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Mohanty P, Sahoo N, Lenka A, Bhattacharyya S. Unusual presentation of Langerhans cell sarcoma as bilateral submandibular gland swelling - A rare case report. Indian J Cancer 2022; 59:123-127. [PMID: 35645054 DOI: 10.4103/ijc.ijc_819_20] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Langerhans cell sarcoma (LCS) is a rare malignant tumor of Langerhans cells and uncommonly involves head and neck regions. Unlike Langerhans cell histiocytosis (LCH), it has an aggressive clinical course with malignant cytological features. Till now, a handful of cases have been reported and the common anatomical sites involved are skin, lymph node, and bone in loco - regional cases and lymph node, lung, liver, spleen, and bone in disseminated disease. Due to its rarity, standard protocols of treatment for these patients are not yet well established. Herein, we report such a case in a 25-year-old male presenting with a bilateral submandibular swelling, which was diagnosed as LCH on Fine Needle Aspiration Cytology (FNAC) and later confirmed to be a case of LCS in histopathological examination and immunohistochemistry. The authors are aware of only a single similar case being reported in the English literature.
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Affiliation(s)
- Pranita Mohanty
- Department of Pathology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
| | - Nibedita Sahoo
- Department of Pathology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
| | - Anasuya Lenka
- Department of Pathology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
| | - Suvodip Bhattacharyya
- Department of Pathology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
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Madakshira MG, Sharma N, Malhotra P, Bal A. Langerhans cell sarcoma with BRAF-V600E mutation and hemophagocytosis: An autopsy report. Indian J Cancer 2022; 59:119-122. [PMID: 35645053 DOI: 10.4103/ijc.ijc_749_20] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Langerhans cell sarcoma (LCS) is a rare high-grade neoplasm of langerhans cell phenotype having unambiguous malignant cytological features. We report such a rare case in a 20-year-old man who presented with dyspnea and high-grade fever. On evaluation, he had generalized lymphadenopathy, hepatosplenomegaly, and a large anterior mediastinal mass. Fine needle aspiration from the mediastinal mass and bone marrow aspirate showed numerous atypical cells, many of which showed grooved nuclei. In addition, the bone marrow showed prominent hemophagocytosis. The patient had a stormy hospital stay and succumbed to the illness. The autopsy revealed a rare multisystem involvement by LCS involving the lymph nodes, liver, spleen, lungs, and intestine, which harbored a BRAFV600E mutation and was associated with hemophagocytosis.
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Affiliation(s)
- Manoj G Madakshira
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Navneet Sharma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Internal Medicine and Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amanjit Bal
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Jouenne F, Reger de Moura C, Lorillon G, Meignin V, Dumaz N, Lebbe C, Mourah S, Tazi A. RASA1 loss in a BRAF-mutated Langerhans cell sarcoma: a mechanism of resistance to BRAF inhibitor. Ann Oncol 2019; 30:1170-1172. [PMID: 30977771 DOI: 10.1093/annonc/mdz125] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F Jouenne
- Paris-Diderot University, Sorbonne Cité, Paris; UMR_S976, INSERM, Paris; Pharmacogenomics Department
| | | | - G Lorillon
- Pulmonology Department, National Reference Centre for Histiocytoses
| | - V Meignin
- Pathology Department, INSERM, UMR_S1165
| | | | - C Lebbe
- Paris-Diderot University, Sorbonne Cité, Paris; UMR_S976, INSERM, Paris; Department of Dermatology Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - S Mourah
- Paris-Diderot University, Sorbonne Cité, Paris; UMR_S976, INSERM, Paris; Pharmacogenomics Department
| | - A Tazi
- Paris-Diderot University, Sorbonne Cité, Paris; UMR_S976, INSERM, Paris; Pulmonology Department, National Reference Centre for Histiocytoses.
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Abstract
RATIONALE Langerhans cell sarcoma (LCS) is a rare, high-grade neoplasm characterized by overtly malignant cytologic features and a poor prognosis. Herein, we present a rare case of langerhans cell histiocytosis (LCH) that later transformed into langerhans cell sarcoma 11 months after the benign mass was excised from soft tissue in the right groin. PATIENT CONCERNS A 41-year-old patient who presented with a mass in the right groin for 3 years earlier after being bitten by ants. DIAGNOSES The patient was diagnosed with langerhans cell sarcoma arising from antecedent langerhans cell histiocytosis. INTERVENTIONS The patient underwent with 6 cycles of a modified etoposide, cyclophosphamide, vindesine, dexamethasone (E-CHOP) regimen. OUTCOMES The patient is currently receiving follow-up care. LESSONS LCH transformed into LCS is a rare case. E-CHOP as an effective first-line therapy to treat LCS cases, but, the mechanism is unclear. Due to their rarity, further data on clinical outcomes are necessary to establish the optimal treatment strategy for LCS.
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Affiliation(s)
- Wu Yi
- Department of Haematology
| | | | | | | | - Wen-na Liang
- Department of Nephrology, Zhejiang Provincial People's Hospital, People's Hospital Of Hangzhou Medical College, Hangzhou, China
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Kim SW, Choi MK, Han HS, Song H, Koh Y, Son SM, Lee OJ, Lee JY, Lee KM, Lee KH, Kwon J. A Case of Pulmonary Langerhans Cell Sarcoma Simultaneously Diagnosed with Cutaneous Langerhans Cell Histiocytosis Studied by Whole-Exome Sequencing. Acta Haematol 2017; 138:24-30. [PMID: 28614815 DOI: 10.1159/000476026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 10/26/2016] [Accepted: 04/24/2017] [Indexed: 12/18/2022]
Abstract
Langerhans cell histiocytosis (LCH) and Langerhans cell sarcoma (LCS) are clonal proliferations of Langerhans-type cells. Unlike in LCH, the pathophysiology and clinical course of LCS are unclear due to its rarity. Here, we report the case of a 73-year-old male patient who was diagnosed with cutaneous LCH and pulmonary LCS at the same time. Pathological review of these 2 tumors revealed similar immunohistochemical findings. However, the tumor cells in LCS had more aggressive cytological features than those in LCH. Results of BRAF mutation analysis using real-time PCR were negative for both tumors. In whole-exome sequencing (WES), stop-gain mutations in TP53 gene were discovered only in LCS cells. The mechanism of development of LCS from various progenitor cells is currently unclear. According to the results of the WES study, changes in TP53 gene might have contributed to the malignant features of LCS.
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Affiliation(s)
- Si-Wook Kim
- Department of Thoracic and Cardiovascular Surgery, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
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Gagnon AL, Daniel S, Greer K, Patterson JW, Tchernev G, Chokoeva AA, Wollina U, Lotti T, Fioranelli M, Roccia MG, Guarneri C, Aguilera N. Langerhans cell sarcoma: an unusual microscopic presentation. J BIOL REG HOMEOS AG 2016; 30:39-43. [PMID: 27373133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 70-year-old Caucasian male presented to our clinic for a pruritic eruption progressing over several months. He complained of fatigue with a 20-pound weight loss over the past year. On presentation, the patient had browny-yellow to violaceous, purpuric, macular and papular lesions on the legs, arms, lower abdomen and back. Initial biopsy showed an angiocentric infiltrate with a suggestion of intraluminal proliferation; CD31 and Fli-1 positivity suggested either reactive angioendotheliomatosis or an unusual intravascular histiocytosis. Further excisional biopsies demonstrated perivascular collections of cells with ample cytoplasm, prominent nuclear pleomorphism and mitotic activity. The nuclei demonstrated nuclear folding, grooves and indentations. The atypical cells were S100, CD1a and CD56 positive with immunohistochemistry. A diagnosis of Langerhans cell sarcoma (LCS) was made. LCS is a rare, aggressive malignancy that can involve multiple organs including the skin, lymph nodes, lung, bone marrow, spleen, heart, and brain. The skin and lymph nodes are commonly involved, and the cutaneous presentation varies greatly. Immunohistochemistry characteristically shows CD1a and S100 positivity. CD56 expression is uncommon and often portends a poor prognosis. There is no established treatment of LCS due to its rarity. Surgery, radiation, and chemotherapy have been used with varied outcomes. Our patient was treated with prednisone with improvement of cutaneous disease. He did not develop systemic involvement, but died 1.5 years later from complications associated with heart failure. Langerhans cell sarcoma should be considered when faced with an unusual angiocentric infiltrate in which initial immunohistochemical staining results may be misleading.
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Affiliation(s)
- A L Gagnon
- Department of Dermatology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - S Daniel
- Departments of Pathology and Dermatology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - K Greer
- Department of Dermatology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - J W Patterson
- Departments of Pathology and Dermatology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - G Tchernev
- Medical Institute of Ministry of Interior (MVR-Sofia), Department of Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - A A Chokoeva
- Onkoderma- Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria; Department of Dermatology and Venereology, Medical University of Plovdiv, Medical Faculty, Plovdiv, Bulgaria
| | - U Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - T Lotti
- Department of Dermatology, University of Rome G. Marconi Rome, Italy
| | - M Fioranelli
- History Department, G. Marconi University, Rome, Italy
| | - M G Roccia
- University B.I.S. Group of Institutions, Punjab Technical University, Punjab, India
| | - C Guarneri
- Department of Clinical and Experimental Medicine, Unit of Dermatology University Hospital of Messina, Messina, Italy
| | - N Aguilera
- Department of Pathology, University of Virginia Health System, Charlottesville, Virginia, USA
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Ren JJ, Zhao Y, Liu MJ, Liu G, Chen F. Langerhans cell sarcoma arising from the root of tongue: a rare case. Int J Clin Exp Pathol 2015; 8:15312-15315. [PMID: 26823886 PMCID: PMC4713672] [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: 09/16/2015] [Accepted: 10/24/2015] [Indexed: 06/05/2023]
Abstract
Langerhans cell sarcoma (LCS), a rare malignant disease with markedly malignant cytological features and poor outcome, originates from Langerhans cells and most commonly affects the lymph nodes, skin, and bone. This paper presents the case of a 58-year-old female with LCS at the root of her tongue, with neither local recurrence nor distant metastasis observed during 47 months of follow up following radiotherapy for more than one month after complete tumor resection. Histological and immunophenotypic tests revealed that the malignant tumor cells were positive for S-100 protein, CD1a, and LCA, and partially positive for CD3ε. By contrast, the tumor cells were negative for langenin, CD30, HMB45, PCK, CK5/6, and P63. Their Ki-67proliferation index ranged from 30% to 40%. This neoplasm was diagnosed as LCS according to the classification of WHO2008. This work is the first report on LCS arising from the root of tongue. This rare case may serve as a reference for future clinical studies.
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Affiliation(s)
- Jian-Jun Ren
- Department of Oto-Rhino-Laryngology West China Hospital, West China Medical School, Sichuan UniversitySichuan, China
| | - Yu Zhao
- Department of Oto-Rhino-Laryngology West China Hospital, West China Medical School, Sichuan UniversitySichuan, China
| | - Ming-Juan Liu
- Department of Pathology West China Hospital, West China Medical School, Sichuan UniversitySichuan, China
| | - Guo Liu
- Department of Oto-Rhino-Laryngology West China Hospital, West China Medical School, Sichuan UniversitySichuan, China
| | - Fei Chen
- Department of Oto-Rhino-Laryngology West China Hospital, West China Medical School, Sichuan UniversitySichuan, China
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Abstract
Langerhans cell sarcoma (LCS) is a rare tumor with markedly malignant cytological features originating from Langerhans cells. LCS diagnosis is difficult and requires differentiation from other malignant tumors and Langerhans cell histiocytosis (LCH). Immunochemical antibodies, such as langerin, S-100 protein, and CD1a, have been used to diagnose LCS, but the results are crossed with LCH. To determine more significant biomarkers of LCS, we studied the expression and distribution pattern of Wilms tumor 1 (WT1) and cluster of differentiation 44 (CD44) in LCS. A broad panel of antibodies was used for immunohistochemical technology. Simultaneously, dual immunofluorescence staining examination and fluorescence in situ hybridization staining methods were used to study the location of WT1 and CD44 in LCS tumor cells. The results showed that tumor cells expressed WT1, CD44, and other special Langerhans cell markers (langerin, CD1a, and S-100 protein). LCS cells in all the cases showed normal cytogenetic findings without overexpression of WT1 and CD44. The expression of WT1 and CD44 was observed on langerin tumor cells by dual immunofluorescence staining examination in LCS. Our results suggest that WT1 and CD44 are potential biomarkers for LCS diagnosis. Clear understanding of their functional roles may further explain the pathogenesis of this highly malignant tumor and develop some novel immunotherapy strategies.
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Affiliation(s)
- Chang-song Wang
- From the Department of Pathology (C-sW, Y-pC, W-hH, JY, PW, X-xL); Institute of Anal-Colorectal Surgery (C-fG), 150th Hospital, Luoyang, Henan; and Department of Otorhinolaryngology and Head-Neck Surgery (HL), Xinqiao Hospital, Third Military Medical University, Chongqing, China
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Miyazawa Y, Tahara K, Yuzuriha A, Mihara M, Toyama K, Yokohama A, Handa H, Jinbo T. [Clinical experience of bendamustine for adult Langerhans cell sarcoma]. Rinsho Ketsueki 2014; 55:563-569. [PMID: 24881923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A 40-year-old man was diagnosed with Langerhans cell histiocytosis (LCH) in October 2010. His LCH was refractory to conventional chemotherapy, and thus worsened to Langerhans cell sarcoma (LCS) in May 2011. Although we repeated combination chemotherapies, new infiltration of the liver and bone marrow, as well as primary lesions of the bone, lymph nodes, and skin, appeared. These intensive chemotherapies caused candida liver abscesses, invasive aspergillosis, disseminated varicella zoster virus infection and bacterial sepsis. We administered bendamustine for chemotherapy, which resulted in a partial response (PR) with no severe adverse events. Because of pancytopenia caused by secondary myelodysplastic syndrome, we stopped the bendamustine chemotherapy after two courses. PR was maintained for 4 months. We plan to perform allogeneic hematopoietic stem cell transplantation from a sibling donor after a conditioning regimen. Optimal therapy for adult LCH, which is a rare and treatment-resistant disease, has yet to be established. Bendamustine is a potential chemotherapeutic agent for standard treatment of LCS.
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Abstract
Langerhans cell sarcoma, a tumour with markedly malignant cytological features that originates from Langerhans cells, is a very rare disease. We report the first case of 39-year-old male with Langerhans cell sarcoma arising in the nasopharynx. We chose the 2-chlorodeoxyadenosine (2-CDA) regimen as first-line chemotherapy, and clinical improvement of Langerhans cell sarcoma was obtained. After the fourth cycle of 2-CDA therapy, however, disease progression was observed, and we administered ESHAP regimen (etoposide, carboplatin, cytarabine, methylprednisolone) as a second-line therapy. After we administered two cycles of ESHAP, however, the patient developed aggressive progression and he died. The importance of immunohistochemical findings is obvious in Langerhans cell sarcoma diagnosis. Considering that Langerhans cell sarcoma behaves in a very malignant fashion, a more aggressive treatment approach is necessary for patients with Langerhans cell sarcoma.
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Affiliation(s)
- M Keklik
- Doctor, Department of Hematology, Faculty of Medicine, Erciyes Stem Cell Transplantation Hospital, Erciyes University, Turkey
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Abstract
Langerhans cell sarcoma (LCS) is extremely rare, with only 36 cases reported in English literature. In this report we represent the case of a 77-year-old woman with a 1-month history of left neck swelling and pain. A diagnosis of LCS was rendered from pathological findings of the cervical lymph node biopsy. The patient's condition deteriorated rapidly and she died 2 days after diagnosis. A literature review in the context of the present case was performed to better enhance understanding of the early diagnosis and treatment of this unusual lesion.
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Affiliation(s)
- Yi-ni Wang
- Department of Hematology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Shimizu I, Takeda W, Kirihara T, Sato K, Fujikawa Y, Ueki T, Sumi M, Ueno M, Ichikawa N, Kobayashi H, Watanabe M, Uehara T, Nakamura S. [Long-term remission of Langerhans cell sarcoma by AIM regimen combined with involved-field irradiation]. Rinsho Ketsueki 2012; 53:1911-1915. [PMID: 23257672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A 67-year-old woman presented with a right inguinal mass in May 2006. CT scan showed lymph node involvement from the right inguinal to the common iliac and (18)F-FDG-PET revealed uptake in those areas. Biopsy results indicated Langerhans cell sarcoma (LCS). Interestingly, tumor cells expressed a high MIB1 index of 30%. We administered doxorubicin, ifosfamide, and mesna (AIM) chemotherapy, which were reported to effectively treat soft tissue sarcoma. After 5 courses of AIM therapy and involved-field radiation for residual diseases and a relapsed lesion on her right cervical node, she has remained in complete remission for more than 4 years. LCS is an intractable malignant disease and the optimal therapeutic strategy remains unclear. The AIM regimen combined with radiation therapy may be an effective treatment option for this disease.
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Affiliation(s)
- Ikuo Shimizu
- Department of Hematology, Nagano Red Cross Hospital, Japan
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Langfort R, Radzikowska E, Czarnowska E, Wiatr E, Grajkowska W, Błasińska-Przerwa K, Giedronowicz D, Witkiewicz I. [Langerhans cell sarcoma with pulmonary manifestation, mediastinum involvement and bronchoesophageal fistula. A rare location and difficulties in histopathological diagnosis]. Pneumonol Alergol Pol 2009; 77:327-334. [PMID: 19591108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Langerhans cell sarcoma, a neoplastic proliferation of Langerhans cells with malignant cytologic features, is a very rare disease. Only a few cases have been documented in the English-language literature. Special methods, like immunohistochemistry and/or ultrastructural examination, are indispensable for appropriate diagnosis. Correct diagnosis is difficult. In fact, the disease is often misdiagnosed. We present the case of a 47 year-old man with a large mass in the middle lobe of the lung, infiltrating anterior mediastinum, with multiple pulmonary round lesions and enlargement of local lymph nodes, and with bronchoesophageal fistula. Clinical examination indicated the possibility of advanced primary lung cancer. However, the first histological diagnosis was Langerhans cell histiocytosis. In spite of treatment, the progression of pulmonary lesions was observed. Therefore, upper- and middle-lobectomy was performed. The diagnosis of Langerhans histiocytosis was confirmed microscopically again. Nevertheless, the patient's condition deteriorated progressively and he was admitted to the National Tuberculosis and Lung Diseases Research Institute in order to establish a final diagnosis. Revision of earlier resected specimens, as well as an immunohistochemical and ultrastructural examination of samples, taken once again from a bronchial tumor, led to the establishment of a diagnosis of a unique form of Langerhans cell sarcoma with rare pulmonary manifestation.
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Affiliation(s)
- Renata Langfort
- Zakład Patomorfologii Instytutu Gruźlicy i Chorób Płuc w Warszawie.
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Lian YL, He HY, Liao SL, Yin LJ, Han ZH, Zheng J. [Langerhans cell sarcoma of talus: report of a case]. Zhonghua Bing Li Xue Za Zhi 2006; 35:697-8. [PMID: 17374221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Jülg BD, Weidner S, Mayr D. Pulmonary manifestation of a Langerhans cell sarcoma: case report and review of the literature. Virchows Arch 2005; 448:369-74. [PMID: 16328350 DOI: 10.1007/s00428-005-0115-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Accepted: 10/10/2005] [Indexed: 10/25/2022]
Abstract
In the following, we describe the very rare case of Langerhans cell sarcoma (LCS) in the lung. Throughout the medical literature, only a few cases have been published, and, to the best of our knowledge, this is the first case to be reported in Germany. The patient was an 81-year-old man who showed symptoms such as chronic cough and weight loss. Clinical examination including needle biopsy indicated a high possibility of carcinoma in the right lung and in the mediastinum; however, the final histopathological diagnosis after immunohistochemistry gave evidence of LCS. LCS is a neoplastic proliferation of Langerhans cells with malignant cytological features exhibiting a very aggressive behaviour. LCS can be distinguished from other carcinomas, lymphomas and sarcomas by the typical morphological features of Langerhans cells and the immunophenotype with a consistent expression of S-100 protein and CD1a. In contrast to Langerhans cell histiocytosis, the LCS consists of Langerhans cells with high atypia and a very high mitotic rate.
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Affiliation(s)
- Boris Dominik Jülg
- Medizinische Poliklinik, Ludwig, Maximilian University, Munich, Germany.
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