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Zhang L, Chen H, Ding Y, Wang W, Wa G, Zheng B, Wang J. Pulmonary Langerhans Cell Histiocytosis in an African Lion: A Rare Case Report. Animals (Basel) 2024; 14:1011. [PMID: 38612250 PMCID: PMC11010851 DOI: 10.3390/ani14071011] [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: 02/22/2024] [Revised: 03/17/2024] [Accepted: 03/24/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Feline pulmonary Langerhans cells histiocytosis (PLCH) is a rare disorder that results in progressive respiratory failure secondary to pulmonary parenchymal infiltration with Langerhans cells (LCs). A diagnosis of PLCH is proposed based on the clinical features and pathological findings and confirmed based on the infiltrating histiocytic cells. There are few documented cases of feline PLCH, and this case report of PLCH in an African Lion could present new information and aspects of this feline histiocytic disease. CASE PRESENTATION An African lion at Hohhot Zoo showing severe hyporexia and dyspnea with subsequent mental depression and emaciation died of exhaustion after a 35-day course of illness. Empirical treatment did not have a significant effect. An autopsy revealed that the lungs were enlarged and hardened due to infiltrative lesions, with many yellowish-white foci in all the lobes and sections. Furthermore, the kidneys were atrophied and had scattered grayish-white lesions on the surface. At the same time, congestion was widely distributed in various locations, including the liver, subcutaneous loose connective tissues, serosal surface and other tissues and organs. Histologically, proliferative histiocytic cells (PHCs) were scattered in the alveolar cavities, bronchioles and submucosa of bronchioles, with evident cellular and nuclear pleomorphism, and thus the alveolar septa were obliterated. The histopathological changes in other organs included chronic sclerosing glomerulonephritis, proliferated Kupffer cells in the liver, adrenal edema and interstitial connective tissue hyperplasia, as well as atrophy of the small intestines and spleen. Furthermore, immunohistochemical analysis results were strongly positive for CD1a, vimentin, S100 and E-cadherin in the membrane or cytoplasm of PHCs, supporting an LC phenotype. CONCLUSIONS Here, we present a rare pulmonary Langerhans cell histiocytosis case in an African lion.
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Affiliation(s)
- Liang Zhang
- College of Veterinary Medicine, Inner Mongolia Agricultural University, Hohhot 010018, China; (L.Z.); (H.C.); (Y.D.); (W.W.)
- Key Laboratory of Clinical Diagnosis and Treatment Techniques for Animal Disease, Ministry of Agriculture and Rural Affairs, Hohhot 010018, China
- Inner Mongolia Autonomous Region Key Laboratory of Veterinary Fundamentals and Disease Prevention and Control of Herbivorous Livestock, Hohhot 010018, China
| | - Hui Chen
- College of Veterinary Medicine, Inner Mongolia Agricultural University, Hohhot 010018, China; (L.Z.); (H.C.); (Y.D.); (W.W.)
- Key Laboratory of Clinical Diagnosis and Treatment Techniques for Animal Disease, Ministry of Agriculture and Rural Affairs, Hohhot 010018, China
- Inner Mongolia Autonomous Region Key Laboratory of Veterinary Fundamentals and Disease Prevention and Control of Herbivorous Livestock, Hohhot 010018, China
| | - Yulin Ding
- College of Veterinary Medicine, Inner Mongolia Agricultural University, Hohhot 010018, China; (L.Z.); (H.C.); (Y.D.); (W.W.)
- Key Laboratory of Clinical Diagnosis and Treatment Techniques for Animal Disease, Ministry of Agriculture and Rural Affairs, Hohhot 010018, China
- Inner Mongolia Autonomous Region Key Laboratory of Veterinary Fundamentals and Disease Prevention and Control of Herbivorous Livestock, Hohhot 010018, China
| | - Wenlong Wang
- College of Veterinary Medicine, Inner Mongolia Agricultural University, Hohhot 010018, China; (L.Z.); (H.C.); (Y.D.); (W.W.)
- Key Laboratory of Clinical Diagnosis and Treatment Techniques for Animal Disease, Ministry of Agriculture and Rural Affairs, Hohhot 010018, China
- Inner Mongolia Autonomous Region Key Laboratory of Veterinary Fundamentals and Disease Prevention and Control of Herbivorous Livestock, Hohhot 010018, China
| | - Gao Wa
- Inner Mongolia Autonomous Region Key Laboratory of Tick-Borne Zoonotic Infectious Disease, Bayan Nur 015000, China;
- Department of Medicine, College of Hetao, Bayan Nur 015000, China
| | | | - Jinling Wang
- College of Veterinary Medicine, Inner Mongolia Agricultural University, Hohhot 010018, China; (L.Z.); (H.C.); (Y.D.); (W.W.)
- Key Laboratory of Clinical Diagnosis and Treatment Techniques for Animal Disease, Ministry of Agriculture and Rural Affairs, Hohhot 010018, China
- Inner Mongolia Autonomous Region Key Laboratory of Veterinary Fundamentals and Disease Prevention and Control of Herbivorous Livestock, Hohhot 010018, China
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Song W, Hu F, Shi W, Wang F, Zhang Y, Lan X, Xia X. Case report: Exploring the utility of whole-body bone scintigraphy for pediatric Langerhans cell histiocytosis: insights from clinical practice. Front Oncol 2024; 14:1294772. [PMID: 38406811 PMCID: PMC10884278 DOI: 10.3389/fonc.2024.1294772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/19/2024] [Indexed: 02/27/2024] Open
Abstract
Purpose This mini-review delves into the realm of Langerhans cell histiocytosis (LCH) in children, focusing on its skeletal involvement. By synthesizing pertinent literature, we sought to provide a comprehensive understanding of LCH's clinical and radiographic spectrum. Our study then demonstrates the diagnostic prowess of whole-body 99mTc-methyl diphosphonate (MDP) scintigraphy in LCH cases, underscoring its value in tandem with existing knowledge. Methods Our approach involved an extensive literature review that contextualized LCH within the current medical landscape. Subsequently, we presented a case series featuring five pediatric instances of skeletal LCH, one accompanied by soft tissue infiltration. The principal aim was to illuminate the diagnostic and staging potential of whole-body 99mTc-MDP scintigraphy, augmenting existing insights. Results Through meticulous literature synthesis, we highlighted pediatric LCH's protean clinical manifestations and radiological variability. Aligning with this spectrum, our case series underscored the role of 99mTc-MDP scintigraphy in diagnosing and staging LCH. Among the five pediatric cases, one demonstrated concurrent soft tissue involvement. This aligns with the multifaceted nature of LCH presentations. Conclusion Pediatric LCH can present with a wide range of clinical and radiologic features. By amalgamating our cases with extant literature, we stress the necessity of a multimodal strategy. 99mTc-MDP scintigraphy emerged as an indispensable tool for accurate staging and soft tissue detection. Our findings collectively advocate for a holistic approach to managing LCH, ensuring informed therapeutic decisions for optimal patient outcomes.
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Affiliation(s)
- Wenyu Song
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Fan Hu
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Wei Shi
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fang Wang
- Department of Nuclear Medicine, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yongxue Zhang
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xiaoli Lan
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xiaotian Xia
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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Podzimek J, Jecker P, Koscielny S. [Painful swelling on the forehead in childhood]. HNO 2024; 72:51-53. [PMID: 37592095 DOI: 10.1007/s00106-023-01347-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 08/19/2023]
Affiliation(s)
- J Podzimek
- Klinik für HNO und plastische Kopf-Halschirurgie, Klinikum Bad Salzungen, Lindigallee 3, 36433, Bad Salzungen, Deutschland.
| | - P Jecker
- Klinik für HNO und plastische Kopf-Halschirurgie, Klinikum Bad Salzungen, Lindigallee 3, 36433, Bad Salzungen, Deutschland
| | - S Koscielny
- Klinik für HNO und plastische Kopf-Halschirurgie, Universitätsklinikum Jena, Jena, Deutschland
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Kajal P, Dhingra H, Bhutani N. Mandibular unifocal Langerhans cell histiocytosis in a child - Report of successful management of a rare condition. Int J Surg Case Rep 2023; 112:108940. [PMID: 37852095 PMCID: PMC10667783 DOI: 10.1016/j.ijscr.2023.108940] [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: 08/28/2023] [Revised: 10/05/2023] [Accepted: 10/07/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Langerhans cell histiocytosis (LCH) is a proliferation of dendritic mononuclear cells with infiltration into organs locally or diffusely. Its aetiology is still unknown, and its clinical spectrum is quite wide. CASE PRESENTATION A 2-year-old-male child presented to us with a solitary swelling in left mandibular region which was painless and increasing in size with time. It was diagnosed to be unifocal LCH of mandible on the basis of X-ray, ultrasonography of the involved mandible and fine needle aspiration cytology of the swelling and managed conservatively with oral steroids. DISCUSSION LCH is often classified as single system, when the disease affects only one part of the body; or multisystem, when it affects more than one part of the body (Jezierska et al., 2018 [1]). In children, histiocytosis usually involves the bones and may consist of single or multiple sites. The skull is frequently affected. Children over five years of age usually have the single system disease, with just bone involvement but our patient was 2-year-old and had unifocal disease involving mandible. Young children, especially infants, are more likely to have the multisystem disease (Jezierska et al., 2018 [1]). CONCLUSION Mandibular involvement associated with LCH is quite uncommon in paediatric population. Early diagnosis and prompt initiation of treatment are key to a good eventual outcome.
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Affiliation(s)
- Pradeep Kajal
- Department of Paediatric Surgery, PGIMS Rohtak, Haryana, India.
| | | | - Namita Bhutani
- Dept. of Pathology, North DMC Medical College and Hindu Rao Hospital, New Delhi, India
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Betansos KM, Cachero MJ, Santos C, Fernandez E, Mabulac M, Abad L. Langerhans Cell Histiocytosis Presenting as Anterior Neck Mass in a Child: A Case Report. J ASEAN Fed Endocr Soc 2023; 38:149-153. [PMID: 38045678 PMCID: PMC10692419 DOI: 10.15605/jafes.038.02.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 03/09/2023] [Indexed: 12/05/2023] Open
Abstract
Thyroid involvement in Langerhans Cell Histiocytosis (LCH) is rare. We report a 10-year-old Filipino male who presented with a rapidly enlarging goiter. Computed tomography scan showed thyroid and bilateral submandibular masses with malignant features, pulmonary blebs and hepatic cysts. Ultrasound-guided core needle biopsy findings were consistent with LCH and chemotherapy was initiated. This case demonstrates that LCH should be considered in patients with goiter. Multidisciplinary management is warranted to achieve proper diagnosis and institute timely treatment.
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Affiliation(s)
- Kristine Mae Betansos
- Section of Pediatric Endocrinology, Philippine Children's Medical Center, Quezon City, Philippines
| | - Melissa Joyanne Cachero
- Section of Pediatric Endocrinology, Philippine Children's Medical Center, Quezon City, Philippines
| | - Caridad Santos
- Section of Pediatric Endocrinology, Philippine Children's Medical Center, Quezon City, Philippines
| | - Eve Fernandez
- Section of Pediatric Endocrinology, Philippine Children's Medical Center, Quezon City, Philippines
| | - Marichu Mabulac
- Section of Pediatric Endocrinology, Philippine Children's Medical Center, Quezon City, Philippines
| | - Lorna Abad
- Section of Pediatric Endocrinology, Philippine Children's Medical Center, Quezon City, Philippines
- Department of Pediatrics, Philippine General Hospital, Manila
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Lou Y, Zhao C, Cao H, Yan B, Chen D, Jia Q, Li L, Xiao J. Multiple Langerhans cell histiocytosis with spinal involvement. Bone Joint J 2023; 105-B:679-687. [PMID: 37257861 DOI: 10.1302/0301-620x.105b6.bjj-2022-1129.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Aims The aim of this study was to report the long-term prognosis of patients with multiple Langerhans cell histiocytosis (LCH) involving the spine, and to analyze the risk factors for progression-free survival (PFS). Methods We included 28 patients with multiple LCH involving the spine treated between January 2009 and August 2021. Kaplan-Meier methods were applied to estimate overall survival (OS) and PFS. Univariate Cox regression analysis was used to identify variables associated with PFS. Results Patients with multiple LCH involving the spine accounted for 15.4% (28/182 cases) of all cases of spinal LCH: their lesions primarily involved the thoracic and lumbar spines. The most common symptom was pain, followed by neurological dysfunction. All patients presented with osteolytic bone destruction, and 23 cases were accompanied by a paravertebral soft-tissue mass. The incidence of vertebra plana was low, whereas the oversleeve-like sign was a more common finding. The alkaline phosphatase was significantly higher in patients with single-system multifocal bone LCH than in patients with multisystem LCH. At final follow-up, one patient had been lost to follow-up, two patients had died, three patients had local recurrence, six patients had distant involvement, and 17 patients were alive with disease. The median PFS and OS were 50.5 months (interquartile range (IQR) 23.5 to 63.1) and 60.5 months (IQR 38.0 to 73.3), respectively. Stage (hazard ratio (HR) 4.324; p < 0.001) and chemotherapy (HR 0.203; p < 0.001) were prognostic factors for PFS. Conclusion Pain is primarily due to segmental instability of the spine from its destruction by LCH. Chemotherapy can significantly improve PFS, and radiotherapy has achieved good results in local control. The LCH lesions in some patients will continue to progress. It may initially appear as an isolated or single-system LCH, but will gradually involve multiple sites or systems. Therefore, long-term follow-up and timely intervention are important for patients with spinal LCH.
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Affiliation(s)
- Yan Lou
- Department of Orthopedic Oncology, Spine Tumor Center, Changzheng Hospital, Naval Military Medical University, Shanghai, China
| | - Chenglong Zhao
- Department of Orthopedic Oncology, Spine Tumor Center, Changzheng Hospital, Naval Military Medical University, Shanghai, China
| | - Haotian Cao
- Department of Pathology, Changzheng Hospital, Naval Military Medical University, Shanghai, China
| | - Bing Yan
- Medical Imaging Diagnostic Center, Shanghai University, Shanghai, China
| | - Dingbang Chen
- Department of Orthopedic Oncology, Spine Tumor Center, Changzheng Hospital, Naval Military Medical University, Shanghai, China
| | - Qi Jia
- Department of Orthopedic Oncology, Spine Tumor Center, Changzheng Hospital, Naval Military Medical University, Shanghai, China
| | - Lin Li
- Department of Orthopedic Oncology, Spine Tumor Center, Changzheng Hospital, Naval Military Medical University, Shanghai, China
| | - Jianru Xiao
- Department of Orthopedic Oncology, Spine Tumor Center, Changzheng Hospital, Naval Military Medical University, Shanghai, China
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Huang E, Wolfe VG, Yaeger SK, Fugok KL. Case Presentation of a Nine-Year-Old Female With Chronic Recurrent Multifocal Osteomyelitis. Cureus 2023; 15:e38054. [PMID: 37228560 PMCID: PMC10208142 DOI: 10.7759/cureus.38054] [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: 03/02/2023] [Accepted: 04/22/2023] [Indexed: 05/27/2023] Open
Abstract
Multifocal bone pain in a pediatric patient prompts a broad differential diagnosis, which should include chronic recurrent multifocal osteomyelitis (CRMO), particularly when the patient has a personal or family history of autoimmune diseases or chronic inflammatory disorders. CRMO is a difficult diagnosis, as several similar disorders must be ruled out first, and it requires extensive verification based on clinical, radiological, and pathological criteria. It often mimics other medical diagnoses, including Langerhans cell histiocytosis and infectious osteomyelitis. Maintaining a high index of suspicion for CRMO is important to minimize unnecessary medical testing, optimize pain control, and preserve physical function. We present the case of a nine-year-old female who presented with multifocal bone pain and was diagnosed with CRMO.
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Affiliation(s)
- Evanie Huang
- Department of Emergency and Hospital Medicine/University of South Florida (USF) Morsani College of Medicine, Lehigh Valley Health Network, Bethlehem, USA
| | - Viktoriya G Wolfe
- Department of Pediatrics/University of South Florida (USF) Morsani College of Medicine, Lehigh Valley Health Network, Bethlehem, USA
| | - Susan K Yaeger
- Department of Emergency and Hospital Medicine/University of South Florida (USF) Morsani College of Medicine, Lehigh Valley Health Network, Allentown, USA
| | - Kimberly L Fugok
- Department of Emergency and Hospital Medicine/University of South Florida (USF) Morsani College of Medicine, Lehigh Valley Health Network, Bethlehem, USA
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Burtsev EA, Bronin GO. Langerhans Cell Histiocytosis in Children: Literature Review. CURRENT PEDIATRICS 2023. [DOI: 10.15690/vsp.v22i1.2520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Relevant information on Langerhans cell histiocytosis development and course in children is presented. The current concepts of disease pathogenesis, principles of its severity evaluation, patients stratification into risk groups, as well as of clinical course features are described. Modern approaches to the disease treatment via targeted therapy are summarized and analyzed.
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Saeed SM, Bilal S, Loya A, Yusuf MA. Relapse of Non-Gastrointestinal Langerhans Cell Histiocytosis in the Rectum in a Child: A Case Report. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476231163961. [PMID: 37033676 PMCID: PMC10074612 DOI: 10.1177/11795476231163961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/28/2023] [Indexed: 04/05/2023]
Abstract
Langerhans cell histiocytosis (LCH) is a rare disorder most commonly involving skin, bone and lung. The gastrointestinal tract (GIT) is an uncommon site of disease and only a handful of case reports exist. We present a case of a 15-year old boy with treated LCH involving the skin, bones, central nervous system (CNS) and pituitary gland. He presented with rectal bleeding and on investigation was found to have a single rectal polyp which was confirmed histologically and immunologically to be LCH. Further investigation revealed no other foci of disease.
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Affiliation(s)
- Saad Muhammad Saeed
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan
| | - Sundus Bilal
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan
| | - Asif Loya
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan
| | - Muhammed Aasim Yusuf
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan
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Rameh V, Voss S, Bedoya MA, Beaulieu D, Zhang D, Degar BA, Tsai A. The added value of skeletal surveys in the initial evaluation of children diagnosed with Langerhans cell histiocytosis in the era of staging 18 F-FDG PET/CT: A retrospective study. Pediatr Blood Cancer 2023; 70:e30057. [PMID: 36266951 DOI: 10.1002/pbc.30057] [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: 06/29/2022] [Revised: 08/22/2022] [Accepted: 08/30/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Currently, there is no consensus protocol on the initial staging evaluation for Langerhans cell histiocytosis (LCH). Our institutional protocol consists of a skeletal survey and a whole-body positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro-D-glucose integrated with computed tomography (FDG PET/CT) study. The utility of the PET/CT lies in its sensitivity in detecting osseous and extra-osseous lesions, and in determining the baseline metabolic activity of LCH lesions to assess treatment response. However, the added utility of the skeletal survey in staging LCH is unclear. Therefore, this study retrospectively assessed the added diagnostic value of skeletal surveys in patients with baseline PET/CTs for initial staging of LCH. METHODS We retrospectively searched the medical records of all patients less than or equal to 18 years old at a large children's hospital (May 2013 to September 2021). The inclusion criteria were (a) biopsy-proven diagnosis of LCH and (b) initial staging PET/CT and skeletal survey performed less than or equal to 1 month apart. A blinded pediatric radiologist reviewed the skeletal surveys and another reviewed the PET/CTs in identifying LCH osseous lesions. RESULTS Our study cohort consisted of 49 children with 86 LCH osseous lesions. In non-extremity locations, PET/CT identified 70/70 (100%) osseous lesions, while skeletal surveys detected 43/70 (61.4%) osseous lesions. In the extremities, PET/CT identified 13/16 (81.3%) osseous lesions, while skeletal surveys detected 15/16 (93.8%) osseous lesions. CONCLUSION Skeletal surveys increased the detection rate of osseous lesions in the extremities, but added no diagnostic value to the detection of osseous lesions in non-extremity locations. Therefore, we propose to abbreviate the skeletal survey to include only extremity radiographs.
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Affiliation(s)
- Vanessa Rameh
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephan Voss
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - M Alejandra Bedoya
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Danielle Beaulieu
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Da Zhang
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Barbara A Degar
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Andy Tsai
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Sadr S, Modarresi SZ, Eshghi P, Shahkar L, Khalili M, Khoddami M, Karimi Rouzbahani A. Congenital Skin Rashes in an IVF Baby Progressed to Multisystem Langerhans Cell Histiocytosis with Lung and Bone Involvement: A Case Report and Literature Review. TANAFFOS 2023; 22:176-181. [PMID: 37920317 PMCID: PMC10618583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/28/2022] [Indexed: 11/04/2023]
Abstract
Langerhans cell histiocytosis is an uncommon proliferative disorder that may influence many organs; so, the clinical presentations vary. Here we describe an 85-day-old female who was born with In vitro fertilization after 10 years of infertility. She referred to us due to severe pulmonary insufficiency and congenital progressive maculopapular rash with desquamation. There were significant cystic changes in chest imaging studies. Further evaluation demonstrated lytic lesions in cranial, femoral, and humorous bones. The skin biopsy verified the diagnosis of LCH. A combination of Vinblastine, VP16, and Dexamethasone regimen was applied for the patient. In the course of the disease, she encountered multiple bilateral pneumothoraxes but didn't respond to tube thoracostomy and chemotherapy management. The patient died due to respiratory failure raised from complications of lung involvement as a multisystem LCH, 29 days later. Pediatricians should pay much more attention to the cutaneous lesions in the neonatal period especially if there is any risk factor for presenting LCH such as IVF. The lesions should be monitored closely owing to a high correlation between skin lesions and MS LCH.
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Affiliation(s)
- Saeed Sadr
- Department of Pediatric Pulmonology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyedeh Zalfa Modarresi
- Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Peyman Eshghi
- Pediatric Congenital Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Lobat Shahkar
- Neonatal and Children's Health Research Center, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mitra Khalili
- Department of Radiology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maliheh Khoddami
- Pediatric Pathology Research Center, Research Institute for Children’s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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McCambridge TM, Papakyrikos C, Levin A. Langerhans Cell Histiocytosis Presenting as a Lesser Trochanter Fracture in an Adolescent: A Case Report. JBJS Case Connect 2023; 13:01709767-202303000-00001. [PMID: 36821120 DOI: 10.2106/jbjs.cc.21.00820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/11/2022] [Indexed: 02/24/2023]
Abstract
CASE We present the case of an 18-year-old man with right hip pain who was found to have a lytic lesion of the lesser trochanter of the right femur with cortical destruction and a lytic lesion of the left inferior pubic ramus. Additional imaging and pathology testing confirmed a diagnosis of multifocal, single-system Langerhans cell histiocytosis (LCH) of the bone. CONCLUSION LCH is a rare pediatric disease most commonly diagnosed in toddlers and young school-age children. Its epidemiologic characteristics are poorly described for young adults and older adolescents, in whom clinical suspicion should be maintained when evaluating multifocal osseous lesions.
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Affiliation(s)
| | - Cole Papakyrikos
- Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
| | - Adam Levin
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland.,Department of Oncology, The Johns Hopkins University, Baltimore, Maryland
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Thaeren J, Muschler E, Ko YD, Winnesberg A, Wilhelm K. [Atypical acromion fracture after fall of an 18-year-old patient]. RADIOLOGIE (HEIDELBERG, GERMANY) 2022; 62:1075-1078. [PMID: 36125523 DOI: 10.1007/s00117-022-01070-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Jennifer Thaeren
- Radiologie, Johanniter-Krankenhaus Bonn, Johanniter Str. 3-5, 53113, Bonn, Deutschland.
| | - Eugen Muschler
- Radiologie, Johanniter-Krankenhaus Bonn, Johanniter Str. 3-5, 53113, Bonn, Deutschland
| | - Yon-Dschun Ko
- Innere Medizin/Internistische Onkologie, Johanniter-Krankenhaus Bonn, Bonn, Deutschland
| | - Arnd Winnesberg
- Unfallchirurgie, Johanniter-Krankenhaus Bonn, Bonn, Deutschland
| | - Kai Wilhelm
- Radiologie, Johanniter-Krankenhaus Bonn, Johanniter Str. 3-5, 53113, Bonn, Deutschland
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Benhoummad O, Cherrabi K, Imdary M. Diagnosis difficulty of histiocytosis in the thyroid region of a child: a rare case report with literature review of differential diagnoses. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2022. [DOI: 10.1186/s43163-022-00338-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Isolated histiocytosis of thyroid region is very rare; clinical history, exam, and radiological aspects are non-specific, and etiological reasoning is quite difficult considering the tremendous number of differential diagnoses.
Case presentation
This is the case of a 6-year-old girl who came to the emergency room with an acute presentation bulging of the anterior and left lateral regions of the neck. The palpation of the mass showed tenderness; there was no sign of inflammation, nor was there any fistula to the anterior border of the sternocleidomastoid muscle.
The patient was stable. She did not have any signs of compression. The initial blood showed anemia and inflammatory syndrome. She underwent cervical ultrasound exam that showed a mass at the expense of the left thyroid lobe; the mass extends through the sub-hyoid muscles to the lateral cervical region.
A CT scan with and without contrast injection was performed. It showed a heterogenous mass, which seemed centered in the anterior compartment, and from which it extended to the left lateral compartment, as well as the posterior compartment, invading the prevertebral muscles and englobing the carotid and the internal jugular vein.
The patient underwent surgical biopsy. A basal cervical incision was made, dissection with the myo-cutaneous plane. Per-operative observation established that the mass breeched the infrahyoid muscles, as well as the sternocleidomastoid muscle. A biopsy was performed without opening the middle line.
The pathological exam showed an eosinophilic granulomatosis, associated with Stembergoid cells. The immune-histochemical exam concluded that the lesion is histiocytosis. The patient underwent a cervicothoracic and pelvic CT scan to rule out systemic forms. The diagnosis of isolated histiocytosis of thyroid region was confirmed.
The patient underwent hemithyroidectomy, associated with careful dissection of extension of the mass to lateral compartment of the neck. Postoperative exam showed no abnormalities. No dysphonia and no hypocalcemia were observed.
The 8-month follow-up showed satisfactory results, no cervical swelling, and no signs of inflammation or compression. Postoperative naso-fibroscopy was normal.
Conclusions
The most important takeaway message of this work is that methodical approach of neck masses allows to rule out the most aggressive lesions frequently encountered, which allows clinicians to establish thorough diagnosis and management without further delay.
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Sharma C, Tiwari A, Goel A, Vashist S, Raheja V, Jakhar A. Rare Cause of CSOM: Langerhans Cell Histiocytosis. Indian J Otolaryngol Head Neck Surg 2022; 74:3678-3681. [PMID: 36742476 PMCID: PMC9895658 DOI: 10.1007/s12070-021-02431-0] [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: 10/28/2020] [Accepted: 01/25/2021] [Indexed: 02/07/2023] Open
Abstract
Langerhans cell histiocytosis (LCH) is a proliferation of dendritic mononuclear cells with infiltration into organs locally or diffusely. Most cases occur in children. LCH can also present as chronic otitis media and otitis externa due to involvement of the mastoid and petrous portions of the temporal bone with partial obstruction of the auditory canal. A 4 year old male child presented with complaints of bilateral ear discharge for 4 months and inability to walk and giddiness for 2 days. On otoscopic examination, in right ear, polypoidal tissue was present in the external auditory canal which bled on touch. CECT head and MRI brain was done which showed large altered intensities in the region of bilateral external and middle ears involving the temporal bone. It also showed a well defined ovoid expansile lesion involving the skull vault in left high parietal region. Biopsy was taken from the polypoidal tissue in the right EAC which on HPE showed features suspicious for LCH. On IHC, the tissue was found out to be immunoreactive for CD 68, CD 1a and S-100 with score of 4+ for all three of the IHC markers. Patient was later put on chemotherapy and steroids which resulted in disease remission.
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Affiliation(s)
- Chandni Sharma
- Department of Otorhinolaryngology, Pt. B.D. Sharma PGIMS, Rohtak, Haryana 124001 India
| | - Abhiraj Tiwari
- Department of Otorhinolaryngology, Pt. B.D. Sharma PGIMS, Rohtak, Haryana 124001 India
| | - Ashiya Goel
- Department of Otorhinolaryngology, Pt. B.D. Sharma PGIMS, Rohtak, Haryana 124001 India
| | - Swati Vashist
- Department of Otorhinolaryngology, Pt. B.D. Sharma PGIMS, Rohtak, Haryana 124001 India
| | - Vinny Raheja
- Department of Otorhinolaryngology, Pt. B.D. Sharma PGIMS, Rohtak, Haryana 124001 India
| | - Aman Jakhar
- Department of Otorhinolaryngology, Maharaja Agrasen Medical College, Agroha, Haryana India
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16
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Muacevic A, Adler JR. Langerhans Cell Histiocytosis of the Orbit Presenting as Periorbital Cellulitis. Cureus 2022; 14:e32656. [PMID: 36654630 PMCID: PMC9844022 DOI: 10.7759/cureus.32656] [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] [Accepted: 12/18/2022] [Indexed: 12/23/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare disease of the reticuloendothelial system. It is characterized by misguided differentiation of myeloid dendritic cell precursors. LCH most commonly presents in childhood and the clinical presentation is dependent on the site and extent of organ involvement. We report a case of orbital Langerhans cell histiocytosis in a 12-year-old boy who presented with left periorbital cellulitis with subsequent proptosis. He later underwent a successful left orbital-frontal-temporal craniotomy and is currently undergoing postoperative chemotherapy.
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17
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Childhood Langerhans Cell Histiocytosis (LCH) - A ten year study from Pakistan. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2022. [DOI: 10.1016/j.phoj.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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18
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Kim SJ, Hah SI, Kwak JY, Choi JW, Cho HC, Ha CY, Jung WT, Lee OJ, Lee CM. Langerhans Cell Histiocytosis with the Synchronous Invasion of Stomach and Colon in an Adult Patient: A Case Report. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2022; 80:149-153. [PMID: 36156038 DOI: 10.4166/kjg.2022.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 07/02/2022] [Accepted: 07/17/2022] [Indexed: 06/16/2023]
Abstract
Langerhans cell histiocytosis (LCH) is reported less frequently in adults than in children. The most common site of involvement in adults is the bone, accounting for 30-50% of cases. The gastrointestinal tract is very rare, accounting for approximately 2%. We present a case of Langerhans cell histiocytosis that simultaneously invaded multiple organs, including the stomach and colon, in an adult. A 37-year-old woman with no underlying disease complained of chest discomfort and a palpable right submandibular mass. A right Level II neck mass and mediastinal LN enlargement were confirmed on the pharynx and chest CT scan. Multiple subepithelial masses with central ulceration and erosion were observed in the corpus and fundus on the esophagogastroduodenoscopy and in the right colon on the colonoscopy. The histopathology findings were the same in each tissue biopsied from the stomach, colon, and right neck lymph nodes. Langerhans cells with classical reniform nuclei and prominent eosinophils invaded the normal glands, and S100 and CD1a were positive in the immunohistochemical stain. Gastrointestinal involvement of LCH in adults is rare, asymptomatic,and can involve multiple digestive organs simultaneously, so upper endoscopy and colonoscopy should be considered for a diagnosis.
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Affiliation(s)
- Seong Je Kim
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Korea
| | - Se In Hah
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Korea
| | - Ji Yoon Kwak
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Korea
| | - Jung Woo Choi
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Korea
| | - Hyun Chin Cho
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Chang Yoon Ha
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Woon Tae Jung
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Ok Jae Lee
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Chang Min Lee
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
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19
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Afra TP, Daroach M, Mahajan R, De D, Handa S. Pustular lesions in the neonate: Focused diagnostic approach based on clinical clues. Indian J Dermatol Venereol Leprol 2022; 88:708-716. [DOI: 10.25259/ijdvl_209_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/01/2022] [Indexed: 11/04/2022]
Abstract
Pustules in a neonate can be due to various causes. Though the majority of conditions causing pustules in a neonate are benign, it is essential to clearly differentiate these from serious ones. A systematic approach based on detailed history and clinical examination of the neonate along with basic laboratory evaluation narrows down diagnostic possibilities and aids in the correct diagnosis. This review outlines a step-by-step approach so as to avoid clinical dilemmas and unnecessary intervention.
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Affiliation(s)
| | - Manju Daroach
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Rahul Mahajan
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Dipankar De
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Sanjeev Handa
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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20
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Menon J, Rammohan A, Vij M, Shanmugam N, Rela M. Current perspectives on the role of liver transplantation for Langerhans cell histiocytosis: A narrative review. World J Gastroenterol 2022; 28:4044-4052. [PMID: 36157108 PMCID: PMC9403430 DOI: 10.3748/wjg.v28.i30.4044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/30/2022] [Accepted: 07/22/2022] [Indexed: 02/06/2023] Open
Abstract
Langerhans cell histiocytosis (LCH) is a malignant disease of the histiocytes involving various organ systems. The spectrum of liver involvement in LCH ranges from mild transaminitis to end-stage liver disease. The hallmark of hepatic LCH is secondary sclerosing cholangitis, which manifests due to a progressive destruction of the biliary tree by malignant histiocytes. Chemotherapy remains the mainstay of treatment for active LCH. Early recognition, diagnosis and a systematic approach to the management of LCH can ameliorate the disease process. Nonetheless, the liver involvement in these patients may progress despite the LCH being in remission. Liver transplantation (LT) remains central in the management of such patients. Various facets of the management of LCH, especially those with liver involvement remain unclear. Furthermore, aspects of LT in LCH with regards to the indication, timing and post-LT management, including immunosuppression and adjuvant therapy, remain undefined. This review summarises the current evidence and discusses the practical aspects of the role of LT in the management of LCH.
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Affiliation(s)
- Jagadeesh Menon
- Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai 600044, India
| | - Ashwin Rammohan
- Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai 600044, India
| | - Mukul Vij
- Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai 600044, India
| | - Naresh Shanmugam
- Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai 600044, India
| | - Mohamed Rela
- Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai 600044, India
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21
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Trabelsi I, Kbaier S, Rekaya S, Ouederni M, Hamouda S, Boussetta K. Title: Langerhans cell histiocytosis of the cervical spine in a child: A case report and review of the literature. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2022. [DOI: 10.1016/j.phoj.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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22
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Cariello V, Lombardo P, Castelli L, Brillantino C, De Fusco C, Rossi A, Minelli R, Paviglianiti G, Grassi R, Rossi E. Integrated imaging of systemic Langerhans cell histiocytosis in an infant. Radiol Case Rep 2022; 17:2747-2753. [PMID: 35990570 PMCID: PMC9388885 DOI: 10.1016/j.radcr.2022.05.016] [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: 03/14/2022] [Revised: 04/30/2022] [Accepted: 05/05/2022] [Indexed: 11/26/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a myeloid neoplasm characterized by a clonal proliferation of CD1a+/CD207+ dendritic cells. Although individuals of any age can be affected, the disease is most common in infants younger than 5 years of age, especially males. A wide range of manifestations, from asymptomatic to aggressive, have been described, along with multiorgan involvement. Even though the majority of bone lesions are observed, skin, lymph nodes, brain and lungs can also be involved. The involvement of hematopoietic system, including bone marrow, liver and spleen, is less frequent yet associated with worse prognosis, due to a worse treatment response. Diagnosis of LCH is based on the integration of clinical, laboratory, and radiological data; however, only histopathological examination might confirm it. As far as the spleen involvement is concerned, according to literature, it has been reported in about 15% patients with multisystem involvement, nonetheless only a few cases show parenchymal lesions. The present study reports the case of an infant with LCH with multisystem involvement, including bone, skin, liver, and spleen, with evidence of parenchymal lesions.
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23
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Grout SE, Peterson RJ. Palatal Mass in a 17-month-old Girl. Pediatr Rev 2022; 43:400-403. [PMID: 35773539 DOI: 10.1542/pir.2022-002378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Rachel J Peterson
- Indiana University Health Riley Hospital for Children, Indianapolis, IN
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24
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Acharyya BC, Roy M, Chakraborty H. Unifocal Gastric Langerhans Cell Histiocytosis in a Child-A Unique Case to Remember. JPGN REPORTS 2022; 3:e192. [PMID: 37168914 PMCID: PMC10158364 DOI: 10.1097/pg9.0000000000000192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 12/23/2021] [Indexed: 05/13/2023]
Abstract
Langerhans cell histiocytosis (LCH) is the most common of the histiocytic disorders and occurs when the body accumulates too many CD1a/CD 207 positive Langerhans cells, a subset of the histiocytes in certain parts of the body where they can form tumors or damage organs. LCH is not a very common diagnosis in the pediatric age group. More than two-thirds of cases have the single-system disease with bones or skin as the commonly involved sites. Here, we present a 4-year-old child who had acute abdominal pain as chief complaint and etiological workup eventually led to a diagnosis of gastric LCH without affection of any other organ system. To the best of our knowledge, this is the first report of a unifocal gastric LCH in a child.
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Affiliation(s)
- Bhaswati C. Acharyya
- From the Department of Paediatric Gastroenterology, Institute of Child Health, Kolkata, India
| | - Mandira Roy
- Department of Paediatrics; Institute of Child Health, Kolkata, India
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25
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Kricke S, Rao K, Adams S. The significance of mixed chimaerism and cell lineage chimaerism monitoring in paediatric patients post haematopoietic stem cell transplant. Br J Haematol 2022; 198:625-640. [PMID: 35421255 DOI: 10.1111/bjh.18190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 11/28/2022]
Abstract
Haematopoietic stem cell transplants (HSCTs) are carried out across the world to treat haematological and immunological diseases which would otherwise prove fatal. Certain diseases are predominantly encountered in paediatric patients, such severe primary immunodeficiencies (PID) and diseases of inborn errors of metabolism (IEM). Chimaerism testing for these disorders has different considerations compared to adult diseases. This review focuses on the importance of cell-lineage-specific chimaerism testing and examines the appropriate cell populations to be assessed in individual paediatric patient groups. By analysing disease-associated subpopulations, abnormalities are identified significantly earlier than in whole samples and targeted clinical decisions can be made. Chimaerism methods have evolved over time and lead to an ever-increasing level of sensitivity and biomarker arrays to distinguish between recipient and donor cells. Short tandem repeat (STR) is still the gold standard for routine chimaerism assessment, and hypersensitive methods such as quantitative and digital polymerase chain reaction (PCR) are leading the forefront of microchimaerism testing. The rise of molecular methods operating with minute DNA amounts has been hugely beneficial to chimaerism testing of paediatric samples. As HSCTs are becoming increasingly personalised and risk-adjusted towards a child's individual needs, chimaerism testing needs to adapt alongside these medical advances ensuring the best possible care.
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Affiliation(s)
- Susanne Kricke
- Specialist Integrated Haematology and Malignancy Diagnostic Service, Department of Haematology, Great Ormond Street Hospital for Children, London, UK
| | - Kanchan Rao
- Department of Blood and Marrow Transplantation, Great Ormond Street Hospital for Children, London, UK
| | - Stuart Adams
- Specialist Integrated Haematology and Malignancy Diagnostic Service, Department of Haematology, Great Ormond Street Hospital for Children, London, UK
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26
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Devarapalli UV, Sarma MS, Mathiyazhagan G. Gut and liver involvement in pediatric hematolymphoid malignancies. World J Gastrointest Oncol 2022; 14:587-606. [PMID: 35321282 PMCID: PMC8919016 DOI: 10.4251/wjgo.v14.i3.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/22/2021] [Accepted: 02/27/2022] [Indexed: 02/06/2023] Open
Abstract
Hematolymphoid malignancies are common neoplasms in childhood. The involvement of the gastrointestinal (GI) tract, liver, biliary system, pancreas, and peritoneum are closely interlinked and commonly encountered. In leukemias, lymphomas, and Langerhans cell histiocytosis (LCH), the manifestations result from infiltration, compression, overwhelmed immune system, and chemotherapy-induced drug toxicities. In acute leukemias, major manifestations are infiltrative hepatitis, drug induced gastritis, neutropenic typhlitis and chemotherapy related pancreatitis. Chronic leukemias are rare. Additional presentation in lymphomas is cholestasis due to infiltration or biliary obstruction by lymph nodal masses. Presence of ascites needs a thorough workup for the underlying pathophysiology that may modify the therapy and affect the outcome. Uncommon hematolymphoid malignancies are primary hepatic, hepatosplenic, and GI lymphomas which have strict definitions. In advanced diseases with extensive spread, it may be impossible to distinguish these diseases from the primary site of origin. LCH produces biliary strictures that mimic as sclerosing cholangitis. Liver infiltration is associated with poor liver recovery even after chemotherapy. The heterogeneity of gut and liver manifestations in hematolymphoid malignancies has a clinical impact on their management. Though chemotherapy is the mainstay of therapy in all hematolymphoid malignancies, debulking surgery and radiotherapy have an adjuvant role in specific clinical scenarios. Rare situations presenting as liver failure or end-stage liver disease require liver transplantation. At their initial presentation to a primary care physician, given the ambiguity in clinical manifestations and the prognostic difference with time-bound management, it is vital to recognize them early for optimal outcomes. Pooled data from robust registries across the world is required for better understanding of these complications.
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Affiliation(s)
- Umeshreddy V Devarapalli
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
| | - Moinak S Sarma
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
| | - Gopinathan Mathiyazhagan
- Department of Hematology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
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27
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Wang Q, Jin S, Xiang B, Chen J. Liver transplantation in a child with liver cirrhosis caused by langerhans cell histiocytosis: a case report. BMC Pediatr 2022; 22:18. [PMID: 34980070 PMCID: PMC8721976 DOI: 10.1186/s12887-021-03090-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 12/22/2021] [Indexed: 02/08/2023] Open
Abstract
Background Langerhans cell histiocytosis (LCH) is a rare condition that has a variety of clinical manifestations. But LCH in children localized only in the hepatobiliary system is unusual. Case presentation. Here we reported a rare case of a 2-year-old boy who was serendipitously found to have elevated liver enzymes while undergoing treatment of a perianal abscess. After a period of earlier conservative treatment in another hospital, the perianal abscess had resolved but the levels of liver enzymes were still rising slowly. The child was then referred to our institution for a definitive diagnosis. After laboratory tests, imaging and pathological examinations, a diagnosis of liver cirrhosis and sclerosing cholangitis was established, although the cause was unclear. Subsequently, living-donor liver transplantation was performed due to deterioration in liver function. Following successful liver transplantation, a diagnosis of LCH localized only within the hepatobiliary system was finally confirmed, based on additional pathological and imaging investigation. Additionally, the BRAF V600E mutation in this patient was also confirmed. The child has now recovered without evidence of LCH recurrence. Conclusions LCH localized only within the hepatobiliary system is unusual. The presence of unexplainable sclerosing cholangitis and liver cirrhosis in any child should raise the suspicion of LCH. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-03090-4.
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Affiliation(s)
- Qi Wang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Shuguang Jin
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Bo Xiang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jing Chen
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
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28
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Pomsoong C, Suchonwanit P. A Case of Extensive Mass on the Scalp with Alopecia. Skin Appendage Disord 2022; 8:73-77. [PMID: 35118135 PMCID: PMC8787517 DOI: 10.1159/000518575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/19/2021] [Indexed: 01/03/2023] Open
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29
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Rossi C, Simoncelli G, Arpa G, Stracuzzi A, Parente P, Fassan M, Vanoli A, Villanacci V. Histopathology of intestinal villi in neonatal and paediatric age: main features with clinical correlation - Part II. Pathologica 2021; 114:22-31. [PMID: 34856605 PMCID: PMC9040546 DOI: 10.32074/1591-951x-338] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 07/30/2021] [Indexed: 11/30/2022] Open
Abstract
In this paper, we will continue the description of histological findings of infantile and paediatric small bowel alterations with the main clinical pictures and differential diagnosis. We emphasise once again the need to evaluate the biopsies in an adequate clinical contest and with a systematic approach, including epithelial alterations, lamina propria changes, mucosal architecture, and the distribution of inflammation, together with other morphological signs more specific of certain diseases. We describe the histological findings of coeliac and Crohn’s disease, gastrointestinal food allergic diseases, Langerhans cell histiocytosis, nutritional deficiencies and infections. Finally, we suggest the principal issues in the drafting the pathological report for appropriate interpretation and usefulness in clinical practice.
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Affiliation(s)
- Chiara Rossi
- Unit of Anatomic Pathology, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | | | - Giovanni Arpa
- Unit of Anatomic Pathology, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Alessandra Stracuzzi
- Pathological Anatomy Unit, Department of Diagnostic and Laboratory Medicine, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Paola Parente
- Pathology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Matteo Fassan
- Department of Medicine (DIMED), Surgical Pathology Unit, University of Padua, Padua, Italy; Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Alessandro Vanoli
- Unit of Anatomic Pathology, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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30
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Yang D, Ren X, Lu Y, Han J. Current diagnosis and management of rare pediatric diseases in China. Intractable Rare Dis Res 2021; 10:223-237. [PMID: 34877234 PMCID: PMC8630464 DOI: 10.5582/irdr.2021.01134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 12/22/2022] Open
Abstract
This review categorizes and summarizes the rare pediatric diseases that have been included in the First List of Rare Diseases that was jointly published by the National Health Commission and four other government departments in China in 2018. In total, 58 diseases that develop during childhood are included. These diseases involve nine organ systems, including the musculoskeletal, respiratory, immune, endocrine and metabolic, nervous, cardiovascular, hematological, urinary, and integumentary systems. Affected children often have multiorgan involvement with various presentations. Severe diseases can cause acute symptoms starting in the neonatal period that lead to increased morbidity and mortality without prompt management. Early diagnosis and treatment can significantly change the course of a disease and improve its prognosis. This work systemically reviews the status of rare pediatric diseases with a relatively high incidence in the First List of Rare Diseases.
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Affiliation(s)
- Dan Yang
- Department of Endocrinology, The First Hospital Affiliated with Shandong First Medical University, Ji'nan, China
- National Health Commission Key Laboratory for Biotech-Drugs, Shandong Province Key Laboratory for Rare & Uncommon Diseases, Biomedical Sciences College, Shandong First Medical University & Shandong Academy of Medical Sciences, Ji'nan, China
| | - Xiuzhi Ren
- Department of Orthopaedic Surgery, The People's Hospital of Wuqing District, Tianjin, China
| | - Yanqin Lu
- Department of Endocrinology, The First Hospital Affiliated with Shandong First Medical University, Ji'nan, China
- National Health Commission Key Laboratory for Biotech-Drugs, Shandong Province Key Laboratory for Rare & Uncommon Diseases, Biomedical Sciences College, Shandong First Medical University & Shandong Academy of Medical Sciences, Ji'nan, China
| | - Jinxiang Han
- Department of Endocrinology, The First Hospital Affiliated with Shandong First Medical University, Ji'nan, China
- National Health Commission Key Laboratory for Biotech-Drugs, Shandong Province Key Laboratory for Rare & Uncommon Diseases, Biomedical Sciences College, Shandong First Medical University & Shandong Academy of Medical Sciences, Ji'nan, China
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31
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Spencer H, Banerjee R. Evolving Scalp Lesions in an 8-day-old Infant. Pediatr Rev 2021; 42:164-167. [PMID: 34470900 DOI: 10.1542/pir.2019-0308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Hillary Spencer
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN
| | - Ritu Banerjee
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN
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Zhao M, Tang L, Sun S, Cui J, Chen H. Radiologic findings that aid in the reduction of misdiagnoses of Langerhans cell histiocytosis of the bone: a retrospective study. World J Surg Oncol 2021; 19:146. [PMID: 33971894 PMCID: PMC8112044 DOI: 10.1186/s12957-021-02261-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/05/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND This study aimed to identify the characteristic radiological signs for the diagnosis of Langerhans cell histiocytosis (LCH) of the bone. METHODS We retrospectively studied 82 cases of LCH with bone lesions confirmed by pathology. Clinical and radiological features of the patients were analyzed. RESULTS A total of 64 and 18 patients had single and multiple bone lesions, respectively. With regard to LCH with single bone lesions, 37.5% (24/64) of lesions were located in the skull and presented as bone destruction with or without soft tissue mass. The correct diagnosis rate of these lesions was 60.0% (9/15) in children and adolescents, but was only 22.2% (2/9) in adults. A total of 26.5% (17/64) of the solitary lesions were found in the spine. Of these, 88.2% (15/17) were located in the vertebral body and appeared to have different degrees of collapse, and 66.7% (10/15) of these lesions were correctly diagnosed. Of the unifocal lesions, 21.8% (14/64) were located in other flat and irregular bones and manifested as osteolysis. Only 21.4% (3/14) of these cases were correctly diagnosed. In total, 14.1% (9/64) of the isolated bone LCH lesions were located in the long bones. Of these, 77.8% (7/9) were located in the diaphysis and presented as central bone destruction with or without fusiform periosteal reaction and extensive peripheral edema, of which 42.9% (3/7) were correctly diagnosed before surgery or biopsy. With regard to LCH with multiple bony destructive lesions, 71.4% (10/14) of cases in children and adolescents were correctly diagnosed; however, all four cases among adults were misdiagnosed. CONCLUSION In all age groups, isolated diaphyseal destruction of the long bone with fusiform periosteal reaction and extensive peripheral edema, vertebra plana of the spine, and bevelled edge of skull defects accompanied by soft tissue masses strongly suggest LCH diagnosis. Moreover, the multiple bone osteolytic destruction in children and adolescents strongly suggests LCH diagnosis. Familiarity with these typical radiological signs of LCH is necessary to decrease misdiagnoses.
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Affiliation(s)
- Mimi Zhao
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Limin Tang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Shiqing Sun
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Jiufa Cui
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Haisong Chen
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China.
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33
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Ji W, Ladner J, Rambie A, Boyer K. Multisystem Langerhans Cell Histiocytosis in an infant. Radiol Case Rep 2021; 16:1798-1805. [PMID: 34025890 PMCID: PMC8120863 DOI: 10.1016/j.radcr.2021.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/10/2021] [Accepted: 04/11/2021] [Indexed: 11/10/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare enigmatic disease that pre-dominantly affects children under 5 years of age. We report an interesting case of a 5 month old female diagnosed with multisystem LCH. Her disease process included osseous, pulmonary, gastrointestinal, cutaneous, hematopoietic and neurologic involvement. This case highlights the varying clinical symptoms, risk factors, pathogenesis, and management of multisystem LCH. This case also emphasizes the role of diagnostic imaging in this multifaceted disease.
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Affiliation(s)
- William Ji
- Department of Radiology, Madigan Army Medical Center, 9040A Jackson Ave, Joint Base Lewis-McChord, WA 98431, USA
| | - Joshua Ladner
- Department of Radiology, Madigan Army Medical Center, 9040A Jackson Ave, Joint Base Lewis-McChord, WA 98431, USA
| | - Aimee Rambie
- Department of Radiology, Madigan Army Medical Center, 9040A Jackson Ave, Joint Base Lewis-McChord, WA 98431, USA
| | - Kathleen Boyer
- Department of Radiology, Madigan Army Medical Center, 9040A Jackson Ave, Joint Base Lewis-McChord, WA 98431, USA
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34
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Ultrasound-assisted diagnosis of Langerhans cell hyperplasia of the sternum: A case report. Radiol Case Rep 2021; 16:1535-1538. [PMID: 33948130 PMCID: PMC8081871 DOI: 10.1016/j.radcr.2021.03.061] [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] [Received: 01/26/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 11/20/2022] Open
Abstract
Langerhans cell hyperplasia is a group of diseases characterized by the proliferation or dissemination of the Langerhans cell, which can come in the form of localized benign lesions, or extensive disseminated invasive neoplastic lesions. These lesions mainly invade the patient's bone. In this paper, we describe the case of a 3-year-old boy who was admitted to the pediatric department with sternum pain. Following a focused sternum ultrasound, a diagnosis was made of Langerhans cell histiocytosis.
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35
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Cherian LM, Sasikumar D, Sathyan P, Varghese BE. Langerhans cell histiocytosis: A diagnostic enigma in the oral cavity. J Oral Maxillofac Pathol 2021; 25:S27-S31. [PMID: 34083966 PMCID: PMC8123262 DOI: 10.4103/jomfp.jomfp_296_20] [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] [Received: 07/15/2020] [Revised: 12/15/2020] [Accepted: 01/29/2021] [Indexed: 11/04/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare reactive and proliferative disease of histiocytes. The disease occurs predominantly in children and rarely in adults. This disease of unknown etiology exhibits extreme clinical heterogeneity. Even though LCH manifests initially in the oral cavity in most of the cases, owing to the relative rarity of the condition, it remains a disease in which the diagnosis is often delayed, missed or misdiagnosed. This is a case of LCH in a child which presented with swelling in the mandibular region.
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Affiliation(s)
- Latha Mary Cherian
- Department of Oral Pathology and Microbiology, Government Dental College, Kottayam, Kerala, India
| | - Dhanya Sasikumar
- Department of Oral Pathology and Microbiology, Government Dental College, Kottayam, Kerala, India
| | - Pradeesh Sathyan
- Department of Oral Pathology and Microbiology, Government Dental College, Kottayam, Kerala, India
| | - Binuja Elsa Varghese
- Department of Oral Pathology and Microbiology, Government Dental College, Kottayam, Kerala, India
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36
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Machado I, Columbie A, Nieto Morales G, Forteza-Suarez M, Renó Céspedes JDLS, Marhuenda Fluixa A, Llombart-Bosch A. [Bone and soft tissue Langerhans cell histiocytosis with multinucleated giant cells and BRAF V600E mutation]. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2021; 54:136-140. [PMID: 33726891 DOI: 10.1016/j.patol.2018.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/21/2018] [Accepted: 08/15/2018] [Indexed: 10/28/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a heterogeneous disease characterized by proliferation of Langerhans cells and BRAF mutation in almost half of the cases. Bone involvement is common but large soft tissue disease is uncommon. We report a pediatric patient with a large tumor mass involving the left iliac bone and the adjacent soft tissue. The computed tomography scan showed an osteolytic lesion with soft tissue extension. Surgical curettage of the lesion was performed and the final histopathologic diagnosis was LCH with CD1a immunoreactivity in tumor cells. The molecular analysis revealed a BRAF V600E mutation. We discuss the histopathological and immunohistochemical differential diagnosis with histiocytosis other than LCH.
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Affiliation(s)
- Isidro Machado
- Departamento de Patología, Instituto Valenciano de Oncología, Valencia, España.
| | - Ariel Columbie
- Departamento de Patología, Instituto Nacional de Oncología y Radiobiología (INOR), La Habana, Cuba
| | - Gema Nieto Morales
- Laboratorio de Biología Molecular, Departamento de Patología, Universidad de Valencia, Valencia, España
| | - Mariuska Forteza-Suarez
- Servicio de Oncología Pediátrica, Instituto Nacional de Oncología y Radiobiología (INOR), La Habana, Cuba
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37
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Joshua LM, Rijhwani A, Gupta MK, Yhoshu E, Chaudhary G. Surgical Occlusion of Leaking Bronchus by a Serratus Anterior Flap in a Child with Langerhans Cell Histiocytosis. J Indian Assoc Pediatr Surg 2021; 26:123-125. [PMID: 34083898 PMCID: PMC8152404 DOI: 10.4103/jiaps.jiaps_66_20] [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: 03/24/2020] [Revised: 06/07/2020] [Accepted: 07/23/2020] [Indexed: 11/22/2022] Open
Abstract
Langerhans cell histiocytosis is an uncommon disease of childhood. Intrathoracic transposition flaps have been described for a management of number of conditions. We discuss our experience of the use of serratus anterior flap for the obliteration of a pulmonary bulla with a communicating airway, in a 1½-year-old pediatric patient with multisystem Langerhans cell histiocytosis who presented with recurrent pneumothorax with empyema due to rupture of bullae.
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Affiliation(s)
- Lokavarapu Manoj Joshua
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ashok Rijhwani
- Department of Paediatric Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Manish Kumar Gupta
- Department of Paediatric Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Enono Yhoshu
- Department of Paediatric Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Gyanendra Chaudhary
- Department of Paediatric Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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38
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Pradhan P, Raman S, Mohanty S, Tudu H, Dash K. Paediatric cutaneous langerhans cell histiocytosis mimicking hemangioma: A deceitful entity. CLINICAL CANCER INVESTIGATION JOURNAL 2021. [DOI: 10.4103/ccij.ccij_168_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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39
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Lian H, Wei A, He L, Yang Y, Ma H, Zhang L, Guan Y, Zhang Q, Wang D, Li Z, Zhang R, Wang T. Clinical Analysis of Pediatric Systemic Juvenile Xanthogranulomas: A Retrospective Single-Center Study. Front Pediatr 2021; 9:672547. [PMID: 34178890 PMCID: PMC8222597 DOI: 10.3389/fped.2021.672547] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/18/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate the clinical characteristics, treatment, and prognosis of children with systemic juvenile xanthogranuloma (JXG). Methods: Clinical data of children with JXG who were hospitalized in Beijing Children's Hospital, Capital Medical University, from January 2012 to December 2019 were retrospectively analyzed, including clinical manifestations, laboratory determinations, treatment, and prognosis of the children. Patients were treated with vindesine + prednisone as the first-line treatment and cytarabine + vindesine + dexamethasone ± cladribine as the second-line treatment. Results: Ten patients, including 8 males and 2 females, with a median of onset age of 1.95 (0.80-7.30) years, exhibited multi-system dysfunction. The median age of diagnosis was 2.45 (1.30-12.10) years. The most common location of extracutaneous lesions was the central nervous system (6 cases), followed by the lung (5 cases) and bone (4 cases). Nine patients underwent first-line chemotherapy, and 6 patients underwent second-line chemotherapy, including 5 patients with poorly controlled disease after first-line treatment. The median observation time was 29 (3-115) months. Nine patients survived, whereas one patient died of respiratory failure caused by pulmonary infection. At the end of follow-up, 7 patients were in active disease (AD)/regression state (AD-better), and 2 patients were in an AD/stable state (AD-stable). Three patients had permanent sequelae, mainly central diabetes insipidus. The rates of response to the first-line treatment and the second-line treatment were 40.0 and 66.7% respectively. Conclusion: The chemotherapy protocol for Langerhans cell histiocytosis (LCH) may be effective for patients with systemic JXG. Central nervous system involvement may not impact overall survival, but serious permanent sequelae may occur.
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Affiliation(s)
- Hongyun Lian
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing, China.,National Key Discipline of Pediatrics, Capital Medical University, Beijing, China.,Key Laboratory of Major Disease in Children, Ministry of Education, Beijing, China.,Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ang Wei
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing, China.,National Key Discipline of Pediatrics, Capital Medical University, Beijing, China.,Key Laboratory of Major Disease in Children, Ministry of Education, Beijing, China.,Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Lejian He
- Department of Pathology, Beijing Children's Hospital Affiliated With Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ying Yang
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing, China.,National Key Discipline of Pediatrics, Capital Medical University, Beijing, China.,Key Laboratory of Major Disease in Children, Ministry of Education, Beijing, China.,Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Honghao Ma
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing, China.,National Key Discipline of Pediatrics, Capital Medical University, Beijing, China.,Key Laboratory of Major Disease in Children, Ministry of Education, Beijing, China.,Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Liping Zhang
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing, China.,National Key Discipline of Pediatrics, Capital Medical University, Beijing, China.,Key Laboratory of Major Disease in Children, Ministry of Education, Beijing, China.,Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yitong Guan
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing, China.,National Key Discipline of Pediatrics, Capital Medical University, Beijing, China.,Key Laboratory of Major Disease in Children, Ministry of Education, Beijing, China.,Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Qing Zhang
- National Key Discipline of Pediatrics, Capital Medical University, Beijing, China.,Key Laboratory of Major Disease in Children, Ministry of Education, Beijing, China.,Hematologic Disease Laboratory, Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing, China.,Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Dong Wang
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing, China.,National Key Discipline of Pediatrics, Capital Medical University, Beijing, China.,Key Laboratory of Major Disease in Children, Ministry of Education, Beijing, China.,Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhigang Li
- National Key Discipline of Pediatrics, Capital Medical University, Beijing, China.,Key Laboratory of Major Disease in Children, Ministry of Education, Beijing, China.,Hematologic Disease Laboratory, Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing, China.,Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Rui Zhang
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing, China.,National Key Discipline of Pediatrics, Capital Medical University, Beijing, China.,Key Laboratory of Major Disease in Children, Ministry of Education, Beijing, China.,Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Tianyou Wang
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing, China.,National Key Discipline of Pediatrics, Capital Medical University, Beijing, China.,Key Laboratory of Major Disease in Children, Ministry of Education, Beijing, China.,Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Singh J, Rajakulasingam R, Saifuddin A. Langerhans cell histiocytosis of the shoulder girdle, pelvis and extremities: a review of radiographic and MRI features in 85 cases. Skeletal Radiol 2020; 49:1925-1937. [PMID: 32451558 DOI: 10.1007/s00256-020-03472-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To describe the radiographic and MRI features of histologically proven Langerhans cell histiocytosis (LCH) of the bone. MATERIALS AND METHODS A retrospective review of the radiographic and MRI features of 85 histologically proven cases of skeletal LCH over a 12-year period. Clinical data recorded included age, gender and location. Radiographic features evaluated included Lodwick grading, cortical/periosteal response and matrix mineralisation. MRI features assessed included lesion size and T1-weighted signal intensity (T1W SI), nature of margin, hypointense rim, enhancement pattern, bone marrow and soft tissue oedema, soft tissue mass, fluid-fluid levels, the penumbra sign and the budding and bulging signs. RESULTS The study included 85 patients, 54 males and 31 females with mean age of 13 years (range 1-76 years). The femur was the commonest bone involved (38.8%), followed by the scapula (9.4%), clavicle (8.2%), ilium (8.2%) and ischium (8.2%). The mean maximal lesion size was 40 mm (range 16-85 mm). The commonest radiographic appearance was of a lytic lesion with no appreciable sclerotic rim, an intact expanded cortex and either absent or laminated periosteal response. MRI demonstrated a hypointense rim (41.5%), the budding (31.7%) and bulging (36.6%) signs, eccentric extra-osseous mass (42.7%), prominent bone marrow (95.3%) and soft tissue oedema (84.1%). Rarer features included haemorrhage (2.4%), the penumbra sign (3.5%) and fluid-fluid levels (2.4%). Thirteen of 25 post-contrast studies showed peripheral/rim enhancement with central necrosis. CONCLUSIONS LCH classically presents as a moderately aggressive lytic bone lesion on radiography, with prominent reactive bone and soft tissue oedema being a characteristic feature on MRI.
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Affiliation(s)
- J Singh
- Department of Medical Imaging, Guru Nanak Dev Superspeciality hospital, Goindwal Sahib Road, Taran Sahib, Punjab, 143401, India
| | - R Rajakulasingam
- Department of Medical Imaging, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK.
| | - A Saifuddin
- Department of Medical Imaging, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
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41
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Gargan ML, Wong JL, Leidhin CN, Owens C, Byrne A. Langerhans cell histiocytosis in children under 12 months of age: The spectrum of imaging and clinical findings: Experience in an Irish tertiary referral centre. Eur J Radiol 2020; 134:109375. [PMID: 33261936 DOI: 10.1016/j.ejrad.2020.109375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/17/2020] [Accepted: 10/20/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Langerhans cell histiocytosis is an uncommon condition and it is unusual for it to present in children under one year of age. Our aim is to review the clinical presentation, and present the radiologic findings and clinical outcome in this particular cohort of patients and determine how this differs from the imaging features of older children presenting with LCH. MATERIALS AND METHODS A database of 17 patients with LCH who presented between 0 and 12 months of age was retrospectively reviewed. Radiologic findings, initial clinical presentation and ultimate clinical outcome were documented in table format. RESULTS Eight patients (47 %) initially presented with cutaneous stigmata, seven patients (41 %) had skeletal involvement, five patients (29 %) had splenic involvement, two patients (24 %) had central nervous system involvement either at presentation or at follow-up, three patients (18 %) had lymphadenopathy, two patients (12 %) had liver involvement, and two patients (12 %) had gastrointestinal (GI) involvement. Four patients (24 %) had multisystem involvement either at presentation or at follow-up. One patient died during follow-up. CONCLUSION LCH in children under one year of age is uncommon and may have an unusual clinical presentation. The radiologic findings are varied and may differ from the classical imaging appearance more commonly seen in the older age group, with multisystem involvement seen more readily in younger patients.
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Affiliation(s)
- Mary-Louise Gargan
- Children's Health Ireland at Crumlin, Dublin, Ireland; Children's Health Ireland, Cooley Road, Crumlin, Dublin, D12 N512, Ireland.
| | - Jsun Loong Wong
- Children's Health Ireland at Crumlin, Dublin, Ireland; Children's Health Ireland, Cooley Road, Crumlin, Dublin, D12 N512, Ireland.
| | - Caoilfhionn Ni Leidhin
- Children's Health Ireland at Crumlin, Dublin, Ireland; Children's Health Ireland, Cooley Road, Crumlin, Dublin, D12 N512, Ireland.
| | - Cormac Owens
- Children's Health Ireland at Crumlin, Dublin, Ireland; Children's Health Ireland, Cooley Road, Crumlin, Dublin, D12 N512, Ireland.
| | - Angela Byrne
- Children's Health Ireland at Crumlin, Dublin, Ireland; Children's Health Ireland, Cooley Road, Crumlin, Dublin, D12 N512, Ireland.
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Mohammad SS, Angiti RR, Biggin A, Morales-Briceño H, Goetti R, Perez-Dueñas B, Gregory A, Hogarth P, Ng J, Papandreou A, Bhattacharya K, Rahman S, Prelog K, Webster RI, Wassmer E, Hayflick S, Livingston J, Kurian M, Chong WK, Dale RC. Magnetic resonance imaging pattern recognition in childhood bilateral basal ganglia disorders. Brain Commun 2020; 2:fcaa178. [PMID: 33629063 PMCID: PMC7891249 DOI: 10.1093/braincomms/fcaa178] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/24/2020] [Accepted: 09/18/2020] [Indexed: 12/18/2022] Open
Abstract
Bilateral basal ganglia abnormalities on MRI are observed in a wide variety of childhood disorders. MRI pattern recognition can enable rationalization of investigations and also complement clinical and molecular findings, particularly confirming genomic findings and also enabling new gene discovery. A pattern recognition approach in children with bilateral basal ganglia abnormalities on brain MRI was undertaken in this international multicentre cohort study. Three hundred and five MRI scans belonging to 201 children with 34 different disorders were rated using a standard radiological scoring proforma. In addition, literature review on MRI patterns was undertaken in these 34 disorders and 59 additional disorders reported with bilateral basal ganglia MRI abnormalities. Cluster analysis on first MRI findings from the study cohort grouped them into four clusters: Cluster 1—T2-weighted hyperintensities in the putamen; Cluster 2—T2-weighted hyperintensities or increased MRI susceptibility in the globus pallidus; Cluster 3—T2-weighted hyperintensities in the globus pallidus, brainstem and cerebellum with diffusion restriction; Cluster 4—T1-weighted hyperintensities in the basal ganglia. The 34 diagnostic categories included in this study showed dominant clustering in one of the above four clusters. Inflammatory disorders grouped together in Cluster 1. Mitochondrial and other neurometabolic disorders were distributed across clusters 1, 2 and 3, according to lesions dominantly affecting the striatum (Cluster 1: glutaric aciduria type 1, propionic acidaemia, 3-methylglutaconic aciduria with deafness, encephalopathy and Leigh-like syndrome and thiamine responsive basal ganglia disease associated with SLC19A3), pallidum (Cluster 2: methylmalonic acidaemia, Kearns Sayre syndrome, pyruvate dehydrogenase complex deficiency and succinic semialdehyde dehydrogenase deficiency) or pallidum, brainstem and cerebellum (Cluster 3: vigabatrin toxicity, Krabbe disease). The Cluster 4 pattern was exemplified by distinct T1-weighted hyperintensities in the basal ganglia and other brain regions in genetically determined hypermanganesemia due to SLC39A14 and SLC30A10. Within the clusters, distinctive basal ganglia MRI patterns were noted in acquired disorders such as cerebral palsy due to hypoxic ischaemic encephalopathy in full-term babies, kernicterus and vigabatrin toxicity and in rare genetic disorders such as 3-methylglutaconic aciduria with deafness, encephalopathy and Leigh-like syndrome, thiamine responsive basal ganglia disease, pantothenate kinase-associated neurodegeneration, TUBB4A and hypermanganesemia. Integrated findings from the study cohort and literature review were used to propose a diagnostic algorithm to approach bilateral basal ganglia abnormalities on MRI. After integrating clinical summaries and MRI findings from the literature review, we developed a prototypic decision-making electronic tool to be tested using further cohorts and clinical practice.
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Affiliation(s)
- Shekeeb S Mohammad
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia.,TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, Australia.,The Children's hospital at Westmead Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW 2145, Australia
| | - Rajeshwar Reddy Angiti
- Newborn and Peadiatric Emergency Transport Service (NETS), Bankstown, NSW, Australia.,Department of Neonatology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Andrew Biggin
- The Children's hospital at Westmead Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW 2145, Australia
| | - Hugo Morales-Briceño
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Robert Goetti
- Medical Imaging, The Children's Hospital at Westmead and Sydney Medical School, University of Sydney, Sydney, Australia
| | - Belen Perez-Dueñas
- Paediatric Neurology Department, Hospital Vall d'Hebrón Universitat Autónoma de Barcelona, Vall d'Hebron Research Institute Barcelona, Barcelona, Spain
| | - Allison Gregory
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR, USA
| | - Penelope Hogarth
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR, USA
| | - Joanne Ng
- Molecular Neurosciences, Developmental Neurosciences, UCL-Institute of Child Health, London, UK
| | - Apostolos Papandreou
- Molecular Neurosciences, Developmental Neurosciences, UCL-Institute of Child Health, London, UK
| | - Kaustuv Bhattacharya
- Western Sydney Genomics Program, The Children's Hospital at Westmead and Sydney Medical School, University of Sydney, Sydney, Australia
| | - Shamima Rahman
- Mitochondrial Research Group, Genetics and Genomic Medicine, Institute of Child Health, University College London and Metabolic Unit, Great Ormond Street Hospital, London, UK
| | - Kristina Prelog
- Medical Imaging, The Children's Hospital at Westmead and Sydney Medical School, University of Sydney, Sydney, Australia
| | - Richard I Webster
- TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, Australia
| | - Evangeline Wassmer
- Department of Paediatric Neurology, Birmingham Children's Hospital, Birmingham, UK
| | - Susan Hayflick
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR, USA
| | - John Livingston
- Department of Paediatric Neurology, Leeds Teaching Hospitals Trust, University of Leeds, UK
| | - Manju Kurian
- Molecular Neurosciences, Developmental Neurosciences, UCL-Institute of Child Health, London, UK
| | - W Kling Chong
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | - Russell C Dale
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia.,TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, Australia.,The Children's hospital at Westmead Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW 2145, Australia
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Widodo I, Sahara N, Dwianingsih EK, Ferronika P. Case series of cutaneous Langerhans cell histiocytosis in Indonesian children; The clinicopathological spectrum. Dermatol Reports 2020; 12:8777. [PMID: 33408833 PMCID: PMC7772770 DOI: 10.4081/dr.2020.8777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/23/2020] [Indexed: 12/15/2022] Open
Abstract
Langerhans Cell Histiocytosis (LCH) is a rare disease characterized by the clonal proliferation of Langerhans cells, which are immunoreactive to S-100 and CD-1a/ CD207 (Langerin). Cutaneous involvement is the most common presentation of LCH in children. It is suggested that the patients with single-system LCH limited to the skin have a better prognosis than those with systemic involvement. Three histologic reactions of cutaneous LCH have been reported and are associated with the clinical types of LCH. These histological reactions include: proliferative, granulomatous, and xanthomatous. This study presents the clinicopathological features of ten cutaneous LCH cases collected from Dr. Sardjito General Hospital Yogyakarta Indonesia between 2014-2018. The ten cases showed various clinical features, in which some features mimic other diseases. The microscopic features of skin biopsies showed granulomatous reaction in 80% of cases and proliferative reaction in the other 20%. Five patients (50% of cases) who died had systemic manifestation of thrombocytopenia, anemia, icterus, hepatosplenomegaly, and revealed the granulomatous type from their skin biopsy specimens. The clinical recognition of LCH and subsequent histological reaction determination are important since some cases may develop multisystem disease and have a poor prognosis.
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Affiliation(s)
- Irianiwati Widodo
- Department of Anatomical Pathology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Nita Sahara
- Department of Anatomical Pathology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ery Kus Dwianingsih
- Department of Anatomical Pathology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Paranita Ferronika
- Department of Anatomical Pathology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Abstract
Langerhans cell histiocytosis is a rare pathology with different clinical manifestations in the neonatal period ranging from isolated bone lesions to systemic compromise.
We report a case of Langerhans cell histiocytosis including a literature review focused on the clinical manifestations, diagnosis, and treatment. A one-month-old patient was brought to medical consultation with lymphadenopathy and skin lesions, which were initially managed as an infectious pathology. The disease continued its progression without improvement with the treatment until the patient died due to respiratory failure.
The lymph node and skin biopsies revealed infiltration of atypical cells with positive immunohistochemistry for S100, CD1, and CD68 confirming Langerhans cell histiocytosis.
This disorder represents a great challenge and, therefore, it is important to alert and sensitize medical teams about it for timely diagnosis and management.
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Zhang C, Gao J, He J, Liu C, Lv X, Yin X, Deng Y, Lu Z, Tian Z. Regulatory T-cell expansion in oral and maxillofacial Langerhans cell histiocytosis. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:547-556. [PMID: 32988807 DOI: 10.1016/j.oooo.2020.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 06/22/2020] [Accepted: 08/02/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Langerhans cell histiocytosis (LCH) is a rare myeloid-origin neoplasm characterized by the expansion and dissemination of CD1 a+/CD207+ dendritic cells (LCH cells), but the rarity of its occurrence has long impeded progress in understanding its pathology. We focus on the potentially important role that regulatory T cells (T-reg) play in the oral and maxillofacial LCH tumor microenvironment (TME). STUDY DESIGN Nine cases of oral and maxillofacial LCH, diagnosed from 2009 to 2019, were collected retrospectively from the affiliated hospitals of Southern Medical University. Immunohistochemistry was conducted characterizing T cells and T-reg phenotype. Data were evaluated by 1-sample Wilcoxon's test. RESULTS Significantly increased frequency and abnormal distributions of T-reg were identified in all the LCH lesion sections. Proliferating T-reg account for a mean average of 11.5% of the total T-cell subsets, with significant difference (Wilcoxon's test; P < .05). CONCLUSIONS T-reg expansion in the localized inflammatory TME leads to a failure of immune regulation by suppressing antitumor response, which can be a latent and significant factor contributing to LCH progression. However, T-reg may also acquire the capability for aiding in initiating T-cell responses under the "cytokine storm" at the beginning of LCH onset. T-reg might contribute to the augmentation of tissue repair by transforming growth factor-β (TGF-β), explaining the self-limiting character of LCH.
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Affiliation(s)
- Chuhan Zhang
- Department of Stomatology, School of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Jingyi Gao
- Department of Stomatology, School of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Jianghai He
- Department of Stomatology, School of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Chundong Liu
- Department of Stomatology, School of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Xiaozhi Lv
- Department of Stomatology, School of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Xuemin Yin
- Department of Stomatology, School of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Yongjian Deng
- Department of Pathology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Zhiyun Lu
- Department of Stomatology, School of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China.
| | - Zhihui Tian
- Department of Stomatology, School of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China.
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A Case of Langerhans Cell Histiocytosis With Multifocal, Single-System GI Tract Involvement and Literature Review. J Pediatr Hematol Oncol 2020; 42:e491-e493. [PMID: 31764515 DOI: 10.1097/mph.0000000000001662] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Langerhans cell histiocytosis (LCH) is the most common histiocytic disorder, characterized by the pathologic clonal proliferation and accumulation of immature Langerhans cells within organs. Multiple organ systems can be affected, resulting in a spectrum of clinical manifestations. Isolated gastrointestinal involvement in LCH is rare and usually presents in childhood as a multisystem disease and usually has poor outcomes. We describe a 20-year-old Hispanic female with multifocal, single-system gastrointestinal LCH. Initially diagnosed from a CD1a, S100, and CD207 (Langerin) positive appendix tissue after an appendectomy and confirmed multifocal with an endoscopy. She had a full clinical and endoscopic resolution of disease with cytarabine therapy.
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Gerbaux M, Diallo S, Dedeken L, Dangoisse C, Bott A, Heritier S, Salik D, Ferster A. Effective rescue treatment with vemurafenib of an infant with high-risk Langerhans cell histiocytosis. Ann Dermatol Venereol 2020; 147:782-785. [PMID: 32653217 DOI: 10.1016/j.annder.2020.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/19/2020] [Accepted: 05/05/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The recently identified role of a BRAF somatic mutation in the pathophysiology of Langerhans cell histiocytosis (LCH) offers new therapeutic options. Herein we describe the case of a 10-month-old infant with refractory high-risk LCH successfully treated with vemurafenib. OBSERVATION The patient first presented with cutaneous LCH at the age of 2 months. The disease remained undiagnosed until she was 6 months old, when it rapidly evolved to a multisystemic high-risk and life-threatening disease, refractory to 2 lines of chemotherapy. BRAFV600E mutation was found at skin biopsy, and targeted therapy with vemurafenib was started when she was 10 months old. The treatment induced a fast and sustained response, but rapid relapse occurred after treatment discontinuation, leading to resumption of treatment, once more resulting in a sustained response. CONCLUSION Our case highlights the first-line role of dermatologists in establishing the diagnosis of LCH, especially in children, in whom the eruption may be difficult to identify, leading to delayed diagnosis. Targeted therapy with vemurafenib has recently been described in children in this indication and our results support its efficacy, highlighting the need for prolonged treatment and raising the question of maintenance therapy, as well as the necessity for large-scale and long-term studies.
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Affiliation(s)
- M Gerbaux
- Department of hematology and oncology, université libre de Bruxelles, hôpital universitaire des enfants reine Fabiola, 266, avenue Brugmann, 1180 Uccle, Brussels, Belgium.
| | - S Diallo
- Department of hematology and oncology, université libre de Bruxelles, hôpital universitaire des enfants reine Fabiola, 266, avenue Brugmann, 1180 Uccle, Brussels, Belgium
| | - L Dedeken
- Department of hematology and oncology, université libre de Bruxelles, hôpital universitaire des enfants reine Fabiola, 266, avenue Brugmann, 1180 Uccle, Brussels, Belgium
| | - C Dangoisse
- Department of dermatology, université libre de Bruxelles, hôpital universitaire des enfants reine Fabiola, Brussels, Belgium
| | - A Bott
- Department of dermatology, université libre de Bruxelles, hôpital universitaire des enfants reine Fabiola, Brussels, Belgium
| | - S Heritier
- JF. Emile, laboratory EA4340, GHU Paris-Saclay, Versailles university, Ambroise-Paré hospital, Paris, France
| | - D Salik
- Department of dermatology, université libre de Bruxelles, hôpital universitaire des enfants reine Fabiola, Brussels, Belgium
| | - A Ferster
- Department of hematology and oncology, université libre de Bruxelles, hôpital universitaire des enfants reine Fabiola, 266, avenue Brugmann, 1180 Uccle, Brussels, Belgium
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Barclay M, Devaney R, Bhatt JM. Paediatric pulmonary Langerhans cell histiocytosis. Breathe (Sheff) 2020; 16:200003. [PMID: 32684994 PMCID: PMC7341617 DOI: 10.1183/20734735.0003-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 02/10/2020] [Indexed: 12/24/2022] Open
Abstract
Paediatric pulmonary Langerhans cell histiocytosis (pPLCH) is a rare diffuse cystic lung disease. Unlike pulmonary Langerhans cell histiocytosis (LCH) in adults, which is often seen as an isolated condition with smoking being a major risk factor, isolated pPLCH is vanishingly rare in children and it is most often a component of multisystem LCH. Diagnosis should be based on histological and immunophenotypic examination of affected tissue in addition to clinical and radiological features. It should be considered an important differential for diffuse cystic lung disease in paediatric patients. Recent progress in the biological understanding of the disease supports the classification of LCH as an inflammatory myeloid neoplasia. Chemotherapy and specific management of respiratory complications are the mainstays of treatment. The lungs are no longer considered a "risk organ" in LCH as pulmonary involvement is not associated with a worse prognosis than the involvement of other organs. Multidisciplinary treatment approaches are needed. Prognosis can be good but is adversely influenced by multisystem involvement, and complications such as pneumothoraces and respiratory failure can be life threatening. This review aims to give an overview of this condition, with a focus on the diagnosis, monitoring and management of complications such as pneumothoraces and respiratory failure, which can be challenging for the paediatric respiratory specialist. EDUCATIONAL AIMS To give an overview of paediatric pulmonary LCH.To discuss the differential diagnosis of paediatric cystic lung disease.
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Affiliation(s)
- Mhairi Barclay
- Paediatric Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Rebecca Devaney
- Paediatric Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jayesh. M. Bhatt
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Vahabi-Amlashi S, Hoseininezhad M, Tafazzoli Z. Juvenile Xanthogranuloma: Case Report and Literature Review. Int Med Case Rep J 2020; 13:65-69. [PMID: 32158278 PMCID: PMC7049274 DOI: 10.2147/imcrj.s240115] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/14/2020] [Indexed: 12/24/2022] Open
Abstract
Juvenile Xanthogranuloma (JXG) is a relatively uncommon non-Langerhans cell histiocytosis, which often occurs at an early age and is usually asymptomatic. Herein, we present the case of a 17-year-old man with numerous asymptomatic yellow-brown papulonodular lesions with a symmetric distribution on upper and lower extremities, face, and trunk, developed over the past 4 years. In the histopathologic examination, histiocytes with a Touton-like appearance were observed in favor of xanthogranuloma. The patient was treated with isotretinoin 20 mg daily for 2 months, which surprisingly led to the progression of lesions and thus was discontinued. Although JXG may cause severe morbidities in some circumstances, it is a self-limiting benign disorder and patients should be assured regarding the benign self-regressive nature of the disease.
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Affiliation(s)
- Sadegh Vahabi-Amlashi
- Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoumeh Hoseininezhad
- Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Tafazzoli
- Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Lira-Valero FJ, Pulido-Díaz N, Quintal-Ramírez MDJ. Langerhans Cell Histiocytosis with Isolated Cutaneous Involvement Refractory to Polychemotherapy: A Case Report. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2020; 13:32-34. [PMID: 32082469 PMCID: PMC7028377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND: Langerhans cell histiocytosis (LCH) is a neoplasm of the monocyte-macrophage lineage, characterized by clonal proliferation and dissemination of cells that express CD1a+ and CD207. It is a disorder that predominates in childhood. Although the skin is the second most frequently affected organ (30-60%), isolated cutaneous involvement is rare; its frequency does not exceed 4 to 12 percent of cases. Single system-LCH usually has a good prognosis. We describe a case of LCH with isolated cutaneous involvement that presented in an adult patient and was refractory to polychemotherapy.
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Affiliation(s)
- Francisco Javier Lira-Valero
- All authors are with the Department of Dermatology at the Instituto Mexicano del Seguro Social and Centro Médico Nacional La Raza in México City, México
| | - Nancy Pulido-Díaz
- All authors are with the Department of Dermatology at the Instituto Mexicano del Seguro Social and Centro Médico Nacional La Raza in México City, México
| | - Marissa De Jesús Quintal-Ramírez
- All authors are with the Department of Dermatology at the Instituto Mexicano del Seguro Social and Centro Médico Nacional La Raza in México City, México
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