1
|
Murakami I, Wada N, Nakashima J, Iguchi M, Toi M, Hashida Y, Higuchi T, Daibata M, Matsushita M, Iwasaki T, Kuwamoto S, Horie Y, Nagata K, Hayashi K, Oka T, Yoshino T, Imamura T, Morimoto A, Imashuku S, Gogusev J, Jaubert F. Merkel cell polyomavirus and Langerhans cell neoplasm. Cell Commun Signal 2018; 16:49. [PMID: 30134914 PMCID: PMC6103986 DOI: 10.1186/s12964-018-0261-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 08/14/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The relationship between various external agents such as pollen, food, and infectious agents and human sensitivity exists and is variable depending upon individual's health conditions. For example, we believe that the pathogenetic potential of the Merkel cell polyomavirus (MCPyV), the resident virus in skin, is variable and depends from the degree of individual's reactivity. MCPyV as well as Epstein-Barr virus, which are normally connected with humans under the form of subclinical infection, are thought to be involved at various degrees in several neoplastic and inflammatory diseases. In this review, we cover two types of Langerhans cell neoplasms, the Langerhans cell sarcoma (LCS) and Langerhans cell histiocytosis (LCH), represented as either neoplastic or inflammatory diseases caused by MCPyV. METHODS We meta-analyzed both our previous analyses, composed of quantitative PCR for MCPyV-DNA, proteomics, immunohistochemistry which construct IL-17 endocrine model and interleukin-1 (IL-1) activation loop model, and other groups' data. RESULTS We have shown that there were subgroups associated with the MCPyV as a causal agent in these two different neoplasms. Comparatively, LCS, distinct from the LCH, is a neoplastic lesion (or sarcoma) without presence of inflammatory granuloma frequently observed in the elderly. LCH is a proliferative disease of Langerhans-like abnormal cells which carry mutations of genes involved in the RAS/MAPK signaling pathway. We found that MCPyV may be involved in the development of LCH. CONCLUSION We hypothesized that a subgroup of LCS developed according the same mechanism involved in Merkel cell carcinoma pathogenesis. We proposed LCH developed from an inflammatory process that was sustained due to gene mutations. We hypothesized that MCPyV infection triggered an IL-1 activation loop that lies beneath the pathogenesis of LCH and propose a new triple-factor model.
Collapse
Affiliation(s)
- Ichiro Murakami
- Department of Pathology, Kochi Medical School, Kochi University, Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
- Department of Pathology, Kochi University Hospital, 185-1 Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
| | - Noriko Wada
- Department of Pathology, Kochi University Hospital, 185-1 Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
| | - Junko Nakashima
- Department of Pathology, Kochi Medical School, Kochi University, Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
- Department of Pathology, Kochi University Hospital, 185-1 Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
| | - Mitsuko Iguchi
- Department of Pathology, Kochi Medical School, Kochi University, Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
- Department of Pathology, Kochi University Hospital, 185-1 Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
| | - Makoto Toi
- Department of Pathology, Kochi University Hospital, 185-1 Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
| | - Yumiko Hashida
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
| | - Tomonori Higuchi
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
| | - Masanori Daibata
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
| | - Michiko Matsushita
- Department of Pathobiological Science and Technology, School of Health Science, Faculty of Medicine, Tottori University, 86 Nishi, Yonago, Tottori, 683-8503 Japan
| | - Takeshi Iwasaki
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka 812-8582 Japan
| | - Satoshi Kuwamoto
- Department of Pathology, Tottori University Hospital, 86 Nishi, Yonago, Tottori, 683-8503 Japan
- Division of Molecular Pathology, Faculty of Medicine, Tottori University, 86 Nishi, Yonago, Tottori, 683-8503 Japan
| | - Yasushi Horie
- Department of Pathology, Tottori University Hospital, 86 Nishi, Yonago, Tottori, 683-8503 Japan
| | - Keiko Nagata
- Division of Molecular Pathology, Faculty of Medicine, Tottori University, 86 Nishi, Yonago, Tottori, 683-8503 Japan
| | - Kazuhiko Hayashi
- Division of Molecular Pathology, Faculty of Medicine, Tottori University, 86 Nishi, Yonago, Tottori, 683-8503 Japan
| | - Takashi Oka
- Department of Virology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Kita-ku, Okayama, Okayama 700-8558 Japan
| | - Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Kita-ku, Okayama, Okayama 700-8558 Japan
| | - Toshihiko Imamura
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Kyoto 602-8566 Japan
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan
| | - Shinsaku Imashuku
- Division of Laboratory Medicine, Uji-Tokushukai Medical Center, 145 Ishibashi, Makishima, Uji, Kyoto, 611-0041 Japan
| | - Jean Gogusev
- Inserm U507 and U1016, Institut Cochin, 75014 Paris, France
| | - Francis Jaubert
- AP-HP Hôpital Necker-Enfants Malades, University Paris Descartes (Paris 5), 75006 Paris, France
| |
Collapse
|
2
|
Abstract
Langerhans cell histiocytosis (LCH) is a rare disease affecting both genders and can occur at any age. It often evolves through successive flares, and its severity varies from benign forms that don't require treatment to life threatening disease. Some patients have important functional impairment with psychological and social consequences and prolonged disability. LCH may affect only one organ, with uni- or multifocal involvement or be multisystem disease involving multiple organs. The organs most frequently involved are bones, lung, skin and the endocrinal system. Pulmonary LCH is strongly related to smoking. Some patients have mixed histocytosis combining LCH and other histiocytic disorders. The diagnosis relies on the histological study of tissues samples, and shows tissue infiltration with large cell with pale cytoplasm and reniform nucleus, staining for CD1a and Langerin (CD207) on immunohistochemistry. The BRAFV600E mutation is observed in tissue samples in approximately half of patients and the activation of the RAS-RAF-MEK-ERK pathway has been shown to be constantly activated in LCH lesions, regardless the BRAF status. These findings represent an important forward step in the understanding of the physiopathology of the disease. Treatment must be adapted to the severity of the disease and goes from conservative observation to systemic chemotherapy. Therapies targeting the RAS-RAF-MEK-ERK pathway are promising treatments for progressive disease.
Collapse
Affiliation(s)
- Mathilde de Menthon
- Assistance publique-Hôpitaux de Paris, hôpital Saint-Louis, département de médecine interne, 75010 Paris, France.
| | - Véronique Meignin
- Assistance publique-Hôpitaux de Paris, hôpital Saint-Louis, Inserm UMR_S1165, service de pathologie, 75010 Paris, France
| | - Alfred Mahr
- Assistance publique-Hôpitaux de Paris, hôpital Saint-Louis, département de médecine interne, 75010 Paris, France; Université Paris-Diderot, Sorbonne Paris Cité, Inserm UMR 1153 CRESS, équipe de recherche en biostatistiques et épidémiologie clinique, 75010 Paris, France
| | - Abdellatif Tazi
- Université Paris-Diderot, Sorbonne Paris Cité, Inserm UMR 1153 CRESS, équipe de recherche en biostatistiques et épidémiologie clinique, 75010 Paris, France; Assistance publique-Hôpitaux de Paris, hôpital Saint-Louis, centre national de référence de l'histiocytose langerhansienne, service de pneumologie, 75010 Paris, France
| |
Collapse
|
3
|
Human Herpesvirus-6 DNA and Langerhans Cell Histiocytosis. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2016. [DOI: 10.5812/pedinfect.36299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
4
|
Mandibular Reconstruction for a Neglected Langerhans Cell Histiocytosis by Using Free Osteocutaneous Fibula Flap. J Craniofac Surg 2015; 26:e554-5. [PMID: 26355989 DOI: 10.1097/scs.0000000000001993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
5
|
Ribeiro KB, Degar B, Antoneli CBG, Rollins B, Rodriguez-Galindo C. Ethnicity, race, and socioeconomic status influence incidence of Langerhans cell histiocytosis. Pediatr Blood Cancer 2015; 62:982-7. [PMID: 25586293 DOI: 10.1002/pbc.25404] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 11/25/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a rare disease, and its etiology is not well understood. Population-based studies may contribute to etiologic research by defining incidence patterns. This study was designed to evaluate the descriptive epidemiology of disseminated LCH in the United States, using data from population-based cancer registries. PROCEDURE We analyzed the incidence and survival of disseminated LCH in children and adolescents (0-19 years) from 18 SEER registries during 2000-2009. Age-standardized incidence rates (ASIR) per million and rate ratios (RR) were calculated by gender, race, ethnicity, age, and socioeconomic variables (crowding, rural/urban, education, and poverty) using the SEER*Stat software 8.0.1. Relative survival (RS) estimates were calculated using Ederer II method. RESULTS One hundred forty-five cases of disseminated LCH were recorded; ASIR was 0.70/million per year. Lower ASIR was observed for blacks (vs. whites) (RR = 0.41, 95% CI 0.18-0.81), while higher ASIR was noted for Hispanics (vs. non-Hispanics) (RR = 1.63, 95% CI 1.15-2.29). Risk of LCH was higher in crowded counties (RR = 1.84, 95% CI 1.31-2.58) and also in areas with low educational level (RR = 1.49, 95% CI 1.02-2.22). Five-year relative survival was 90.0% (95% CI 83.0-94.2). Important differences in survival were noted according to gender (male: RS = 96.0 vs. female: RS = 83.4%, P = 0.029) and age (<1 year: RS = 78.5, 1-4 years: RS = 95.6%, 5-19 years: RS = 100%, P = 0.004). CONCLUSIONS This population-based study shows significant variations in the incidence of disseminated LCH by race and ethnic group, as well as the influence of socioeconomic factors. These data may provide clues to causation and point toward the need for analytical epidemiologic studies.
Collapse
Affiliation(s)
- Karina Braga Ribeiro
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Department of Social Medicine, São Paulo, Brazil
| | | | | | | | | |
Collapse
|
6
|
Langerhans Cell Histiocytosis: a Case Report. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2013. [DOI: 10.2478/sjdv-2013-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Langerhans cell histiocytosis is a disease which results from accumulation or proliferation of a clonal population of cells with the phenotype of Langerhans cells arrested at an early stage of activation that are functionally deficient. The etiology and pathogenesis of the disorder are still unknown. There are ongoing investigations to determine whether it is a reactive or a neoplastic disease. The fact is that neoplastic and reactive processes may have many clinical and pathological similarities. Some emphasize the role of “cytokine storm” in Langerhans cells. Further studies are necessary in all areas, from the etiology and pathogenesis to diagnosis and therapy. Langerhans cell histiocytosis primarily affects bones, but less commonly it may involve other organ systems, or present as a multisystem disease. The clinical course is variable, from benign forms with spontaneous resolution, to chronic disseminated forms with fatal outcome. This is a report of a 29-year-old man with Langerhans cell histiocytosis with an onset at the age of 8, which later progressed to a multisystem disease. Apart from lesions on the skin and exposed mucous membranes, the patient also presented with: diabetes insipidus, granuloma of the right femur and slight bulbar protrusion of the right eye. The patient experienced spontaneous pneumothorax on two occasions. The diagnosis of Langerhans cell histiocytosis was histologically confirmed using electron microscopy by presence of Birbeck granules in the histiocytes. A favorable therapeutic response was obtained after systemic corticosteroid therapy.
Collapse
|
7
|
Murakami I, Morimoto A, Oka T, Kuwamoto S, Kato M, Horie Y, Hayashi K, Gogusev J, Jaubert F, Imashuku S, Al-Kadar LA, Takata K, Yoshino T. IL-17A receptor expression differs between subclasses of Langerhans cell histiocytosis, which might settle the IL-17A controversy. Virchows Arch 2012; 462:219-28. [PMID: 23269323 DOI: 10.1007/s00428-012-1360-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 11/25/2012] [Accepted: 12/13/2012] [Indexed: 01/01/2023]
Abstract
Langerhans cell histiocytosis (LCH) is a lymphoproliferative disorder consisting of abnormal Langerhans cell-like cells and other lymphoid cells. LCH presents as either a multisystem LCH (LCH-MS) or a single-system LCH (LCH-SS). Currently, neither the pathogeneses nor the factors that define these disease subclasses have been elucidated. The interleukin (IL)-17A autocrine LCH model and IL-17A-targeted therapies have been proposed and have engendered much controversy. Those authors showed high serum IL-17A levels in LCH and argued that serum IL-17A-dependent fusion activities in vitro, rather than serum IL-17A levels, correlated with LCH severity (i.e. the IL-17A paradox). In contrast, others could not confirm the IL-17A autocrine model. So began the controversy on IL-17A, which still continues. We approached the IL-17A controversy and the IL-17A paradox from a new perspective in considering the expression levels of IL-17A receptor (IL-17RA). We detected higher levels of IL-17RA protein expression in LCH-MS (n = 10) as compared to LCH-SS (n = 9) (P = 0.041) by immunofluorescence. We reconfirmed these data by re-analyzing GSE16395 mRNA data. We found that serum levels of IL-17A were higher in LCH (n = 38) as compared to controls (n = 20) (P = 0.005) with no significant difference between LCH subclasses. We propose an IL-17A endocrine model and stress that changes in IL-17RA expression levels are important for defining LCH subclasses. We hypothesize that these IL-17RA data could clarify the IL-17A controversy and the IL-17A paradox. As a potential treatment of LCH-MS, we indicate the possibility of an IL-17RA-targeted therapy.
Collapse
Affiliation(s)
- Ichiro Murakami
- Division of Molecular Pathology, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, Tottori 683-8503, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a rare group of disorders of unknown etiology with a wide spectrum of clinical presentation. We sought to identify what, if any, has changed in the past 3 decades. This review outlines the current concepts in etiology and molecular biology, clinical manifestations, imaging features, treatment guidelines, and outcomes for skeletal LCH. METHODS A database of LCH cases diagnosed at a tertiary referral center during a 3-decade period was retrospectively reviewed to identify children with primary bone involvement. All patients' charts and available imaging examinations were reviewed, and the data collected included sex, age, number and location of the musculoskeletal lesions, presence of extraskeletal lesions and/or systemic disease, presence of clinical symptoms, treatment (medical and/or surgical), complications, and outcomes. RESULTS Seventy-nine children met the inclusion criteria. Forty-five (57%) of the 79 children had single-bone disease, with a mean age at presentation of 8.9 years, whereas 34 (43%) of the 79 children presented with multiple skeletal lesions (range, 2-7 lesions) at a mean age of 7.4 years. There were 165 skeletal lesions in the 79 patients (mean, 2 lesions per patient). The most common presenting symptom was pain at the lesion site (63 patients, 79%). On imaging, the lesion usually presented as a well-defined, radiolucent lesion located within the diaphysis or metaphysis. Among children with single-bone involvement, 11 underwent observation and symptomatic treatment, 17 had biopsy followed by observation and symptomatic treatment, and 17 had biopsy followed by excision. Eight children also received chemotherapy, and 2 had radiation (early in the series). Among children with multiple-bone disease, 10 underwent biopsy followed by symptomatic treatment, 24 underwent biopsy, followed by chemotherapy, and 3 also received radiation (early in the series). CONCLUSION There is variability of presentation in musculoskeletal LCH. Biopsy is usually indicated for diagnostic confirmation. Although the natural history for most lesions is of gradual healing, curettage and grafting are sometimes indicated to accelerate the healing process. Internal fixation for stability is occasionally necessary. Chemotherapy is used for multisystemic disease, and radiotherapy is no longer used.
Collapse
|
9
|
Jeziorski E, Senechal B, Molina TJ, Devez F, Leruez-Ville M, Morand P, Glorion C, Mansuy L, Gaudelus J, Debre M, Jaubert F, Seigneurin JM, Thomas C, Joab I, Donadieu J, Geissmann F. Herpes-virus infection in patients with Langerhans cell histiocytosis: a case-controlled sero-epidemiological study, and in situ analysis. PLoS One 2008; 3:e3262. [PMID: 18810271 PMCID: PMC2533395 DOI: 10.1371/journal.pone.0003262] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Accepted: 08/16/2008] [Indexed: 11/25/2022] Open
Abstract
Background Langerhans cell histiocytosis (LCH) is a rare disease that affects mainly young children, and which features granulomas containing Langerhans-type dendritic cells. The role of several human herpesviruses (HHV) in the pathogenesis of LCH was suggested by numerous reports but remains debated. Epstein-barr virus (EBV, HHV-4), & Cytomegalovirus (CMV, HHV-5) can infect Langerhans cells, and EBV, CMV and HHV-6 have been proposed to be associated with LCH based on the detection of these viruses in clinical samples. Methodology We have investigated the prevalence of EBV, CMV and HHV-6 infection, the characters of antibody response and the plasma viral load in a cohort of 83 patients and 236 age-matched controls, and the presence and cellular localization of the viruses in LCH tissue samples from 19 patients. Principal Findings The results show that prevalence, serological titers, and viral load for EBV, CMV and HHV-6 did not differ between patients and controls. EBV was found by PCR in tumoral sample from 3/19 patients, however, EBV small RNAs EBERs –when positive-, were detected by in situ double staining in bystander B CD20+ CD79a+ lymphocytes and not in CD1a+ LC. HHV-6 genome was detected in the biopsies of 5/19 patients with low copy number and viral Ag could not be detected in biopsies. CMV was not detected by PCR in this series. Conclusions/Significance Therefore, our findings do not support the hypothesis of a role of EBV, CMV, or HHV-6 in the pathogenesis of LCH, and indicate that the frequent detection of Epstein-barr virus (EBV) in Langerhans cell histiocytosis is accounted for by the infection of bystander B lymphocytes in LCH granuloma. The latter observation can be attributed to the immunosuppressive micro environment found in LCH granuloma.
Collapse
Affiliation(s)
- Eric Jeziorski
- Laboratory of biology of the mononuclear phagocyte system, INSERM U838, University Paris-Descartes, Paris, France
| | - Brigitte Senechal
- Laboratory of biology of the mononuclear phagocyte system, INSERM U838, University Paris-Descartes, Paris, France
| | - Thierry Jo Molina
- Laboratory of biology of the mononuclear phagocyte system, INSERM U838, University Paris-Descartes, Paris, France
- Hopital de l'Hotel Dieu, Pathology department, AP-HP, Paris, France
| | - Francis Devez
- Hopital de l'Hotel Dieu, Pathology department, AP-HP, Paris, France
| | | | - Patrice Morand
- Centre Hospitalo-Universitaire Michallon, Virology department, Grenoble, France
| | | | - Ludovic Mansuy
- Centre Hospitalo-Universitaire de Nancy, Medecine infantile II, Nancy, France
| | - Joel Gaudelus
- Hopital Jean Verdier, AP-HP, service de Pediatrie, Bondy, France
| | | | - Francis Jaubert
- Laboratory of biology of the mononuclear phagocyte system, INSERM U838, University Paris-Descartes, Paris, France
- Hopital Necker-Enfants Malades, AP-HP, Paris, France
| | | | - Caroline Thomas
- Centre Hospitalo-Universitaire de Nantes, Pediatrie, Nantes, France
| | - Irene Joab
- UMR542 Inserm-Universite Paris Sud, Hopital Paul Brousse, Villejuif, France
| | - Jean Donadieu
- Hopital d'Enfants Armand Trousseau, Pediatric Hematology unit, Centre de référence de l'histiocytose AP-HP, Paris, France
| | - Frederic Geissmann
- Laboratory of biology of the mononuclear phagocyte system, INSERM U838, University Paris-Descartes, Paris, France
- Hopital Necker-Enfants Malades, AP-HP, Paris, France
- * E-mail:
| |
Collapse
|
10
|
Abstract
The clinical manifestations of Langerhans cell histiocytosis have been recognized for more than a century. For most of that time, physicians have viewed the disease from different perspectives, interpreting portions of its clinical spectrum as if they were distinct and unrelated entities. More recently, Langerhans cell histiocytosis has been unified into a single concept, though the disease continues to defy traditional classification. By most accounts, Langerhans cell histiocytosis appears to be a morphologically benign proliferation of inflammatory cells that escapes regulatory control mechanisms. Studies from patients with all stages of the disease, however, document clonal proliferation of immune processing cells (i.e., Langerhans cells), suggesting a malignant disease process. The most common ophthalmic manifestation of Langerhans cell histiocytosis is a solitary lesion of orbital bone, which typically responds to minimally invasive therapy. The best management of solitary orbital Langerhans cell histiocytosis is debatable and has been complicated by its recent designation as a risk factor for central nervous system disease. This article summarizes recent developments in understanding the biology of Langerhans cell histiocytosis, reviews its ophthalmic manifestations, prognosis, and the controversy surrounding treatment of isolated orbital disease.
Collapse
Affiliation(s)
- Curtis E Margo
- Department of Ophthalmology and Pathology, University of South Florida, College of Medicine, Tampa, Florida, USA.
| | | |
Collapse
|
11
|
Sakata N, Toguchi N, Kimura M, Nakayama M, Kawa K, Takemura T. Development of Langerhans cell histiocytosis associated with chronic active Epstein-Barr virus infection. Pediatr Blood Cancer 2008; 50:924-7. [PMID: 17474115 DOI: 10.1002/pbc.21249] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Chronic active Epstein-Barr virus (CAEBV) infection is characterized by a status of lymphoproliferative disease of EBV-infected cells, resulting in chronic or recurrent infectious mononucleosis-like symptoms. CAEBV is always accompanied by life-threatening complications. We report the case of a 2-year-old female patient with CAEBV who subsequently developed Langerhans cell histiocytosis (LCH) presenting with bilateral exophthalmos, bone, and skin involvement. In situ hybridization for EBER revealed EBV-infected B-cells present in lesional tissue implying that interactions between EBV-infected B-cells and lesional Langerhans cells may be associated with the development of LCH.
Collapse
Affiliation(s)
- Naoki Sakata
- Department of Pediatrics, Kinki University School of Medicine, Osaka, Japan.
| | | | | | | | | | | |
Collapse
|
12
|
Csire M, Mikala G, Jákó J, Masszi T, Jánosi J, Dolgos J, Füle T, Tordai A, Berencsi G, Vályi-Nagy I. Persistent long-term human herpesvirus 6 (HHV-6) infection in a patient with langerhans cell histiocytosis. Pathol Oncol Res 2007; 13:157-60. [PMID: 17607379 DOI: 10.1007/bf02893493] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Accepted: 03/10/2007] [Indexed: 10/21/2022]
Abstract
Langerhans cell histiocytosis (eosinophilic granuloma) was first diagnosed in the adolescence of a male patient presented. Several years later persisting human herpesvirus 6 (HHV-6) infection was recognized. The HHV-6 infection could be verified retrospectively in his historical histological samples; the continuous presence of HHV-6 could be established through 17 years of disease course. The patient was operated several times during this period for painful relapses, and developed diabetes insipidus. At variable time points during the clinical course, Varicella zoster (VZV), Epstein-Barr virus (EBV) and human herpesvirus 8 (HHV-8) infections were temporarily detected from blood samples and biopsy specimens. HHV-6 was the only virus continuously identified throughout the entire follow-up period. Antiviral therapy effectively cleared EBV and HHV-8, but HHV-6 remained detectable throughout the disease course. Since DNA sequences of HHV-6 could be detected in the pathologic histiocytes of eosinophilic granuloma, and from other samples taken later on, it is suggested that long-term HHV-6 infection may be associated with development or progression of Langerhans cell histiocytosis.
Collapse
Affiliation(s)
- Márta Csire
- Division of Virology, National Center for Epidemiology, Budapest, H-1097, Hungary.
| | | | | | | | | | | | | | | | | | | |
Collapse
|