients. Second-line treatments led to complete or partial response in 18/37(37.5%) patients. Mutational data were reported on 10 patients (4.46%). Conclusions This review highlights the limited published data about neurologic RDD, which presents with varied symptomatology and outcome. Further study is needed about its mutational landscape, and more effective therapies are needed for recurrent and refractory disease. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02220-0.
Collapse
Affiliation(s)
- Ruham Alshiekh Nasany
- Department of Neurology, Memorial Sloan Kettering Cancer Center, 160 East 53rd Street, 2nd Floor, New York, NY, 10022, USA
| | - Anne S Reiner
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jasmine H Francis
- Ophthalmic Oncology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oussama Abla
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Katherine S Panageas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eli L Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, 160 East 53rd Street, 2nd Floor, New York, NY, 10022, USA.
| |
Collapse
|
4
|
Tomás-Velázquez A, Reyes-Múgica M, González-Menchen A, Estenaga Á, Antoñanzas J, Morelló-Vicente A, Salido-Vallejo R. Neoadjuvant intralesional methotrexate for juvenile xanthogranuloma in an adult. Dermatol Ther 2021; 35:e15200. [PMID: 34761843 DOI: 10.1111/dth.15200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 10/17/2021] [Accepted: 11/07/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Alejandra Tomás-Velázquez
- Department of Dermatology, University Clinic of Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - Miguel Reyes-Múgica
- Department of Pathology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Ángela Estenaga
- Department of Dermatology, University Clinic of Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - Javier Antoñanzas
- Department of Dermatology, University Clinic of Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - Ana Morelló-Vicente
- Department of Dermatology, University Clinic of Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - Rafael Salido-Vallejo
- Department of Dermatology, University Clinic of Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| |
Collapse
|
5
|
Bilgin E, Ökten AI. Fatal Disseminated Multiple Intracranial Juvenile Xanthogranuloma without Cutaneous and Other Organ Involvement: A Rare Case Report. Pediatr Neurosurg 2021; 56:166-170. [PMID: 33735896 DOI: 10.1159/000513940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/21/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Juvenile xanthogranuloma (JXG) is a disorder of histiocytic proliferation that affects young children and usually presents as spontaneously regressing cutaneous lesions. JXG with systemic involvement is a rare entity associated with significant morbidity and mortality. Intracranial solitary lesions are uncommon, and when comorbid with multiple lesions of the central nervous system in young children, it has an extremely worse prognosis. CASE PRESENTATION We have reported here an unusual case of a 6-year-old boy who initially presented with the complaints of headache, vomiting, seizure, and speech disorder without cutaneous and other organ involvement and a neurological tendency to sleep. Acute hydrocephalus was detected in his brain CT. As an emergency intervention, ventriculo-peritoneal shunt operation was performed on the patient. His postoperative MRI revealed a disseminated intracranial disease involving the extensive dural, sellar-suprasellar region, the orbit, and the brain parenchyma. The patient accordingly underwent a pterional approach for open biopsy and for the mass tissue diagnosis. Histopathology reports were consistent with JXG. Unfortunately, the patient succumbed to the disseminated disease within 2 months of the JXG diagnosis. CONCLUSION JXG is a disorder that usually affects the skin. Intracranial lesion can be simple or have multiple involvement. This is a rare case of fatal disseminated multiple intracranial JXG without cutaneous and other organ manifestations. The presentation as a sellar-suprasellar, extensive dural, orbit, and parenchymal involvement at the time of diagnosis is unusual and rarely described in the literature.
Collapse
Affiliation(s)
- Emre Bilgin
- Department of Neurosurgery, Adana City Training and Research Hospital, Adana, Turkey,
| | - Ali Ihsan Ökten
- Department of Neurosurgery, Adana City Training and Research Hospital, Adana, Turkey
| |
Collapse
|
6
|
Karwacki MW, Wysocki M, Perek-Polnik M, Jatczak-Gaca A. Coordinated medical care for children with neurofibromatosis type 1 and related RASopathies in Poland. Arch Med Sci 2019; 17:1221-1231. [PMID: 34522251 PMCID: PMC8425254 DOI: 10.5114/aoms.2019.85143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 04/12/2019] [Indexed: 11/17/2022] Open
Abstract
Coordinated medical care offered in Poland for patients suffering from neurofibromatosis type 1 and related RASopathies combines complex multispecialty consultation with permanent supervision and the patient's oriented longitudinal care. Neurofibromatosis type 1 is one of the most common single gene disorders in the global population, observed in 1 out of 2500-3000 live births. It is a primary neoplasia disease with 100% penetration of the gene mutation but remarkable age-dependent onset of different disease signs and symptoms, outstanding clinical heterogeneity between patients even in one family and lack of genotype-phenotype correlation, a high rate of spontaneous mutation exceeding 50%, and multiple comorbidities among which increased risk of malignancy is the most important. Medical practice proved that not only patient-oriented complex but also coordinated care provided in centers of competence is indispensable for patients and the families and provides a sense of medical security to them in conjunction with public health costs rationalization.
Collapse
Affiliation(s)
- Marek W. Karwacki
- Coordinated Care Center for Neurofibromatoses and related RASopathies, Department of Pediatrics, Hematology and Oncology, Medical University of Warsaw, Poland
| | - Mariusz Wysocki
- Department of Paediatrics, Haematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Marta Perek-Polnik
- Neuro-oncology Division, Department of Oncology, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Agnieszka Jatczak-Gaca
- Department of Paediatrics, Haematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| |
Collapse
|
7
|
Gaspar BL, Vasishta RK, Das R, Bhalla A. Erdheim-Chester disease with unusual clinicopathological features complicated by DRESS syndrome, disseminated Cytomegalovirus infection and hemophagocytic lymphohistiocytosis. APMIS 2017; 125:669-676. [PMID: 28418177 DOI: 10.1111/apm.12694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
| | | | - Reena Das
- Department of Hematology, PGIMER, Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine, PGIMER, Chandigarh, India
| |
Collapse
|
8
|
Abstract
Juvenile xanthogranuloma is a non-Langerhans cell lesion mostly limited to the skin but occasionally presenting in extracutaneous locations or associated with systemic conditions. Lesions need to be distinguished mainly from dermatofibroma, xanthoma, Langerhans cell histiocytosis, or reticulohistiocytoma. Herein, we present a hemosiderotic variant of juvenile xanthogranuloma in a 12-year-old girl, which we have not found described in literature. The lesion presented at the back of the scalp as a slowly growing yellowish polypoid lesion showing occasional bleeding. The histopathological examination demonstrated a cellular infiltrate expanding the dermis, with a Grenz zone and with no remarkable changes in the overlying epidermis. The papule was made of mononucleated macrophages, many of which were xanthomatous. There were some Touton giant cells. The lesion was intermingled with a mild inflammatory infiltrate comprising lymphocytes, plasma cells, neutrophils, and some eosinophils. Many of the macrophages contained abundant cytoplasmic deposits of iron. The macrophages expressed CD68 and CD163, whereas they failed to express S100 protein, CD1a, and Langerin.
Collapse
|
9
|
Clinicoradiologic Features and Surgical Outcomes of Sellar Xanthogranulomas: A Single-Center 10-Year Experience. World Neurosurg 2017; 99:439-447. [DOI: 10.1016/j.wneu.2016.12.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/04/2016] [Accepted: 12/05/2016] [Indexed: 11/23/2022]
|
10
|
Maintz L, Wenzel J, Irnich M, Reinhard H, Bieber T. Successful treatment of systemic juvenile xanthogranulomatosis with cytarabine and 2-chlorodeoxyadenosine: case report and review of the literature. Br J Dermatol 2016; 176:481-487. [PMID: 27312940 DOI: 10.1111/bjd.14813] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2016] [Indexed: 11/30/2022]
Abstract
The non-Langerhans cell histiocytosis (LCH) juvenile xanthogranulomatosis (JXG) is usually a benign disease limited to the skin. Only a few cases of systemic disease with at least two affected organs and lethal outcomes have been reported to date. Treatment is controversial and no standard protocol is available. We report the rare case of a 22-month-old boy presenting multiple erythematous brownish papules of the head, trunk and legs, which had developed starting from his 6th month of life. Additional symptoms were delayed psychomotor development, hydrocephalus and hepatosplenomegaly. Further diagnostics revealed a systemic JXG with involvement of the skin, central nervous system, liver and spleen. The patient did not respond to initial therapy with prednisone and vinblastine according to protocol III for LCH. However, further therapy with cytarabine and 2-chlorodeoxyadenosine followed by a consolidation phase with 2-chlorodeoxyadenosine alone was successful and the patient is in his 4th year of remission. We provide a comprehensive review of the reported cases of systemic JXG to date.
Collapse
Affiliation(s)
- L Maintz
- Department of Dermatology and Allergy, University of Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany
| | - J Wenzel
- Department of Dermatology and Allergy, University of Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany
| | - M Irnich
- Department of Pediatrics, Division of Haematology and Oncology, Asklepios Hospital, Sankt Augustin, Germany
| | - H Reinhard
- Department of Pediatrics, Division of Haematology and Oncology, Asklepios Hospital, Sankt Augustin, Germany
| | - T Bieber
- Department of Dermatology and Allergy, University of Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany
| |
Collapse
|
11
|
The clinical diagnosis and management options for intracranial juvenile xanthogranuloma in children: based on four cases and another 39 patients in the literature. Acta Neurochir (Wien) 2016; 158:1289-97. [PMID: 27173098 DOI: 10.1007/s00701-016-2811-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 04/11/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Juvenile xanthogranulomas (JXGs) are uncommon non-Langerhans cell histiocytic proliferations which occur most often in children. Rare cases of intracranial JXGs in children have been reported. The precise treatment strategy for intracranial JXG with high fatality is still unclear. METHOD We present four cases of intracranial JXG with 2-6 years of follow-up. Review of the previous literature since 1980 revealed another 39 pediatric intracranial JXGs. RESULTS Their clinical characteristics varied significantly. Most intracranial JXGs presented in young children (88 %). Males (72 %) were affected more often than females. The differential diagnosis included two important components: the magnetic resonance imaging (MRI) characteristics and the pathohistiocytic markers. Statistical analysis suggested that there were no significant association between resection of intracranial lesions, multiple intracranial lesions, systematic lesions and clinic outcome (p = 0.12, p = 0.13, p = 0.60 respectively). Also, the manifestation with multiple intracranial lesions did not have a significant association with systematic JXG (p = 0.26). CONCLUSIONS We found no significant associations between clinic characteristics, surgical resection and outcome. When feasible, total surgical resection of intracranial lesion may be curative.
Collapse
|
12
|
Hashmi SS, Guha-Thakurta N, Ketonen L, Williams MD, Shah S, Debnam JM. Central Nervous System and Head and Neck Histiocytoses: A Comprehensive Review on the Spectrum of Imaging Findings. ACTA ACUST UNITED AC 2016; 6:114-122. [PMID: 30417172 DOI: 10.3174/ng.2160150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The histiocytoses are a rare group of varied but related disorders characterized by abnormal tissue proliferation of macrophages and dendritic cells within tissues. The purpose of this article was to review the imaging findings in patients presenting with CNS and with head and neck manifestations of these disorders. Histiocytoses include but are not limited to Rosai-Dorfman disease, Erdheim Chester disease, Langerhans cell histiocytosis, histiocytic sarcoma, and juvenile xanthogranuloma. A review of the literature was performed to determine the sites of disease involvement. This article includes the demographics, histopathologic criteria for diagnosis, and imaging features of these histiocytoses, and describes the manifestations in locations known to harbor disease: intraaxial and extra-axial intracranial regions, the calvaria, skull base, hypothalamopituitary axis, orbits, paranasal sinuses, spine, and the head and neck region. Histiocytoses have variable imaging appearances in the CNS and in the head and neck region, and radiologists should be aware of the spectrum of findings to avoid mistaking them for other disease processes. Learning Objective To understand the general pathophysiology, clinical presentation, and typical imaging characteristics of the most common histiocytoses; comprehend the morphologic and immunohistochemical characteristics of these histiocytoses and the hallmark findings on pathology; and be able to differentiate between these disorders based on their most common presentations.
Collapse
Affiliation(s)
- S S Hashmi
- Department of Radiology (S.S.H.), University of Texas Health Sciences Center at Houston, Houston, Texas, Section of Neuroradiology (N.G.-T., L.K., J.M.D.), Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, Department of Pathology (M.D.W.), The University of Texas MD Anderson Cancer Center, Houston, Texas, and Division of Neuroradiology (S.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - N Guha-Thakurta
- Department of Radiology (S.S.H.), University of Texas Health Sciences Center at Houston, Houston, Texas, Section of Neuroradiology (N.G.-T., L.K., J.M.D.), Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, Department of Pathology (M.D.W.), The University of Texas MD Anderson Cancer Center, Houston, Texas, and Division of Neuroradiology (S.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - L Ketonen
- Department of Radiology (S.S.H.), University of Texas Health Sciences Center at Houston, Houston, Texas, Section of Neuroradiology (N.G.-T., L.K., J.M.D.), Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, Department of Pathology (M.D.W.), The University of Texas MD Anderson Cancer Center, Houston, Texas, and Division of Neuroradiology (S.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - M D Williams
- Department of Radiology (S.S.H.), University of Texas Health Sciences Center at Houston, Houston, Texas, Section of Neuroradiology (N.G.-T., L.K., J.M.D.), Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, Department of Pathology (M.D.W.), The University of Texas MD Anderson Cancer Center, Houston, Texas, and Division of Neuroradiology (S.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - S Shah
- Department of Radiology (S.S.H.), University of Texas Health Sciences Center at Houston, Houston, Texas, Section of Neuroradiology (N.G.-T., L.K., J.M.D.), Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, Department of Pathology (M.D.W.), The University of Texas MD Anderson Cancer Center, Houston, Texas, and Division of Neuroradiology (S.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - J M Debnam
- Department of Radiology (S.S.H.), University of Texas Health Sciences Center at Houston, Houston, Texas, Section of Neuroradiology (N.G.-T., L.K., J.M.D.), Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, Department of Pathology (M.D.W.), The University of Texas MD Anderson Cancer Center, Houston, Texas, and Division of Neuroradiology (S.S.), Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
13
|
Picarsic J, Jaffe R. Nosology and Pathology of Langerhans Cell Histiocytosis. Hematol Oncol Clin North Am 2015; 29:799-823. [DOI: 10.1016/j.hoc.2015.06.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
14
|
Dalia S, Shao H, Sagatys E, Cualing H, Sokol L. Dendritic cell and histiocytic neoplasms: biology, diagnosis, and treatment. Cancer Control 2015; 21:290-300. [PMID: 25310210 DOI: 10.1177/107327481402100405] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Dendritic and histiocytic cell neoplasms are rare malignancies that make up less than 1% of all neoplasms arising in lymph nodes or soft tissues. These disorders have distinctive disease biology, clinical presentations, pathology, and unique treatment options. Morphology and immunohistochemistry evaluation by a hematopathologist remains key for differentiating between these neoplasms. In this review, we describe tumor biology, clinical features, pathology, and treatment of follicular dendritic cell sarcoma, interdigitating dendritic cell sarcoma, indeterminate dendritic cell sarcoma, histiocytic sarcoma, fibroblastic reticular cell tumors, and disseminated juvenile xanthogranuloma. METHODS A literature search for articles published between 1990 and 2013 was undertaken. Articles are reviewed and salient findings are systematically described. RESULTS Patients with dendritic cell and histiocytic neoplasms have distinct but variable clinical presentations; however, because many tumors have recently been recognized, their true incidence is uncertain. Although the clinical features can present in many organs, most occur in the lymph nodes or skin. Most cases are unifocal and solitary presentations have good prognoses with surgical resection. The role of adjuvant therapy in these disorders remains unclear. In cases with disseminated disease, prognosis is poor and data on treatment options are limited, although chemotherapy and referral to a tertiary care center should be considered. Excisional biopsy is the preferred method of specimen collection for tissue diagnosis, and immunohistochemistry is the most important diagnostic method for differentiating these disorders from other entities. CONCLUSIONS Dendritic cell and histiocytic cell neoplasms are rare hematological disorders with variable clinical presentations and prognoses. Immunohistochemistry remains important for diagnosis. Larger pooled analyses or clinical trials are needed to better understand optimal treatment options in these rare disorders. Whenever possible, patients should be referred to a tertiary care center for disease management.
Collapse
Affiliation(s)
- Samir Dalia
- Mercy Clinic Oncology-Hematology, Joplin, MO 64804, USA.
| | | | | | | | | |
Collapse
|
15
|
Ferguson SD, Waguespack SG, Langford LA, Ater JL, McCutcheon IE. Fatal juvenile xanthogranuloma presenting as a sellar lesion: case report and literature review. Childs Nerv Syst 2015; 31:777-84. [PMID: 25503249 DOI: 10.1007/s00381-014-2604-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 11/26/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Juvenile xanthogranuloma (JXG) is a histiocytic condition in the spectrum of non-Langerhans histiocytosis that preferentially affects children. Rarely this condition can involve the central nervous system (CNS) with devastating consequences. METHODS The authors report the unique case of an 11-year-old child who initially presented with a sellar lesion without evidence of the cutaneous stigmata typical of JXG. She was later discovered to have JXG following initial diagnosis of granulomatous hypophysitis, with development of widespread intracranial disease and subsequent neurological deterioration. She underwent subtotal resection of her sellar lesion followed by whole brain radiation and systemic chemotherapy; however, she succumbed to her disseminated disease within 1 month of the JXG diagnosis. CONCLUSIONS This is a rare case of fatal disseminated intracranial JXG without cutaneous manifestations. Additionally, the initial presentation as a sellar lesion is particularly unusual and seldom described in the literature.
Collapse
Affiliation(s)
- Sherise D Ferguson
- Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, 1400, Holcombe Blvd., Unit 442, Houston, TX, 77030, USA,
| | | | | | | | | |
Collapse
|
16
|
Neska-Matuszewska M, Zimny A, Kałwak K, Sąsiadek MJ. Central nervous system lymphoma in a 3-year-old male suffering from a severe juvenile xanthogranuloma - the usefulness of perfusion weighted imaging and diffusion weighted imaging in the diagnostics of pediatric brain tumors. Pol J Radiol 2015; 80:31-5. [PMID: 25624957 PMCID: PMC4306264 DOI: 10.12659/pjr.892106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 09/09/2014] [Indexed: 11/30/2022] Open
Abstract
Background Primary Central Nervous System Lymphomas (PCNSLs) are rare, malignant brain tumors derived from lymphocytes B. Juvenile xanthogranuloma (JXG) is a non-Langerhans histiocytic cell disorder in children which mostly affects the skin. Rare fatalities have been reported in extracutaneous manifestation. Brain magnetic resonance imaging (MRI) is a method of choice in the diagnostics of all neoplastic CNS lesions. Perfusion weighted imaging (PWI) and diffusion weighted imaging (DWI) allow for more detailed analysis of brain tumors including the rate of neoangiogenesis and cellularity. We presented a pediatric patient suffering from JXG with CNS involvement and the role of brain MRI including DWI and PWI in the evaluation of brain focal lesions. Case Report A 3-year-old male with severe JXG underwent two stem cell transplantations with a development of neurological complications. The patient underwent emergency CT and MRI which revealed a non-specific enhancing focal brain lesion. In DWI it showed restricted diffusion while PWI revealed low values of rCBV and the signal intensity curve returning above the baseline level. Advanced MRI techniques such as DWI and PWI suggested PCNSL. Stereotactic biopsy confirmed PCNSL due to Ebstein-Barr virus reactivation. Conclusions The use of advanced MRI sequences is important to differentiate brain lesions in pediatric patients. The use of PWI and DWI facilitated the diagnosis of PCNSL. It is important to remember that PCNSLs show a very typical pattern of changes visualized with MRI such as: usually strong homogenous enhancement, restricted diffusion and low perfusion.
Collapse
Affiliation(s)
- Małgorzata Neska-Matuszewska
- Department of General and Interventional Radiology and Neuroradiology, Chair of Radiology, Wrocław Medical University, Wrocław, Poland
| | - Anna Zimny
- Department of General and Interventional Radiology and Neuroradiology, Chair of Radiology, Wrocław Medical University, Wrocław, Poland
| | - Krzysztof Kałwak
- Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wrocław Medical University, Wrocław, Poland
| | - Marek J Sąsiadek
- Department of General and Interventional Radiology and Neuroradiology, Chair of Radiology, Wrocław Medical University, Wrocław, Poland
| |
Collapse
|
17
|
Tan LA, Uy BR, Munoz LF. Recurrent juvenile xanthogranuloma manifesting as diffuse miliary brain lesions. Br J Neurosurg 2014; 28:817-8. [PMID: 24827069 DOI: 10.3109/02688697.2014.918582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Lee A Tan
- Departments of Neurosurgery, Rush University Medical Center , Chicago, IL , USA
| | | | | |
Collapse
|
18
|
Zahir ST, Sharahjin NS, Vahedian H, Akhavan A. Juvenile xanthogranuloma presenting as a large neck mass and ocular complications: a diagnostic and therapeutic dilemma. BMJ Case Rep 2014; 2014:bcr-2013-202683. [PMID: 24810447 DOI: 10.1136/bcr-2013-202683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Juvenile xanthogranuloma is a non-Langerhans cell histiocytosis that originates from dendritic cells. Dendritic cells can accumulate in the skin of the head, neck, trunk, arms and legs. They may also involve other tissues such as the bones, lung, liver, heart, bone marrow, central nervous system, spleen and large intestine in rare cases. We report a rare case of juvenile xanthogranuloma in a 16-year-old girl who presented with a neck mass and left-sided ptosis 2.5 months previously. Excisional biopsy of the neck lesion revealed proliferated histiocytes admixed with numerous eosinophils and multinucleated giant cells that simulate eosinophilic granuloma; however, the histiocytes were negative for CD1a, CD123 and S-100 protein and positive for CD68 and CD14. The course of the disease led to treatment of the patient with chemotherapy, followed by low-dose radiotherapy.
Collapse
Affiliation(s)
- Shokouh Taghipour Zahir
- Department of Pathology, Shahid Sadoughi University of Medical Sciences, Yazd, Islamic Republic of Iran
| | | | | | | |
Collapse
|
19
|
Meshkini A, Shahzadi S, Alikhah H, Naghavi-Behzad M. Role of stereotactic biopsy in histological diagnosis of multiple brain lesions. Asian J Neurosurg 2013; 8:69-73. [PMID: 24049547 PMCID: PMC3775184 DOI: 10.4103/1793-5482.116374] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background and Aim: The current advances in diagnostic and therapeutic modalities and increasing in survival of patients with systemic diseases and immunosuppressive cases have caused to increasing frequency and variety of Central Nervous System neuropathologic processes indicating the necessary need for accurate localization of space-occupying lesions by cytology and histology. This study was aimed to evaluate the usefulness and safety of stereotactic biopsy in histological diagnosis of such lesions. Materials and Methods: Of 2081 patients underwent stereotactic biopsy of brain lesions using Riechert-Mundinger system, 158 had multifocal brain lesions, and were enrolled. Results: The ages of studied cases were ranged from 2 years to 75 years (Mean age: 41.3 year), 114 were male and 44 were females. Incidence of histopathologic diagnosis of multifocal brain lesions included Astrocytoma grade II (41.3%), Astrocytoma grade I (12.9%), glioblastoma multiform (11.1%), Astrocytoma grade III (10.2%), malignant lymphoma (10.2%), metastasis (4.6%), pilocytic Astrocytoma (2.7%), abscess (2.7%), craniopharyngioma (1.8%) vascular malformations (0.9%), and tuberculosis (0.9%). Mortality due to operation is none. Conclusions: Histopathologic diagnosis of multiple brain lesions is necessary for decision of appropriate management and stereotactic biopsy of brain lesion is a useful and safe method for histological diagnosis.
Collapse
Affiliation(s)
- Ali Meshkini
- Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | | | |
Collapse
|
20
|
Gressot LV, Patel AJ, Bollo RJ, Mohila CA, Jea A. Disseminated intracranial juvenile xanthogranulomatosis in a neonate without cutaneous lesions. J Neurosurg Pediatr 2013; 12:187-91. [PMID: 23790105 DOI: 10.3171/2013.5.peds1332] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Juvenile xanthogranuloma (JXG) is a rare disease that is part of a spectrum of histiocytic dendritic cell disorders. The authors report an unusual case of a 6-week-old male who presented with seizures. Neuroimaging revealed disseminated intracranial disease involving the optic apparatus, basal ganglia, lateral ventricles, and brainstem. The patient did not have any cutaneous lesions or evidence of extracranial disease. The patient underwent open biopsy of a large right midbrain lesion; pathology was consistent with JXG. He underwent postoperative chemotherapy and is doing well 7 months after surgery with regression of the intracranial lesions. To the best of the authors' knowledge, this is the first report of a neonate with disseminated intracranial JXG without cutaneous stigmata.
Collapse
Affiliation(s)
- Loyola V Gressot
- Department of Neurosurgery, Texas Children’s Hospital, Houston, Texas 77030, USA
| | | | | | | | | |
Collapse
|