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Maldonado A, Muñoz R, Alarcon N, Ventura JVL, de Andrade BAB, Villarroel-Dorrego M, de Arruda JAA. Congenital Juvenile Xanthogranuloma in the Perioral Region: A Case Image. Head Neck Pathol 2024; 18:35. [PMID: 38687428 PMCID: PMC11061067 DOI: 10.1007/s12105-024-01649-y] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 04/18/2024] [Indexed: 05/02/2024]
Abstract
Juvenile xanthogranuloma (JXG) is the most common form of non-Langerhans cell histiocytosis in childhood. It often presents with cutaneous involvement and exhibits a predilection for the head and neck region. This article illustrates a case of congenital JXG in a 5-month-old boy, characterized by a solitary, well-circumscribed nodule above the left upper lip. Histopathologically, the lesion exhibited histiocytes with eosinophilic cytoplasm and Touton giant cells. Immunohistochemistry revealed histiocytes positive for CD68 and Factor XIIIa, while negative for S-100 protein. Clinicians should become familiar with the broad clinical spectrum of cutaneous JXG, particularly its congenital presentation, in order to ensure timely and accurate management.
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Affiliation(s)
| | - Rubén Muñoz
- Hospital Universitario Dr. Ángel Larralde, Valencia, Venezuela
| | - Nayari Alarcon
- Hospital Universitario Dr. Ángel Larralde, Valencia, Venezuela
| | - José Victor Lemos Ventura
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, R. Rodolpho Paulo Rocco, N. 325, 1st Floor, Cidade Universitária, Rio de Janeiro, RJ, CEP: 21.941-902, Brazil
| | - Bruno Augusto Benevenuto de Andrade
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, R. Rodolpho Paulo Rocco, N. 325, 1st Floor, Cidade Universitária, Rio de Janeiro, RJ, CEP: 21.941-902, Brazil
| | | | - José Alcides Almeida de Arruda
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, R. Rodolpho Paulo Rocco, N. 325, 1st Floor, Cidade Universitária, Rio de Janeiro, RJ, CEP: 21.941-902, Brazil.
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Sakai Y, Ikawa Y, Takenaka M, Noguchi K, Fujiki T, Ikeda H, Wada T. Histopathological maturation in juvenile xanthogranuloma: a blueberry muffin infant mimicking aleukemic leukemia cutis. Int J Hematol 2024; 119:93-98. [PMID: 37989992 DOI: 10.1007/s12185-023-03675-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/27/2023] [Indexed: 11/23/2023]
Abstract
Juvenile xanthogranuloma (JXG) is usually identified by Touton giant cells, so their absence can complicate diagnosis. We encountered a case of non-typical neonatal JXG lacking Touton giant cells, which was difficult to differentiate from aleukemic leukemia cutis because of overlapping histopathological characteristics. A 1 month-old girl presented with a blueberry muffin rash and multiple 1-2 cm nodules within the subcutaneous and deeper soft tissues. Blood tests revealed pancytopenia. The initial nodule biopsy showed mononuclear cell infiltration, suggestive of mature monocytes or histiocytes, but no Touton giant cells. Bone marrow examination showed no evidence of leukemia. Despite worsening of the rash, pancytopenia, and weight gain over the following month, the results of the second biopsy remained consistent with the initial findings. Consequently, we provisionally diagnosed aleukemic leukemia cutis and initiated chemotherapy. After two courses of chemotherapy, the pancytopenia improved, but the nodules only partially regressed. A third biopsy of the nodule was performed to evaluate the histological response, and revealed Touton giant cells, confirming the diagnosis of JXG. In conclusion, distinguishing non-typical JXG from aleukemic leukemia cutis is challenging. This case highlights the importance of multiple biopsies and the potential for histopathological maturation.
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Affiliation(s)
- Yuta Sakai
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Yasuhiro Ikawa
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Mika Takenaka
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kazuhiro Noguchi
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Toshihiro Fujiki
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hiroko Ikeda
- Department of Diagnostic Pathology, Kanazawa University Hospital, Kanazawa, Japan
| | - Taizo Wada
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
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Rios IS, Silva DR, Goncalves PE, Souza Junior JF, Gurgel RQ, Oliveira AMP. Juvenile xanthogranuloma as a differential diagnosis for sellar and suprasellar lesions in child: Case report and review of literature. Neurochirurgie 2023; 69:101472. [PMID: 37482184 DOI: 10.1016/j.neuchi.2023.101472] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 07/25/2023]
Abstract
Juvenile xanthogranuloma (JXG) is a rare type of non-Langerhans cell histiocytosis. Its systemic form affects 4% of patients. Lesions in the Central Nervous System (CNS) occur in 2% of systemic cases. Sellar JXG should be one of the differential diagnoses for sellar lesions in young. This is a 15-year-old patient with non-specific headache, progressive visual loss and magnetic resonance imaging showing sellar lesion with suprasellar extension. The patient underwent microsurgery by pterional craniotomy with partial resection of the tumor. Pathology evidenced JXG. It progressively evolved with impairment of neuroendocrine functions, new lesions in different CNS locations and death two years after diagnosis. Sellar JXG without cutaneous manifestations is rare. There are no specific findings of the disease. Diagnosis requires additional tests, being defined by pathological analysis. Total resection presents a greater potential control comparing to partial resection. Even so, some patients may have progressive disease with poor clinical outcome.
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Affiliation(s)
- I S Rios
- Department of Medicine, Federal University of Sergipe, Campus Professor Antonio-Garcia-Filho, Lagarto, Sergipe, Brazil
| | - D R Silva
- Department of Medicine, Federal University of Sergipe, Campus Professor Antonio-Garcia-Filho, Lagarto, Sergipe, Brazil
| | - P E Goncalves
- Department of Medicine, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - J F Souza Junior
- Department of Medicine, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - R Q Gurgel
- Department of Medicine, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - A M P Oliveira
- Department of Medicine, Federal University of Sergipe, Aracaju, Sergipe, Brazil; Department of Neurosurgery, Hospital de Cirurgia, Aracaju, Sergipe, Brazil.
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Margariti P, Benekos T. Solitary juvenile xanthogranuloma in the parotid gland. Radiol Case Rep 2023; 18:1784-1787. [PMID: 36923389 PMCID: PMC10009337 DOI: 10.1016/j.radcr.2023.01.103] [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: 12/30/2022] [Revised: 01/25/2023] [Accepted: 01/28/2023] [Indexed: 03/06/2023] Open
Abstract
Juvenile xanthogranuloma (JX) is a non-Langerhans cell histiocytosis. Although precipitating factors remain unclear, it has been described mainly in infancy and early childhood. The giant variant of JX is a rare form that presents in infancy, measures over 2 cm and tends to involute only partly. Herein, we report a very rare localization of a giant JX in the parotid gland, discovered at age 1 month in an infant of a twin pregnancy and studied with ultrasound and magnetic resonance imaging.
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Affiliation(s)
- Persefoni Margariti
- Department of Radiology, University Hospital of Ioannina, St Niarchou 1, 45110 Ioannina, Greece
| | - Thomas Benekos
- Department of Radiology, University Hospital of Ioannina, St Niarchou 1, 45110 Ioannina, Greece
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García-Martínez FJ, Hernández-Martín A. Neurofibromatosis Type 1: Diagnostic Timelines in Children. Actas Dermosifiliogr 2023; 114:187-93. [PMID: 36370836 DOI: 10.1016/j.ad.2022.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The neurofibromatosis 1 (NF1) diagnosis is challenging in young children without a family history of NF1. The aims of this study were to estimate diagnostic delays in children without a family history of NF1 and to examine the effects of using café au lait macules and skin fold freckling as a single diagnostic criterion. PATIENTS AND METHODS Retrospective, descriptive, observational study of all patients diagnosed with NF1 before the age of 18 years who were seen at our hospital. The medical records of those included were reviewed to identify the date on which the diagnostic criteria of NF1 were objectified. The patients were categorized into 2 groups: those with a known parental history of NF1 and those without. Café au lait macules and skin fold freckling were assessed as a single diagnostic criterion, and genetic evidence was considered to confirm highly suspicious cases. RESULTS We studied 108 patients younger than the age of 18 years with a diagnosis of NF1. Mean (SD) age at diagnosis was 3.94 (±3.8) years for the overall group, 1 year for patients with a parental history of NF1, and 4 years and 8 months for those without. Diagnosis was therefore delayed by 3 years and 8 months in patients without a family history. CONCLUSION Skin lesions were the first clinical manifestation of NF1 in most patients. We believe that the National Institutes of Health's diagnostic criteria for NF1 should be updated to aid diagnosis in young children.
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García-Martínez FJ, Hernández-Martín A. [Translated article] Neurofibromatosis Type 1: Diagnostic Timelines in Children. Actas Dermosifiliogr 2023; 114:T187-93. [PMID: 36717073 DOI: 10.1016/j.ad.2022.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Diagnosis of neurofibromatosis 1 (NF1) diagnosis is challenging in young children without a family history of NF1. The aims of this study were to estimate diagnostic delays in children without a family history of NF1 and to examine the effects of considering café-au-lait macules and skinfold freckling as a single diagnostic criterion. PATIENTS AND METHODS Retrospective, descriptive, observational study of all patients diagnosed with NF1 before the age of 18 years who were seen at our hospital. The medical records of those included were reviewed to identify the date on which the diagnostic criteria of NF1 were objectified. The patients were categorized into 2 groups: those with a known parental history of NF1 and those without. Café-au-lait macules and skinfold freckling were assessed as a single diagnostic criterion, and genetic evidence was considered to confirm highly suspicious cases. RESULTS We studied 108 patients younger than the age of 18 years with a diagnosis of NF1. Mean (SD) age at diagnosis was 3.94 (±3.8) years for the overall group, 1 year for patients with a parental history of NF1, and 4 years and 8 months for those without. Diagnosis was therefore delayed by 3 years and 8 months in patients without a family history. CONCLUSION Skin lesions were the first clinical manifestation of NF1 in most patients. We believe that the National Institutes of Health's diagnostic criteria for NF1 should be updated to aid diagnosis in young children.
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Chen Y, Yang Z, Shi J, Qiao Z. Imaging features of juvenile xanthogranuloma. Pediatr Radiol 2023; 53:265-272. [PMID: 36040525 DOI: 10.1007/s00247-022-05486-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/17/2022] [Accepted: 08/16/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Juvenile xanthogranuloma is rare in children and there are limited data on its imaging features. OBJECTIVE To analyze the computed tomography (CT) and magnetic resonance imaging (MRI) features of juvenile xanthogranuloma in children. MATERIALS AND METHODS A retrospective review was performed of clinical and radiographic data of histologically confirmed juvenile xanthogranuloma between January 2009 and June 2020. RESULTS Fourteen children (4 girls, 10 boys; age range: 1 day to 13 years, mean age: 73 months) were included in the study: 4/14 had CT only, 5/14 had MRI only and 5/14 had CT and MRI. Sites of extracutaneous juvenile xanthogranuloma involvement included subcutaneous soft tissue (8/14), liver (2/14), lungs (2/14), kidney (2/14), nose (2/14), pancreas (1/14), central nervous system (1/14) and greater omentum (1/14), mainly manifested as single or multiple nodules or masses in different organs. On CT, the lesions mainly manifested as an iso-hypo density mass with mild or marked enhancement. On MRI, the lesions mainly manifested as slightly hyperintense on T1 and slightly hypointense on T2, with decreased diffusivity and homogeneous enhancement. Juvenile xanthogranuloma was not included in the imaging differential diagnosis in any case. CONCLUSION Juvenile xanthogranuloma mainly manifests as single or multiple nodules or masses in different organs. Slight hyperintensity on T1 and slight hypointensity on T2 with decreased diffusivity and homogeneous enhancement are relatively characteristic imaging findings of juvenile xanthogranuloma. Combined with its typical skin lesions and imaging features, radiologists should include juvenile xanthogranuloma in the differential diagnosis when confronted with similar cases.
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Affiliation(s)
- Yanan Chen
- Department of Radiology, Shanghai Pulmonary Hospital, 507 Zhengmin Rd, Shanghai, 200082, China
| | - Zhiming Yang
- Department of Radiology, Children's Hospital of Fudan University, 399 Wanyuan Rd, Shanghai, 201100, China
| | - Jingyun Shi
- Department of Radiology, Shanghai Pulmonary Hospital, 507 Zhengmin Rd, Shanghai, 200082, China.
| | - Zhongwei Qiao
- Department of Radiology, Children's Hospital of Fudan University, 399 Wanyuan Rd, Shanghai, 201100, China
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Baskoro W, Pratama MFR, Christi AY, Faris M, Subagio EA, Wicaksono P, Kameswari B. Case of compressive myelopathy due to juvenile xanthogranuloma of cervicothoracic junction in a 28-year-old male. Surg Neurol Int 2023; 14:17. [PMID: 36751446 PMCID: PMC9899458 DOI: 10.25259/sni_1129_2022] [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] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/04/2023] [Indexed: 01/22/2023] Open
Abstract
Background Juvenile xanthogranuloma (JXG) is a proliferative disorder of non-Langerhans histiocytes. The lesions typically occur in children as solitary cutaneous lesions, but are only rarely found in adults in their late twenties to thirties. Approximately 5-10% of JXG are extracutaneous in location, with spinal JXG being only rarely encountered. Here, we described a 28-year-old male with an extradural spinal JXG resulting in severe C6- T1 spinal cord compression and a progressive quadriparesis that warranted a decompressive laminectomy/C6-T2 fusion. Case Description A 28-year-old male presented with a progressive quadriparesis of 12 months' duration that rapidly worsened over the last 3 months. When the MRI revealed severe cord epidural C6-T1 cord compression, the patient successfully underwent a C6-T1 laminectomy for gross total tumor excision followed by a C6-T2 instrumented fusion. The histopathology confirmed the diagnosis of a spinal JXG. Conclusion Spinal JXGs in adults are only rarely encountered and should be treated with gross total tumor excision with/without fusion to achieve the best long-term outcomes.
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Affiliation(s)
- Wisnu Baskoro
- Department of Neurosurgery, Dr. Soeradji Tirtonegoro Central Public Hospital, Klaten, Indonesia,Corresponding author: Wisnu Baskoro, Department of Neurosurgery, Dr. Soeradji Tirtonegoro Central Public Hospital, Klaten, Indonesia.
| | | | - Ayu Yoniko Christi
- Department of Neurosurgery, Dr. Soeradji Tirtonegoro Central Public Hospital, Klaten, Indonesia
| | - Muhammad Faris
- Department of Neurosurgery, Universitas Airlangga – Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Eko Agus Subagio
- Department of Neurosurgery, Universitas Airlangga – Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Pandu Wicaksono
- Department of Neurosurgery, Universitas Airlangga – Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Bidari Kameswari
- Department of Pathology Anatomy, Dr. Soeradji Tirtonegoro Central Public Hospital, Klaten, Indonesia
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Wiffen J, Kalantary A, Ardakani NM, Turner A. Adult onset xanthogranuloma of the eyelid. Am J Ophthalmol Case Rep 2022; 29:101775. [PMID: 36544751 PMCID: PMC9762145 DOI: 10.1016/j.ajoc.2022.101775] [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] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/19/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
Purpose To report a rare case of an eyelid lesion in an adult, with histological features of juvenile xanthogranuloma (JXG). Observations Juvenile xanthogranuloma primarily affects the skin of infants and young children. It infrequently can involve the structures of the eye and orbit and rarely occurs in individuals beyond the second decade of life. We present a case of adult onset xanthogranuloma (AXG) involving the eyelid of a 29-year-old female. This lesion required management with multiple treatment modalities. Conclusions This is a rare example of an eyelid xanthogranuloma in an adult. As such, JXG-like lesions should be included as a differential diagnosis for lesions of the eye and orbit in adults. Surgical management may be required if there is no response to intralesional steroids.
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Affiliation(s)
- James Wiffen
- The Lions Outback Vision, Lions Eye Institute, Nedlands, Western Australia, Australia,Corresponding author. Lions Outback Vision, 2 Verdun Street, Nedlands, Western Australia, 6009, Australia.
| | - Amy Kalantary
- The Lions Outback Vision, Lions Eye Institute, Nedlands, Western Australia, Australia
| | - Nima Mesbah Ardakani
- Department of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, Western Australia, Australia,College of Science, Health, Engineering and Education, Murdoch University, Perth, Western Australia, Australia
| | - Angus Turner
- The Lions Outback Vision, Lions Eye Institute, Nedlands, Western Australia, Australia,Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, Western Australia, Australia
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Damodharan S, Diamond C, Helgager J, Iskandar B. Intralesional glucocorticoid treatment of an isolated intracranial juvenile xanthogranuloma: a case report. Childs Nerv Syst 2022; 38:2021-4. [PMID: 35304626 DOI: 10.1007/s00381-022-05500-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/14/2022] [Indexed: 11/03/2022]
Abstract
Juvenile xanthogranuloma is a type of non-Langerhans cell histiocytic process that appears primarily in children and is described as a benign lesion. Although they typically present as a cutaneous lesion, it can also present in other areas including within the central nervous system. We report a 6-month-old infant who presented with seizure-like activity who was found to have a single intracranial mass within the right temporal area on magnetic resonance imaging of the head. The mass was biopsied and pathologically identified as a juvenile xanthogranuloma. In order to avoid the morbidity associated with a gross total resection, an intralesional steroid injection was utilized for treatment which our patient tolerated well. Intralesional steroid injection for the treatment of a symptomatic isolated intracranial juvenile xanthogranuloma has not been described but was successful for our patient.
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Kwon HN, Choi KU, Oh SJ, Choi SW. Rapidly growing juvenile xanthogranuloma of the auricle. Ear Nose Throat J 2022:1455613221113795. [PMID: 35791499 DOI: 10.1177/01455613221113795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ha-Nee Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Kyung Un Choi
- Department of Pathology and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Se-Joon Oh
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sung-Won Choi
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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Miraglia E, Laghi A, Moramarco A, Giustini S. Juvenile xanthogranuloma in neurofibromatosis type 1. Prevalence and possible correlation with lymphoproliferative diseases: experience of a single center and review of the literature. Clin Ter 2022; 173:353-355. [PMID: 35857053 DOI: 10.7417/ct.2022.2445] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Neurofibromatosis type 1 (NF1), is a rare genetic disorder that may involve almost every organ system in the body such as cutaneous, ophthalmologic and central and peripheral nervous system. Cutaneous findings are usually the first sign of the disease. In this study, we investigate the real prevalence of xanthogranulomas juvenile (JXG) and possible correlation with lymphoproliferative diseases. This is a retrospective study conducted on a population with NF1 followed by February 1983 to February 2022 at the "Sapienza" University of Rome, Italy. We investigate the real prevalence of juvenile xanthogranuloma in NF1 and possible correlation with lymphoproliferative diseases. JXG was present in 39 cases (3.1%). JXG is more frequent in NF1 than in the general population while the possible association with lymphoproliferative diseases in NF1 remains controversial.
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Affiliation(s)
- E Miraglia
- Dermatologic Clinic, "Sapienza" University of Rome, Rome, Italy
| | - A Laghi
- Dermatologic Clinic, "Sapienza" University of Rome, Rome, Italy
| | - A Moramarco
- Department of Sense Organs, "Sapienza" University of Rome, Rome, Italy
| | - S Giustini
- Dermatologic Clinic, "Sapienza" University of Rome, Rome, Italy
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Mota CP, Silva Cunha JL, Magalhães MCSV, Israel MS, Freire NDA, Dos Santos ERC, Canedo NHS, Agostini M, Abrahão AC, de Andrade BAB, Romañach MJ, de Sousa SF. Oral Juvenile Xanthogranuloma: A Clinicopathological, Immunohistochemical and BRAF V600E Study of Five New Cases, with Literature Review. Head Neck Pathol 2022; 16:407-415. [PMID: 34414559 PMCID: PMC9187812 DOI: 10.1007/s12105-021-01373-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/14/2021] [Indexed: 11/30/2022]
Abstract
Juvenile xanthogranuloma (JXG) is the most common form of non-Langerhans cell histiocytosis and oral mucosal involvement is exceedingly rare. Histiocytic disorders harbor activating mutations in MAPK pathway, including the report of BRAF V600E in JXG of extracutaneous site. However, no information is available for oral JXG. Herein, the clinicopathological and immunohistochemical features of five new oral JXG were evaluated in conjunction with literature review. Also, we assessed the BRAF V600E in oral samples. Five oral JXG were retrieved from pathology archives. Morphological and immunohistochemical analyses were performed. The BRAF V600E status was determined with TaqMan allele-specific qPCR. The series comprised of three female and two male patients, most of them adults, with a median age of 39 years (range 13-68 years). Clinically, the lesions appeared as asymptomatic solitary nodules, measuring until 2.5 cm, with more incident to the buccal mucosa. Morphologically, most of the cases presented classical histological features of JXG, with histiocytic cells consistent with the non-Langerhans cell immunophenotype. BRAF V600E was not detected in the cases tested. This is the first and largest published series of oral JXG affecting adults and a Brazilian population. The molecular pathogenesis of oral JXG remains unknown. Clinicians and pathologists must recognize JXG to avoid misdiagnoses with oral benign or malignant lesions.
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Affiliation(s)
- Carolina Peres Mota
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - John Lennon Silva Cunha
- Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas (FOP-UNICAMP), Piracicaba, Brazil
| | | | - Mônica Simões Israel
- Clinic of Stomatology, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Nathália de Almeida Freire
- Clinic of Stomatology, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | | | | | - Michelle Agostini
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Aline Corrêa Abrahão
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | - Mário José Romañach
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Sílvia Ferreira de Sousa
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil.
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Chen R, Liu S, Tang L, Yu X, Meng Z, Hu Y, Li J, Liang X. On the knowledge of solitary juvenile xanthogranuloma of the eyelid: a case series and literature review. Graefes Arch Clin Exp Ophthalmol 2022; 260:2339-45. [PMID: 35084531 DOI: 10.1007/s00417-022-05560-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/01/2022] [Accepted: 01/11/2022] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Solitary eyelid juvenile xanthogranuloma (JXG) is extremely rare, and there is limited literature on its clinical features and treatment outcomes. Here, we present a case series and comprehensive review of the literature on patients with isolated eyelid JXG. METHODS We systematically extracted data from our institution's records of isolated eyelid JXG cases and conducted a search for additional cases from the literature utilising the PubMed, Wanfang, and Chinese National Knowledge Infrastructure (CNKI) databases. Patients with JXG were analysed with respect to age, sex, clinical presentation, therapy, and outcome. Group comparisons were performed. RESULTS Thirty-two patients (including 13 at our institution and 19 from prior publications) were identified. The median age at first presentation was higher in current patients than in the patients from the published cases (median 9 years, range 1.2 to 47.0 years; median 2 years, range 0.5 months to 46.0 years, respectively, P = 0.014). Of the patients who had known characteristics, no significant differences were observed between the two groups in terms of sex, affected eye, eyelid site, type of cutaneous involvement, or duration of symptoms (each P > 0.05). Seventeen (54.8%) patients were male. The most common lesion location was the upper eyelid (n = 10, 62.5%). Twenty-four (75.0%) cutaneous lesions had full-thickness skin involvement; 8 (25.0%) subcutaneous masses had a chalazion-like appearance. Histologically, the JXG masses were characterised by Touton giant cells with inflammatory cells. Additionally, there was no significant difference in treatment modalities between the two groups (P = 0.072), and 24 (75.0%) patients underwent surgical excision. The overall recurrence-free survival was 3.6 to 52.8 (median 27.0) months in the current patients. For published cases with available follow-up information, there was no recurrence in 10 cases and improvement in 1 case, with a median follow-up of 9.5 months. CONCLUSION Solitary eyelid JXG is a rare clinical entity and should be included in the differential diagnosis of eyelid mass lesions in patients of all age groups. Surgical excision is often selected for efficient treatment and to obtain an excisional biopsy.
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15
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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.
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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
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16
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Alkatan HM, Alzahem TA, Maktabi AMY. Ophthalmic histiocytic lesions: a baseline demographic and clinicopathological study of 28 cases from two eye centers. Int Ophthalmol 2021; 42:1221-1232. [PMID: 34727265 DOI: 10.1007/s10792-021-02108-1] [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: 02/14/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Ophthalmic histiocytic lesions comprise a heterogeneous rare group of disorders that are characterized by an abnormal proliferation of histiocytes and may affect all age groups of both sexes. The aim of this study was to highlight the basic demographic, clinical, and histopathological characteristics of this rare group of diseases in ophthalmic practice, which has not been previously studied in this area. Only individual cases have been previously reported. METHODS This was a retrospective study of all biopsied ocular and periocular histiocytic lesions from two centers, King Khaled Eye Specialist Hospital (KKESH) and King Abdulaziz University Hospital (KAUH) in Riyadh, Saudi Arabia, from January 1993 to December 2018. The histopathological diagnosis was confirmed, and the cases were re-classified by reviewing all histopathological slides. The corresponding demographic and clinical data were analyzed. A relevant literature review was also carried out for comparison of our collected analyzed data to published data and to draw our own conclusions. RESULTS A total of 34 ocular/periocular histiocytic lesions in 28 patients who were mostly Saudis (92.9%) were included. The male-to-female ratio was 4:3. The median age at presentation was 6.4 years (range: 2.8-35 years). Twenty-two patients had unilateral involvement, and six patients had bilateral lesions. In patients with Langerhans cell histiocytosis (LCH; L group), the most common presenting findings were eyelid swelling (75%), periocular tenderness (37.5%), proptosis/globe displacement (37.5%) eyelid erythema (25%), and orbital pain (12.5%). In patients with Rosai Dorfman disease (RDD; R group), proptosis/globe displacement occurred in all patients and 80% had decreased vision. Patients in the C group (Cutaneous non-LCH histiocytoses) had variable clinical features because of the different locations of the histiocytic lesions, with the majority involving the eyelids (66.7%). Diagnosis was accurately reached clinically in 38.8%, 33.7%, and 46.7% of patients in the L, C, and R groups, respectively. Overall, the clinical diagnosis was in concordance with the histopathologic diagnosis in 14 out of 34 lesions (41.2%). CONCLUSIONS Histiocytic disease is more likely to be overlooked clinically owing to its rarity. In the C group, juvenile xanthogranuloma (JXG) was the most commonly encountered histiocytic lesion and had a tendency to present at a later age with extremely rare intraocular involvement in contrast to previously published reports. The median age at presentation was higher in group R. All patients in group L had strictly unilateral disease, while RDD (group R) was most commonly bilateral. Future research on genetic aspects, management, and prognosis is necessary.
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Affiliation(s)
- Hind M Alkatan
- Ophthalmology Department, College of Medicine, King Saud University, P.O. Box: 266, Riyadh, 11362, Saudi Arabia. .,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia. .,Pathology and Laboratory Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Tariq A Alzahem
- Ophthalmology Department, College of Medicine, King Saud University, P.O. Box: 266, Riyadh, 11362, Saudi Arabia.,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.,Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Azza M Y Maktabi
- Pathology and Laboratory Medicine Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Choraria A, Andrei V, Rajakulasingam R, Saifuddin A. Musculoskeletal imaging features of non-Langerhans cell histiocytoses. Skeletal Radiol 2021; 50:1921-1940. [PMID: 33787962 DOI: 10.1007/s00256-021-03765-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/01/2021] [Accepted: 03/19/2021] [Indexed: 02/02/2023]
Abstract
The non-Langerhans cell histiocytoses (N-LCH) represent a group of rare diseases with different clinical presentations and imaging features to classical LCH. While there is a long list of entities, only few present with musculoskeletal soft tissue and osseous manifestations alongside the more commonly reported systemic findings. Erdheim-Chester disease (ECD) is typically seen in adults as bilateral and symmetrical long bone osteosclerosis. Rosai-Dorfman disease (RDD) is more commonly seen in children and young adults with bone involvement usually being a manifestation of extra-nodal disease. Primary osseous RDD is very rare, with both displaying rather non-specific imaging features of an expansile lucent lesion with or without an extra-osseous component. Juvenile xanthogranuloma (JXG) is a benign disorder typically seen in very young children. The most common imaging manifestation is a dermal or sub-dermal soft tissue mass. This article reviews the musculoskeletal imaging appearances of the commoner N-LCH.
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Affiliation(s)
- Anika Choraria
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - Vanghelita Andrei
- Department of Histopathology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - Ramanan Rajakulasingam
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
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18
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Itin K, Häusermann P, Itin P, Fosse N. Symmetrical Facial Giant Plaque-Type Juvenile Xanthogranuloma: Case Report and Review of the Literature. Case Rep Dermatol 2021; 13:399-406. [PMID: 34413740 PMCID: PMC8339506 DOI: 10.1159/000515151] [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] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 02/07/2021] [Indexed: 11/19/2022] Open
Abstract
Juvenile xanthogranuloma (JXG) is the most common type of non-Langerhans cell histiocytosis. JXG is a rare benign tumor, which may be present at birth or develop later. The classical form of JXG is characterized by a red-yellowish benign papule or nodule with predilection sites on the head, neck, and trunk, although lesions can appear on extremities or extracutaneous sites. In most cases there is only one lesion, whereas numerous papules or nodules may occur. Special forms of JXG such as mixed, giant, subcutaneous, eruptive, clustered, and plaque-like have been reported and associations between JXG and systemic diseases have been made. Diagnosis mainly relies on the clinical appearance, and histology usually can confirm the disease. Here we present a very rare case of symmetrical giant facial plaque-type juvenile xanthogranuloma (SGFP-JXG) and compare it with classical JXG, variations of JXG, and discuss the differential diagnosis. A 4-year-old Caucasian female presented with plaque-like lesions composed of yellowish confluent papules on both the cheeks. The histological evaluation revealed a histiocytic lesion with a formation of Touton giant cells and immunohistochemistry results confirmed the diagnosis of the SGFP-JXG. In comparison to classical JXG, the onset of SGFP-JXG sometimes occurs later and the spontaneous resolution period may be prolonged. No associated diseases and no systemic involvements were observed. Histopathology is required to differentiate this form of JXG from other histiocytosis. To the best of our knowledge, only four cases of SGFP-JXG have been reported in the literature so far.
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Affiliation(s)
- Kaspar Itin
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Peter Häusermann
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Peter Itin
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Nicole Fosse
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
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Calderon C, Ramsingh A, Pattron R, Umakanthan S, Ramnarine D. Multiple intracranial juvenile xanthogranuloma not a straightforward diagnosis (a case report). Int J Surg Case Rep 2021; 85:106265. [PMID: 34388899 PMCID: PMC8353501 DOI: 10.1016/j.ijscr.2021.106265] [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] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/31/2021] [Accepted: 08/01/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Juvenile xanthogranuloma (JXG) rarely presents as multifocal intracranial disease in the paediatric population. Therefore, this case of extensive tumour burden, primarily within the lateral ventricles, presented a neurosurgical challenge on numerous fronts. PRESENTATION OF CASE This is the case of a 9-year-old male presenting with a 2-year history of visual disturbances. Radiographic imaging demonstrated extensive intracranial masses involving both lateral ventricles, the straight sinus and right cerebellum. A staged tumour resection was planned, targeting the lesions within the right lateral ventricle initially. Complete resection was achieved during surgery. Post-operative morbidity showed a decline in the patient's functional status with respect to mobility and communication, Glasgow outcome scale 3. Extensive immunohistochemical analysis ultimately revealed a diagnosis of JXG. The patient is undergoing chemotherapy, with subsequent surgical resection being dependent on overall recovery. CLINICAL DISCUSSION JXG is the most common form of non-Langerhans histiocytosis and typically arises as a cutaneous disorder during early childhood. It is a rare cause of extensive intracranial tumour burden, with limited publications of this kind in the literature. This is even more atypical given the absence of any of the classic cutaneous morphology seen in JXG. CONCLUSION JXG involving the central nervous system is a rare encounter. Therefore, a clear algorithm for the management of a case of extensive intracranial tumours resulting from JXG has not been defined. This only amplifies the difficulty in treating these cases.
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Affiliation(s)
- Chrystal Calderon
- Department of Surgery, Eric Williams Medical Sciences Complex, North Central Regional Health Authority, Trinidad and Tobago,Corresponding author at: Savoie 5, French Village, Eric Williams Medical Sciences Complex, Mount Hope, Trinidad and Tobago.
| | - Amit Ramsingh
- Department of Surgery, Eric Williams Medical Sciences Complex, North Central Regional Health Authority, Trinidad and Tobago
| | - Rohini Pattron
- Department of Surgery, Eric Williams Medical Sciences Complex, North Central Regional Health Authority, Trinidad and Tobago
| | - Srikanth Umakanthan
- Department of Paraclinical Sciences Pathology Unit, Faculty of Medical Sciences, University of the West Indies Eric Williams Medical Sciences Complex, North Central Regional Health Authority, Trinidad and Tobago
| | - Devindra Ramnarine
- Honorary Adult & Paediatric Neurosurgeon, Department of Paediatric Surgery, Eric Williams Medical Sciences Complex, North Central Regional Health Authority, Trinidad and Tobago
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20
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Abstract
Langerhans cell histiocytosis, Rosai-Dorfman disease, and juvenile xanthogranuloma may present at birth or any time afterward. Some patients have minimal skin or lymph node involvement, but others present with life-threatening pulmonary, hepatic, bone marrow, or central nervous system lesions. There is often a delay in diagnosis because of confusing overlap with more common neonatal diseases. Many treatment regimens have been applied to these diseases, but those directed at myeloid cells, such as cytarabine and clofarabine or mutation-targeting inhibitors, are gaining favor. This article provides information on the pathophysiology, clinical presentation, evaluation guidelines, and treatment of these uncommon tumors of neonates.
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21
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Al-Owaid AA, Al-Dossari S, Maktabi A, Edward D, Sesma G. Bilateral Spontaneous Hyphema in Juvenile Xanthogranuloma: A Case Report. Case Rep Ophthalmol 2021; 11:668-675. [PMID: 33568985 PMCID: PMC7841722 DOI: 10.1159/000510905] [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] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/15/2020] [Indexed: 11/19/2022] Open
Abstract
Juvenile xanthogranuloma (JXG) is an idiopathic granulomatous inflammatory condition that usually affects children. Intraocular involvement, especially bilateral, is rare in JXG. Most patients with ocular lesions are typically infants and usually present with hyphema, iridocyclitis, and secondary glaucoma. We report a case of a 3-month-old baby girl who presented to our emergency department with bilateral hyphema that started 3 weeks ago. She was medically free with no history of any recent trauma or preceding febrile illness. General physical examination showed a quiet baby with multiple hyperpigmented macules over the inner thigh and right upper arm, with one pinkish nodule over the occiput. She also had high intraocular pressures. A detailed ophthalmic assessment was done under general anesthesia. The nodular lesion was excised and sent for histopathological evaluation, which confirmed the diagnosis of JXG. Treatment of JXG cases present a challenge to ophthalmologist due to rebleeding and refractory glaucoma. Our case was admitted multiple times for rebleeding and refractory glaucoma and was treated with full antiglaucoma drops, steroid drops and peribulbar injection of steroid.
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Affiliation(s)
- Abdullah A Al-Owaid
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Department of Ophthalmology, King Fahd University Hospital, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | | | - Azza Maktabi
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Deepak Edward
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Gorka Sesma
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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22
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Peruilh-Bagolini L, Silva-Astorga M, Hernández San Martín MJ, Manoli MS, Papageorgiou C, Apalla Z, Lallas A. Dermoscopy of Juvenile Xanthogranuloma. Dermatology 2020; 237:946-951. [PMID: 33075787 DOI: 10.1159/000510265] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 06/03/2020] [Accepted: 07/16/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Dermoscopy is useful for the evaluation of juvenile xanthogranuloma (JXG). The classical "setting sun" pattern is characteristic of JXG, but its sensibility appears to be limited. An extensive description of other dermoscopic findings is not available in the literature. OBJECTIVES The aim of this study was to valuate and describe the clinical and dermoscopic characteristics of a series of JXG cases. METHODS This is a retrospective descriptive study, including cases with histopathologic diagnosis of JXG, and the availability of clinical and dermoscopic images, assessed for the presence of dermoscopic features based on the available literature. RESULTS A total of 17 lesions were analyzed. 70.6% showed global symmetry, 35.3% presented the typical "setting sun" pattern. All lesions showed yellow-orange and/or pink-red structureless color. Other dermoscopic features were yellow globules (35.3%), shiny white streaks (23.5%), brown globules (17.6%), pale-brown network (11.8%), negative network (11.8%), erosion/ulceration (11.8%), rosettes (5.9%), and hemorrhage (5.9%). Scales were seen in 64.7% of patients. Vascular structures were observed in all the lesions, mostly in an irregular distribution (76.5%). The observed vessel types were dotted (52.9%), linear (52.9%), branching-arboriform (29.4%), comma-like (23.5%), hairpin-like (17.6%), globular (17.6%), coiled (11.8%), and milky-red globules (5.9%). CONCLUSIONS Symmetry, yellow/orange-pink/red color, yellow globules, shiny white streaks, and irregularly distributed different types of vascular structures are the main dermoscopic features of JXG. This is the largest dermoscopic registry of JXG published to date.
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Affiliation(s)
| | - Mariana Silva-Astorga
- Department of Dermatology, Faculty of Medicine, University of Chile, Santiago, Chile
| | | | | | | | - Zoe Apalla
- Second Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
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23
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de Soccio G, Savastano V, Minasi S, Bertin S, Serafini M, Vittori T, Riminucci M, Corsi A. Solitary juvenile xanthogranuloma of the hypopharynx. Clinico-pathologic study in a child with β-Thalassemia Major and Cutaneous Mastocytosis. Int J Pediatr Otorhinolaryngol 2020; 135:110088. [PMID: 32505931 DOI: 10.1016/j.ijporl.2020.110088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 02/07/2023]
Abstract
Juvenile Xanthogranuloma (JXG), the most common pediatric non-Langerhans cell histiocytosis, may rarely occur in association with Neurofibromatosis (types 1 and 2), Juvenile Myelomonocytic Leukemia and Cutaneous Mastocytosis (CM) and, morphologically, mimics Erdheim-Chester Disease tissue lesions and ALK-positive histiocytosis. We describe a 4-year-old girl with Beta-Thalassemia Major who developed an hypopharyngeal BRAFV600E- and ALK-negative JXG and CM. JXG has been rarely reported in the aerodigestive tract and in association with CM. In this molecular era, knowledge of genetic heterogeneity of JXG and clinical scenarios in which it may develop is essential for the appropriate diagnosis and treatment of each individual patient.
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Affiliation(s)
| | - Vincenzo Savastano
- Pediatric ENT Unit, Department of Pediatrics, Sapienza University of Rome, Italy
| | - Simone Minasi
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Italy
| | - Serena Bertin
- Pediatric ENT Unit, Department of Pediatrics, Sapienza University of Rome, Italy
| | - Marta Serafini
- Centro Ricerca M. Tettamanti, Department of Paediatrics, San Gerardo Hospital, University of Milano-Bicocca, Monza, MB, Italy
| | - Tommaso Vittori
- Pediatric ENT Unit, Department of Pediatrics, Sapienza University of Rome, Italy
| | - Mara Riminucci
- Department of Molecular Medicine, Sapienza University of Rome, Italy
| | - Alessandro Corsi
- Department of Molecular Medicine, Sapienza University of Rome, Italy.
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Hernández-San Martín MJ, Vargas-Mora P, Aranibar L. Juvenile Xanthogranuloma: An Entity With a Wide Clinical Spectrum. Actas Dermosifiliogr (Engl Ed) 2020; 111:725-733. [PMID: 32721389 DOI: 10.1016/j.ad.2020.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 05/20/2020] [Revised: 06/28/2020] [Accepted: 07/06/2020] [Indexed: 12/13/2022] Open
Abstract
Juvenile xanthogranulomas (JXGs) are rare, benign lesions that belong to the large group of non-Langerhans cell histiocytoses. JXG presents with 1 or more erythematous or yellowish nodules that are usually located on the head or neck. Most JXG lesions are congenital or appear during the first year of life. Extracutaneous involvement is rare, but the literature traditionally suggests investigating the possibility of ocular compromise. JXG is mainly a clinical diagnosis, but a skin biopsy may sometimes be needed for confirmation. JXGs on the skin are self-limiting and usually do not require treatment. This review describes the clinical and therapeutic aspects of JXG, emphasizing available evidence and the diagnosis of extracutaneous involvement.
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Affiliation(s)
| | - P Vargas-Mora
- Departamento de Dermatología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - L Aranibar
- Departamento de Dermatología, Facultad de Medicina, Universidad de Chile, Santiago, Chile; Servicio de Dermatología, Hospital Luis Calvo Mackenna, Santiago, Chile.
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25
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Vergara-de-la-Campa L, Torrelo A, Isabel Sánchez-Moya A, Recuero-Pradillo M, Mollejo M, Matito A. Simultaneous occurrence of cutaneous mastocytosis and juvenile xanthogranuloma in a child: Random or true association? Pediatr Dermatol 2020; 37:716-720. [PMID: 32372415 DOI: 10.1111/pde.14185] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/17/2020] [Accepted: 04/05/2020] [Indexed: 11/29/2022]
Abstract
Juvenile xanthogranuloma (JXG) and cutaneous mastocytosis (CM) are two distinct conditions that have rarely been reported in association. We report a child with CM and disseminated JXG, who showed a significant decrease in serum tryptase levels and regression of JXG lesions over time. Due to the paucity of reports, a true association between these two conditions has not been validated, although a potential induction of histiocytic lesions by mast cell degranulation has been proposed.
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Affiliation(s)
| | - Antonio Torrelo
- Department of Dermatology, Hospital Infantil Universitario del Niño Jesús, Spanish Network on Mastocytois (REMA), Madrid, Spain
| | | | | | - Manuela Mollejo
- Department of Pathology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Almudena Matito
- Instituto de Estudios de Mastocitosis de Castilla La Mancha (CLMast), Spanish Network on Mastocytosis (REMA), Toledo, Spain
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26
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Lu Q, Shi XY, Wang YY, Zhang MN, Wang WZ, Wang J, Wang QH, Chen HM, Zou LP. Juvenile xanthogranuloma as a new type of skin lesions in tuberous sclerosis complex. Orphanet J Rare Dis 2020; 15:147. [PMID: 32532290 PMCID: PMC7291636 DOI: 10.1186/s13023-020-01396-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 05/04/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Tuberous sclerosis complex (TSC) is a rare autosomal dominant genetic disease with many manifestations, and it involves any organ. In this study, we report a TSC patient with new type skin lesions. METHODS A 7-month-old TSC boy with multiple cutaneous nodules was admitted in our hospital. We collected the clinical data of the patient. We performed biopsy of cutaneous nodules and whole-exome sequencing in both paraffin block tissue and blood samples. RESULTS The patient presented with a 2 month history of gradual growth multiple cutaneous nodules. He had cardiac rhabdomyoma, subependymal giant cell astrocytoma (SEGA) and hypomelanotic macules. The pathological finding of cutaneous nodules was consistent with juvenile xanthogranuloma (JXG). After 3 months of sirolimus treatment, the multiple nodules disappeared. The whole-exome sequencing identified TSC1 (c.2356C > T, p.R786*) mutation in both paraffin block tissue and blood samples. We overturned the original pathological diagnosis and finally identified JXG as a new type of skin lesions in TSC. CONCLUSION This is the first report on the occurrence of JXG skin lesions in TSC patient. Genetic testing is necessary in JXG. These findings expand the phenotype of skin in patients with TSC and contribute to the elucidation of JXG pathogenesis and treatment.
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Affiliation(s)
- Qian Lu
- Department of Pediatrics, the First Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Xiu-Yu Shi
- Department of Pediatrics, the First Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Yang-Yang Wang
- Department of Pediatrics, the First Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Meng-Na Zhang
- Department of Pediatrics, the First Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Wen-Ze Wang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Jing Wang
- Department of Pediatrics, the First Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Qiu-Hong Wang
- Department of Pediatrics, the First Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Hui-Min Chen
- Center for Brain Disorders Research, Capital Medical University, Beijing Institute for Brain Disorders, Beijing, 100069, China
| | - Li-Ping Zou
- Department of Pediatrics, the First Medical Center of PLA General Hospital, Beijing, 100853, China. .,Center for Brain Disorders Research, Capital Medical University, Beijing Institute for Brain Disorders, Beijing, 100069, China.
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AlQazlan S, Albakr A, Al Towim A, Alsaadan Y, Hassan H, Aljerian K, Elwatidy S. Aggressive surgical management of recurrent intracranial juvenile xanthogranuloma: case report and review of the literature. Childs Nerv Syst 2020; 36:213-217. [PMID: 31385088 DOI: 10.1007/s00381-019-04323-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/28/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Juvenile xanthogranuloma (JXG) with the central nervous system (CNS) involvement is a rare disease entity that remains poorly understood, especially when the condition develops following treatment for Langerhans cell histiocytosis (LCH). CASE REPORT A 21-year-old man who was diagnosed with LCH at age 2, several years following which he developed signs and symptoms of CNS involvement. Magnetic resonance imaging (MRI) of the brain revealed JXG with bilateral choroid plexus involvement. As radiation therapy for the intraventricular masses proved unsuccessful, he underwent two surgical resections. In the following years, he developed another large JXG in the meninges, which was managed conservatively until he required surgery due to symptom progression. Twelve years after the first surgery, the patient is in stable condition with no evidence of recurrence. CONCLUSION Due to the rarity of JXG in the CNS, optimal treatment strategies and the precise duration of therapy remain to be determined. Future studies should aim to develop an appropriate treatment algorithm for such rare cases.
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Affiliation(s)
- Salman AlQazlan
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman Albakr
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia. .,Division of Neurosurgery, Department of Neurosciences, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada.
| | - Abdullah Al Towim
- Department of Neurosurgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Yazeed Alsaadan
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hamdy Hassan
- Department of Radiology and Medical Imaging, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khaldoon Aljerian
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sherif Elwatidy
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Saifaldein AA, Almahmoudi FH, Babgi RI, Alsammahi AA. A Subcutaneous Juvenile Xanthogranuloma in a 4-Year-Old Girl Who Presented with a Lower Eyelid Mass. Case Rep Ophthalmol 2019; 10:153-159. [PMID: 31692617 PMCID: PMC6760366 DOI: 10.1159/000500224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/08/2019] [Indexed: 11/19/2022] Open
Abstract
Juvenile xanthogranuloma (JXG) is a relatively uncommon, benign, histiocytic proliferative cutaneous disorder that typically affects children, with the head and neck being the most common sites. The present case report describes an isolated subcutaneous JXG in a 4-year-old girl who presented with a circumscribed oval mass located in the lower eyelid of the right eye. This lesion was histologically diagnosed as JXG after a surgical resection of the mass.
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Affiliation(s)
- Amjad A Saifaldein
- Department of Ophthalmology, KAMC - Ministry of Health, Jeddah, Saudi Arabia
| | - Faeeqah H Almahmoudi
- Department of Ophthalmology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Rafaa I Babgi
- Department of Ophthalmology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
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Höck M, Zelger B, Schweigmann G, Brunner B, Zelger B, Kropshofer G, Kiechl-Kohlendorfer U. The various clinical spectra of juvenile xanthogranuloma: imaging for two case reports and review of the literature. BMC Pediatr 2019; 19:128. [PMID: 31018833 PMCID: PMC6482499 DOI: 10.1186/s12887-019-1490-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/05/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Juvenile xanthogranuloma (JXG) belongs to the heterogeneous group of non-Langerhans cell histiocytosis and is caused by an accumulation and proliferation of macrophages. In the majority of cases JXG is a disorder of early childhood presenting during the first 2 years of life. The typical presentation is a solitary reddish or yellowish skin papule or nodule with spontaneous regression and no need for treatment. CASE PRESENTATION Two infants with an atypical presentation of JXG, one with multiple blueberry muffin rash-like skin lesions and the other with severe multi-systemic involvement, are reported. Diagnosis was established by skin biopsy including histological work-up and immunostaining, where markers for macrophages (CD68 and CD163) exhibited significant reactivity. CONCLUSION JXG is the most common of the non-Langerhans cell histiocytosis. The typical presentation is a solitary skin lesion. The purpose of this report is to familiarize paediatricians with an unusual variant of this entity in order to facilitate early diagnosis and raise awareness for possible visceral complications and associated medical conditions.
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Affiliation(s)
- Michaela Höck
- Department of Paediatrics II Neonatology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Bernhard Zelger
- Department of Dermatology and Venerology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gisela Schweigmann
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Barbara Brunner
- Department of Paediatrics II Neonatology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Bettina Zelger
- Department of Pathology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gabriele Kropshofer
- Department of Paediatrics I Oncology, Medical University of Innsbruck, Innsbruck, Austria
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Lee YI, Oh SH. Symmetrical Giant Facial Plaque-Type Juvenile Xanthogranuloma: A Case Report with a Successful Response to Fractional CO 2 Laser Treatment. Ann Dermatol 2019; 31:209-212. [PMID: 33911571 PMCID: PMC7992681 DOI: 10.5021/ad.2019.31.2.209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/09/2018] [Accepted: 03/14/2018] [Indexed: 11/08/2022] Open
Abstract
Symmetrical giant facial plaque-type juvenile xanthogranuloma (SGFP-JXG) is a rare variant of juvenile xanthogranuloma, reported only in two cases in the literature. We report a case of a 3-year-old Korean boy who developed bilateral yellowish indurated plaques on both cheeks since 1 year after birth. A skin biopsy revealed numerous foam cells and Touton type giant cells throughout the upper dermis, and its immunohistochemical studies resulted positive for CD68 and negative for S-100. The boy was therefore diagnosed as a persistent SGFP-JXG. As the lesion did not show any signs of spontaneous regression, we performed a single session of fractional ablative CO2 laser, which resulted in a significant reduction of the lesion. This is the first case report of a persistent SGFP-JXG on which a single ablative laser therapy was performed with a successful outcome.
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Affiliation(s)
- Young In Lee
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Ho Oh
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Rajasekhar R, Karthigeyan M, Salunke P, Gupta K. A novel fixation technique using anterior C1 screw in a pediatric solitary cervical spinal juvenile xanthogranuloma. Eur Spine J 2019; 28:56-60. [PMID: 30771048 DOI: 10.1007/s00586-019-05915-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/22/2018] [Accepted: 02/09/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE Juvenile xanthogranuloma (JXG) presenting as solitary vertebral body lesion is infrequently seen and usually limited to one or two levels. We report a case of an isolated JXG with extensive cervical spinal (bony and extradural) involvement in a 6-year-old child. There was a diagnostic dilemma as the radiologic and intraoperative picture resembled tuberculosis. The spinal reconstruction was also challenging due to involvement of multiple vertebral levels and necessitated an anterior C1 screw. METHODS The lytic lesion was multicompartmental, involving the craniovertebral junction and the subaxial spine (till C6 vertebral body) and extending into the retropharyngeal space. Noticeably, an associated thoracic syringomyelia was also present. Near-total excision of the lesion and 360° spinal fixation was performed using fibular strut graft. The graft was cranially anchored to the C1 anterior arch, thereby sharing the load with the posterior occipito-cervical instrumentation in order to avoid a construct failure due to cantilever effect. RESULTS At 12-month follow-up, the patient had good clinico-radiologic outcome with evidence of bony fusion and resolution of syrinx. CONCLUSION The report highlights the diagnostic dilemma of JXG lesion on both the radiology and surgery and discusses the challenges in the management and the relevant literature. The described technique can be a viable option in pediatric tumors with extensive C2 vertebral body involvement. Occasionally, extradural compression can have associated syrinx formation and the primary treatment per se could tackle the underlying syringomyelia.
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Affiliation(s)
- Rekhapalli Rajasekhar
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research (PGIMER), Sector 12, Chandigarh, 160012, India
| | - Madhivanan Karthigeyan
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research (PGIMER), Sector 12, Chandigarh, 160012, India.
| | - Pravin Salunke
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research (PGIMER), Sector 12, Chandigarh, 160012, India
| | - Kirti Gupta
- Department of Histopathology, PGIMER, Chandigarh, India
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Abstract
Juvenile xanthogranuloma (JXG) is a rare and benign tumor in infants. A solitary lesion on the eyelid has been reported in patients with JXG. We report a 15-year-old boy with multiple involvement of JXG on both eyelids. A mass on the left inner canthus was resected because of disturbance of the visual field and a risk of malignancy in terms of central ulceration in the lesion. The mass was examined by light microscopy. The mass had Touton giant cells with a wreath of nuclei surrounded by foamy histiocytes. No malignancy was observed. The mass showed no recurrence after resection.
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Affiliation(s)
- Hidetsugu Mori
- Department of Ophthalmology, Kansai Medical University, Osaka, Japan
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Wolfe C, El Ahmadieh TY, Aoun SG, Vance AZ, Hatanpaa KJ, Wohlfeld B. Intradural Juvenile Xanthogranuloma with Involvement of Multiple Nerve Roots: A Case Report and Review of the Literature. World Neurosurg 2018; 119:189-196. [PMID: 30096507 DOI: 10.1016/j.wneu.2018.07.273] [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: 06/06/2018] [Revised: 07/29/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Juvenile xanthogranuloma (JXG) is a rare, non-Langerhans cell histiocytic disorder that primarily presents as multiple cutaneous lesions in young males. Solitary lesions in the spinal column are an especially rare presentation of this disease, and central nervous system involvement can portend a poor prognosis. We report an unusual case of an adult woman with an unresectable JXG of the lumbar spine. A review of the reported cases of thoracolumbar JXG and the current data regarding diagnosis and treatment are presented. CASE DESCRIPTION A 28-year-old woman presented with back pain and worsening lower extremity pain, numbness, and weakness. Magnetic resonance imaging demonstrated an enhancing lumbar mass. However, at surgery, no discrete mass was identified. Multiple roots were grossly enlarged, and electrical stimulation identified the L4 root with the most abnormal findings. Despite an attempt at debulking, most of the mass could not be safely removed. The patient experienced incomplete improvement of the symptoms postoperatively but elected to forgo chemotherapy. The 3-month follow-up imaging study showed active lumbar spinal disease, and imaging and follow-up examinations at 27 months revealed no changes. Her symptoms were satisfactorily controlled with conservative therapy. CONCLUSIONS JXG of the spine is a rare disease with nonspecific clinical and radiographic findings that can make it difficult to diagnose and dictates the use of immunohistochemical staining. If possible, total surgical resection will offer the best outcomes; however, other modalities such as chemotherapy can be viable alternatives or adjuvant modalities.
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Affiliation(s)
- Cody Wolfe
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, School of Medicine, Dallas, Texas, USA
| | - Tarek Y El Ahmadieh
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Salah G Aoun
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Awais Z Vance
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kimmo J Hatanpaa
- Department of Pathology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Bryan Wohlfeld
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Lee TK, Jung TY, Baek HJ, Kim SK, Lee KH, Yun SJ. Disseminated juvenile xanthogranuloma occurring after treatment of Langerhans cell histiocytosis: a case report. Childs Nerv Syst 2018; 34:765-770. [PMID: 29209883 DOI: 10.1007/s00381-017-3675-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 11/27/2017] [Indexed: 10/18/2022]
Abstract
CASE PRESENTATION An 11-year-old boy presented with a complaint of a painful temporal mass. Brain magnetic resonance imaging (MRI) showed a 3-cm-sized, homogeneously enhancing mass in the greater wing of the left sphenoid bone, which was diagnosed as Langerhans cell histiocytosis (LCH). Chemotherapy with vincristine and prednisolone was performed for 1 year. After 1 year and 11 months off treatment, he developed symptoms such as polydipsia and polyuria. Brain MRI showed thickening of the pituitary stalk with enhancement, suggestive of LCH involvement, and no recurrence in the sphenoid bone. After 4 years and 4 months off treatment, he developed multiple, subcutaneous, asymptomatic, and yellowish variable-sized papules on his face, posterior neck, and back, which were pathologically diagnosed as juvenile xanthogranuloma (JXG). Brain MRI revealed multifocal enhancing skull lesions in the left parietal, right frontal, and left occipital bones, which were also diagnosed as JXG. After 5 years and 8 months off treatment, the number of variable-sized skin lesions was increased without changes in the lesions in the skull and pituitary stalk. CONCLUSION We report a case of disseminated JXG occurring after treatment of LCH. These clinical co-presentations suggested a close relationship between their pathogenesis.
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Affiliation(s)
- Tae-Kyu Lee
- Department of Neurosurgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, 160, Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, Republic of Korea
| | - Tae-Young Jung
- Department of Neurosurgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, 160, Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, Republic of Korea.
| | - Hee-Jo Baek
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, 160, Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, Republic of Korea.
| | - Seul-Kee Kim
- Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Kyung-Hwa Lee
- Department of Pathology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Jeollanam-do, Republic of Korea
| | - Sook Jung Yun
- Department of Dermatology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Jeollanam-do, Republic of Korea
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Ram R, Marolf MD, Chévez-Barrios P, Herce HH. Juvenile Xanthogranuloma in a Pediatric Patient with Langerhans Cell Histiocytosis. Ocul Oncol Pathol 2017; 4:141-144. [PMID: 29765943 DOI: 10.1159/000479524] [Citation(s) in RCA: 5] [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: 06/07/2017] [Revised: 07/11/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose To report a case of juvenile xanthogranuloma that simulated a chalazion and to discuss the association between juvenile xanthogranuloma and Langerhans cell histiocytosis. Method Case report and review of literature. Results A 13-year-old boy with a prior history of Langerhans cell histiocytosis was referred to our clinic for a possible chalazion. The patient had undergone treatment for Langerhans cell histiocytosis 10 years prior. The patient underwent an excisional biopsy. Histopathology revealed a proliferation of histiocytes and lymphocytes with Touton giant cells, consistent with a diagnosis of juvenile xanthogranuloma. Conclusions Though the relationship between Langerhans cell histiocytosis and juvenile xanthogranuloma has yet to be fully elucidated, juvenile xanthogranuloma should be included in the differential diagnosis for any former Langerhans cell histiocytosis patient presenting with a new cutaneous lesion.
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Affiliation(s)
- Radha Ram
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA.,Department of Ophthalmology, Texas Children's Hospital, Houston, TX, USA
| | - Marissa D Marolf
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
| | - Patricia Chévez-Barrios
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA.,Department of Pathology and Genomic Medicine and Ophthalmology, Houston Methodist Hospital, Houston, TX, USA
| | - Honey H Herce
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA.,Department of Ophthalmology, Texas Children's Hospital, Houston, TX, USA
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Pirillo V, Prontera A, Rizzo P, Cecchi PC, Maffei M, Schwarz A. A rare case of intramedullary solitary juvenile xanthogranuloma of the lumbar spine in the adult: a case report. J Spine Surg 2017; 3:504-508. [PMID: 29057365 DOI: 10.21037/jss.2017.08.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Solitary juvenile xanthogranuloma (SJX) of the spine is an extremely rare proliferative histiocytic disorder with only few cases reported in literature. We present the first case of intramedullary spinal SJX. A 22-year-old male presented with a nine-month history of progressively worsening sphincteric disturbances and saddle hypoesthesia. Magnetic resonance imaging showed an intra-axial lesion located in the conus medullaris; T1 hypointense, T2 iso-hyperintense and uniformly enhancing after contrast administration. The lesion was removed through a T12-L1 laminectomy and a median myelotomy with neurophysiological monitoring. Histological examination and immunohistochemical testing confirmed the diagnosis of SJX. Due to the intramedullary localization and the absence of a clear cleavage plane, radical removal was not possible. The tumor subsequently recurred and new surgical procedures were necessary followed by adjuvant radiotherapy. Patient made good neurological recovery. Three years after the latest treatment, MRI showed no recurrence. In accordance with the literature, the treatment of choice for SJX its radical removal, or subtotal removal followed by adjuvant radiotherapy.
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Affiliation(s)
- Vania Pirillo
- Department of Neurosurgery, S. Maurizio Hospital, Bolzano, Italy
| | - Andrea Prontera
- Department of Neurosurgery, S. Maurizio Hospital, Bolzano, Italy
| | - Paolo Rizzo
- Department of Neurosurgery, S. Maurizio Hospital, Bolzano, Italy
| | | | - Martin Maffei
- Department of Radiation Oncology, S. Maurizio Hospital, Bolzano, Italy
| | - Andreas Schwarz
- Department of Neurosurgery, S. Maurizio Hospital, Bolzano, Italy
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Ramos Suárez A, Ayet Roger I, Serra Castanera A. Neonatal glaucoma associated with juvenile xanthogranuloma: Case report. Arch Soc Esp Oftalmol 2017; 92:394-397. [PMID: 28522113 DOI: 10.1016/j.oftal.2017.02.012] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 02/20/2017] [Accepted: 02/20/2017] [Indexed: 06/07/2023]
Abstract
CASE REPORT The case concerns a 22 day-old male child with juvenile xanthogranuloma (JXG), which manifested as a unilateral glaucoma and with fibrinous haemorrhagic exudate in the anterior chamber affecting the angle of the right eye. Despite a high level of suspicion, the definitive diagnosis was not possible until the infant reached the age of 10 months, after the appearance of the skin lesions typical of this condition and histopathological study of them. CONCLUSION JXG is a rare disease, characterised by yellowish skin lesions on the trunk, neck, or head. Up to 10% of cases will have ocular involvement, which is the most common extracutaneous manifestation of the disease.
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Affiliation(s)
- A Ramos Suárez
- Servicio de Oftalmología, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España; Departamento de Oftalmología, Hospital Costa del Sol, Marbella, Málaga, España.
| | - I Ayet Roger
- Servicio de Oftalmología, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - A Serra Castanera
- Servicio de Oftalmología, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
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Techavichit P, Sosothikul D, Chaichana T, Teerapakpinyo C, Thorner PS, Shuangshoti S. BRAF V600E mutation in pediatric intracranial and cranial juvenile xanthogranuloma. Hum Pathol 2017; 69:118-122. [PMID: 28504206 DOI: 10.1016/j.humpath.2017.04.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 04/07/2017] [Indexed: 11/15/2022]
Abstract
Juvenile xanthogranuloma (JXG) is a cutaneous form of non-Langerhans cell histiocytosis, primarily affecting children. The lesion is presumed to originate from either macrophages or dermal dendritic cells. JXG can rarely present as an isolated intracranial lesion and, in contrast to the dismal outcome of patients with systemic disease, cranial JXG has been shown to carry a more favorable prognosis. Here, we report for the first time 3 pediatric cases of JXG with a BRAF V600E mutation, 2 with intracranial lesions and 1 with cranial lesions. Although these intracranial/cranial lesions have been referred to as JXG, they likely differ from cutaneous JXG in both the clinical features and BRAF status. It may be more appropriate to classify intracranial/cranial JXG in the same group as Langerhans cell histiocytosis and Erdheim-Chester disease, which also have a BRAF V600E mutation. Further study of BRAF status in a larger series of JXG is warranted.
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Affiliation(s)
- Piti Techavichit
- Division of Hematology and Oncology, Department of Pediatric, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Darintr Sosothikul
- Division of Hematology and Oncology, Department of Pediatric, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Thiamjit Chaichana
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Chinachote Teerapakpinyo
- Chulolongkorn GenePRO Center, Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Paul Scott Thorner
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand; Department of Laboratory Medicine, Hospital for Sick Children and University of Toronto, Toronto M5G 1X8, Canada
| | - Shanop Shuangshoti
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand; Chulolongkorn GenePRO Center, Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
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Matsubara K, Mori H, Hirai N, Yasukawa K, Honda T, Takanashi JI. Elevated taurine and glutamate in cerebral juvenile xanthogranuloma on MR spectroscopy. Brain Dev 2016; 38:964-967. [PMID: 27435377 DOI: 10.1016/j.braindev.2016.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 06/24/2016] [Accepted: 07/04/2016] [Indexed: 10/21/2022]
Abstract
MRI in a 2-year-old female presenting afebrile seizures and left blepharoptosis revealed multiple well-marginated round-shaped lesions, isointensity to gray matter on T1- and T2-weighted images with homogenously reduced diffusion and diffuse contrast enhancement. MRS revealed elevation of taurine, choline and glutamate, and reduction of N-acetylaspartate. A brain biopsy confirmed a diagnosis of juvenile xanthogranuloma (JXG). JXG should be considered when MR spectroscopy shows elevated taurine and glutamate, which has only previously been reported in medulloblastomas.
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Affiliation(s)
- Ken Matsubara
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Japan
| | - Harushi Mori
- Department of Radiology, Graduate School and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nozomi Hirai
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Japan
| | - Kumi Yasukawa
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Japan
| | - Takafumi Honda
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Japan
| | - Jun-Ichi Takanashi
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Japan.
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Abstract
We herein report a case of hair follicle nevus, a rare hamartoma found on the face and showing follicular differentiation, which was associated with sebaceous hyperplasia. Dermoscopy of the lesion showed yellow globules surrounded by crown vessels/telangiectasias and scattered tiny hairs. Histopathological investigation revealed hyperplasia of the sebaceous glands and proliferation of well-differentiated vellus hair follicles. These pathological findings were thought to correspond to the yellowish globules and tiny hairs observed under dermoscopy. Hair follicle nevus associated with sebaceous hyperplasia is extremely rare; however, dermoscopic examination can suggest an appropriate diagnosis. The present case proved the diagnostic usefulness of dermoscopy for cutaneous tumors with hair follicular and sebaceous glandular differentiation.
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Affiliation(s)
- Kazutoshi Harada
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Yuichiro Kato
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Yukihiko Kato
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Ryoji Tsuboi
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
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Hernández-Martín A, Duat-Rodríguez A. An Update on Neurofibromatosis Type 1: Not Just Café-au-Lait Spots and Freckling. Part II. Other Skin Manifestations Characteristic of NF1. NF1 and Cancer. Actas Dermosifiliogr 2016; 107:465-73. [PMID: 26956402 DOI: 10.1016/j.ad.2016.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 11/16/2015] [Revised: 01/07/2016] [Accepted: 01/17/2016] [Indexed: 12/16/2022] Open
Abstract
Neurofibromatosis type 1 (NF1) is the most common neurocutaneous syndrome and probably the one best known to dermatologists. Although the genetic locus of NF1 was identified on chromosome 17 in 1987, diagnosis of the disease is still based primarily on clinical observations. The 7 diagnostic criteria of the National Institutes of Health, which were established in 1988, include 3 skin manifestations (café-au-lait spots, freckling on flexural areas, and cutaneous neurofibromas). The age at which these diagnostic lesions appear is variable: onset can be late in some patients while others never develop certain symptoms. Definitive diagnosis may therefore be delayed by years. Although the appearance of the characteristic café-au-lait spots and freckling in the early years of childhood are very suggestive of the disease, these signs are not pathognomonic and, in isolation, do not constitute sufficient evidence to establish a definitive diagnosis. Thus, other diagnoses should be considered in patients whose only symptoms are café-au-lait spots and freckling. By contrast, the presence of multiple cutaneous neurofibromas or at least 1 plexiform neurofibroma is a very specific indication of NF1. Identification of the different types of neurofibroma allows us to confirm the diagnosis and initiate appropriate management.
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Affiliation(s)
- A Hernández-Martín
- Servicio de Dermatología Hospital Infantil del Niño Jesús. Madrid, España.
| | - A Duat-Rodríguez
- Servicio de Neurología, Hospital Infantil del Niño Jesús, Madrid, España
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Pfeifer K, Mian A, Adebowale A, Alomari A, Kalra V, Krejci E, Shin MS. Radiographic and Pathologic Manifestations of Uncommon and Rare Pulmonary Lesions. Can Assoc Radiol J 2015; 67:179-89. [PMID: 26690551 DOI: 10.1016/j.carj.2015.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 03/26/2015] [Revised: 07/07/2015] [Accepted: 07/28/2015] [Indexed: 12/21/2022] Open
Abstract
Pulmonary opacities/nodules are common findings on computed tomography examinations, which may represent an underlying infections or malignancy. However, not every pulmonary nodule or opacity represents malignancy or infection. We present a pictorial essay illustrating common as well as obscure noninfectious, nonmalignant pulmonary lesions. Lesions discussed include organizing pneumonia, Langerhans cell histiocytosis, pulmonary amyloidosis, hyalinizing granuloma, tumourlet (benign localized neuroendocrine cell proliferations), atypical alveolar hyperplasia, inflammatory myofibroblastic tumour, papillary alveolar adenoma, plasma cell granuloma, juvenile xanthogranuloma, and sclerosing hemangiomas. We discuss the clinical presentation, prevalence, radiographic clues, pathology, and diagnostic pitfalls of these rare lesions.
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Affiliation(s)
- Kyle Pfeifer
- Department of Radiology, Yale New Haven Hospital, New Haven, Connecticut, USA.
| | - Ali Mian
- Department of Radiology, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Adeniran Adebowale
- Department of Pathology, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Ahmed Alomari
- Department of Pathology, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Vivek Kalra
- Department of Radiology, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Elise Krejci
- Department of Pathology, Lawrence and Memorial Hospital, New London, Connecticut, USA
| | - Myung Soo Shin
- Department of Radiology, Yale New Haven Hospital, New Haven, Connecticut, USA
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Abstract
Juvenile xanthogranuloma (JXG) is the most common form of non-Langerhans cell histiocytic lesion, characterized by benign, usually asymptomatic, self-healing yellowish brown papulonodular lesions of skin and other organs in the absence of metabolic disorder. The cells of origin of JXG are dermal dendrocytic cells. Histopathologically there is dermal infiltration of foamy or non-foamy histiocytes with or without giant cell. Immunohistochemistry shows CD68 positivity with CD1a and S-100 negativity of lesional cells although S-100-positive JXG have been reported. JXG may be associated with neurofibromatosis type one (NF 1) with increased risk of juvenile chronic myelogenous leukemia and other hematological malignancies. Our case was S-100 immunoreactive multiple, cutaneous JXGs with NF 1 without any visceral involvement or malignant complication. We are presenting this case due to its rarity.
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Affiliation(s)
- Chinmay Kar
- Department of Dermatology, Malda Medical College and Hospital, Malda, West Bengal, India
| | - Kapildev Das
- Department of Dermatology, Malda Medical College and Hospital, Malda, West Bengal, India
| | - Jayanta K Barua
- Department of Dermatology, Malda Medical College and Hospital, Malda, West Bengal, India
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Shibuya R, Tanizaki H, Kaku Y, Yonezawa M, Ryu Y, Otsuka A, Kabashima K, Miyachi Y. A plaque-type solitary reticulohistiocytoma in a two-year-old boy. Case Rep Dermatol 2015; 7:7-9. [PMID: 25759651 PMCID: PMC4327552 DOI: 10.1159/000371733] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Reticulohistiocytoma (RH) is a dermal histiocytic infiltration composed of large histiocytes with eosinophilic glassy cytoplasm. RH is classified into three clinical forms: solitary RH, diffuse cutaneous RH without systemic involvement and multicentric reticulohistiocytosis with systemic diseases. Solitary RH generally manifests as a nodular lesion in adults without accompanying systemic diseases. Herein, we describe a case of solitary RH with an atypical clinical manifestation as a red-brown-colored plaque in a 2-year-old boy. Atypical presentations of RH may pose diagnostic difficulty unless RH is considered. A correct diagnosis of RH can ensure avoidance of unnecessary invasive procedures.
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Affiliation(s)
- Rintaro Shibuya
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hideaki Tanizaki
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan ; Department of Dermatology, Nagahama Red Cross Hospital, Nagahama, Japan
| | - Yo Kaku
- Department of Dermatology, Nagahama Red Cross Hospital, Nagahama, Japan
| | - Masao Yonezawa
- Department of Dermatology, Nagahama Red Cross Hospital, Nagahama, Japan
| | - Yuri Ryu
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan ; Department of Dermatology, Nagahama Red Cross Hospital, Nagahama, Japan
| | - Atsushi Otsuka
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Kabashima
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshiki Miyachi
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Zhi Y, Duan Y, Zhang H, Yin X, Qu T, Guan G, Su L, Dong Q. Solitary juvenile xanthogranuloma with tibial involvement: a case report. Int J Clin Exp Pathol 2015; 8:164-170. [PMID: 25755703 PMCID: PMC4348839] [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] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 11/01/2014] [Indexed: 06/04/2023]
Abstract
Juvenile xanthogranuloma (JXG) is a rare disease that is part of a spectrum of histiocytic dendritic cell disorders. Most patients present with a solitary cutaneous lesion; however, others present with extracutaneous manifestations or even with systemic involvement. We present the first report of an 11-month-old girl in whom was diagnosed a unifocal extracutaneous JXG involving the tibia. Histological and immunohistochemical staining results are presented. A review of the literature on these unusual lesions is conducted, along with discussion of their differential diagnosis and key aspects of the patient's evaluation, management, and pathological diagnosis.
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Affiliation(s)
- Yunlai Zhi
- Department of Pediatric Surgery, The Affiliated Hospital of Qingdao UniversityQingdao, Shandong, China
| | - Yuhe Duan
- Department of Pediatric Surgery, The Affiliated Hospital of Qingdao UniversityQingdao, Shandong, China
| | - Hong Zhang
- Department of Pediatric Surgery, The Affiliated Hospital of Qingdao UniversityQingdao, Shandong, China
| | - Xiaofeng Yin
- Department of Neurosurgery, The Affiliated Hospital of Qingdao UniversityQingdao, Shandong, China
| | - Tingting Qu
- Department of Pathology, The Affiliated Hospital of Qingdao UniversityQingdao, Shandong, China
| | - Ge Guan
- Department of Organ Transplantation Center, The Affiliated Hospital of Qingdao UniversityQingdao, Shandong, China
| | - Lin Su
- Digital Computer-aided Medicine and Surgery Key Laboratory, The Affiliated Hospital of Qingdao UniversityQingdao, Shandong, China
| | - Qian Dong
- Department of Pediatric Surgery, The Affiliated Hospital of Qingdao UniversityQingdao, Shandong, China
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Vanotti S, Chiaverini C, Rostain G, Cardot-Leccia N, Lacour JP. [Localized eruptive juvenile xanthogranuloma]. Ann Dermatol Venereol 2014; 141:206-10. [PMID: 24635955 DOI: 10.1016/j.annder.2013.10.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 05/15/2013] [Revised: 06/29/2013] [Accepted: 10/29/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Juvenile xanthogranuloma (JXG) is a non-Langerhans histiocytosis of young children characterized by solitary or multiple yellowish cutaneous nodules. Atypical skin lesions such as lichenoid eruptions, and pedunculated, maculopapular, plaque-like or linear lesions have been described. We report a case of eruptive XGJ en plaque in the left leg in an infant. PATIENTS AND METHODS A 13-month-old child presented asymptomatic eruptive, yellowish papules of the leg measuring 5 to 10mm since the age of 2months. There was no cutaneous infiltration between the lesions. Darier's sign was negative. Histological examination confirmed the diagnosis of JXG. The course of the disease comprised a gradual decrease in the number of active lesions with slight residual pigmentation. DISCUSSION Our case was suggestive of JXG en plaque. Only 7 cases have been reported in the literature, all appearing before the age of 5months. The lesions corresponded mostly to an asymptomatic erythematous plaque studded with small yellowish/red nodules of variable localisation. Spontaneous involvement was noted in all cases. No systemic involvement was found. Herein we present a unique case of localised multiple JXG without evident clinical infiltrating plaque progressing with self-resolving flares.
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Affiliation(s)
- S Vanotti
- Service de dermatologie, hôpital Archet-2, CHU de Nice, BP 3079, 06202 Nice, France; Service de pédiatrie, hôpital Fondation Lenval, CHU, 57, avenue de la Californie, 06200 Nice, France
| | - C Chiaverini
- Service de dermatologie, hôpital Archet-2, CHU de Nice, BP 3079, 06202 Nice, France; Service de pédiatrie, hôpital Fondation Lenval, CHU, 57, avenue de la Californie, 06200 Nice, France.
| | - G Rostain
- Cabinet de dermatologie, 11, rue Chateauneuf, 06100 Nice, France
| | - N Cardot-Leccia
- Laboratoire d'anatomie pathologique, hôpital Pasteur, CHU de Nice, 30, avenue de la Voie-Romaine, 06000 Nice, France
| | - J-P Lacour
- Service de dermatologie, hôpital Archet-2, CHU de Nice, BP 3079, 06202 Nice, France; Faculté de médecine, université de Nice Sofia Antipolis, 28, avenue de Valombrose, 06107 Nice cedex 2, France
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Castro-Gómez M, Villena-Irigoyen O, Caballero-González S, Vergara Alcaide E. [ Juvenile xanthogranuloma of the corneoscleral limbus in adults]. ACTA ACUST UNITED AC 2013; 89:242-4. [PMID: 24269431 DOI: 10.1016/j.oftal.2013.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/06/2013] [Revised: 05/16/2013] [Accepted: 05/27/2013] [Indexed: 10/26/2022]
Abstract
CASE REPORT A 25-year-old woman noticed a painless yellow-orange mass on her right eye. Her visual acuity was 20/20 in both eyes, and a slit-lamp examination showed a yellow-orange mass located at the superior limbus of the right eye. No other ocular abnormalities were observed. DISCUSSION Surgical excision was carried out and the lesion was sent for histological examination. This showed a granulomatous lesion, rich in Touton-type giant cells, features that are strongly suggestive of juvenile xanthogranuloma (JXG). Ocular involvement occurs in 10% of cases of JXG.
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Affiliation(s)
- M Castro-Gómez
- Servicio de Oftalmología, Hospital Santa Ana, Motril, Granada, España.
| | | | | | - E Vergara Alcaide
- Servicio de Anatomía Patológica, Hospital General de Baza, Granada, España
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Abstract
Histiocytic disorders represent a group of complex pathologies characterized by the accumulation of histiocytes, an old term for tissue-resident macrophages and dendritic cells. Langerhans cell histiocytosis is the most frequent of histiocytosis in humans and has been thought to arise from the abnormal accumulation of epidermal dendritic cells called Langerhans cells. In this chapter, we discuss the origin and differentiation of Langerhans cells and dendritic cells and present accumulated evidence that suggests that Langerhans cell histiocytosis does not result from abnormal Langerhans cell homeostasis but rather is a consequence of misguided differentiation programs of myeloid dendritic cell precursors. We propose reclassification of Langerhans cell histiocytosis, juvenile xanthogranuloma, and Erdheim-Chester disease as inflammatory myeloid neoplasias.
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49
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Lee SJ, Jo DJ, Lee SH, Kim SM. Solitary xanthogranuloma of the upper cervical spine in a male adult. J Korean Neurosurg Soc 2012; 51:54-8. [PMID: 22396846 PMCID: PMC3291709 DOI: 10.3340/jkns.2012.51.1.54] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 07/04/2011] [Accepted: 01/08/2012] [Indexed: 11/27/2022] Open
Abstract
We present the rare case of solitary xanthogranuloma in the upper cervical column mimicking a Brown-Sequard syndrome. A 29-year-old man complained with right hemiparesis and left hypoesthesia after a car accident. Computed tomography and magnetic resonance images revealed a lobulated homogenously well-enhancing mass in between posterior arch of the atlas (C1) and spinous process of the axis (C2) resulting in a marked spinal canal narrowing with cortical erosions. The patient was managed by complete resection of the tumor with partial laminectomy with lower half of C1 posterior arch and upper half of C2 spinous process. The authors advise complete removal of the xanthogranuloma and consideration as a differential diagnosis of lesions among upper cervical lesions.
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Affiliation(s)
- Sun Joo Lee
- Department Neurosurgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
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50
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Koca R, Bektaş S, Altinyazar HC, Sezer T. Benign cephalic histiocytosis: a case report. Ann Dermatol 2011; 23:508-11. [PMID: 22148022 PMCID: PMC3229948 DOI: 10.5021/ad.2011.23.4.508] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 12/06/2010] [Accepted: 12/06/2010] [Indexed: 11/23/2022] Open
Abstract
Histiocytic skin disorders are usually classified as either Langerhans' cell histiocytosis (LCH) or non LCH, based on the pathology. Benign cephalic histiocytosis (BCH) is a rare type of non-Langerhans histiocytitic disorder and is characterized by self-healing multiple small eruptions of yellow to red-brown papules on the face and upper trunk. Histologic features of this disorder show dermal proliferation of histiocytes that have intracytoplasmic comma-shaped bodies, coated vesicles and desmosome-like structures. In this study, we report on a 7-month-old boy who contained small yellow-red papules on his face that spread to his upper trunk. The clinical and histologic features in this patient were consistent with BCH.
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Affiliation(s)
- Rafet Koca
- Department of Dermatology, Faculty of Medicine, Zonguldak Karaelmas University, Zonguldak, Turkey
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