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Zhang L, Zhang G, Zheng H, Jiang B, Ju Y, Duan Q, An L, Shi H. A rare case of primary central nervous system histiocytic sarcoma harboring a novel ARHGAP45::BRAF fusion: a case report and literature review. Brain Tumor Pathol 2024; 41:18-29. [PMID: 38100030 DOI: 10.1007/s10014-023-00471-8] [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] [Received: 09/26/2023] [Accepted: 12/06/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Patients with histiocytic sarcoma occurring in the central nervous system (CNS) are rare and have a very poor prognosis. The increased use of molecular diagnostic approaches in solid tumors has brought more opportunities for the diagnosis and treatment of central nervous system histiocytic sarcoma (CNSHS). CASE DESCRIPTION A 9-year-old girl was admitted to the hospital with pain in her head and neck, as well as vomiting. Imaging scans showed a prominent abnormality in the anterior falciform region, and histopathology revealed the presence of CD68 (+) and CD163 (+) cells, leading to a preliminary diagnosis of primary intracerebral CNSHS. Molecular profiling tests identified a new variant of ARHGAP45::BRAF fusion in this case, which has not been reported in any other tumor. The patient underwent surgical removal of the tumor and will require long-term monitoring. CONCLUSION The presence of the BRAF point mutation, predominantly BRAF p.V600E, has been documented in prior literature of CNSHS. This is the first case of pediatric histiocytic sarcoma in the anterior falciform region who has a unique ARHGAP45::BRAF fusion. The findings of our study indicate that a broader range of molecular assays should be employed in the diagnosis of CNSHS and opens up new possibilities for the treatment of the patient.
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Affiliation(s)
- Luyi Zhang
- Department of Neurosurgery, Xi'an Children's Hospital Affiliated to Xi'an Jiaotong University, No 69, Xiju Yuan Lane, Lianhu District, Xi'an, 710000, Shanxi, People's Republic of China
| | - Gang Zhang
- Department of Neurosurgery, Xi'an Children's Hospital Affiliated to Xi'an Jiaotong University, No 69, Xiju Yuan Lane, Lianhu District, Xi'an, 710000, Shanxi, People's Republic of China
| | - Han Zheng
- Department of Neurosurgery, Xi'an Children's Hospital Affiliated to Xi'an Jiaotong University, No 69, Xiju Yuan Lane, Lianhu District, Xi'an, 710000, Shanxi, People's Republic of China
| | - Bin Jiang
- Department of Neurosurgery, Xi'an Children's Hospital Affiliated to Xi'an Jiaotong University, No 69, Xiju Yuan Lane, Lianhu District, Xi'an, 710000, Shanxi, People's Republic of China
| | - Yongzhi Ju
- The Medical Department, State Key Laboratory of Neurology and Oncology Drug Development, Jiangsu Simcere Pharmaceutical Co., Ltd., Jiangsu Simcere Diagnostics Co., Ltd., Nanjing, Jiangsu, People's Republic of China
| | - Qianqian Duan
- The Medical Department, State Key Laboratory of Neurology and Oncology Drug Development, Jiangsu Simcere Pharmaceutical Co., Ltd., Jiangsu Simcere Diagnostics Co., Ltd., Nanjing, Jiangsu, People's Republic of China
| | - Lu An
- Department of Pathology, Xi'an Children's Hospital Affiliated to Xi'an Jiaotong University, Xi'an, Shanxi, People's Republic of China
| | - Hangyu Shi
- Department of Neurosurgery, Xi'an Children's Hospital Affiliated to Xi'an Jiaotong University, No 69, Xiju Yuan Lane, Lianhu District, Xi'an, 710000, Shanxi, People's Republic of China.
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Meyer LK, Nichols KE. Hyperactive TLR signaling: putting the "H" in H syndrome. Blood 2023; 142:1679-1681. [PMID: 37971762 DOI: 10.1182/blood.2023022381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
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Riancho JA, Hernández JL, González-Vela C, López-Sundh AE, González-Lopez MA, Gomez de la Fuente F, Quirce R, Diamond EL. Erdheim-Chester Disease Due to a Novel Internal Duplication of NRAS: Response to Targeted Therapy with Cobimetinib. Int J Mol Sci 2023; 24:15467. [PMID: 37895147 PMCID: PMC10606995 DOI: 10.3390/ijms242015467] [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: 09/09/2023] [Revised: 10/08/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
Histiocytoses encompass a group of exceptionally rare disorders characterized by the abnormal infiltration of tissues by histocytes. Among these, Erdheim-Chester disease (ECD) stands out as a multisystem histiocytosis that typically affects bones and various other tissues. Historically, the treatment of ECD has been challenging. However, recent breakthroughs in our understanding, particularly the discovery of somatic mutations in the RAS-MAPK pathway, have opened new opportunities for targeted therapy in a significant subset of patients with ECD and other histiocytoses. In this report, we present the case of a patient with ECD harboring a previously unidentified microduplication in the NRAS gene in a small fraction of skin cells. This discovery played a pivotal role in tailoring an effective therapeutic approach involving kinase inhibitors downstream of NRAS. This case underscores the crucial role of deep sequencing of tissue samples in ECD, enabling the delivery of personalized targeted therapy to patients.
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Affiliation(s)
- José A. Riancho
- Servicio de Medicina Interna, Hospital U.M. Valdecilla, Universidad de Cantabria, IDIVAL, CIBERER, 39008 Santander, Spain;
| | - José L. Hernández
- Servicio de Medicina Interna, Hospital U.M. Valdecilla, Universidad de Cantabria, IDIVAL, CIBERER, 39008 Santander, Spain;
| | - Carmen González-Vela
- Servicio de Anatomía Patológica, Hospital U.M. Valdecilla, Universidad de Cantabria, IDIVAL, 39008 Santander, Spain
| | - Ana E. López-Sundh
- Servicio de Dermatología, Hospital U.M. Valdecilla, Universidad de Cantabria, IDIVAL, 39008 Santander, Spain; (A.E.L.-S.); (M.A.G.-L.)
| | - Marcos A. González-Lopez
- Servicio de Dermatología, Hospital U.M. Valdecilla, Universidad de Cantabria, IDIVAL, 39008 Santander, Spain; (A.E.L.-S.); (M.A.G.-L.)
| | - Francisco Gomez de la Fuente
- Servicio de Medicina Nuclear, Hospital U.M. Valdecilla, Universidad de Cantabria, IDIVAL, 39008 Santander, Spain; (F.G.d.l.F.); (R.Q.)
| | - Remedios Quirce
- Servicio de Medicina Nuclear, Hospital U.M. Valdecilla, Universidad de Cantabria, IDIVAL, 39008 Santander, Spain; (F.G.d.l.F.); (R.Q.)
| | - Eli L. Diamond
- Departments of Neurology and Medicine, Memorial Sloan Kettering Center, New York, NY 10065, USA;
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