1
|
Fayiga FF, Reyes-Hadsall SC, Moreno BA, Oh KS, Brathwaite C, Duarte AM. Novel ANKRD26 and PDGFRB gene mutations in pediatric case of non-Langerhans cell histiocytosis: Case report and literature review. J Cutan Pathol 2023; 50:425-429. [PMID: 36753059 DOI: 10.1111/cup.14404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 02/09/2023]
Abstract
Cutaneous non-Langerhans cell histiocytosis (NLCH) is a rare and biologically benign entity that can be broadly classified into two categories: xanthogranuloma and non-xanthogranuloma. The xanthogranuloma family is characterized by a proliferation of histiocytes with both macrophage and dendritic cell differentiation, negative BRAF mutation, and rare Touton-type giant cells. Molecular studies have reported that mutations involved in the MAPK signaling pathways are implicated in the pathophysiology of histiocytoses. While LCH is associated with the somatic mutation of BRAF v600e, however, mutations and gene fusions in NLCH cases are undefined. We hereby present a 19-month-old female with recalcitrant nodular rashes diagnosed as NLCH with associated novel genetic mutation involving ANKRD26 and PDGFRB genes, as well as PDGFRB::CD74 fusion mRNA. Immunohistochemical staining showed strong and diffuse CD68 and CD163 positivity, and negative CD1a, CD207, ALK D5F3, S100 protein, and BRAF V600E (VE1). Albeit unknown significance, this case of an ANKRD26 and PDGFRB gene mutation in cutaneous NLCH has not been reported prior in the literature. Our case highlights the advantage of pathology and genetic studies in cutaneous NLCH to increase the understanding of this heterogeneous enigmatic disorder and identify further options in management.
Collapse
Affiliation(s)
- Folasade F Fayiga
- Children's Skin Center, Miami, Florida, USA.,Division of Dermatology, Department of Pediatrics, Nicklaus Children's Hospital, Miami, Florida, USA.,Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
| | - Sophia C Reyes-Hadsall
- Children's Skin Center, Miami, Florida, USA.,Division of Dermatology, Department of Pediatrics, Nicklaus Children's Hospital, Miami, Florida, USA.,University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Brian A Moreno
- Children's Skin Center, Miami, Florida, USA.,Division of Dermatology, Department of Pediatrics, Nicklaus Children's Hospital, Miami, Florida, USA.,Lake Erie College of Osteopathic Medicine, Bradenton, Florida, USA
| | - Kei Shing Oh
- Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Carole Brathwaite
- Department of Pathology and Laboratory Medicine, Nicklaus Children's Hospital, Miami, Florida, USA
| | - Ana M Duarte
- Children's Skin Center, Miami, Florida, USA.,Division of Dermatology, Department of Pediatrics, Nicklaus Children's Hospital, Miami, Florida, USA
| |
Collapse
|
2
|
Clark EE, Walton M, Chow LML, Boyd JT, Yohannan MD, Arya S. Disseminated Juvenile Xanthogranuloma with a Novel MYH9-FLT3 Fusion Presenting as a Blueberry Muffin Rash in a Neonate. AJP Rep 2023; 13:e5-e10. [PMID: 36816441 PMCID: PMC9937778 DOI: 10.1055/a-2015-1080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 12/19/2022] [Indexed: 01/20/2023] Open
Abstract
Juvenile xanthogranuloma (JXG) is a benign proliferative histiocytic disorder of the dendritic cell phenotype. It mostly presents in the pediatric age group as a solitary skin lesion. We describe a rare case of an infant born with disseminated JXG who presented with a blueberry muffin rash at birth. A term infant was noted to have multiple petechiae, purple nodules, and macules (1 mm-2 cm in diameter) and hepatosplenomegaly, at the time of birth. Further investigations revealed thrombocytopenia and direct hyperbilirubinemia and a magnetic resonance imaging showed scattered tiny foci of restricted diffusion in multiple areas of the brain. Patient received multiple platelet transfusions in the first few weeks with gradual improvement in thrombocytopenia. Ultimately, a biopsy of one of the lesions revealed the diagnosis of disseminated JXG with notable atypical features. Somatic mutation analysis showed a novel MYH9-FLT3 fusion, but a bone marrow biopsy was negative. The lesions faded over time, relative to patient's growth and normal neurodevelopment was noted at 18 months of age. JXG should be considered in the differentials of blueberry muffin rash in an infant. Although, JXG is mostly a self-limited condition, congenital disseminated JXG may be associated with significant morbidity and mortality.
Collapse
Affiliation(s)
- Emily E Clark
- Department of Neonatology, Dayton Children's Hospital, Dayton, Ohio
| | - Mollie Walton
- Department of Pediatric Cardiology, Children's Mercy Kansas City, Overland Park, Kansas
| | - Lionel M L Chow
- Department of Pediatric Hematology/Oncology, Wright State University Boonshoft School of Medicine and Dayton Children's Hospital, Dayton, Ohio
| | - J Todd Boyd
- Department of Pathology and Laboratory Medicine, Wright State University Boonshoft School of Medicine and Dayton Children's Hospital, Dayton, Ohio
| | - M David Yohannan
- Department of Neonatology, Dayton Children's Hospital, Dayton, Ohio.,Department of Neonatal-Perinatal Medicine, Wright State University Boonshoft School of Medicine and Dayton Children's Hospital, Dayton, Ohio
| | - Shreyas Arya
- Department of Neonatology, Dayton Children's Hospital, Dayton, Ohio.,Department of Neonatal-Perinatal Medicine, Wright State University Boonshoft School of Medicine and Dayton Children's Hospital, Dayton, Ohio
| |
Collapse
|
3
|
Wee LWY, Ling HY, Ho VPY, Foong AYW, Koh MJA. Juvenile xanthogranulomas in Asian children. Dermatol Ther 2021; 35:e15224. [PMID: 34820973 DOI: 10.1111/dth.15224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 11/19/2021] [Indexed: 01/04/2023]
Abstract
Juvenile xanthogranuloma (JXG) is the most common non-Langerhans cell histiocytic disorder. It can rarely be associated with systemic involvement. There is a paucity of literature on JXG in Asian children. We aim to describe the epidemiology, clinical features, systemic associations, histological features and outcome of a cohort of Asian children with JXG, and review the literature on the condition. We retrospectively reviewed the demographic, clinical and histological data of patients less than 16 years of age, diagnosed with JXG at our tertiary pediatric hospital between January 2002 and April 2019. A total of 147 children with JXG were identified, with a slight male preponderance of 53.1%. The median age of the onset was 15.5 months, with 69.4% presenting before 2 years of age. There was no racial predilection. The most frequently involved site was the head and neck region (44.2%). The majority of patients (76.2%) presented with a solitary lesion. Spontaneous resolution was documented in 57.7% of our patients with mean duration to resolution of 18.8 months. The proportion and speed of resolution did not differ in children with single or multiple lesions. No ophthalmologic complications were detected in our study cohort. JXG in children is generally limited to the skin and is rarely associated with systemic involvement, including the eye. Unless clinically indicated, the results from our study does not support routine screening for juvenile myelomonocytic leukemia, eye or systemic complications, even in the setting of multiple cutaneous JXGs.
Collapse
Affiliation(s)
- Lynette Wei Yi Wee
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Hua Yen Ling
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | | | - Alice Yee Wah Foong
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Mark Jean Aan Koh
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| |
Collapse
|
4
|
Picarsic J, Pysher T, Zhou H, Fluchel M, Pettit T, Whitehead M, Surrey LF, Harding B, Goldstein G, Fellig Y, Weintraub M, Mobley BC, Sharples PM, Sulis ML, Diamond EL, Jaffe R, Shekdar K, Santi M. BRAF V600E mutation in Juvenile Xanthogranuloma family neoplasms of the central nervous system (CNS- JXG): a revised diagnostic algorithm to include pediatric Erdheim-Chester disease. Acta Neuropathol Commun 2019; 7:168. [PMID: 31685033 PMCID: PMC6827236 DOI: 10.1186/s40478-019-0811-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 09/14/2019] [Indexed: 02/06/2023] Open
Abstract
The family of juvenile xanthogranuloma family neoplasms (JXG) with ERK-pathway mutations are now classified within the "L" (Langerhans) group, which includes Langerhans cell histiocytosis (LCH) and Erdheim Chester disease (ECD). Although the BRAF V600E mutation constitutes the majority of molecular alterations in ECD and LCH, only three reported JXG neoplasms, all in male pediatric patients with localized central nervous system (CNS) involvement, are known to harbor the BRAF mutation. This retrospective case series seeks to redefine the clinicopathologic spectrum of pediatric CNS-JXG family neoplasms in the post-BRAF era, with a revised diagnostic algorithm to include pediatric ECD. Twenty-two CNS-JXG family lesions were retrieved from consult files with 64% (n = 14) having informative BRAF V600E mutational testing (molecular and/or VE1 immunohistochemistry). Of these, 71% (n = 10) were pediatric cases (≤18 years) and half (n = 5) harbored the BRAF V600E mutation. As compared to the BRAF wild-type cohort (WT), the BRAF V600E cohort had a similar mean age at diagnosis [BRAF V600E: 7 years (3-12 y), vs. WT: 7.6 years (1-18 y)] but demonstrated a stronger male/female ratio (BRAF V600E: 4 vs WT: 0.67), and had both more multifocal CNS disease ( BRAFV600E: 80% vs WT: 20%) and systemic disease (BRAF V600E: 40% vs WT: none). Radiographic features of CNS-JXG varied but typically included enhancing CNS mass lesion(s) with associated white matter changes in a subset of BRAF V600E neoplasms. After clinical-radiographic correlation, pediatric ECD was diagnosed in the BRAF V600E cohort. Treatment options varied, including surgical resection, chemotherapy, and targeted therapy with BRAF-inhibitor dabrafenib in one mutated case. BRAF V600E CNS-JXG neoplasms appear associated with male gender and aggressive disease presentation including pediatric ECD. We propose a revised diagnostic algorithm for CNS-JXG that includes an initial morphologic diagnosis with a final integrated diagnosis after clinical-radiographic and molecular correlation, in order to identify cases of pediatric ECD. Future studies with long-term follow-up are required to determine if pediatric BRAF V600E positive CNS-JXG neoplasms are a distinct entity in the L-group histiocytosis category or represent an expanded pediatric spectrum of ECD.
Collapse
Affiliation(s)
- J Picarsic
- Department of Pathology, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
| | - T Pysher
- Department of Pathology, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA
| | - H Zhou
- Department of Pathology, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA
| | - M Fluchel
- Department of Pediatric Hematology-Oncology, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA
| | - T Pettit
- Children's Hematology Oncology Centre, Christchurch Hospital, Christchurch, New Zealand
| | - M Whitehead
- Department of Pathology, Christchurch Hospital, Christchurch, New Zealand
| | - L F Surrey
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - B Harding
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - G Goldstein
- Department of Pediatric Hematology-Oncology, Hadassah University Hospital, Jerusalem, Israel
| | - Y Fellig
- Department of Pathology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - M Weintraub
- Acquired Brain Injury Service, Alyn Pediatric and Adolescent Rehabilitation Hospital, Jerusalem, Israel
| | - B C Mobley
- Department of Pathology, Vanderbilt Hospital, Nashville, USA
| | - P M Sharples
- Department of Pediatric Neurology, Bristol Royal Hospital for Children, Bristol, England
| | - M L Sulis
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York City, USA
| | - E L Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - R Jaffe
- Department of Pathology, University of Pittsburgh School of Medicine, UPMC Magee Women's Hospital, Pittsburgh, PA, USA
| | - K Shekdar
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - M Santi
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| |
Collapse
|
5
|
Marque M, Roubertie A, Jaussent A, Carneiro M, Meunier L, Guillot B, Pinson L, Pinson S, Bessis D. Nevus anemicus in neurofibromatosis type 1: a potential new diagnostic criterion. J Am Acad Dermatol 2013; 69:768-775. [PMID: 23972508 DOI: 10.1016/j.jaad.2013.06.039] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 06/09/2013] [Accepted: 06/21/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Children with multiple café-au-lait macules (CALMs) may be followed for years before a second National Institutes of Health clinical criterion of neurofibromatosis type 1 (NF1) develops to confirm the diagnosis. OBJECTIVE We sought to assess the prevalence of nevus anemicus (NA) in NF1 and its association with neuro-ophthalmologic complications. METHODS This was a prospective multicenter case-control study of 210 consecutive patients with multiple CALMs. Patients with NF1 were matched for age, sex, and center with control subjects. We documented the number, location, and morphologic appearance of NA; dermatologic features of NF1; magnetic resonance imaging results; and family history. RESULTS In all, 77 (51%) patients with NF1 had NA compared with 6 (2%) control subjects. NA was not detected in 26 patients with other genodermatoses associated with CALMs. Patients with NF1 and NA were younger than those without NA (median age: 17 years) (P = .002). NA was mostly localized to the upper anterior aspect of the chest. NA was not significantly linked with other clinical manifestations of NF1, including optic glioma and unidentified bright objects. LIMITATIONS A potential referral bias associated with tertiary care centers is a limitation. CONCLUSIONS NA appears to have a high prevalence and specificity in NF1 and might serve as a marker for NF1 in children with multiple CALMs.
Collapse
Affiliation(s)
- Myriam Marque
- Department of Dermatology, Caremeau Hospital, CHU (Centre Hospitalier Universitaire) Nîmes, Nîmes, France
| | - Agathe Roubertie
- University of Montpellier 1, Neuropediatric Department, Gui de Chauliac Hospital, CHU Montpellier, Montpellier, France; Center of Competence for Neurofibromatosis, CHU Montpellier, Montpellier, France
| | - Audrey Jaussent
- Unit of Clinical Research and Epidemiology, Department of Medical Information, CHU Montpellier, Montpellier, France
| | - Maryline Carneiro
- University of Montpellier 1, Neuropediatric Department, Gui de Chauliac Hospital, CHU Montpellier, Montpellier, France; Center of Competence for Neurofibromatosis, CHU Montpellier, Montpellier, France
| | - Laurent Meunier
- Department of Dermatology, Caremeau Hospital, CHU (Centre Hospitalier Universitaire) Nîmes, Nîmes, France
| | - Bernard Guillot
- Center of Competence for Neurofibromatosis, CHU Montpellier, Montpellier, France; University of Montpellier 1, Department of Dermatology, Saint-Eloi Hospital, CHU de Montpellier, Montpellier, France
| | - Lucile Pinson
- University of Montpellier 1, Department of Medical Genetics, Arnaud de Villeneuve Hospital, CHU de Montpellier, Montpellier, France
| | - Stéphane Pinson
- University of Lyon, Laboratory of Molecular Genetics, Edouard Herriot Hospital, CHU Lyon, Lyon, France
| | - Didier Bessis
- Center of Competence for Neurofibromatosis, CHU Montpellier, Montpellier, France; University of Montpellier 1, Department of Dermatology, Saint-Eloi Hospital, CHU de Montpellier, Montpellier, France; Center of Competence for Pediatric Genetic Skin Disorders, CHU Montpellier, Montpellier, France.
| |
Collapse
|