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Bielamowicz K, Dimitrion P, Abla O, Bomken S, Campbell P, Collin M, Degar B, Diamond EL, Eckstein OS, El-Mallawany N, Fluchel M, Goyal G, Henry MM, Hermiston M, Hogarty M, Jeng M, Jubran R, Lubega J, Kumar A, Ladisch S, McClain KL, Merad M, Mi QS, Parsons DW, Peckham-Gregory E, Picarsic J, Prudowsky ZD, Rollins BJ, Shaw PH, Wistinghausen B, Rodriguez-Galindo C, Allen CE. Langerhans cell histiocytosis: NACHO update on progress, chaos, and opportunity on the path to rational cures. Cancer 2024. [PMID: 38687639 DOI: 10.1002/cncr.35301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/14/2024] [Accepted: 02/27/2024] [Indexed: 05/02/2024]
Abstract
Langerhans cell histiocytosis (LCH) is a myeloid neoplastic disorder characterized by lesions with CD1a-positive/Langerin (CD207)-positive histiocytes and inflammatory infiltrate that can cause local tissue damage and systemic inflammation. Clinical presentations range from single lesions with minimal impact to life-threatening disseminated disease. Therapy for systemic LCH has been established through serial trials empirically testing different chemotherapy agents and durations of therapy. However, fewer than 50% of patients who have disseminated disease are cured with the current standard-of-care vinblastine/prednisone/(mercaptopurine), and treatment failure is associated with long-term morbidity, including the risk of LCH-associated neurodegeneration. Historically, the nature of LCH-whether a reactive condition versus a neoplastic/malignant condition-was uncertain. Over the past 15 years, seminal discoveries have broadly defined LCH pathogenesis; specifically, activating mitogen-activated protein kinase pathway mutations (most frequently, BRAFV600E) in myeloid precursors drive lesion formation. LCH therefore is a clonal neoplastic disorder, although secondary inflammatory features contribute to the disease. These paradigm-changing insights offer a promise of rational cures for patients based on individual mutations, clonal reservoirs, and extent of disease. However, the pace of clinical trial development behind lags the kinetics of translational discovery. In this review, the authors discuss the current understanding of LCH biology, clinical characteristics, therapeutic strategies, and opportunities to improve outcomes for every patient through coordinated agent prioritization and clinical trial efforts.
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Affiliation(s)
- Kevin Bielamowicz
- Department of Pediatrics, College of Medicine at the University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Pediatric Hematology and Oncology, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Peter Dimitrion
- Center for Cutaneous Biology and Immunology, Henry Ford Health, Detroit, Michigan, USA
| | - Oussama Abla
- Division of Hematology/Oncology, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Simon Bomken
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Patrick Campbell
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Matthew Collin
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- National Institute for Health and Care Research, Newcastle Biomedical Research Center, Newcastle upon Tyne, United Kingdom
| | - Barbara Degar
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Eli L Diamond
- Departments of Neurology and Medicine, Memorial Sloan Kettering Center, New York, New York, USA
| | - Olive S Eckstein
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas, USA
| | - Nader El-Mallawany
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas, USA
| | - Mark Fluchel
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Seattle Children's Hospital and University of Washington School of Medicine, Seattle, Washington, USA
| | - Gaurav Goyal
- Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael M Henry
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Michelle Hermiston
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Michael Hogarty
- Division of Hematology and Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael Jeng
- Department of Pediatrics, Pediatric Hematology/Oncology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California, USA
| | - Rima Jubran
- Division of Pediatric Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Joseph Lubega
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas, USA
| | - Ashish Kumar
- Division of Bone Marrow Transplant and Immune Deficiency, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Stephan Ladisch
- Center for Cancer and Immunology Research, Children's National Medical Center and George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Kenneth L McClain
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas, USA
| | - Miriam Merad
- Marc and Jennifer Lipschultz Precision Immunology Institute, New York, New York, USA
- The Tisch Cancer Institute, New York, New York, USA
- Department of Oncology Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Qing-Sheng Mi
- Center for Cutaneous Biology and Immunology, Henry Ford Health, Detroit, Michigan, USA
| | - D Williams Parsons
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas, USA
| | - Erin Peckham-Gregory
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas, USA
| | - Jennifer Picarsic
- University of Cincinnati College of Medicine and Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Zachary D Prudowsky
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas, USA
| | - Barrett J Rollins
- Department of Medical Oncology, Dana-Farber Cancer Institute and Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter H Shaw
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Birte Wistinghausen
- Center for Cancer and Immunology Research, Children's National Medical Center and George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Carlos Rodriguez-Galindo
- Department of Global Pediatric Medicine and Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Carl E Allen
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas, USA
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2
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Goldstein EL, White EG, Giamanco NM, Rooks VJ. Dyad of infantile cutaneous and thymic Langerhans cell histiocytosis: Is it rare? Pediatr Blood Cancer 2023; 70:e30703. [PMID: 37794571 DOI: 10.1002/pbc.30703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/06/2023]
Affiliation(s)
| | - Elena Grace White
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Liu Q, Liao F, Liu Y, Cheng Y, Qi C. Primary unifocal thymic Rosai-Dorfman disease: an extremely rare challenge in diagnostic practice. J Cardiothorac Surg 2023; 18:284. [PMID: 37817188 PMCID: PMC10566069 DOI: 10.1186/s13019-023-02381-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/30/2023] [Indexed: 10/12/2023] Open
Abstract
Rosai-Dorfman disease (RDD) is currently considered a group of neoplastic diseases of unknown etiology, with monoclonal proliferation of histiocytes, showing unique histopathologic features and varying clinical presentation. Primary thymic RDD is an extremely rare extranodal form of this disorder. In this study, we describe the case of an otherwise healthy 64-year-old Chinese man who presented with an isolated, asymptomatic soft tissue density lesion in the anterior mediastinum detected by computed tomography. Histology of the surgical specimen revealed infiltration of thymic tissue by sheets of large histiocytes with mixed lymphocytes and plasma cells, and background fibrosis. Immunohistochemical staining of the histiocytes was positive for S100, CD68, CD163, OCT2 and cyclin D1, but negative for CD1a and BrafV600E expression, thus supporting a diagnosis of RDD. Primary thymic RDD is extremely rare and may be a diagnostic challenge when presenting as mediastinal lesion.
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Affiliation(s)
- Qian Liu
- Department of Pathology, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, No. 152, Aiguo Road, Nanchang, 330006, China
| | - Fengxiang Liao
- Department of Nuclear medicine, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, China
| | - Yong Liu
- Department of Pathology, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, No. 152, Aiguo Road, Nanchang, 330006, China
| | - Yang Cheng
- Department of Pathology, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, No. 152, Aiguo Road, Nanchang, 330006, China
| | - Chubo Qi
- Department of Pathology, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, No. 152, Aiguo Road, Nanchang, 330006, China.
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Inclusion of thymic Langerhans cell histiocytosis in the "5 Ts" of the differential diagnosis of anterior mediastinal mass. Int J Hematol 2023; 117:311-313. [PMID: 36738439 DOI: 10.1007/s12185-023-03554-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
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Clinicogenomic associations in childhood Langerhans cell histiocytosis: an international cohort study. Blood Adv 2022; 7:664-679. [PMID: 36083130 PMCID: PMC9979766 DOI: 10.1182/bloodadvances.2022007947] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/23/2022] [Accepted: 08/28/2022] [Indexed: 11/20/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare neoplastic disorder caused by somatic genetic alterations in hematopoietic precursor cells differentiating into CD1a+/CD207+ histiocytes. LCH clinical manifestation is highly heterogeneous. BRAF and MAP2K1 mutations account for ∼80% of genetic driver alterations in neoplastic LCH cells. However, their clinical associations remain incompletely understood. Here, we present an international clinicogenomic study of childhood LCH, investigating 377 patients genotyped for at least BRAFV600E. MAPK pathway gene alterations were detected in 300 (79.6%) patients, including 191 (50.7%) with BRAFV600E, 54 with MAP2K1 mutations, 39 with BRAF exon 12 mutations, 13 with rare BRAF alterations, and 3 with ARAF or KRAS mutations. Our results confirm that BRAFV600E associates with lower age at diagnosis and higher prevalence of multisystem LCH, high-risk disease, and skin involvement. Furthermore, BRAFV600E appeared to correlate with a higher prevalence of central nervous system (CNS)-risk bone lesions. In contrast, MAP2K1 mutations associated with a higher prevalence of single-system (SS)-bone LCH, and BRAF exon 12 deletions seemed to correlate with more lung involvement. Although BRAFV600E correlated with reduced event-free survival in the overall cohort, neither BRAF nor MAP2K1 mutations associated with event-free survival when patients were stratified by disease extent. Thus, the correlation of BRAFV600E with inferior clinical outcome is (primarily) driven by its association with disease extents known for high rates of progression or relapse, including multisystem LCH. These findings advance our understanding of factors underlying the remarkable clinical heterogeneity of LCH but also question the independent prognostic value of lesional BRAFV600E status.
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Yao JF, Wang D, Ma HH, Lian HY, Zhang L, Wang TY, Li ZG, Jiang J, Cui L, Zhang R. Characteristics and Treatment Outcomes of Pediatric Langerhans Cell Histiocytosis with Thymic Involvement. J Pediatr 2022; 244:194-202.e5. [PMID: 35065150 DOI: 10.1016/j.jpeds.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/31/2021] [Accepted: 01/11/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the characteristics and treatment outcomes of patients with pediatric Langerhans cell histiocytosis (LCH) with thymic involvement. STUDY DESIGN We retrospectively described the clinical, biological, and imaging characteristics of a series of 19 patients with pediatric LCH with thymic involvement in our center between September 2016 and December 2019. We further analyzed the treatment response and outcomes of patients treated with chemotherapy or targeted therapy. RESULTS Thymic involvement was found in 4.4% of a 433-consecutive pediatric LCH cohort; all LCH-thymic involvement presented with multisystem disease. Patients with thymic involvement were typically younger, harboring more lung and thyroid involvement and less bone involvement than those without thymic involvement. Most patients with thymic involvement had alteration of immunocompetence with decreased numbers of T-lymphocyte subsets and immunoglobulin G levels. Overall, 47.1% of patients demonstrated a response after 6 weeks of induction therapy, and 92.3% of the patients who did not respond to the first-line treatment had resolution of thymus after the second-line and/or targeted therapy. The progression/relapse rate showed no difference between patients who shifted to second-line therapy and those to dabrafenib (33.3% vs 25%, P = 1.000). The survival for patients with thymic involvement did not differ from those without thymic involvement. More patients treated with second-line chemotherapy had severe adverse events than those given dabrafenib (88.9% vs 0, P < .001). CONCLUSIONS Thymic involvement was observed rarely in LCH and had specific clinical characteristics. Chemotherapy could resolve most thymic lesions, and BRAF inhibitors might provide a promising treatment option with less toxicity for infants with BRAF-V600E mutation. TRIAL REGISTRATION http://www.chictr.org.cn, identifier: ChiCTR2000030457 (BCH-LCH 2014 study); ChiCTR2000032844 (dabrafenib study).
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Affiliation(s)
- Ja-Feng Yao
- Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; National Key Discipline of Pediatrics, Capital Medical University, Beijing, China; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Dong Wang
- Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; National Key Discipline of Pediatrics, Capital Medical University, Beijing, China; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Hong-Hao Ma
- Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; National Key Discipline of Pediatrics, Capital Medical University, Beijing, China; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Hong-Yun Lian
- Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; National Key Discipline of Pediatrics, Capital Medical University, Beijing, China; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Li Zhang
- Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; National Key Discipline of Pediatrics, Capital Medical University, Beijing, China; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Tian-You Wang
- Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; National Key Discipline of Pediatrics, Capital Medical University, Beijing, China; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Zhi-Gang Li
- Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; National Key Discipline of Pediatrics, Capital Medical University, Beijing, China; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China; Hematologic Diseases Laboratory, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jin Jiang
- Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; National Key Discipline of Pediatrics, Capital Medical University, Beijing, China; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Lei Cui
- Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; National Key Discipline of Pediatrics, Capital Medical University, Beijing, China; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China; Hematologic Diseases Laboratory, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
| | - Rui Zhang
- Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; National Key Discipline of Pediatrics, Capital Medical University, Beijing, China; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
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7
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Thymic Langerhans' cell histiocytosis. Pediatr Neonatol 2020; 61:661-662. [PMID: 32861596 DOI: 10.1016/j.pedneo.2020.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 08/12/2020] [Indexed: 11/23/2022] Open
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Bao Z, Deng M, Zou Y, Wang H, Liang J, Mi Y. Case report of Langerhans cell histiocytosis in a fetus detected by magnetic resonance imaging. J Obstet Gynaecol Res 2020; 47:456-462. [PMID: 33145868 DOI: 10.1111/jog.14559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/05/2020] [Accepted: 10/16/2020] [Indexed: 11/30/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a rare disease, and the diagnosis of LCH is mainly based on clinical manifestation, imaging and pathological examinations. But during pregnancy, imaging examinations especially play an important role in the diagnosis and prognostic assessment of fetal LCH. Up to now, there has been no report about magnetic resonance imaging (MRI) features of fetal LCH. We reported a 32-year-old woman at 36 weeks' gestation took fetal MRI because of fetal anomalies diagnosed by ultrasonography. On the fetus's MR images, the thymus was slightly enlarged with smooth or lobulated contour in supra anterior mediastinum, displayed heterogeneous signals and contained multiple small cysts on T2WI. Innumerable irregular nodules and patchy shadows were present throughout both lungs. Pulmonary lesions were bilateral and diffuse with relative sparing of the costophrenic angles. The margins of these lesions were fluffy and indistinct. These lesions showed heterogeneous signals on T2WI. MRI showed no lesions in skin region. After birth, lots of round or oval skin lesions distributed all over the baby's body presenting as ulcerated or blister-like rashes. The chest computer tomography (CT) showed punctate calcification and heterogeneous enhancement in the thymus and bilateral diffuse reticular or reticulonodular opacities in both lungs with fluffy and indistinct margins. Pathological finding was consistent with LCH. Through reporting MRI features of LCH in one fetus, this study aims to improve awareness of fetal LCH in radiologists and clinicians, to improve the prenatal diagnostic rate of this disorder.
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Affiliation(s)
- Zhongkun Bao
- Department of Radiology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Meixiang Deng
- Department of Radiology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yu Zou
- Department of Radiology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hongzhu Wang
- Department of Equipment, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jiawei Liang
- Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yanhong Mi
- Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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9
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Della Valle V, Donadieu J, Sileo C, Barkaoui MA, Héritier S, Brisse H, Boutry N, Tréguier C, Chateil JF, Petit P, Pracros JP, Chastagner P, Boyer C, Veillon F, Durand C, Mounayer C, Kambouchner M, Brauner M, Tazi A, Epaud R, Ducou le Pointe H. Chest computed tomography findings for a cohort of children with pulmonary Langerhans cell histiocytosis. Pediatr Blood Cancer 2020; 67:e28496. [PMID: 32710685 DOI: 10.1002/pbc.28496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/19/2020] [Accepted: 05/25/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This study was undertaken to describe the spectrum of lung computed-tomography (CT) findings in children with pulmonary Langerhans cell histiocytosis (PLCH) and to evaluate for this population the CT-scan nodule and cyst scores proposed by adult pulmonologists at diagnosis and during follow-up. METHODS Among 175 children with PLCH identified in the French national population-based Langerhans cell histiocytosis cohort, 60 were retrospectively selected by the availability of CT for a central review by three pediatric radiologists. These 60 patients are representative of childhood PLCH for almost all clinical aspects, except a lower percentage of risk organ involvement (38% vs 54%; P = 0.05). RESULTS The 60 children's chest CT scans (n = 218) were reviewed. At diagnosis, 63% of them had nodules, 53% had cysts, and 29% had both. The percentages of patients with nodules or cysts increased from diagnosis to peak disease activity, respectively, from 63% to 73% and from 53% to 66%. The costophrenic angle was involved in 71%. Patients with pneumothorax (25%) had a higher median cyst score. Alveolar consolidation was observed in 34%. Patients with low CT-scan nodule and cyst scores had no long-term pulmonary sequelae. CONCLUSIONS Well-known characteristics of adult PLCH (nodules and cysts) were observed in children. The chest CT scores proposed by adult pulmonologists could easily be applied to childhood PLCH. Lesions in children, unlike those in adults, are frequently located near the costophrenic angles. Alveolar consolidation might be considered an atypical feature of childhood PLCH.
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Affiliation(s)
- Valeria Della Valle
- Pediatric Radiology Department, Assistance Publique-Hopitaux de Paris (APHP), Trousseau Hospital, Paris, France.,Sorbonne Université, Paris, France
| | - Jean Donadieu
- French Referral Center for Langerhans' Cell Histiocytosis, APHP, Trousseau Hospital, Paris, France
| | - Chiara Sileo
- Pediatric Radiology Department, Assistance Publique-Hopitaux de Paris (APHP), Trousseau Hospital, Paris, France
| | - Mohamed Aziz Barkaoui
- French Referral Center for Langerhans' Cell Histiocytosis, APHP, Trousseau Hospital, Paris, France
| | - Sébastien Héritier
- French Referral Center for Langerhans' Cell Histiocytosis, APHP, Trousseau Hospital, Paris, France
| | - Hervé Brisse
- Radiology Department, Institut Curie, Paris, France
| | - Nathalie Boutry
- Radiology Department, Jeanne-de-Flandre Hospital (CHRU), Lille, France
| | | | | | - Philippe Petit
- Radiology Department, La Timone Hospital (APHM), Marseille, France
| | | | | | - Corinne Boyer
- Radiology Department, L'Archet Hospital (CHU), Nice, France
| | - Francis Veillon
- Radiology Department, Hautepierre Hospital (CHU), Strasbourg, France
| | - Chantal Durand
- Radiology Department, Couple Enfant Hospital (CHU), Grenoble, France
| | | | | | - Michel Brauner
- Radiology Department, APHP, Avicennes Hospital, Bobigny, France
| | - Abdellatif Tazi
- Pneumology Department, French Referral Center for Langerhans Cell Histiocytosis, APHP, Trousseau Hospital, Paris, France
| | - Ralp Epaud
- Service de Pédiatrie Générale, Centre Hospitalier Intercommunal, Creteil, France
| | - Hubert Ducou le Pointe
- Pediatric Radiology Department, Assistance Publique-Hopitaux de Paris (APHP), Trousseau Hospital, Paris, France.,Sorbonne Université, Paris, France
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10
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Orman G, Masand P, Hicks J, Huisman TAGM, Guillerman RP. Pediatric thoracic mass lesions: Beyond the common. Eur J Radiol Open 2020; 7:100240. [PMID: 32577435 PMCID: PMC7300149 DOI: 10.1016/j.ejro.2020.100240] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/08/2020] [Accepted: 06/05/2020] [Indexed: 01/03/2023] Open
Abstract
Thoracic mass lesions can be categorized as originating in one of the three major compartments: a) chest wall and pleura, b) lung parenchyma and airways, c) mediastinum. While some of these, such as lymphoma, are common in both children and adults, others are rare and unique to childhood. The goal of this review is to familiarize radiologists with unusual but distinctive mass lesions of the pediatric thorax.
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Affiliation(s)
- Gunes Orman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin Street, Houston, TX, 77030 United States
| | - Prakash Masand
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin Street, Houston, TX, 77030 United States
| | - John Hicks
- Department of Pathology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States
| | - Thierry A G M Huisman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin Street, Houston, TX, 77030 United States
| | - R Paul Guillerman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin Street, Houston, TX, 77030 United States
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11
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Azadi P, Khodabande A, Riazi Esfahani M, Ghassemi F, Aliabadi N. Bilateral choroidal osteoma associated with langerhans cell histiocytosis, a coincidence? J Curr Ophthalmol 2019; 31:109-112. [PMID: 30899858 PMCID: PMC6407095 DOI: 10.1016/j.joco.2018.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/06/2018] [Accepted: 02/20/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose To describe a case of bilateral choroidal osteoma (CO) in a patient with a history of langerhans cell histiocytosis (LCH). Methods A 24-year-old man complaining of gradually decreasing visual acuity in both eyes is presented. He had a history of lymphadenopathy, respiratory symptoms, and pathology-proven diagnosis of LCH. Results Ophthalmic clinical and imaging studies revealed bilateral CO. Conclusion In this patient, we suggest a possible relationship between LCH and CO.
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Affiliation(s)
- Pejvak Azadi
- Eye Research Center, Emam Khomeini Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Khodabande
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammd Riazi Esfahani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA, USA
| | - Fariba Ghassemi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Aliabadi
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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12
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Matsumoto N, Toriumi N, Sarashina T, Hatakeyama N, Azuma H. Langerhans cell histiocytosis isolated to the thymus in a 7-month-old infant. Pediatr Int 2019; 61:205-206. [PMID: 30767312 DOI: 10.1111/ped.13749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/12/2018] [Accepted: 12/07/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Naoya Matsumoto
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
| | - Naohisa Toriumi
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
| | - Takeo Sarashina
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
| | - Naoki Hatakeyama
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
| | - Hiroshi Azuma
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
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13
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Galambrun C, Garaix F, Ughetto F, Picard C, Petit P, Bosdure E, Poullin P, Stremler N, Mace L, Donadieu J. Cladribine-related immunosuppression may have fostered graft-versus-host disease after lung transplant for pulmonary Langerhans cell histiocytosis. Pediatr Blood Cancer 2019; 66:e27477. [PMID: 30270491 DOI: 10.1002/pbc.27477] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 09/10/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Claire Galambrun
- Unité de greffe de Moelle, Service d'hémato oncologie, Pédiatrique Hôpital La Timone APHM, Marseille, France
| | - Florentine Garaix
- Unité de néphrologie et transplantations pédiatriques, Service de Pédiatrie Multidisciplinaire, Hôpital La Timone APHM, Marseille, France
| | - Fabrice Ughetto
- Service réanimation pédiatrique, Hôpital La Timone APHM, Marseille, France
| | | | - Philippe Petit
- Radiologie pédiatrique, Hôpital La Timone APHM, Marseille, France
| | | | - Pascale Poullin
- Service d'Hémaphérèse, autotransfusion, CHU de Marseille-Hôpital de la Conception, Marseille, France
| | | | - Loic Mace
- Unité de néphrologie et transplantations pédiatriques, Service de Pédiatrie Multidisciplinaire, Hôpital La Timone APHM, Marseille, France
| | - Jean Donadieu
- Service d'Hémato-Oncologie Pédiatrique, APHP Hopital Trousseau, Paris, France
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14
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Langerhans cell histiocytosis in children - a disease with many faces. Recent advances in pathogenesis, diagnostic examinations and treatment. Postepy Dermatol Alergol 2018; 35:6-17. [PMID: 29599667 PMCID: PMC5872238 DOI: 10.5114/pdia.2017.67095] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/16/2017] [Indexed: 02/06/2023] Open
Abstract
Langerhans cell histiocytosis is a rare clonal disease characterized by the proliferation of CD1a-positive immature dendritic cells. The purpose of this article was to present an updated review of recent advances in the pathogenesis, clinical features, imaging and treatment of this disease. The discovery of oncogenic BRAF mutations and the presence of proinflammatory cytokines and chemokines confirmed the unusual characteristics of this disease. Currently, children with organ involvement who do not have a good response to chemotherapy and have neurodegeneration or diabetes insipidus are the most problematic patients. Further research is needed to improve the results of treatment.
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15
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Bedran NR, Carlos R, de Andrade BAB, Bueno APS, Romañach MJ, Milito CB. Clinicopathological and Immunohistochemical Study of Head and Neck Langerhans Cell Histiocytosis from Latin America. Head Neck Pathol 2017; 12:431-439. [PMID: 29164473 PMCID: PMC6232207 DOI: 10.1007/s12105-017-0867-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 11/13/2017] [Indexed: 01/23/2023]
Abstract
Langerhans cell histiocytosis (LCH) is an inflammatory myeloid neoplastic proliferation with variable clinical behavior caused by the accumulation of CD1a+/CD207+ histiocytes, associated with a variable number of eosinophils, lymphocytes, plasma cells and multinucleated giant cells, most commonly observed in male children. LCH is uncommon in the head and neck region, occurring as ulcerated and reddened plaques or nodules that cause destruction of adjacent soft tissues and bone. The exact etiology of LCH is still unknown and controversial, with possible etiologic role of viruses, including Epstein-Barr virus (EBV). The aim of this study was to describe the clinicopathologic and immunohistochemical features of patients with LCH of the head and neck region. Clinical data from 19 patients with LCH were obtained from the archives of the Federal University of Rio de Janeiro and the Clinical Head and Neck Center of Guatemala. All cases were submitted to morphological, immunohistochemical analysis with CD1a, CD207, CD3, CD20, CD68, S-100 and Ki-67 and in situ hybridization for EBV. Ten cases were female and 9 male, with mean age of 11.5 years. Fourteen cases were located in the oral cavity, three cases in lymph nodes, and two cases in the scalp. In regard to the oral lesions, 13 cases were intra-osseous with six cases in anterior mandible, five cases in posterior mandible, and two cases in posterior maxilla while one case was located exclusively in the gingiva. The inflammatory pattern showed variation in the number of plasma cells, eosinophils and lymphocytes, while tumor cells were positive for CD1a, S-100 and CD68 in all cases, and positive for CD207 in 18 cases. In situ hybridization for EBV were negative in all cases.
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Affiliation(s)
- Natália Rocha Bedran
- Department of Pathology, School of Medicine, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Román Carlos
- Pathology Section, Centro Clínico de Cabeza y Cuello/Hospital Herrera Llerandi, Guatemala City, Guatemala
| | - Bruno Augusto Benevenuto de Andrade
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (FO-UFRJ), Av. Carlos Chagas Filho 373, Prédio do CCS Bloco K, 2° andar Sala 56. Ilha da Cidade Universitária, Rio de Janeiro, 21941-902 Brazil
| | - Ana Paula Silva Bueno
- Pediatric Hematology Section, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mário José Romañach
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (FO-UFRJ), Av. Carlos Chagas Filho 373, Prédio do CCS Bloco K, 2° andar Sala 56. Ilha da Cidade Universitária, Rio de Janeiro, 21941-902 Brazil
| | - Cristiane Bedran Milito
- Department of Pathology, School of Medicine, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Abstract
DEFINITION Langerhans cell histiocytosis (LCH) is defined by the association of a clinical and radiological involvement and a biopsy of a pathological tissue. Extension: it can affect any organ or system of the body but most commonly the bone (80% of cases), the skin (33%) and the pituitary (25%). Other organs are concerned such as liver, spleen, hematopoietic system and the lungs (15% each), lymph nodes (5-10%) and central nervous system (CNS) excluding the pituitary (2-4%). Natural history: the natural history of the disease is very heterogeneous, ranging from auto-regressive lesions to a disease affecting multiple organs with fatal consequences, while some lesions may be responsible for permanent sequels. A multidisciplinary approach: the perception of disease from physicians varies greatly depending on their speciality and experience, as well as the presentation of the disease or the short-term treatment outcomes. But whatever the initial view of the treating physician, a multidisciplinary approach to the LCH is recommended as well as the coordination of the necessary care of this systemic disease and its associated morbidity. THERAPY current treatment protocols, adapted to the situation of each patient, provide a survival of 98% in children. The sequels, such as diabetes insipidus, hormonal deficits, deafness and even more rarely respiratory failure and sclerosing cholangitis are seen in up to 30% of children.
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Affiliation(s)
- Jean Donadieu
- Hôpital Trousseau, centre de référence des histiocytoses, service d'hémato-oncologie pédiatrique, 26, avenue du Dr-Netter, 75012 Paris, France.
| | - Sébastien Héritier
- Hôpital Trousseau, centre de référence des histiocytoses, service d'hémato-oncologie pédiatrique, 26, avenue du Dr-Netter, 75012 Paris, France
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17
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A case of congenital Langerhans cell histiocytosis with skin and thymic lesions: Exploring the prognostic value of thymus involvement. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2016. [DOI: 10.1016/j.phoj.2016.10.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Vargas D, Richards JC, Ocazionez D, Sirajuddin A, Browne L, Restrepo CS. Cardiothoracic manifestations of primary histiocytoses. Br J Radiol 2016; 89:20160347. [PMID: 27603510 DOI: 10.1259/bjr.20160347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The objectives of this article were: (1) to review common and rare manifestations of systemic and pulmonary Langerhans cell histiocytosis, Rosai-Dorfman disease, Erdheim-Chester disease and juvenile xanthogranuloma; (2) to provide the reader with important pathologic, epidemiologic and clinical features of these diseases. The histiocytoses are a diverse group of diseases which typically manifest with multiorgan involvement. Understanding the pathologic, epidemiologic and clinical features of these entities can help the radiologist suggest an accurate diagnosis of histiocytosis when typical imaging features are encountered.
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Affiliation(s)
- Daniel Vargas
- 1 Department of Radiology, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - J Caleb Richards
- 6 Department of Radiology, National Jewish Health. Denver, CO, USA
| | - Daniel Ocazionez
- 2 Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Arlene Sirajuddin
- 3 Department of Medical Imaging, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Lorna Browne
- 4 Department of Radiology, Children's Hospital of Colorado, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Carlos S Restrepo
- 5 Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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19
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Singh AK, Sargar K, Restrepo CS. Pediatric Mediastinal Tumors and Tumor-Like Lesions. Semin Ultrasound CT MR 2016; 37:223-37. [DOI: 10.1053/j.sult.2015.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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20
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Langerhans Cell Histiocytosis in an Infant Mimicking a Lymphoma at Presentation. Case Rep Hematol 2015; 2015:670843. [PMID: 26587301 PMCID: PMC4637459 DOI: 10.1155/2015/670843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 10/09/2015] [Accepted: 10/13/2015] [Indexed: 11/17/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare disorder characterized by proliferation and accumulation of clonal dendritic cells with varied clinical presentation and an unpredictable course. We report a 5-month-old infant with LCH who presented with severe respiratory distress, a large mediastinal mass, significant generalized lymphadenopathy, and hepatosplenomegaly. Lymphoma, especially T cell lymphoblastic lymphoma, can present with superior mediastinal syndrome needing urgent empirical therapy without biopsy. However, lack of response prompted a biopsy which confirmed it to be a case of LCH and that leads to appropriate therapy and survival. There have been reports of LCH presenting with isolated mediastinal mass or with generalized lymphadenopathy, but the combined presentation of generalized lymphadenopathy with large mediastinal mass, hepatosplenomegaly, and fever in an infant has rarely been reported. Conclusion. LCH should also be considered in the differential diagnosis of an infant presenting with generalized lymphadenopathy, mediastinal mass, hepatosplenomegaly, and fever.
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21
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Picarsic J, Jaffe R. Nosology and Pathology of Langerhans Cell Histiocytosis. Hematol Oncol Clin North Am 2015; 29:799-823. [DOI: 10.1016/j.hoc.2015.06.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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22
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Kanamitsu K, Washio K, Oda M, Noda T, Oyama T, Tanimoto T, Tanaka T, Ida K, Shimada A. Suspected early onset of congenital Langerhans cell histiocytosis involving ectopic cervical thymus and mediastinal thymus, simultaneously. Pediatr Blood Cancer 2015; 62:1491-2. [PMID: 25810002 DOI: 10.1002/pbc.25496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 02/05/2015] [Indexed: 11/09/2022]
Affiliation(s)
| | - Kana Washio
- Department of Pediatrics, Okayama University Hospital, Okayama, Japan
| | - Megumi Oda
- Department of Pediatrics, Okayama University Hospital, Okayama, Japan
| | - Takuo Noda
- Department of Pediatric Surgery, Okayama University Hospital, Okayama, Japan
| | - Takanori Oyama
- Department of Pediatric Surgery, Okayama University Hospital, Okayama, Japan
| | - Terutaka Tanimoto
- Department of Pediatric Surgery, Okayama University Hospital, Okayama, Japan
| | - Takehiro Tanaka
- Department of Pathology, Okayama University Hospital, Okayama, Japan
| | - Kentaro Ida
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Akira Shimada
- Department of Pediatrics, Okayama University Hospital, Okayama, Japan
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Picarsic J, Egeler RM, Chikwava K, Patterson K, Jaffe R. Histologic patterns of thymic involvement in Langerhans cell proliferations: a clinicopathologic study and review of the literature. Pediatr Dev Pathol 2015; 18:127-38. [PMID: 25629953 DOI: 10.2350/15-01-1593-oa.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Thymic involvement by Langerhans cell histiocytosis (LCH) has been described mainly in isolated case reports. A description of the histopathologic patterns of LCH proliferations in the thymus, together with therapeutic implications, has not, to our knowledge, been previously addressed. The pathology consultation files at Children's Hospital of Pittsburgh of the University of Pennsylvania Medical Center were reviewed for cases of thymic involvement by LCH. Relevant cases in the literature were also reviewed, and the histopathology and clinical course of those cases were collected. Nine consultation cases of thymic involvement were reviewed, together with 23 cases in the literature, which provided adequate pathologic description and ancillary confirmation (n = 32), revealing 4 distinct pathologic groups. Group 1 showed microscopic collection of hyperplastic LCH-like cells in incidental thymectomies of patients without LCH disease, requiring no further treatment (n = 7; 22%). Group 2 showed solitary and/or cystic LCH of the thymus with gland disruption, and at least 3 cases resolved without systemic therapy (n = 10; 31%). Group 3 showed more variable thymic involvement in multisystemic LCH disease, with either a medullary restricted pattern or more diffuse gland involvement, requiring adjuvant therapy and having a higher mortality rate (n = 13; 41%). Group 4 showed a mixed histiocytic lesion with a concurrent LCH and juvenile xanthogranuloma-like proliferation (n = 2; 6%). Thymic involvement in LCH is quite rare. Based on our cases and those in the literature, we propose 4 distinct pathologic groups of thymic involvement in Langerhans cell proliferations with relevance for diagnosis and treatment.
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Affiliation(s)
- Jennifer Picarsic
- 1 Department of Pathology, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Morimoto A, Oh Y, Shioda Y, Kudo K, Imamura T. Recent advances in Langerhans cell histiocytosis. Pediatr Int 2014; 56:451-61. [PMID: 24840547 DOI: 10.1111/ped.12380] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 03/27/2014] [Accepted: 05/01/2014] [Indexed: 12/12/2022]
Abstract
The purpose of this review is to provide an updated overview of the pathogenesis and treatment of Langerhans cell histiocytosis (LCH). The pathogenesis of LCH remains obscure and the optimal treatment for LCH has not been established, although incremental progress has been made. Proinflammatory cytokines and chemokines are known to play a role in LCH, which suggests that LCH is an immune disorder. However, the oncogenic BRAF mutation is also detected in more than half of LCH patients, which suggests that LCH is a neoplastic disorder. Remaining major issues in the treatment of LCH are how to rescue patients who have risk-organ involvement but do not respond to first-line therapy, the optimal treatment for the orphan disease of multifocal adult LCH, and how to reduce and treat central nervous system-related consequences, such as central diabetes insipidus and neurodegeneration. More research is needed to better understand the pathogenesis of this disease and to resolve the treatment issues.
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Affiliation(s)
- Akira Morimoto
- Department of Pediatrics, Jichi Medical University of Medicine, Shimotsuke, Japan
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25
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Bubolz AM, Weissinger SE, Stenzinger A, Arndt A, Steinestel K, Brüderlein S, Cario H, Lubatschofski A, Welke C, Anagnostopoulos I, Barth TFE, Beer AJ, Möller P, Gottstein M, Viardot A, Lennerz JK. Potential clinical implications of BRAF mutations in histiocytic proliferations. Oncotarget 2014; 5:4060-70. [PMID: 24938183 PMCID: PMC4147306 DOI: 10.18632/oncotarget.2061] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 06/05/2014] [Indexed: 12/24/2022] Open
Abstract
For a growing number of tumors the BRAF V600E mutation carries therapeutic relevance. In histiocytic proliferations the distribution of BRAF mutations and their relevance has not been clarified. Here we present a retrospective genotyping study and a prospective observational study of a patient treated with a BRAF inhibitor. Genotyping of 69 histiocytic lesions revealed that 23/48 Langerhans cell lesions were BRAF-V600E-mutant whereas all non-Langerhans cell lesions (including dendritic cell sarcoma, juvenile xanthogranuloma, Rosai-Dorfman disease, and granular cell tumor) were wild-type. A metareview of 29 publications showed an overall mutation frequency of 48.5% and with N=653 samples this frequency is well defined. The BRAF mutation status cannot be predicted based on clinical parameters and outcome analysis showed no difference. Genotyping identified a 45 year-old woman with an aggressive and treatment-refractory, ultrastructurally confirmed systemic BRAF-mutant LCH. Prior treatments included glucocorticoid/vinblastine and cladribine-monotherapy. Treatment with vemurafenib over 3 months resulted in a dramatic metabolic response by FDG-PET and stable radiographic disease; the patient experienced progression after 6 months. In conclusion, BRAF mutations in histiocytic proliferations are restricted to lesions of the Langerhans-cell type. While for most LCH-patients efficient therapies are available, patients with BRAF mutations may benefit from the BRAF inhibitor vemurafenib.
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Affiliation(s)
| | | | | | - Annette Arndt
- Institute of Pathology and Molecular Pathology, Bundeswehrkrankenhaus Ulm, Ulm, Germany
| | - Konrad Steinestel
- Institute of Pathology and Molecular Pathology, Bundeswehrkrankenhaus Ulm, Ulm, Germany
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | | | - Holger Cario
- Department of Pediatric Oncology, Children's Hospital, University Ulm, Ulm, Germany
| | - Anneli Lubatschofski
- Department of Pediatric Oncology, Children's Hospital, University Ulm, Ulm, Germany
| | | | | | | | - Ambros J. Beer
- Department of Nuclear Medicine, University Ulm, Ulm, Germany
| | - Peter Möller
- Institute of Pathology, University Ulm, Ulm, Germany
| | | | - Andreas Viardot
- Department of Internal Medicine III, University Ulm, Ulm, Germany
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26
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Ramzan M, Yadav SP, Joshi R, Das D, Tamhankar P, Shaikh S, Agrawal A, Shrivastava J, Singh A, Choudhary S, Berwal PK, Khichar S, Baid P, Shruthi TK, Shuba S, Rajakumar PS, Chitrambalam S. Case Reports. Indian Pediatr 2014; 51:397-8. [DOI: 10.1007/s13312-014-0405-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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