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Kong L, Xue L, Zhong Y, Wang S, Zheng D, Wang L, Jiao Y, Zhang X, Xue H, Liu X. Crystal-storing histiocytosis in the stomach: A case report and review of the literature. Front Oncol 2022; 12:1024971. [PMID: 36591494 PMCID: PMC9798227 DOI: 10.3389/fonc.2022.1024971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
Crystal-storing histiocytosis (CSH) is a rare disorder characterized by the accumulation of non-neoplastic histiocytes that contain intracytoplasmic crystallized immunoglobulins. Although CSH can occur in various organs, gastric CSH is very rare. Therefore, diagnosing gastric CSH remains a challenge. Here, we present the case of a 69-year-old man with localized gastric CSH who presented with positive fecal occult blood for 2 days. Gastroscopy showed that there was a piece of irregular whitish focus in the big bend of the gastric antrum, which was soft and elastic. Histologically, the biopsied gastric mucosa showed chronic inflammation, mild activity with erosion, and numerous eosinophilic mononuclear cells containing fibrillary crystalloid inclusions in the lamina propria. Immunohistochemically, these crystal-containing cells were positive for CD68/PGM1 and Igk, which revealed that the cells were histiocytes harboring kappa light chain-restricted immunoglobulin crystals. Electron microscopic examination showed numerous high-electron-density particles in the cytoplasm of cells, with crystal structures of different sizes and shapes. This case highlights how immunohistochemistry can help with differential diagnosis and classification.
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Affiliation(s)
- Linghong Kong
- Department of Pathology, Beijing Chuiyangliu hospital, Beijing, China
| | - Liyan Xue
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanfeng Zhong
- Department of Pathology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Shenglan Wang
- Department of Pathology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Danfeng Zheng
- Department of Pathology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Lining Wang
- Department of Pathology, Beijing Chuiyangliu hospital, Beijing, China
| | - Yang Jiao
- Department of Pathology, Beijing Chuiyangliu hospital, Beijing, China
| | - Xinpeng Zhang
- Department of Pathology, Beijing Chuiyangliu hospital, Beijing, China
| | - Huizhong Xue
- Department of Pathology, Beijing Chuiyangliu hospital, Beijing, China
| | - Xiaogang Liu
- Department of Pathology, Beijing Chuiyangliu hospital, Beijing, China,*Correspondence: Xiaogang Liu,
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Bansal N, Puri P, Nagpal N, Naithani R, Gupta R. Lambda-Restricted Crystal-Storing Histiocytosis of Stomach: A Case Report and Review of Literature. Cureus 2021; 13:e15009. [PMID: 34131544 PMCID: PMC8197172 DOI: 10.7759/cureus.15009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Crystal-storing histiocytosis (CSH) is a rare tissue phenomenon that is usually associated with lympho-proliferative diseases. The disease is characterized by prominent collections of macrophages with abundant eosinophilic cytoplasm and fibrillary cytoplasmic inclusions. The inclusions appear as linear crystals within the macrophages which are usually kappa restricted. The disease usually involves lungs, lymph nodes, bone marrow, thymus and spleen with rare involvement of the gastrointestinal tract. We report a rare case of lambda-restricted CSH of the stomach. The diagnosis of CSH triggered further hematological evaluation. The patient was later diagnosed to have diffuse large B-cell lymphoma involving lymph nodes and bone marrow. He received chemotherapy for the same and is on regular follow up. The index case highlights the need to identify CSH of stomach prompting evaluation for hematological malignancies and to increase its awareness among clinicians and pathologists.
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Affiliation(s)
- Nalini Bansal
- Histopathology, Fortis Escorts Heart Institute, New Delhi, IND
| | - Pankaj Puri
- Gastroenterology and Hepatology, Fortis Escorts Heart Institute, New Delhi, IND
| | - Nishant Nagpal
- Gastroenterology and Hepatology, Fortis Escorts Heart Institute, New Delhi, IND
| | - Rahul Naithani
- Hematology and Oncology, Max Hospital Saket, New Delhi, IND
| | - Rahul Gupta
- Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, IND
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Wiese-Hansen H, Leh F, Lodvir Hemsing A, Reikvam H. Immunoglobulin-Storing Histiocytosis: A Case Based Systemic Review. J Clin Med 2021; 10:jcm10091834. [PMID: 33922555 PMCID: PMC8122927 DOI: 10.3390/jcm10091834] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 11/29/2022] Open
Abstract
Crystal-storing histiocytosis (CSH) is a rare event in disorders associated with monoclonal gammopathy and is mostly associated with the accumulation of immunoglobulins (Igs) in the cytoplasm of histiocytes. In this article, we present a case of a 75-year-old female with IgG kappa monoclonal gammopathy of undetermined significance (MGUS) and signs of a non-crystallized version of immunoglobulin-storing histiocytosis (IgSH) in a vertebra corpus. Furthermore, we performed a literature review based on all cases of storing histiocytosis identified by literature search between 1987 and 2020 and identified 140 cases in total. The median age at diagnosis was 60 years (range 18–91), with an equal sex distribution (51% men). The majority of the patients had an underlying neoplastic B-cell disorder, most often multiple myeloma (MM), MGUS, or lymphoplasmacytic lymphoma (LPL). The main affected organ systems or tissue sites were bone (n = 52), followed by head and neck (n = 31), kidney (n = 23), lung (n = 20), and gastrointestinal (GI)-tract (n = 18). IgG was the main immunoglobulin class involved, and most cases were associated with kappa light chain expression. We conclude that IgSH is a rare disease entity but should be considered with unusual findings in several organ systems associated with monoclonal gammopathy, especially with kappa light chain expression.
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Affiliation(s)
- Hanne Wiese-Hansen
- Institute of Clinical Science, Faculty of Medicine University of Bergen, N-5021 Bergen, Norway; (H.W.-H.); (A.L.H.)
| | - Friedemann Leh
- Department of Pathology, Haukeland University Hospital, N-5021 Bergen, Norway;
| | - Anette Lodvir Hemsing
- Institute of Clinical Science, Faculty of Medicine University of Bergen, N-5021 Bergen, Norway; (H.W.-H.); (A.L.H.)
- Department of Medicine, Haukeland University Hospital, N-5021 Bergen, Norway
| | - Håkon Reikvam
- Institute of Clinical Science, Faculty of Medicine University of Bergen, N-5021 Bergen, Norway; (H.W.-H.); (A.L.H.)
- Department of Medicine, Haukeland University Hospital, N-5021 Bergen, Norway
- Correspondence:
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