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Van Brummen A, Jacobs S, Feng S, Li E, J. Amadi A. A Multifaceted Approach to Treatment of Recalcitrant Cutaneous Periorbital Juvenile Xanthogranuloma. J Ophthalmic Vis Res 2023; 18:130-134. [PMID: 36937193 PMCID: PMC10020784 DOI: 10.18502/jovr.v18i1.12733] [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: 05/03/2021] [Accepted: 02/25/2022] [Indexed: 02/24/2023] Open
Abstract
Purpose To demonstrate novel treatments for patients with high juvenile xanthogranuloma (JXG) eyelid lesion burden. Case Report A 14-year-old girl was referred to the oculoplastic surgery service for management of worsening extensive bilateral eyelid and adnexal lesions in the setting of JXG. The patient underwent intra-lesional steroid injections, serial excisions, and reconstruction with skin grafts. She was subsequently treated with CO 2 laser-assisted topical steroid application, which resulted in lesion regression. Conclusion A novel multimodal approach to treatment of severe periocular JXG, incorporating surgical debulking, skin autograft, CO2 laser, and intra-lesional steroids, can be effective for lesion control.
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Affiliation(s)
| | - Sarah Jacobs
- Department of Ophthalmology, University of Alabama, Birmingham, AL, USA
| | - Shu Feng
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Emily Li
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Arash J. Amadi
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
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Chen L, Feng L, E L. Oral Juvenile Xanthogranuloma: a case report of gingival hyperplasia and osteolysis in male adult patient. BMC Oral Health 2022; 22:618. [PMID: 36529720 PMCID: PMC9761958 DOI: 10.1186/s12903-022-02643-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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Juvenile Xanthogranuloma (JXG) is a non-hereditary, self-limiting disease which is usually presented in infancy or early childhood and in males over females. CASE PRESENTATION We report a rare case of oral Juvenile Xanthogranuloma with recurrent progressive gingival hyperplasia and concomitant presentation of osteolysis in a 21-year-old adult male with no significant medical history. Patient presented with generalized gingival hyperplasia, osteolysis of the maxilla and mandible, and a round, firm, nodular mass with clear circumference on the left shoulder. Results of gingival tissue biopsy, karyotype, bone marrow biopsy and immunohistochemistry were suggestive of a diagnosis of Juvenile Xanthogranuloma with no association to hematologic malignancy. Unfortunately, patient declined treatment and elected to be transferred back to local hospital for future evaluation. CONCLUSIONS Juvenile Xanthogranuloma in adults can have atypical manifestations including generalized gingival hyperplasia and osteolysis of the maxilla and mandible. It should be differentiated between Langerhans cell histiocytosis, Papillon-Lefevre Syndrome, and Pyogenic Granulomas. Despite uncommon incidence, it should be included in differential diagnoses in cases of similar clinical presentations.
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Affiliation(s)
- Long Chen
- Department of Stomatology, People’s Hospital of Mancheng District, Baoding, 072150 Hebei China ,grid.414252.40000 0004 1761 8894Department of Oral and Maxillofacial Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, 100853 China
| | - Lin Feng
- grid.414252.40000 0004 1761 8894Department of Oral and Maxillofacial Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, 100853 China
| | - Lingling E
- grid.414252.40000 0004 1761 8894Institute of Stomatology and Oral Maxilla Facial Key Laboratory, First Medical Center of Chinese PLA General Hospital, Beijing, 100853 China
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Richardson S, Banerjee P, Hassan MES, Mobarak FA. Giant Juvenile Xanthogranuloma of face in an adult: A rare complexity. J Stomatol Oral Maxillofac Surg 2022; 123:e364-e366. [PMID: 35395418 DOI: 10.1016/j.jormas.2022.03.019] [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: 03/23/2022] [Accepted: 03/30/2022] [Indexed: 06/14/2023]
Abstract
Juvenile xanthogranuloma, a form of non-Langerhans cell histiocytosis can be defined as the proliferation of cells with macrophage like characteristics. It has been described as a benign, asymptomatic and common self-healing disorder of non-Langerhans cell histiocytosis (LCH), affecting mostly infants, children and rarely adults. We have documented a case of a 40 year old male who presented to us with extensive insidious papulonodulous growth over the face. The facial disfigurement caused was catastrophic. An extensive surgical excision and reconstruction was performed followed by histopathological evaluation. Microscopic study and immune histochemistry revaled Juvenile Xanthogranuloma of adult. The article highlights the presentation, diagnosis and management of this mammoth, rare disease.
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Affiliation(s)
- Sunil Richardson
- Director, Richardsons Dental and Craniofacial Hospital, Nagercoil, Tamil Nadu.
| | - Priyadarshini Banerjee
- Surgical Fellow, Richardsons Dental and Craniofacial Hospital, Nagercoil, Tamil Nadu, India
| | | | - Fahmy A Mobarak
- Department of Oral & Maxillofacial Surgery, Faculty of Oral and Dental Medicine, Cairo University, Egypt
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Picarsic J, Pysher T, Zhou H, Fluchel M, Pettit T, Whitehead M, Surrey LF, Harding B, Goldstein G, Fellig Y, Weintraub M, Mobley BC, Sharples PM, Sulis ML, Diamond EL, Jaffe R, Shekdar K, Santi M. BRAF V600E mutation in Juvenile Xanthogranuloma family neoplasms of the central nervous system (CNS-JXG): a revised diagnostic algorithm to include pediatric Erdheim-Chester disease. Acta Neuropathol Commun 2019; 7:168. [PMID: 31685033 PMCID: PMC6827236 DOI: 10.1186/s40478-019-0811-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 09/14/2019] [Indexed: 02/06/2023] Open
Abstract
The family of juvenile xanthogranuloma family neoplasms (JXG) with ERK-pathway mutations are now classified within the "L" (Langerhans) group, which includes Langerhans cell histiocytosis (LCH) and Erdheim Chester disease (ECD). Although the BRAF V600E mutation constitutes the majority of molecular alterations in ECD and LCH, only three reported JXG neoplasms, all in male pediatric patients with localized central nervous system (CNS) involvement, are known to harbor the BRAF mutation. This retrospective case series seeks to redefine the clinicopathologic spectrum of pediatric CNS-JXG family neoplasms in the post-BRAF era, with a revised diagnostic algorithm to include pediatric ECD. Twenty-two CNS-JXG family lesions were retrieved from consult files with 64% (n = 14) having informative BRAF V600E mutational testing (molecular and/or VE1 immunohistochemistry). Of these, 71% (n = 10) were pediatric cases (≤18 years) and half (n = 5) harbored the BRAF V600E mutation. As compared to the BRAF wild-type cohort (WT), the BRAF V600E cohort had a similar mean age at diagnosis [BRAF V600E: 7 years (3-12 y), vs. WT: 7.6 years (1-18 y)] but demonstrated a stronger male/female ratio (BRAF V600E: 4 vs WT: 0.67), and had both more multifocal CNS disease ( BRAFV600E: 80% vs WT: 20%) and systemic disease (BRAF V600E: 40% vs WT: none). Radiographic features of CNS-JXG varied but typically included enhancing CNS mass lesion(s) with associated white matter changes in a subset of BRAF V600E neoplasms. After clinical-radiographic correlation, pediatric ECD was diagnosed in the BRAF V600E cohort. Treatment options varied, including surgical resection, chemotherapy, and targeted therapy with BRAF-inhibitor dabrafenib in one mutated case. BRAF V600E CNS-JXG neoplasms appear associated with male gender and aggressive disease presentation including pediatric ECD. We propose a revised diagnostic algorithm for CNS-JXG that includes an initial morphologic diagnosis with a final integrated diagnosis after clinical-radiographic and molecular correlation, in order to identify cases of pediatric ECD. Future studies with long-term follow-up are required to determine if pediatric BRAF V600E positive CNS-JXG neoplasms are a distinct entity in the L-group histiocytosis category or represent an expanded pediatric spectrum of ECD.
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Affiliation(s)
- J Picarsic
- Department of Pathology, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
| | - T Pysher
- Department of Pathology, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA
| | - H Zhou
- Department of Pathology, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA
| | - M Fluchel
- Department of Pediatric Hematology-Oncology, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA
| | - T Pettit
- Children's Hematology Oncology Centre, Christchurch Hospital, Christchurch, New Zealand
| | - M Whitehead
- Department of Pathology, Christchurch Hospital, Christchurch, New Zealand
| | - L F Surrey
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - B Harding
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - G Goldstein
- Department of Pediatric Hematology-Oncology, Hadassah University Hospital, Jerusalem, Israel
| | - Y Fellig
- Department of Pathology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - M Weintraub
- Acquired Brain Injury Service, Alyn Pediatric and Adolescent Rehabilitation Hospital, Jerusalem, Israel
| | - B C Mobley
- Department of Pathology, Vanderbilt Hospital, Nashville, USA
| | - P M Sharples
- Department of Pediatric Neurology, Bristol Royal Hospital for Children, Bristol, England
| | - M L Sulis
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York City, USA
| | - E L Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - R Jaffe
- Department of Pathology, University of Pittsburgh School of Medicine, UPMC Magee Women's Hospital, Pittsburgh, PA, USA
| | - K Shekdar
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - M Santi
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Abstract
OBJECTIVE To report the clinical and pathologic features of an elderly patient with a unilateral orbital swelling and proptosis caused by Juvenile Xanthogranuloma diagnosed and confirmed by orbital biopsy. DESIGN Interventional case report. PARTICIPANTS One patient. INTERVENTION Steroids (Medrol dose pack) and radiation. MAIN OUTCOME MEASURES Unusual clinical presentation and pathological features of Juvenile Xanthogranuloma in the orbit. CONCLUSIONS Juvenile Xanthogranuloma affecting one orbit is very rare with unilateral involvement in an elderly patient. Steroids and radiation therapy were very effective in treatment and provided impressive results.
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Affiliation(s)
- K H Patel
- Summa Health System , Akron, Ohio , USA
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Abstract
Juvenile xanthogranuloma is a rare histiocytic disorder of childhood mainly affecting skin and rarely deep soft tissues and viscera. We report a 2-month-old infant who presented with respiratory distress secondary to a large pericardial effusion associated with an epicardial mass. Excisional biopsy was performed and the mass was diagnosed as juvenile xanthogranuloma. The child is well without evidence of disease 8 months following the excision. The corresponding literature on juvenile xanthogranuloma with cardiac manifestations is reviewed.
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Affiliation(s)
- Daisuke Kobayashi
- Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI 48201-2119, USA.
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