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Wang XM, Liu YQ, Li B, Li M, Peng Y, Jiang WC. Single-system Langerhans Cell Histiocytosis with Skin Ulcers as the Initial Presentation. Acta Derm Venereol 2024; 104:adv40193. [PMID: 39101339 PMCID: PMC11318502 DOI: 10.2340/actadv.v104.40193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/17/2024] [Indexed: 08/06/2024] Open
Abstract
Abstract is missing (Short communication)
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Affiliation(s)
| | | | - Bin Li
- Shanghai Skin Disease Hospital, Shanghai, China
| | - Ming Li
- bChildren's hospital of Fudan university, Shanghai, China
| | - Yan Peng
- Shanghai Skin Disease Hospital, Shanghai, China
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Cernova J, Patel M, Ligaj M, Goldsmith P, Dhoat S, O'Toole E, Atkar R. Large Congenital Cutaneous Mastocytoma Presenting With Recurrent Persistent Blistering: A Case Report. Cureus 2023; 15:e50306. [PMID: 38205464 PMCID: PMC10777259 DOI: 10.7759/cureus.50306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/12/2024] Open
Abstract
Congenital cutaneous mastocytoma is an uncommon disorder characterized by abnormal proliferation of mast cells. It typically presents as a single, small, yellowish-brown plaque, and its diagnosis is generally facilitated by distinctive clinical features, including a positive Darrier's sign. This report presents a case of an unusually large, solitary congenital mastocytoma encompassing nearly the entire circumference of the calf, observed in a newborn boy of Bangladeshi origin. Measuring 13x6 cm, the lesion formed large bullae and subsequent erosions. The perplexing clinical appearance prompted a skin biopsy, revealing monomorphic CD117 (c-KIT) positive infiltration without significant cell pleomorphism, confirming the diagnosis of cutaneous mastocytoma. The patient underwent management with potent and very potent topical steroids, oral antihistamines, and non-adhesive dressings, remaining under long-term follow-up with secondary care dermatology. In reporting this case, our objective is to augment the existing scientific literature by providing additional evidence that cutaneous mastocytomas can display a spectrum of clinical presentations, as illustrated in this case.
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Affiliation(s)
- Jeva Cernova
- Dermatology, Barts Health NHS Trust, London, GBR
| | | | - Marcin Ligaj
- Histopathology, Barts Health NHS Trust, London, GBR
| | | | - Sasha Dhoat
- Dermatology, Barts Health NHS Trust, London, GBR
| | - Edel O'Toole
- Dermatology, Barts Health NHS Trust, London, GBR
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3
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Lau LDW, Vu M, Nirenburg A, Scardamaglia L. Adult multisystem Langerhans cell histiocytosis with cutaneous involvement manifesting as extensive flexural erosions. BMJ Case Rep 2023; 16:e254205. [PMID: 37541698 PMCID: PMC10407404 DOI: 10.1136/bcr-2022-254205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023] Open
Abstract
Langerhans cell histiocytosis is a great imitator of other diseases with an often-delayed diagnosis leading to a concerning delay in commencing treatment. We present the case of a male who was previously diagnosed with Hailey-Hailey disease, in whom several treatment options had failed, was referred to the dermatology team for evaluation of a 3-month atypical, extensive, painful and pruritic cutaneous flexural eruption. On systems review, he reported a 2-year history of polyuria and polydipsia. Repeat skin biopsy revealed a prominent histiocytic infiltrate on histopathology with corresponding positive expression of Langerin (CD207), S100, CyclinD1 and p-ERK on immunohistochemistry staining. An MRI of the brain demonstrated posterior pituitary enhancement. The clinical presentation, biopsy and investigations confirmed a diagnosis of a multisystem Langerhans cell histiocytosis, which resulted in longstanding patient morbidity. With considerable multidisciplinary teamwork, a gradual and sustained resolution of his lesions, pain, polyuria and polydipsia was achieved.
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Affiliation(s)
| | - Mi Vu
- Department of Dermatology, Western Health, Footscray, Victoria, Australia
| | - Alex Nirenburg
- Department of Pathology, Western Health, Footscray, Victoria, Australia
| | - Laura Scardamaglia
- Department of Dermatology, Western Health, Footscray, Victoria, Australia
- Department of Medicine, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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4
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Burtsev EA, Bronin GO. Langerhans Cell Histiocytosis in Children: Literature Review. CURRENT PEDIATRICS 2023. [DOI: 10.15690/vsp.v22i1.2520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Relevant information on Langerhans cell histiocytosis development and course in children is presented. The current concepts of disease pathogenesis, principles of its severity evaluation, patients stratification into risk groups, as well as of clinical course features are described. Modern approaches to the disease treatment via targeted therapy are summarized and analyzed.
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Muacevic A, Adler JR, Koizumi M. BRAF Mutation Analysis in Two Cases of Congenital Self-Healing Langerhans Cell Histiocytosis. Cureus 2022; 14:e32497. [PMID: 36644083 PMCID: PMC9837603 DOI: 10.7759/cureus.32497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 12/15/2022] Open
Abstract
Congenital self-healing Langerhans cell histiocytosis (CSHLCH) is a rare type of Langerhans cell histiocytosis (LCH). Here, we report two cases of CSHLCH. The cases presented solitary and multiple skin lesions of various sizes. The diagnosis was confirmed by skin biopsies. The lesions disappeared after one to two months without therapeutic intervention. No BRAF mutations in the skin lesions were detected, and soluble interleukin-2 receptor (sIL-2R) was normal in both cases. Recent studies suggested that the state of differentiation of the precursor cell in which BRAF mutations occur is associated with the clinical types and prognosis of the disease. Further investigation should be needed to elucidate the association between the progression and regression of CSHLCH and BRAF mutation.
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Belysheva TS, Valiev TT, Murashkin NN. Dermatologic masks of Langerhans cell histiocytosis. Case report. CONSILIUM MEDICUM 2022. [DOI: 10.26442/20751753.2022.8.201817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare pathology in pediatric age with heterogeneous clinical presentation in skeletal system, skin, central nervous system, liver, spleen, lungs, lymph nodes and bone marrow. Therefore, a number of diagnostic mistakes increase and inadequate therapy administrates. For a diagnostic period, a try at treatment, LCH disseminates with organs and systems involvement and at the moment of morpho-immunologic diagnosis verification, a disease characterizes as multiorgan multiple site affection, which decreased survival rate. In the current issue a clinical case of LCH with mistaken prolonged (2 year) atopic dermatitis anamneses is presented. The absence of pronounced effect of topical therapy along with nontypical for atopic dermatitis became not an indication for skin biopsy. After appearance of systemic symptoms with anemia, leuko- and thrombocytopenia became an evidence for pediatric oncologist-hematologist consultation.
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Astigarraga I, García-Obregón S, Pérez-Martínez A, Gutiérrez-Carrasco I, Santa-María V, Rodríguez-Vigil Iturrate C, Lorite Reggiori M, Murciano Carrillo T, Torrent M. Histiocitosis de células de Langerhans. Avances en la patogenia y práctica clínica. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Cariello V, Lombardo P, Castelli L, Brillantino C, De Fusco C, Rossi A, Minelli R, Paviglianiti G, Grassi R, Rossi E. Integrated imaging of systemic Langerhans cell histiocytosis in an infant. Radiol Case Rep 2022; 17:2747-2753. [PMID: 35990570 PMCID: PMC9388885 DOI: 10.1016/j.radcr.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/30/2022] [Accepted: 05/05/2022] [Indexed: 11/26/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a myeloid neoplasm characterized by a clonal proliferation of CD1a+/CD207+ dendritic cells. Although individuals of any age can be affected, the disease is most common in infants younger than 5 years of age, especially males. A wide range of manifestations, from asymptomatic to aggressive, have been described, along with multiorgan involvement. Even though the majority of bone lesions are observed, skin, lymph nodes, brain and lungs can also be involved. The involvement of hematopoietic system, including bone marrow, liver and spleen, is less frequent yet associated with worse prognosis, due to a worse treatment response. Diagnosis of LCH is based on the integration of clinical, laboratory, and radiological data; however, only histopathological examination might confirm it. As far as the spleen involvement is concerned, according to literature, it has been reported in about 15% patients with multisystem involvement, nonetheless only a few cases show parenchymal lesions. The present study reports the case of an infant with LCH with multisystem involvement, including bone, skin, liver, and spleen, with evidence of parenchymal lesions.
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Langerhans cell histiocytosis. Advances in pathogenesis and clinical practice. An Pediatr (Barc) 2022; 97:130.e1-130.e7. [PMID: 35869015 DOI: 10.1016/j.anpede.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 05/02/2022] [Indexed: 11/23/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a type of myeloid neoplasia that can affect different organs or tissues and exhibits substantial variability in its clinical presentation and biological behaviour, so it may mimic different diseases. Performance of different clinical assessments and laboratory and imaging tests is recommended to determine the extent of involvement, which may be of a single location or multisystemic, and the presence or absence of dysfunction in risk organs, such as the haematopoietic system, liver and spleen. The diagnosis must be confirmed by histological examination of a biopsy sample. Molecular tests have identified mutations in the mitogen-activated protein kinase (MAPK) pathway, which has expanded treatment options. The diagnosis is complex and there is controversy regarding the management of certain cases. Treatment recommendations depend on the location of the lesions and the extent of involvement. International collaborative studies have demonstrated the effectiveness of prolonged combination therapies such as vinblastine and prednisone in severe or multisystemic forms, and anti-inflammatory drugs such as indomethacin and other cytostatic combinations have proven beneficial. Langerhans cell histiocytosis is a good example of the importance of precision medicine and the benefit of identifying molecular targets, common to different neoplasms, to develop new therapies. MAPK pathway inhibitors offer an alternative treatment option in refractory cases and neurodegenerative forms of LCH. Molecular testing can contribute to the prognosis, treatment and follow-up of LCH, especially in severe forms of disease.
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Katayama S, Ota M. An Uncommon Pediatric Rash: Langerhans Cell Histiocytosis. J Pediatr 2022; 243:233-234. [PMID: 34890586 DOI: 10.1016/j.jpeds.2021.11.071] [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: 10/18/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Sho Katayama
- Department of Dermatology, Chitose City Hospital, Chitose, Japan
| | - Mitsuhito Ota
- Department of Dermatology, Chitose City Hospital, Chitose, Japan
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Zhang L, Shu H. Dermoscopic feature analysis of different skin lesions of Langerhans cell histiocytosis. Clin Exp Dermatol 2022; 47:1350-1353. [PMID: 35150163 DOI: 10.1111/ced.15139] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/09/2022] [Accepted: 02/07/2022] [Indexed: 11/28/2022]
Abstract
Dermoscopy was used to investigate skin lesions in 15 children with Langerhans cell histiocytosis (LCH). Purplish red globules or patches could be seen in different rashes under dermoscopy, and histopathology showed extravasation of red blood cells. Dermoscopy findings were highly consistent with histopathology results. Purplish red globules or patches could be used as important features in dermoscopy test and differential diagnosis.of LCH.
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Affiliation(s)
- Li Zhang
- Department of Dermalogy,Kunming Children's Hospital, Kunming, Yunnan, China
| | - Hong Shu
- Department of Dermalogy,Kunming Children's Hospital, Kunming, Yunnan, China
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12
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Fraitag S, Emile J. Cutaneous histiocytoses in children. Histopathology 2021; 80:196-215. [DOI: 10.1111/his.14569] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/13/2021] [Accepted: 09/17/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Sylvie Fraitag
- Paediatric Dermatopathology Unit Department of Pathology Hôpital Necker‐Enfants Malades AP‐HP ParisFrance
| | - Jean‐Francois Emile
- Department of Pathology Ambroise Paré Hospital AP‐HP Boulogne France
- EA4340‐BECCOH Versailles SQY University Boulogne France
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13
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Quddusi FI, Youssef MJ, Davis DMR. Dermatologic Manifestations of Systemic Diseases in Childhood. Pediatr Rev 2021; 42:655-671. [PMID: 34850179 DOI: 10.1542/pir.2020-000679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Molly J Youssef
- Department of Pediatric and Adolescent Medicine.,Department of Dermatology, Mayo Clinic, Rochester, MN
| | - Dawn Marie R Davis
- Department of Pediatric and Adolescent Medicine.,Department of Dermatology, Mayo Clinic, Rochester, MN
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Xu J, Gilbert JR, Sutton KS, Goudy SL, Abramowicz S. Head and Neck Langerhans Cell Histiocytosis in Children. J Oral Maxillofac Surg 2021; 80:545-552. [PMID: 34852246 DOI: 10.1016/j.joms.2021.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Controversy exists among head and neck surgical specialties regarding management of Langerhan's Cell Histiocytosis (LCH). The purpose of this study was to evaluate diagnosis, management, and treatment outcomes in children with LCH of the head and neck. METHODS This is a retrospective cohort study of children with LCH of the head and neck who presented to Children's Healthcare of Atlanta hospital from 2009 to 2021. The independent variables were demographic information, lesion locations, clinical presentation, radiographic findings, diagnostic workup, treatment, and length of follow-up. The patients were grouped based on these variables. The outcome variable was disease reactivation. Descriptive statistics were calculated. RESULTS There were 3 presentations of LCH of the head and neck. Group 1 presented as a lesion in 1 system without CNS risk (SS-). There were 24 patients with an average age of 10 years. Lesions were located in calvaria and/or mandible. Majority of the patients were treated with only debridement. Two of the patients experienced reactivation. Group 2 presented as a lesion in 1 system with CNS risk (SS+). There were 30 patients with an average age of 6 years. Common locations were temporal bone and/or orbit. These patients present with recurrent ear infections and ptosis. Majority of the patients were treated with chemotherapy (n = 28). One patient had disease reactivation. Group 3 presented with multisystem involvement. There were 13 patients with an average age of 2 years. LCH was found in skin and the lymphatic system. Imaging demonstrated extracranial organ involvement. All of them were treated with chemotherapy. There was 40% reactivation of LCH. CONCLUSIONS Treatment of LCH depends on presentation. SS- subgroup can be adequately treated via surgical debridement. SS+ and multisystem groups benefit from an early disease diagnosis and require chemotherapy.
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Affiliation(s)
- Joyce Xu
- Resident in Training, Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Julie R Gilbert
- Fellow in Hematology and Oncology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Kathryn S Sutton
- Assistant Professor, Division of Hematology and Oncology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Steven L Goudy
- Professor and Chief, Division of Pediatric Otolaryngology, Department of Otolaryngology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Shelly Abramowicz
- Associate Professor in Oral and Maxillofacial Surgery and Pediatrics, Department of Surgery, Emory University School of Medicine, Chief of Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, Georgia.
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Hand and feet swelling with indurated hypopigmented patches in the diaper area: Clue to diagnose Langerhans cell histiocytosis. Pediatr Neonatol 2021; 62:685-686. [PMID: 34489181 DOI: 10.1016/j.pedneo.2021.07.005] [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: 05/05/2021] [Revised: 07/02/2021] [Accepted: 07/26/2021] [Indexed: 11/22/2022] Open
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Rodriguez‐Galindo C. Clinical features and treatment of Langerhans cell histiocytosis. Acta Paediatr 2021; 110:2892-2902. [PMID: 34192374 DOI: 10.1111/apa.16014] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/23/2021] [Accepted: 06/29/2021] [Indexed: 12/11/2022]
Abstract
Langerhans cell histiocytosis (LCH) is caused by the expansion of CD1a+/CD207+ cells and is characterised by a wide spectrum of organ involvement and dysfunction, affecting all ages. While almost all organs and systems can be affected, only the involvement and dysfunction of liver, spleen, and haematopoietic system influence survival. The LCH pathogenic cells are defined by universal activation of the mitogen-activated protein kinase (MAPK) signalling pathway. The most common alteration is a somatic BRAFV600E mutation, which is present in approximately two-thirds of the cases, followed by MAP2K1 mutations. Treatment of LCH is risk-adapted; patients with single lesions may respond well to local treatment, whereas patients with multi-system disease require systemic chemotherapy. While survival for patients without organ dysfunction is excellent, mortality rates for patients with organ dysfunction may reach 20%. Despite progress made in the treatment of LCH, disease reactivation rates remain above 30%, and standard second-line treatment has yet to be established. Long-term effects, including neuroendocrine dysfunction and neurodegeneration, represent a major challenge for survivors. Treatment with BRAF or MEK inhibitors results in immediate responses, but reactivations are very common after discontinuation. Their role as single agents and in combination with chemotherapy is being explored.
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Affiliation(s)
- Carlos Rodriguez‐Galindo
- Departments of Global Pediatric Medicine and Oncology St. Jude Children’s Research Hospital Memphis TN USA
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17
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Fraitag S, Boccara O. What to Look Out for in a Newborn with Multiple Papulonodular Skin Lesions at Birth. Dermatopathology (Basel) 2021; 8:390-417. [PMID: 34449594 PMCID: PMC8395860 DOI: 10.3390/dermatopathology8030043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 12/17/2022] Open
Abstract
Multiple papulonodular skin lesions at birth can indicate the presence of various benign and malignant disorders. Although the lesions’ clinical aspect (color and consistency, in particular) may steer the clinician towards one disorder or another (infantile myofibromatosis, xanthogranuloma, or metastatic neuroblastoma), the diagnosis can only be confirmed by the histopathologic assessment of a biopsy. In neonates, a rapid but accurate diagnosis is critical because skin lesions may be the first manifestation of a malignant disorder like leukemia cutis or metastatic neuroblastoma. Here, we review the various disorders that may manifest themselves as multiple skin lesions at birth.
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Affiliation(s)
- Sylvie Fraitag
- Department of Pathology, Necker-Enfants Malades Hospital, APHP, 75015 Paris, France
- Correspondence:
| | - Olivia Boccara
- Department of Dermatology, Necker-Enfants Malades Hospital, APHP, 75015 Paris, France;
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Mitogen-activating protein kinase pathway alterations in Langerhans cell histiocytosis. Curr Opin Oncol 2021; 33:101-109. [PMID: 33315630 DOI: 10.1097/cco.0000000000000707] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Langerhans cell histiocytosis (LCH) is a rare disorder characterized by the infiltration of involved tissues by specialized dendritic cells. The demonstration of the constant activation of the mitogen-activated protein kinase (MAPK) pathway in LCH lesions has been a breakthrough in the understanding of the pathogenesis of this rare disease. We will summarize the current knowledge on MAPK alterations in LCH and the new therapeutic options indicated by these findings. RECENT FINDINGS Since the description of the B-Raf proto-oncogene, serine/threonine kinase (BRAF)V600E mutation in LCH lesions, several other molecular alterations affecting the MAPK pathway have been identified in most cases. Based on these driver alterations, LCH cells were shown to be derived from hematopoietic precursors, which yielded the current concept of LCH as a myeloid inflammatory neoplasia. MAPK pathway inhibitors have emerged as an innovative therapy in severe forms of LCH, resulting in virtually no acquired resistance. However, although they are highly effective, their effect is only temporary, as the disease relapses upon discontinuation of the treatment. SUMMARY LCH is an inflammatory myeloid neoplastic disorder, driven by mutations activating the MAPK pathway. MAPK-targeted treatments represent an important stepforward in the management of patients with severe progressive LCH.
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Lin H, Zhang Y, Zhang R, Chen F, Yang T, Mai H, Liu S, Hao Y, Chen M. Langerhans cell histiocytosis: A rare aetiology for fetal pleural effusion. Taiwan J Obstet Gynecol 2021; 59:777-779. [PMID: 32917337 DOI: 10.1016/j.tjog.2020.07.029] [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] [Accepted: 04/22/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE We present fetal pleural effusions associated with Langerhans cell histiocytosis (LCH). CASE REPORT We report a case of fetal pleural effusion in late pregnancy. Due to developing rapidly over short period of time, the baby was delivered by caesarean section at 34 weeks gestation. Generalised oedema, sparse haemorrhagic papules, pulmonary involvement, mediastinal mass and liver dysfunction were identified postnatally. Structural malformations, maternal-fetal blood type incompatibility, chromosomal abnormalities and viral infection were excluded. Mediastinal mass biopsy and immunohistochemical examinations confirmed the diagnosis of Langerhans cell histiocytosis (LCH). The baby is currently in a stable condition and undergoing regular chemotherapy. CONCLUSIONS Congenital LCH is a rare aetiology of fetal pleural effusions.
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Affiliation(s)
- Haiying Lin
- Department of Prenatal Diagnosis, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, China.
| | - Yanhua Zhang
- Department of Ultrasound, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, China
| | - Rui Zhang
- Department of Prenatal Diagnosis, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, China
| | - Fangfang Chen
- Department of Pathology, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, China
| | - Ting Yang
- Department of Neonatology and Neonatal Intensive Care Unit, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, China
| | - Huirong Mai
- Department of Hematologic Oncology, Shenzhen Children's Hospital, Shenzhen, China
| | - Shilin Liu
- Department of Hematologic Oncology, Shenzhen Children's Hospital, Shenzhen, China
| | - Yajing Hao
- Department of Radiology, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, China
| | - Min Chen
- Department of Fetal Medicine and Prenatal Diagnosis, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Obstetrics & Gynecology Institute of Guangzhou, Guangzhou, China; The Medical Centre for Critical Pregnant Women in Guangzhou, Guangzhou, China.
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20
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How to Deal with Skin Biopsy in an Infant with Blisters? Dermatopathology (Basel) 2021; 8:159-175. [PMID: 34199848 PMCID: PMC8293140 DOI: 10.3390/dermatopathology8020022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 01/22/2023] Open
Abstract
The onset of blisters in a neonate or an infant is often a source of great concern for both parents and physicians. A blistering rash can reveal a wide range of diseases with various backgrounds (infectious, genetic, autoimmune, drug-related, traumatic, etc.), so the challenge for the dermatologist and the pediatrician is to quickly determine the etiology, between benign causes and life-threatening disorders, for a better management of the patient. Clinical presentation can provide orientation for the diagnosis, but skin biopsy is often necessary in determining the cause of blister formations. In this article, we will provide information on the skin biopsy technique and discuss the clinical orientation in the case of a neonate or infant with a blistering eruption, with a focus on the histology for each etiology.
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Scolaro BL, Pereira GB, Ogata DC, da Cunha FSPFV, Effting ACM, Guanabara RO. Langerhans’ cell histiocytosis diagnosed due to dermatological perianal lesion. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1016/j.jcol.2017.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractLangerhans’ cell histiocytosis is a rare disease characterized by proliferation of Langerhans cells in the body. It affects mainly males, predominantly in childhood. Ulcerated plaques are one of the cutaneous forms of presentation. Diagnostic confirmation is done through immunohistochemistry. As therapeutic options, topical corticosteroids and chemotherapy are good choices. The case is reported of a male patient, aged 14, with perianal ulceration. He consulted a coloproctologist, who performed a biopsy of the region and started local triamcinolone applications. Immunohistochemistry diagnosed Langerhans’ cells histiocytosis. Further investigation revealed diabetes insipidus, osteolytic lesions in the skull and lower limbs, enlarged liver, and encephalic alterations. Chemotherapy was started with Vinblastine, with significant improvement of the lesions.
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Affiliation(s)
- Bruno Lorenzo Scolaro
- Universidade do Vale do Itajaí, Departamento de Cirurgia, Itajaí, SC, Brazil
- Sociedade Brasileira de Coloproctologia, Brusque, SC, Brazil
| | - Gustavo Becker Pereira
- Universidade do Vale do Itajaí, Departamento de Cirurgia, Itajaí, SC, Brazil
- Sociedade Brasileira de Coloproctologia, Brusque, SC, Brazil
| | - Daniel Cury Ogata
- Universidade do Vale do Itajaí, Disciplina Anatomia Patológica, Itajaí, SC, Brazil
- Sociedade Brasileira de Patologia, Brusque, SC, Brazil
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22
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Yang CY, Chiang PH, Yen CF, Shih IH, Chen GH. Diverse and rare clinical manifestations of Langerhans cell histiocytosis. DERMATOL SIN 2021. [DOI: 10.4103/ds.ds_12_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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23
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Schwartz Z, Bender A, Magro CM. Solitary congenital Langerhans cell histiocytoma: A pattern of benign, spontaneous regression in patients with single lesion disease. Pediatr Dermatol 2020; 37:1009-1013. [PMID: 32926467 DOI: 10.1111/pde.14333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 06/26/2020] [Accepted: 08/01/2020] [Indexed: 11/30/2022]
Abstract
Langerhans cell histiocytosis (LCH) is the neoplastic proliferation of dendritic langerin-positive histiocytes manifesting as either single system unifocal, single system multifocal, or multisystem disease. The designation Hashimoto-Pritzker, or self-healing LCH, has fallen out of favor since it is impossible to predict at time of diagnosis whether the disease is truly self-remitting or capable of spreading to other organ systems. We review the English literature on solitary congenital Langerhans cell histiocytoma, draw novel conclusions from the data provided by 81 cases in the literature, and illustrate a typical presentation of the diagnosis with a previously unreported patient. Each of the patients diagnosed with solitary congenital histiocytoma experienced spontaneous resolution and had no signs of systemic disease at latest follow-up. Furthermore, we offer an analysis of the histopathological findings available from the 81 cases and our patient. Based on our study observations, we propose solitary congenital Langerhans cell histiocytoma may portend a good prognosis and represent a distinct entity. However, until further confirmation with prospective studies, we recommend clinicians continue conducting appropriate workup to rule out systemic involvement.
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Affiliation(s)
- Ziv Schwartz
- Weill Cornell Medicine Department of Dermatology, New York, NY, USA.,SUNY Downstate College of Medicine, Brooklyn, NY, USA
| | - Anna Bender
- Weill Cornell Medicine Department of Dermatology, New York, NY, USA
| | - Cynthia M Magro
- Weill Cornell Medicine Department of Dermatology, New York, NY, USA
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24
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Dhar S, Srinivas SM, Dhar S, Basu S, Banerjee R, Malakar R, Ghosh A, Bhattacharya A, Ray SK, Bhattacharya A, Chowdhury J. Langerhans cell histiocytosis in children: A retrospective case series of 126 cases. Pediatr Dermatol 2020; 37:1085-1089. [PMID: 32981115 DOI: 10.1111/pde.14389] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 08/17/2020] [Accepted: 08/27/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Langerhans cell histiocytosis (LCH), a rare neoplasm of hematopoietic myeloid precursor cells, is clinically characterized by spontaneously resolving lesions to a progressive life-threatening multisystem disorder. Diagnosing LCH in children is challenging as it mimics other skin disorders. This study describes the varied clinical presentation and disease course in children less than 18 years diagnosed with LCH. METHODS We performed a retrospective observational study of all cases diagnosed with LCH presenting to a children's hospital in the last 26 years. Data on history, cutaneous and systemic examination, and laboratory evaluation performed, were recorded. RESULTS A total of 126 children diagnosed with LCH were included in the study. There were 68% cases limited only to skin, and 32% children with multisystem involvement at the initial presentation. Scaly papules were the most common morphologic finding in skin. The skeletal system was the second most common organ system to be affected. Failure to thrive was a common symptom. Progression of skin to systemic involvement was seen in 27.9%. In 76.7%, skin lesions cleared over a period of 2 to 4 years. Complete remission was seen in 56.9% of children over a period of 3 to 7 years, while 8.1% children died of complicationsand 31.8% were lost to follow-up. CONCLUSIONS Long-term follow-up in this study has shown cutaneous LCH without systemic involvement has a good prognosis. Skin involvement,along with failure to thrive, was the most common clinical presentation in our study. The skeletal system was the second most common organ system involved.
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Affiliation(s)
- Sandipan Dhar
- Department of Pediatric Dermatology, Institute of Child Health, Kolkata, India
| | - Sahana M Srinivas
- Department of Pediatric Dermatology, Indira Gandhi Institute of Child Health, Bengaluru, India
| | - Subhra Dhar
- Department of Histopathology, SRL Diagnostic, Kolkata, India
| | - Surupa Basu
- Department of Biochemistry, Institute of Child Health, Kolkata, India
| | - Raghubir Banerjee
- Department of Pediatric Dermatology, Institute of Child Health, Kolkata, India
| | - Rajib Malakar
- Department of Pediatric Dermatology, Institute of Child Health, Kolkata, India
| | - Apurba Ghosh
- Department of Pediatric Medicine, Institute of Child Health, Kolkata, India
| | | | - Swapan Kumar Ray
- Department of Radiodiagnosis, Institute of Child Health, Kolkata, India
| | | | - Jaydeep Chowdhury
- Department of Pediatric Medicine, Institute of Child Health, Kolkata, India
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25
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Raciborska A, Bilska K, Węcławek-Tompol J, Gryniewicz-Kwiatkowska O, Hnatko-Kołacz M, Stefanowicz J, Pieczonka A, Jankowska K, Pierelejewski F, Ociepa T, Sobol-Milejska G, Muszyńska-Rosłan K, Michoń O, Badowska W, Radwańska M, Drabko K. Clinical characteristics and outcome of pediatric patients diagnosed with Langerhans cell histiocytosis in pediatric hematology and oncology centers in Poland. BMC Cancer 2020; 20:874. [PMID: 32917181 PMCID: PMC7488688 DOI: 10.1186/s12885-020-07366-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 08/31/2020] [Indexed: 11/10/2022] Open
Abstract
Background Langerhans cell histiocytosis (LCH) affects 1–2 in 1,000,000 people. The disease is not associated with increased risk of treatment failure (especially among older children), but appropriate procedures implemented in advance can eliminate complications which might appear and significantly worsen the patients’ quality of life. Thus, we sought to evaluate the clinical features, management, and outcome of children with LCH treated in Polish pediatric hematology-oncology centers. Materials and methods One hundred eighty two patients with LCH were treated according to the Histiocytic Society Guidelines between 2010 and 2017. The participating centers were requested to provide the following data: demographic, clinical, as well as local or systemic treatment data and patients’ outcome. Overall survival (OS) and event free survival (EFS) were estimated by Kaplan-Meier methods and compared using the log-rank test. Results Sixty nine percent of children were classified as single system (SS). The patients with SS disease were significantly older as compared to the children with multisystem disease (MS), 6 vs. 2.3 years respectively (p 0.003). Bones were involved in 76% of patients. Systemic treatment was applied to 47% of children with SS disease and 98% with MS disease. Fourteen patients relapsed while two children died. OS and EFS in entire group were 0.99 and 0.91 respectively (with median follow-up 4.3 years). Conclusion The treatment of LCH in Polish centers was effective, however, new approaches, including mutation analyses and good inter-center cooperation, are needed to identify patients who might require modification or intensification of treatment.
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Affiliation(s)
- Anna Raciborska
- Department of Oncology and Surgical Oncology for Children and Youth, Institute of Mother and Child, Kasprzaka 17a, 01-211, Warszawa, Poland.
| | - Katarzyna Bilska
- Department of Oncology and Surgical Oncology for Children and Youth, Institute of Mother and Child, Kasprzaka 17a, 01-211, Warszawa, Poland
| | - Jadwiga Węcławek-Tompol
- Department and Clinic of Pediatric Oncology, Hematology and Bone Marrow Transplantation, Wroclaw Medical University, Wrocław, Poland
| | | | | | - Joanna Stefanowicz
- Department of Pediatric Hematology and Oncology, Medical University of Gdansk, Gdańsk, Poland
| | - Anna Pieczonka
- Department of Pediatric Oncology, Hematology and Transplantology, Medical University of Poznan, Poznań, Poland
| | - Katarzyna Jankowska
- Department of Pediatric Hematology and Oncology Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Filip Pierelejewski
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Łódź, Poland
| | - Tomasz Ociepa
- Department of Pediatrics, Hematology and Oncology, Medical University of Szczecin, Szczecin, Poland
| | - Grażyna Sobol-Milejska
- Unit of Pediatric Oncology, Hematology and Chemotherapy, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Muszyńska-Rosłan
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, Children's Clinical Hospital of L. Zamenhof, Białystok, Poland
| | - Olga Michoń
- Department of Pediatrics, Hematology and Oncology, Medical University of Zabrze, Zabrze, Poland
| | - Wanda Badowska
- Department of Pediatric Oncology, Hematology, Medical University of Olsztyn, Olsztyn, Poland
| | - Monika Radwańska
- Department of Pediatric Oncology, Hematology, Medical University of Rzeszow, Rzeszów, Poland
| | - Katarzyna Drabko
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Lublin, Poland
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26
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Ungari M, Caresana G, Tanzi G, Drera B, Frittoli MC, Gusolfino MD, Ferrero G, Varotti E, Manotti L, Trombatore M, Bertoni R. Congenital Unilesional Cutaneous Langerhans Cell Histiocytosis: A Case Report. Am J Dermatopathol 2020; 43:e38-e42. [PMID: 32769549 DOI: 10.1097/dad.0000000000001770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Langerhans cell histiocytosis (LCH) is a clonal proliferation of bone-marrow-derived cells, which normally reside as epidermal and mucosal dendritic cells involved in antigen presentation. It is a rare disease more common in children than adults, that is believed to be neoplastic in most cases. The diagnosis is based on clinical and radiological findings in combination with histopathologic, immunophenotypic, or ultrastructural analyses. LCH have a broad spectrum of clinical manifestations, ranging from benign cutaneous lesions to malignant multisystem disease. Based on the extent of involvement at diagnosis, LCH can be divided in single-system LCH when only one organ or system is involved, usually with multiple lesions, and multisystem LCH, when 2 or more organs or systems are involved at diagnosis. One variant of LCH is characterized by congenital isolated cutaneous involvement. It typically manifests at birth or in the postnatal period with a widespread eruption of red-to-brown papulo-nodules or, more uncommonly, a solitary lesion. The overall prognosis for single lesion skin limited LCH is excellent and most lesions spontaneously resolve within 4-18 weeks. Systemic involvement is rare. Skin findings cannot predict systemic disease and obtaining an oncology consultation is recommended for further evaluation. Herein, we present an additional case in a full-term, well-appearing, female infant with an isolated, asymptomatic, ulcerated, papule of the left arm, that was noted at birth.
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Affiliation(s)
| | | | | | - Bruno Drera
- Intensive Neonatal Therapy, A.S.S.T. Cremona, Cremona, Italy
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27
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Cyr J, Langley A, Demellawy DE, Ramien M. A neonate with Langerhans cell histiocytosis presenting as blueberry muffin rash: Case report and review of the literature. SAGE Open Med Case Rep 2020; 8:2050313X20919616. [PMID: 32547754 PMCID: PMC7273623 DOI: 10.1177/2050313x20919616] [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] [Indexed: 11/28/2022] Open
Abstract
In our case report, we discuss a 1-day-old boy presenting with blueberry muffin
syndrome diagnosed with Langerhans cell histiocytosis. The diagnosis complicated
by an initial difficult-to-interpret biopsy showing only a hint of
perifollicular CD1a-positive cells; however, given our team’s strong clinical
suspicion of Langerhans cell histiocytosis, a second biopsy of a more mature
lesion was done and showed typical histopathology. This case introduces the
possibility of perifollicular Langerhans cells early in this condition,
demonstrates the importance of appropriate biopsy site selection, and highlights
the importance of maintaining a high degree of suspicion when there is poor
clinicopathologic correlation. Our case report contains a comprehensive table
which reviews the systemic and cutaneous clinical features, as well as the
laboratory, pathology, and imaging findings for the differential diagnoses of
blueberry muffin baby.
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Affiliation(s)
- Janelle Cyr
- Division of Dermatology, University of Toronto, Ottawa, ON, Canada
| | - Annie Langley
- Division of Dermatology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Dina El Demellawy
- Division of Pathology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Michele Ramien
- Division of Dermatology, The Ottawa Hospital, Ottawa, ON, Canada.,Division of Rheumatology and Dermatology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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28
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Leung AKC, Lam JM, Leong KF. Childhood Langerhans cell histiocytosis: a disease with many faces. World J Pediatr 2019; 15:536-545. [PMID: 31456157 DOI: 10.1007/s12519-019-00304-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/01/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a group of diseases characterized by the proliferation and accumulation of Langerhans cells. Clinical presentations of LCH vary widely. DATA SOURCES A PubMed search was conducted using Clinical Queries with the key term "Langerhans cell histiocytosis". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. This paper is based on, but not limited to, the search results. RESULTS Generally, patients with LCH can be divided into two groups based on the extent of involvement at diagnosis, namely, single-system LCH and multisystem LCH. The involvement may be unifocal or multifocal. Patients with isolated bone lesions typically present between 5 and 15 years of age, whereas those with multisystem LCH tend to present before 5 years of age. The clinical spectrum is broad, ranging from an asymptomatic isolated skin or bone lesion to a life-threatening multisystem condition. Clinical manifestations include, among others, "punched out" lytic bone lesion, seborrheic dermatitis-like eruption, erythematous/reddish-brown crusted/scaly papules/maculopapules/plaques/patches, and eczematous lesions, diabetes insipidus, hepatosplenomegaly, cytopenias, lymphadenopathy, and an acute fulminant disseminated multisystem condition presenting with fever, skin rash, anemia, thrombocytopenia, lymphadenopathy, and hepatosplenomegaly. The diagnosis is clinicopathologic, based on typical clinical findings and histologic/immunohistochemical examination of a biopsy of lesional tissue. Positive CD1a, S100, and/or CD207 (Langerin) immunohistochemical staining of lesional cells is required for a definitive diagnosis. Watchful waiting is recommended for patients with skin-only LCH. Patients with symptomatic or refractory skin-only LCH may be treated with topical tacrolimus/corticosteroids, topical nitrogen mustard, oral methotrexate, or oral hydroxyurea. The current recommended first-line therapy for patients with multisystem LCH is 12 months therapy with prednisone and vinblastine. Mercaptopurine is added for patients with risk organ involvements. CONCLUSIONS Because of the broad spectrum of clinical manifestations and the extreme diversity of disease, LCH remains a diagnostic dilemma. Morphological identification of LCH cells and positive immunochemical staining with CD1a, S100, and/or CD207 (Langerin) of lesional cells are necessary for a definitive diagnosis.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, and The Alberta Children's Hospital, #200, 233, 16th Avenue NW, Calgary, AB, T2M 0H5, Canada.
| | - Joseph M Lam
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
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29
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Leung AKC, Leong KF, Lam JM. A congenital ulcerated nodule with spontaneous resolution. Paediatr Child Health 2019; 26:14-15. [PMID: 33542769 DOI: 10.1093/pch/pxz142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 09/12/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, and the Alberta Children's Hospital, Calgary, Alberta
| | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, The University of British Columbia, Vancouver, British Columbia
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30
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Localized Acral Sclerosing Langerhans Cell Histiocytosis: A New Form of Presentation of Cutaneous Langerhans Cell Histiocytosis. Am J Dermatopathol 2019; 42:356-359. [PMID: 31725482 DOI: 10.1097/dad.0000000000001572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a rare proliferative disorder, more frequent in children, characterized by an abnormal accumulation of Langerhans cells admixed with eosinophils, lymphocytes, neutrophils, and macrophages. The clinical presentation is variable and depends on whether a single or multiple organs are affected. Skin lesions are common in LCH (40% of cases) and represent a frequent form of presentation (in up to 80% of cases). Cutaneous manifestations of LCH are highly variable, frequently presenting as crusted papules or scaly seborrheic-like lesions localized in the scalp. We report the first case of a localized acral sclerosing LCH, a new form of LCH. This case highlights the broad and surprising form of presentation of LCH which may be overlooked and can significantly delay its diagnosis. The development of systemic disease may occur months to years after the initial skin presentation. Prompt diagnosis and treatment may prevent progression to systemic disease, as documented in some cases.
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31
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St Claire K, Bunney R, Ashack KA, Bain M, Braniecki M, Tsoukas MM. Langerhans cell histiocytosis: A great imitator. Clin Dermatol 2019; 38:223-234. [PMID: 32513402 DOI: 10.1016/j.clindermatol.2019.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Langerhans cell histiocytosis (LCH) is an uncommon but serious inflammatory neoplasia that affects many organs, including the skin. Though uncommon, it should remain high on a clinician's differential diagnosis in treatment-resistant cases of conditions, such as seborrheic dermatitis, diaper dermatitis, arthropod bites, and many more. A thorough history nd physical examination for each patient can aid in the diagnosis; however, if clinically suspicious for LCH, a punch biopsy should be performed. Histologic evaluation of LCH is often enough to differentiate it from the many clinical mimickers. Characteristic findings include a histiocytic infiltrate with "coffee bean"-cleaved nuclei, rounded shape, and eosinophilic cytoplasm. Immunohistochemical stains, including CD1a, S100, and CD207 (langerin) are often needed for a definitive diagnosis. Electron microscopy also demonstrates the ultrastructural presence of Birbeck granules, but this is no longer needed due to immunohistochemical staining. Treatment is often necessary for LCH, if systemic involvement exists.
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Affiliation(s)
- Kayla St Claire
- Department of Dermatology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Ryan Bunney
- Department of Dermatology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Kurt A Ashack
- Department of Dermatology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Michelle Bain
- Department of Dermatology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Marylee Braniecki
- Department of Pathology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Maria M Tsoukas
- Department of Dermatology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA.
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32
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Hansel K, Tramontana M, Troiani S, de Benedictis D, Bianchi L, Cucchia R, Simonetti S, Stingeni L. Congenital Self-Healing Langerhans Cell Histiocytosis: A Rare Presentation of Blueberry Muffin Baby "Spectrum". Dermatopathology (Basel) 2019; 6:37-40. [PMID: 31192198 PMCID: PMC6547258 DOI: 10.1159/000499311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/28/2019] [Indexed: 01/09/2023] Open
Abstract
A case of congenital self-healing Langerhans cell histiocytosis (CSHLCH), also known as Hashimoto-Pritzker disease, is reported. The newborn presented as blueberry muffin baby at birth, showing numerous non-blanching blue-purplish and dark-red papular, nodular lesions without documented infections and systemic involvement. Histopathological and immunohistochemical findings were suggestive for Langerhans cell histiocytosis. During the first 12 weeks of life, the cutaneous lesions progressively and spontaneously regressed with some atrophic scars. One-year follow-up is negative for relapse of cutaneous lesions or systemic involvement, confirming the diagnosis of CSHLCH.
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Affiliation(s)
- Katharina Hansel
- Section of Dermatology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Marta Tramontana
- Section of Dermatology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Stefania Troiani
- Division of Neonatology and Neonatal Intensive Care Unit, Department of Maternal and Child Health, Santa Maria della Misericordia Hospital of Perugia, Perugia, Italy
| | - Diletta de Benedictis
- Division of Neonatology and Neonatal Intensive Care Unit, Department of Maternal and Child Health, Santa Maria della Misericordia Hospital of Perugia, Perugia, Italy
| | - Leonardo Bianchi
- Section of Dermatology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Rosa Cucchia
- Section of Dermatology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Stefano Simonetti
- Section of Dermatology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine, University of Perugia, Perugia, Italy
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Langerhans Cell Histiocytosis: Single Center Experience of 25 Years. Mediterr J Hematol Infect Dis 2019; 11:e2019035. [PMID: 31205639 PMCID: PMC6548207 DOI: 10.4084/mjhid.2019.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 04/17/2019] [Indexed: 11/08/2022] Open
Abstract
Objectives To review a single center outcome of patients with Langerhans Cell Histiocytosis diagnosed at a tertiary referral hospital from Turkey.Methods: The files between 1989 and 2015 of 80 patients with LCH were retrospectively analyzed. Results During the 25 years, 80 patients were diagnosed with LCH. The median age at diagnosis was 53 months (2-180 months) and the median follow-up time of patients was 10 years and 9 months (24 months-25 years). Bone was the most frequently affected organ (n:60, 75%). Initially, 43 patients (54%) had single system (SS) disease, 20 patients (25%) had multisystem (MS) disease without risk organ involvement (MS-RO-), and 17 patients (21%) had a multisystem disease with risk-organ involvement (MS-RO+). The overall survival (OS) rate was 91%, and event-free survival (EFS) rate was 67% at 10 years. 10-year OS rate was lower for patients with MS-RO+ (65%) when compared to those with, MS-RO-, and SS (100%, 97%, p value=<0.001). The overall survival rate was also lower in patients with lack of response to systemic chemotherapy on 12th week (p=<0.001), younger age (<2 years) at presentation (p=<0.02), skin involvement (<0.001) and lack of bone lesions at presentation (<0.001). Discussion In the group with MS-RO+, OS is significantly low compared to other groups. Further efforts are warranted to improve survival in MS-RO+ patients.
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Affiliation(s)
| | - Alysa Poulin
- 1 University of Washington, Seattle, WA, USA.,2 Seattle Children's Hospital, Seattle, WA, USA
| | - Markus D Boos
- 1 University of Washington, Seattle, WA, USA.,2 Seattle Children's Hospital, Seattle, WA, USA
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35
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Poompuen S, Chaiyarit J, Techasatian L. Diverse cutaneous manifestation of Langerhans cell histiocytosis: a 10-year retrospective cohort study. Eur J Pediatr 2019; 178:771-776. [PMID: 30826864 DOI: 10.1007/s00431-019-03356-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/20/2019] [Accepted: 02/20/2019] [Indexed: 12/11/2022]
Abstract
Cutaneous manifestation is a common presentation of LCH and is usually a leading clue for the disease diagnosis. Having cutaneous lesions did not show a significantly early age onset at diagnosis compared to those without skin lesions, P value = 0.71. In the present study, cutaneous findings were found as 77.7%. Seborrheic dermatitis-like lesions were the most common cutaneous type (42.8%), followed by papules/nodules/masses (28.5%), petechiae/hemorrhagic lesions (17.8%), and eczematous lesions (10.7%). Time to diagnosis of LCH presented with seborrheic dermatitis-like lesions was significantly longer than other cutaneous presentations, P value = 0.0011.Conclusion: Patients with LCH who had the manifestations of seborrheic dermatitis-like lesions can have diagnosis delayed due to the difficulty in distinguishing these lesions from normal seborrheic dermatitis lesions. Petechiae/hemorrhagic cutaneous signs in addition to the normal seborrheic dermatitis is the clue for early detection of the disease. To improve early detection of LCH, general pediatricians should be alerted to be aware of these skin symptoms, and if they persist, a dermatologist, pediatric if available, should be immediately consulted. What is Known? • Cutaneous manifestation is a common presentation of LCH and is usually a leading clue for the disease diagnosis. What is New? • Patients with LCH who have the manifestations of seborrheic dermatitis-like lesions can have a delayed diagnosis due to the difficulty in distinguishing normal from seborrheic dermatitis lesions. • Petechiae/hemorrhagic cutaneous signs in addition to the normal seborrheic dermatitis are the clue to the early disease detection.
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Affiliation(s)
- Supattarawadee Poompuen
- Dermatology Division, Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Jitjira Chaiyarit
- Clinical Epidemiology Unit, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Leelawadee Techasatian
- Dermatology Division, Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
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36
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Pediatric Langerhans cell histiocytosis: the impact of mutational profile on clinical progression and late sequelae. Ann Hematol 2019; 98:1617-1626. [DOI: 10.1007/s00277-019-03678-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 03/19/2019] [Indexed: 12/11/2022]
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37
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Mahmood S, Raza M, Nusrat K, Marsia S, Abbas A. Infiltrating the Heart and Kidney: A Rare Pediatric Case of Multisystem Langerhans Cell Histiocytosis from Pakistan. Cureus 2019; 11:e4315. [PMID: 31183295 PMCID: PMC6538118 DOI: 10.7759/cureus.4315] [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] [Indexed: 11/16/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare, clonal disease of the monocyte-macrophage system, varying in its clinical presentation from mere self-healing skin and bone lesions to life-threatening multi-system disease. In descending order of frequency, the disease is known to involve the skeleton, skin, lymph nodes and lesser often, the liver, spleen, lungs, hematopoietic and central nervous systems. Here, we present a pediatric case of multi-system LCH in a five-year-old child, unique in its evident cardiac and renal involvement alongside other organ systems and important in how the diagnosis was aided by a fine needle aspiration cytology instead of the costlier histopathological procedures, in a setting with limited resources.
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Affiliation(s)
- Samar Mahmood
- Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, PAK
| | - Mohammad Raza
- Pediatrics, Dow University of Health Sciences (DUHS), Karachi, PAK
| | - Khushboo Nusrat
- Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, PAK
| | - Shayan Marsia
- Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, PAK
| | - Awais Abbas
- Pediatrics, Dow University of Health Sciences (DUHS), Karachi, PAK
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38
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Wu X, Huang J, Jiang L, Wu H, Cheng Y, Chen C, Xue H. Congenital self-healing reticulohistiocytosis with BRAF V600E mutation in an infant. Clin Exp Dermatol 2019; 44:647-650. [PMID: 30609054 DOI: 10.1111/ced.13880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2018] [Indexed: 11/30/2022]
Abstract
Congenital self-healing reticulohistiocytosis (CSHR) is a rare disorder characterized by benign skin lesions with a tendency to self-heal. Multiple skin lesions are usually present in CSHR. It is very difficult to distinguish between CSHR and an invasive Langerhans cell histiocytosis. We present a case of a 5-month-old infant girl who had hypopigmented skin lesions distributed over her neck, thorax and torso. The skin lesions regressed spontaneously 2 months after the diagnosis of CSHR and the child has remained in complete remission without any sign of recurrence over a 2-year follow-up. BRAF V600E mutation was detected in lesional cells along with a low Ki-67 proliferative activity of about 6%. BRAF oncogene-induced senescence might contribute to a mechanism of self-regression in CSHR; however, the exact role of the somatic BRAF V600E mutation in CSHR remains to be determined.
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Affiliation(s)
- X Wu
- Department of Pediatrics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - J Huang
- Department of Pediatrics, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - L Jiang
- Department of Pediatrics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - H Wu
- Department of Pediatrics, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Y Cheng
- Department of Pediatrics, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - C Chen
- Department of Pediatrics, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - H Xue
- Department of Pediatrics, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
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39
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Langerhans Cell Histiocytoma: A Benign Histiocytic Neoplasm of Diverse Lines of Terminal Differentiation. Am J Dermatopathol 2019; 41:29-36. [DOI: 10.1097/dad.0000000000001255] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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40
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Langerhans cell histiocytosis in children: History, classification, pathobiology, clinical manifestations, and prognosis. J Am Acad Dermatol 2018; 78:1035-1044. [PMID: 29754885 DOI: 10.1016/j.jaad.2017.05.059] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/15/2017] [Accepted: 05/31/2017] [Indexed: 12/16/2022]
Abstract
Langerhans cell histiocytosis (LCH) is an inflammatory neoplasia of myeloid precursor cells driven by mutations in the mitogen-activated protein kinase pathway. When disease involves the skin, LCH most commonly presents as a seborrheic dermatitis or eczematous eruption on the scalp and trunk. Evaluation for involvement of other organ systems is essential, because 9 of 10 patients presenting with cutaneous disease also have multisystem involvement. Clinical manifestations range from isolated disease with spontaneous resolution to life-threatening multisystem disease. Prognosis depends on involvement of risk organs (liver, spleen, and bone marrow) at diagnosis, particularly on presence of organ dysfunction, and response to initial therapy. Systemic treatment incorporating steroids and cytostatic drugs for at least one year has improved prognosis of multisystem LCH and represents the current standard of care.
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41
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Micali G, Verzì AE, Quattrocchi E, Ng CY, Lacarrubba F. Dermatoscopy of Common Lesions in Pediatric Dermatology. Dermatol Clin 2018; 36:463-472. [PMID: 30201155 DOI: 10.1016/j.det.2018.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The use of dermatoscopy to assist in the diagnosis of a variety of proliferative, pigmentary, inflammatory, infectious, congenital, and genetic cutaneous and skin appendage disorders is constantly increasing, as it is effective, affordable, noninvasive, and quick to perform.
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Affiliation(s)
- Giuseppe Micali
- Dermatology Clinic, University of Catania, Via S. Sofia 78, Catania 95123, Italy.
| | - Anna Elisa Verzì
- Dermatology Clinic, University of Catania, Via S. Sofia 78, Catania 95123, Italy
| | - Enrica Quattrocchi
- Dermatology Clinic, University of Catania, Via S. Sofia 78, Catania 95123, Italy
| | - Chau Yee Ng
- Department of Dermatology, College of Medicine, Chang Gung Memorial Hospital, No. 199, Tun-Hwa North Road, Taipei 105, Taiwan
| | - Francesco Lacarrubba
- Dermatology Clinic, University of Catania, Via S. Sofia 78, Catania 95123, Italy
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42
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Fernández Armenteros JM, Arco Huguet N, Sanmartin Novell V, Vilardell Villellas F, Velasco Sanchez A, Martró Català E, Martí Laborda RM, Soria Gili X. Langerhans cell histiocytosis mimicking molluscum contagiosum: A case series. Pediatr Blood Cancer 2018. [PMID: 29528195 DOI: 10.1002/pbc.27047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a disorder characterized by accumulation of Langerhans-like cells in one or various organs. A correct staging work-up is essential since there are multiorgan presentations with a poor prognosis. We report three patients with LCH skin lesions mimicking molluscum contagiosum in association with both high and low risk organ involvement. This peculiar cutaneous presentation can be a clue for the diagnosis of LCH, a disease with potentially severe systemic involvement.
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Affiliation(s)
- José Manuel Fernández Armenteros
- Department of Dermatology, Hospital Universitari Arnau de Vilanova, Lleida, Spain.,Institut de Recerca Biomèdica de Lleida (IRBLleida), University of Lleida, Lleida, Spain
| | - Nuria Arco Huguet
- Department of Pediatrics, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | | | | | - Ana Velasco Sanchez
- Department of Pathology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Elisa Martró Català
- Department of Microbiology, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Rosa Maria Martí Laborda
- Department of Dermatology, Hospital Universitari Arnau de Vilanova, Lleida, Spain.,Institut de Recerca Biomèdica de Lleida (IRBLleida), University of Lleida, Lleida, Spain
| | - Xavier Soria Gili
- Department of Dermatology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
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43
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Langerhans cell histiocytosis in children. J Am Acad Dermatol 2018; 78:1047-1056. [DOI: 10.1016/j.jaad.2017.05.060] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/15/2017] [Accepted: 05/31/2017] [Indexed: 12/23/2022]
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44
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Dennin MH, Roman CJ, Stein SL. Congenital Langerhans cell histiocytosis presenting in a 27-week-gestation neonate. Pediatr Dermatol 2018; 35:e140-e141. [PMID: 29436047 DOI: 10.1111/pde.13416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Langerhans cell histiocytosis is exceedingly rare in premature infants, and the few cases reported suggest a poor prognosis with systemic involvement. We present a case of Langerhans cell histiocytosis limited to a single cutaneous lesion, presenting in a 27-week-gestation infant, which is the youngest gestational age of reported Langerhans cell histiocytosis cases. The lesion showed spontaneous resolution by 41 weeks corrected gestational age, and systemic involvement was absent, demonstrating a mild course of skin-only Langerhans cell histiocytosis in a premature infant.
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Affiliation(s)
- Margaret H Dennin
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Carly J Roman
- Section of Dermatology, University of Chicago, Chicago, IL, USA
| | - Sarah L Stein
- Section of Dermatology, University of Chicago, Chicago, IL, USA
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45
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Tran G, Huynh TN, Paller AS. Langerhans cell histiocytosis: A neoplastic disorder driven by Ras-ERK pathway mutations. J Am Acad Dermatol 2018; 78:579-590.e4. [DOI: 10.1016/j.jaad.2017.09.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/29/2017] [Accepted: 09/10/2017] [Indexed: 12/13/2022]
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46
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Abstract
This article focuses on cutaneous hematopoietic neoplasms that are more likely to be encountered in the pediatric age-group and includes both lymphoproliferative and histiocytic disorders. The cutaneous hematologic disorders in children have a different epidemiologic profile to what is seen during adulthood. Although mycosis fungoides is the most frequent form of cutaneous lymphoma in adults, it is very rare in children. Because lymphoblastic leukemias and lymphomas are more frequent in the pediatric setting, cutaneous leukemic infiltrates are relatively common in this age-group. Similarly, histiocytic disorders are more common in children, particularly Langerhans cell histiocytosis and juvenile xanthogranuloma. Notably, the histiocytic disorders have undergone significant modifications on their nomenclature in the basis of the molecular characteristics that are present in them. A summary of the most frequent cutaneous hematopoietic disorders in children will be discussed further in this review.
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Affiliation(s)
- Alejandro A Gru
- 1 Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Louis P Dehner
- 2 Lauren V. Ackerman Laboratory of Surgical Pathology, St. Louis Children's Hospital and Dermatopathology, Washington University Medical Center, St. Louis, Missouri
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47
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Huang W, Qiu T, Zeng L, Zheng B, Ying J, Feng X. High frequency of clonal IG and T-cell receptor gene rearrangements in histiocytic and dendritic cell neoplasms. Oncotarget 2018; 7:78355-78362. [PMID: 27823979 PMCID: PMC5346644 DOI: 10.18632/oncotarget.13058] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 10/25/2016] [Indexed: 12/26/2022] Open
Abstract
The 2008 World Health Organization (WHO) diagnostic criteria of histiocytic and dendritic cell neoplasms from hematopoietic and lymphoid tissues no longer required the absence of clonal B-cell/T-cell receptor gene rearrangements. It is true that the clonal B-cell/T-cell receptor gene rearrangements have been identified in rare cases of histiocytic and dendritic cell neoplasms, such as those with or following lymphoma/leukemia or in some sporadic histiocytic/dendritic cell sarcomas, but the clonal features of such group of tumor are still not clear. Here we investigated the clonal status of 33 samples including Langerhans cell histiocytosis (LCH), Langerhans cell sarcoma (LCS), follicular dendritic cell sarcoma (FDCS), interdigitating dendritic cell sarcoma (IDCS) and histiocytic sarcoma (HS). Among them, twenty-eight cases were sporadic without current or past lymphoma/leukemia. Three cases were found with a past history of T-cell lymphoma, one case was followed by extraosseous plasmacytoma, and one case was found with diffuse large B-cell lymphoma (DLBCL). Our results showed that there was a high frequency of clonal IG and T-cell receptor gene rearrangements in these cases. Notably, 4 cases of LCH and 2 cases of FDCS showed both B and T cell receptor gene rearrangements concurrently. One case of FDCS synchronous with DLBCL showed identical clonal IGH in both tumor populations and clonal TCRβ in FDCS alone. No matter if the presence of clonal receptor gene rearrangements was associated with the tumor origin or tumorigenesis, it might serve as a novel tumor marker for developing target therapy.
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Affiliation(s)
- Wenting Huang
- Department of Pathology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tian Qiu
- Department of Pathology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Linshu Zeng
- Department of Pathology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Zheng
- Department of Pathology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianming Ying
- Department of Pathology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoli Feng
- Department of Pathology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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48
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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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49
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Luder C, Nordmann T, Ramelyte E, Mühleisen B, Kerl K, Guenova E, Dummer R. Histiocytosis - cutaneous manifestations of hematopoietic neoplasm and non-neoplastic histiocytic proliferations. J Eur Acad Dermatol Venereol 2018; 32:926-934. [DOI: 10.1111/jdv.14794] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 12/11/2017] [Indexed: 01/18/2023]
Affiliation(s)
- C.M. Luder
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| | - T.M. Nordmann
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| | - E. Ramelyte
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| | - B. Mühleisen
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| | - K. Kerl
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| | - E. Guenova
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| | - R. Dummer
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
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50
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Udkoff J, Holmes RE, Dohil MA. Congenital scalp tumor with ulceration. Pediatr Dermatol 2018; 35:145-146. [PMID: 29356114 DOI: 10.1111/pde.13355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jeremy Udkoff
- Pediatric and Adolescent Dermatology, University of California, San Diego School of Medicine and Rady Children's Hospital, University of California, San Diego, CA, USA
| | - Ralph E Holmes
- Pediatric Plastic Surgery, University of California, San Diego and Rady Children's Hospital, San Diego, CA, USA
| | - Magdalene A Dohil
- Pediatric and Adolescent Dermatology, University of California, San Diego School of Medicine and Rady Children's Hospital, University of California, San Diego, CA, USA
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