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Drouillard M, Trunet S, Hervochon R, Azoulay LD, Amoura Z, Cohen-Aubart F, Emile JF, Tankéré F, Haroche J. Sinonasal and ear manifestations of Erdheim-Chester disease. Br J Haematol 2023; 203:194-201. [PMID: 37394840 DOI: 10.1111/bjh.18963] [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: 03/08/2023] [Revised: 05/12/2023] [Accepted: 06/12/2023] [Indexed: 07/04/2023]
Abstract
To calculate the prevalence of sinonasal and ear involvement in an Erdheim-Chester disease (ECD) population, to describe the different ear, nose and throat (ENT) manifestations and to study the association between ENT involvement, other organ involvement, and BRAF mutations. We led a retrospective monocentric study in the national referral center for ECD. One hundred and sixty-two patients with ECD and ENT data were included between January 1, 1980 and December 31, 2020. Ear and nose clinical and radiological findings were noted. We described and studied the prevalence of ENT involvement in ECD population. The association between sinonasal and ear involvement, other organ involvement, and BRAF mutations was calculated. The prevalence of ENT manifestations is around 45%. No clinical rhinologic or otologic signs were specific to ECD. Sinus imaging was abnormal in 70% of cases. A bilateral maxillary sinus frame osteosclerosis was highly specific of ECD. Associations were found between the sinus MRI imaging type and BRAF status, central nervous system involvement, cerebellum involvement and xanthelasma. Sinonasal or ear involvement is frequent in ECD and has specific imaging features for sinuses. Trial registration: #2011-A00447-34.
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Affiliation(s)
- Mylène Drouillard
- ENT Department, Pitié-Salpêtrière Hospital, APHP, Sorbonne University, Paris, France
| | - Stéphanie Trunet
- Neuroradiology Department, Pitié-Salpêtrière Hospital, APHP, Sorbonne University, Paris, France
| | - Rémi Hervochon
- ENT Department, Pitié-Salpêtrière Hospital, APHP, Sorbonne University, Paris, France
| | - Levi-Dan Azoulay
- Department of Internal Medicine 2, National Reference Center for Histiocytosis, Pitié-Salpêtrière Hospital, APHP, Sorbonne University, Paris, France
| | - Zahir Amoura
- Department of Internal Medicine 2, National Reference Center for Histiocytosis, Pitié-Salpêtrière Hospital, APHP, Sorbonne University, Paris, France
| | - Fleur Cohen-Aubart
- Department of Internal Medicine 2, National Reference Center for Histiocytosis, Pitié-Salpêtrière Hospital, APHP, Sorbonne University, Paris, France
| | - Jean-François Emile
- Anatomopathology Laboratory, Ambroise Paré Hospital, APHP, Paris-Saclay University, Boulogne-Billancourt, France
| | - Frédéric Tankéré
- ENT Department, Pitié-Salpêtrière Hospital, APHP, Sorbonne University, Paris, France
| | - Julien Haroche
- Department of Internal Medicine 2, National Reference Center for Histiocytosis, Pitié-Salpêtrière Hospital, APHP, Sorbonne University, Paris, France
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Giardino FR, Cuomo R, Pozzi M, Marcaccini G, Bacchini S, Marzouk El Araby M, Grimaldi L, Nisi G. Erdheim–Chester Disease of the Breast: First Review and First Case of Isolated Severe Gynecomastia. Diagnostics (Basel) 2023; 13:diagnostics13071239. [PMID: 37046457 PMCID: PMC10093613 DOI: 10.3390/diagnostics13071239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/11/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
(1) Introduction: Erdheim–Chester disease (ECD) is a life-threatening condition and often a diagnostic challenge. It has recently been classified as a hematopoietic tumour, and the cases of ECD reported in the literature has dramatically increased during the last 15 years. (2) Methods: We describe the case of a 57-year-old male patient with severe gynecomastia, with a detailed description of his diagnostic iter and consequent surgical operation. We provide the first systematic review of the literature of breast involvement in ECD, following PRISMA guidelines, including 13 studies and 16 patients. (3) Results: Our report resulted to be the first case of gynecomastia as a single clinical and imaging feature of ECD described in English literature. A total of 81.3% of patients included were female. Among them, 76.9% had unilateral and nodular presentation, while male patients presented bilateral heterogeneous breast enlargement. Globally, 87.5% expressed breast alterations as their first manifestations of ECD. Only 50% presented skeletal involvement. (4) Conclusion: The reported case represents a unique addition to the literature. We found two different patterns in ECD-related breast involvement between male and female patients, an unusual M/F ratio, and a lower rate of bone involvement. Breast involvement is frequently the first clinical feature; therefore, breast caregivers should be aware of this dangerous and most likely underestimated condition.
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3
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Kiratli H, Koç I, Söylemezoğlu F. [Erdheim-Chester disease presenting with bilateral orbital involvement: Report of three cases]. J Fr Ophtalmol 2020; 43:851-857. [PMID: 32829941 DOI: 10.1016/j.jfo.2019.11.045] [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: 08/28/2019] [Revised: 10/17/2019] [Accepted: 11/20/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To report treatment outcomes of orbital tumors associated with Erdheim-Chester disease and to highlight the importance of systemic work-up in patients presenting with bilateral proptosis. PATIENTS AND METHODS Three patients with Erdheim-Chester disease, whose initial manifestation was bilateral proptosis, were retrospectively studied. The course of onset, clinical, imaging and histopathological features, systemic associations and response to treatment were reviewed. The main outcome measures were Hertel measurements and orbital tumor regression on imaging studies. RESULTS All patients presented with bilateral non-pulsatile proptosis resistant to retropulsion and headeache without specific localization. Magnetic resonance imaging studies showed bilateral intraconal orbital tumors. Incisional biopsy of these tumors demonstrated CD68+, CD1a-, and S100- histiocytic infiltrates consistent with the diagnosis of Erdheim-Chester disease. The BRAFV600E mutation was found in all cases. Systemic work-up revealed asymptomatic bony involvement in the lower extremities, perirenal fibrosis, central nervous system and cardiac involvement. All patients initially received pegylated interferon-α2a, which resulted in excellent responses except for the orbital tumors. Two patients were then treated with vemurafenib, which resulted in rapid regression of the orbital lesions. CONCLUSION Pegylated interferon-α was highly effective in the control of cardiac, perirenal, skeletal and cerebral involvement but not the orbital tumors. The infiltrative orbital lesions of Erdheim-Chester disease would appear more responsive to vemurafenib.
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Affiliation(s)
- H Kiratli
- Service d'ophtalmologie, hôpitaux universitaires, université de Hacettepe, Ankara, Turquie.
| | - I Koç
- Service d'ophtalmologie, hôpitaux universitaires, université de Hacettepe, Ankara, Turquie
| | - F Söylemezoğlu
- Département de pathologie, faculté de médecine, université de Hacettepe, Ankara, Turquie
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Maria ATJ, Bourgier C, Martinaud C, Borie R, Rozier P, Rivière S, Crestani B, Guilpain P. [From fibrogenesis towards fibrosis: Pathophysiological mechanisms and clinical presentations]. Rev Med Interne 2020; 41:325-329. [PMID: 32046868 DOI: 10.1016/j.revmed.2020.01.002] [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: 12/30/2019] [Accepted: 01/19/2020] [Indexed: 12/24/2022]
Abstract
Fibrogenesis is a universal and ubiquitous process associated with tissue healing. The impairment of tissue homeostasis resulting from the deregulation of numerous cellular actors, under the effect of specific cytokine and pro-oxidative environments can lead to extensive tissue fibrosis, organ dysfunction and significant morbidity and mortality. This situation is frequent in internal medicine, since fibrosis is associated with most organ insufficiencies (i.e. cardiac, renal, or hepatic chronic failures), but also with cancer, a condition with common pathophysiological mechanisms. Finally, fibrosis is a hallmark of numerous systemic autoimmune diseases such as connective tissue disorders (in particular systemic sclerosis), vasculitides, granulomatoses, histiocytoses, and IgG4-associated disease. Although the process leading to tissue fibrosis may be in part irreversible, new pharmacological approaches or cell therapies bring hope in the field of fibrotic conditions.
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Affiliation(s)
- A T J Maria
- Service de médecine interne, maladies multi-organiques de l'adulte, hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier, France; Faculté de médecine, Université de Montpellier, 2, rue de l'École-de-Médecine, 34060 Montpellier cedex 2, France; Inserm U1183, IRMB, Inserm, université Montpellier, CHU de Montpellier, Montpellier, France
| | - C Bourgier
- Département de radiothérapie, ICM-Val d'Aurelle, Montpellier, France; Inserm U1194, IRCM, Montpellier, France
| | - C Martinaud
- Unité de médicaments de thérapie innovante, centre de transfusion sanguine des armées, 1, rue du lieutenant-Batany, 92140 Clamart, France
| | - R Borie
- Service de pneumologie A, centre de référence des maladies pulmonaires rares, hôpital Bichat, DHU Fire, AP-HP, Paris, France; Inserm U1152, Paris, France; Université Paris Diderot, Paris, France
| | - P Rozier
- Service de médecine interne, maladies multi-organiques de l'adulte, hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier, France; Faculté de médecine, Université de Montpellier, 2, rue de l'École-de-Médecine, 34060 Montpellier cedex 2, France; Inserm U1183, IRMB, Inserm, université Montpellier, CHU de Montpellier, Montpellier, France
| | - S Rivière
- Service de médecine interne, maladies multi-organiques de l'adulte, hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier, France
| | - B Crestani
- Service de pneumologie A, centre de référence des maladies pulmonaires rares, hôpital Bichat, DHU Fire, AP-HP, Paris, France; Inserm U1152, Paris, France; Université Paris Diderot, Paris, France
| | - P Guilpain
- Service de médecine interne, maladies multi-organiques de l'adulte, hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier, France; Faculté de médecine, Université de Montpellier, 2, rue de l'École-de-Médecine, 34060 Montpellier cedex 2, France; Inserm U1183, IRMB, Inserm, université Montpellier, CHU de Montpellier, Montpellier, France.
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Malhotra A, Seifert K, Fisayo AA. Rare Case of Bilateral Orbital Masses. JAMA Ophthalmol 2019; 137:1074-1075. [DOI: 10.1001/jamaophthalmol.2019.1053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| | - Kimberly Seifert
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| | - Adeniyi A. Fisayo
- Departments of Neurology and Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
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Choroidal mass as the first presentation of Erdheim-Chester disease. Am J Ophthalmol Case Rep 2019; 16:100539. [PMID: 31463417 PMCID: PMC6706652 DOI: 10.1016/j.ajoc.2019.100539] [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: 10/14/2018] [Revised: 07/24/2019] [Accepted: 08/06/2019] [Indexed: 12/27/2022] Open
Abstract
Purpose To describe a choroidal mass that proved to be histiocytic choroidal infiltration in Erdheim-Chester disease. Observations A 54-years-old Caucasian male presented to our Retina Clinic with a suspect of choroidal melanoma in the left eye. Dilated fundus exam of the left eye showed a yellow-grey lesion along the inferior arcade, with sub-retinal fluid clinically visible. Enhanced depth imaging-OCT (EDI-OCT) showed a dome-shaped choroidal lesion with hyperreflective exudation present between the inner retina and the retinal pigment epithelium (RPE). On fundus autofluorescence the lesion appeared to have a diffuse speckled hyper-autofluorescent pattern secondary to the exudative subretinal material. On ultrasound, the lesion appeared hyper-echoic and dome-shaped, with a baseline thickness of 6.13 mm. Indocyanine green angiography (ICGA) was performed and showed hypocyanescence of the lesion from the early phases that persisted through the whole exam. Chest CT with contrast showed an abnormal, non-calcific, eccentric thickening of segments of the aorta (“coated aorta”) and PET an abnormally strong labeling of the distal ends of the long bones. An additional proximal tibial biopsy was performed to confirm the diagnosis on histology of Erdheim-Chester disease and the patient was started on oral prednisone. The choroidal mass progressively shrunk and the subretinal exudative material on top partially reabsorbed. Conclusions and importance Intraocular involvement in Erdheim-Chester disease is extremely rare but as a result of recent better awareness the number of new diagnosis is increasing. Erdheim-Chester disease should be considered in the differential of every choroidal mass.
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Abstract
Histiocytic and dendritic cell neoplasms are very rare, belonging to a group that share morphologic, immunophenotypic, and ultrastructural characteristics of mature histiocytic/dendritic neoplasms. Histiocytic and dendritic cell neoplasms may arise de novo or in association with B-cell, T-cell, or myeloid neoplasms. Recent molecular findings, particularly the discoveries of the mutations in the RAS-RAF-MEK-ERK pathway, have greatly advanced the diagnosis and treatment options. Histiocytic and dendritic cell neoplasms may closely resemble each other, non-hematopoietic neoplasms, and even reactive processes. Therefore, it is essential to understand the clinicopathologic characteristics, differential diagnoses, and pitfalls of each entity.
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Affiliation(s)
- Zenggang Pan
- Department of Pathology, Yale University School of Medicine, 310 Cedar Street, New Haven, CT 06510-3218, USA
| | - Mina L Xu
- Department of Pathology, Yale University School of Medicine, 310 Cedar Street, New Haven, CT 06510-3218, USA; Department of Laboratory Medicine, Yale University School of Medicine, 310 Cedar Street, New Haven, CT 06510-3218, USA.
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8
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Mekinian A, Maisonobe L, Boukari L, Melenotte C, Terrier B, Ayrignac X, Scheinlitz N, Sène D, Hamidou M, Konaté A, Guilpain P, Abisror N, Ghrenassia E, Lachenal F, Cevallos R, Roos-Weil R, Du LTH, Lhote F, Larroche C, Bergmann JF, Humbert S, Fraison JB, Piette JC, Guillevin L, Dhote R, Amoura Z, Haroche J, Fain O. Characteristics, outcome and treatments with cranial pachymeningitis: A multicenter French retrospective study of 60 patients. Medicine (Baltimore) 2018; 97:e11413. [PMID: 30045263 PMCID: PMC6078725 DOI: 10.1097/md.0000000000011413] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to determine the characteristics, treatment, and outcome according to each etiology of pachymeningitis.We conducted a retrospective multicenter French nationwide study between 2000 and 2016 to describe the characteristics, outcome, and treatment of pachymeningitis.We included 60 patients (median age 55.5 years; interquartile range [IQR] 30-80, female/male ratio 0.43). Neurologic signs were present in 59 patients (98%) and consisted of headache in 43 (72%), cranial nerve palsy in 33 (55%), confusion in 10 (17%), seizures in 7 (12%), and focal neurologic signs in 9 (15%). Fever and weight loss were present in 8 (13%) and 13 cases (22%), respectively. Cerebral venous thrombosis was present in 8 cases (13%). Analysis of cerebrospinal fluid showed moderate hyperproteinorachia (median 0.68 g/L; IQR 0.46-3.2) with or without pleiocytosis. Diagnosis included idiopathic pachymeningitis (n = 18; 30%); granulomatosis with polyangiitis (n = 13; 17%); Erdheim-Chester disease (n = 10; 17%); IgG4-related disease and tuberculosis (n = 3; 5% each); Rosai-Dofman disease, microscopic polyangiitis, and sarcoidosis (n = 2, 3% each); cryptococcal meningitis, Lyme disease, ear-nose-throat infection, postlumbar puncture, low spinal-fluid pressure syndrome, and lymphoma (n = 1 each). We found no difference in demographics and neurologic presentation among idiopathic pachymeningitis, Erdheim-Chester disease, and granulomatosis with polyangiitis. In contrast, frequencies were lower with idiopathic pachymeningitis than Erdheim-Chester disease for general signs (6% and 40%, respectively, P = .041) and complete neurologic response (0% vs 39%, P = .045).The detection of extraneurologic signs and routine screening are needed to classify the pachymeningitis origin. Prospective studies are warranted to determine the best treatment in each case.
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Affiliation(s)
- Arsene Mekinian
- AP-HP, Hôpital Saint Antoine, Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris
| | - Lucas Maisonobe
- AP-HP, Hôpital Saint Antoine, Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris
| | | | - Cléa Melenotte
- Département de Médecine Interne, CHU de la Timone, Aix-Marseille Université, AP-HM, Marseille
| | - Benjamin Terrier
- Université Paris Descartes, Paris
- AP-HP, Hôpital Cochin, Centre de Référence des Maladies Auto-immunes et Systémiques Rares, Service de Médecine Interne, Paris
| | - Xavier Ayrignac
- Département de Neurologie, Hôpital Gui de Chauliac, CHU de Montpellier
| | - Nicolas Scheinlitz
- Département de Médecine Interne, CHU de la Timone, Aix-Marseille Université, AP-HM, Marseille
| | - Damien Sène
- Département de Médecine Interne, GH Saint-Louis Lariboisière Fernand Widal
- Université Paris Diderot, Paris
| | | | - Amadou Konaté
- Service de Médecine Interne et Vasculaire, CHU Montpellier, Montpellier
| | - Philippe Guilpain
- Service de Médecine Interne et Vasculaire, CHU Montpellier, Montpellier
| | - Noémie Abisror
- AP-HP, Hôpital Saint Antoine, Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris
| | - Etienne Ghrenassia
- AP-HP, Hôpital Saint Antoine, Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris
| | | | - Ramiro Cevallos
- Service de Médecine Interne, Clinique Sainte Anne, rue Philippe Thyss, Strasbourg
| | | | - Le Thi Huong Du
- Service de Médecine Interne, Hôpital Pitié Salpetrière, Université Paris, APHP, Paris
- Université Pierre et Marie Curie, Paris, UPMC
- Centre National de Référence des Maladies Auto-immunes et Systémiques Rares
| | - Francois Lhote
- Service de Médecine Interne, Hôpital Delafontaine, Saint Denis
| | - Claire Larroche
- Service de Médecine Interne, Université Paris, AP-HP, Avicenne, Bobigny
| | - Jean-Francois Bergmann
- Département de Médecine Interne, GH Saint-Louis Lariboisière Fernand Widal
- Université Paris Diderot, Paris
| | | | - Jean Baptiste Fraison
- Université Paris Descartes, Paris
- AP-HP, Hôpital Cochin, Centre de Référence des Maladies Auto-immunes et Systémiques Rares, Service de Médecine Interne, Paris
| | - Jean Charles Piette
- Service de Médecine Interne, Hôpital Pitié Salpetrière, Université Paris, APHP, Paris, France
| | - Loïc Guillevin
- Université Paris Descartes, Paris
- AP-HP, Hôpital Cochin, Centre de Référence des Maladies Auto-immunes et Systémiques Rares, Service de Médecine Interne, Paris
| | - Robin Dhote
- Service de Médecine Interne, Université Paris, AP-HP, Avicenne, Bobigny
| | - Zahir Amoura
- Service de Médecine Interne, Hôpital Pitié Salpetrière, Université Paris, APHP, Paris
- Université Pierre et Marie Curie, Paris, UPMC
- Centre National de Référence des Maladies Auto-immunes et Systémiques Rares
| | - Julien Haroche
- Service de Médecine Interne, Hôpital Pitié Salpetrière, Université Paris, APHP, Paris
- Université Pierre et Marie Curie, Paris, UPMC
- Centre National de Référence des Maladies Auto-immunes et Systémiques Rares
| | - Olivier Fain
- AP-HP, Hôpital Saint Antoine, Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris
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Pacios Blanco RE, Gorospe Sarasua L, Reguero ME. Spontaneous Bilateral Pneumothoraces in Erdheim-Chester Disease. Arch Bronconeumol 2017; 54:219. [PMID: 29132763 DOI: 10.1016/j.arbres.2017.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/24/2017] [Accepted: 08/26/2017] [Indexed: 10/18/2022]
Affiliation(s)
| | - Luis Gorospe Sarasua
- Department of Clinical Radiology, Ramón y Cajal University Hospital, Madrid, Spain
| | - María Eugenia Reguero
- Department of Pathological Anatomy, Ramón y Cajal University Hospital, Madrid, Spain
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10
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Fain O, Mekinian A. Les pachyméningites. Rev Med Interne 2017; 38:585-591. [DOI: 10.1016/j.revmed.2017.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 03/10/2017] [Indexed: 01/29/2023]
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Histiocytose langerhansienne et maladie d’Erdheim-Chester, une continuité ? Rev Med Interne 2017; 38:482-487. [DOI: 10.1016/j.revmed.2016.10.389] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/23/2016] [Accepted: 10/20/2016] [Indexed: 12/31/2022]
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12
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Haroche J, Cohen-Aubart F, Rollins BJ, Donadieu J, Charlotte F, Idbaih A, Vaglio A, Abdel-Wahab O, Emile JF, Amoura Z. Histiocytoses: emerging neoplasia behind inflammation. Lancet Oncol 2017; 18:e113-e125. [PMID: 28214412 DOI: 10.1016/s1470-2045(17)30031-1] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/30/2016] [Accepted: 10/17/2016] [Indexed: 12/25/2022]
Abstract
Histiocytoses are disorders characterised by inflammation and the accumulation of cells derived from the monocyte and macrophage lineages, which results in tissue damage. Although they are often considered rare disorders with protean clinical manifestations, considerable advances in the understanding of their genetics have led to increased clinical recognition of these conditions, and fuelled further insights into their pathogenesis. In this Review, we describe insights into the cells of origin, molecular pathology, clinical features, and treatment strategies for some of the most common histiocytic disorders, including Langerhans cell histiocytosis, Erdheim-Chester disease, and Rosai-Dorfman disease. With the discovery of recurrent mutations affecting the mitogen-activated protein kinase and mTOR-AKT pathways in some of these histiocytoses, our understanding of these diseases has now evolved from the concept of a primary inflammatory condition to that of a clonal neoplastic disease. This understanding has led to the development of effective mechanism-based therapeutic strategies for patients with histiocytic diseases.
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Affiliation(s)
- Julien Haroche
- Service de Médecine Interne 2, Centre National de Référence Maladies Auto Immunes Systémiques Rares, Institut E3M, Hôpital Pitié-Salpêtrière, Paris, France.
| | - Fleur Cohen-Aubart
- Service de Médecine Interne 2, Centre National de Référence Maladies Auto Immunes Systémiques Rares, Institut E3M, Hôpital Pitié-Salpêtrière, Paris, France
| | - Barret J Rollins
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jean Donadieu
- AP-HP, Service d'Hématologie, Hôpital Trousseau, Paris, France
| | - Frédéric Charlotte
- AP-HP, Service d'Anatomocytopathologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Ahmed Idbaih
- AP-HP, Service de neurologie Mazarin, Hôpital Pitié-Salpêtrière, Paris, France
| | | | - Omar Abdel-Wahab
- Leukemia Service, Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jean-François Emile
- EA4340 and Pathology Department, Ambroise Paré Hospital AP-HP and Versailles University, Boulogne, France
| | - Zahir Amoura
- Service de Médecine Interne 2, Centre National de Référence Maladies Auto Immunes Systémiques Rares, Institut E3M, Hôpital Pitié-Salpêtrière, Paris, France
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13
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Adult Xanthogranulomatous Disease of the Orbit: Clinical Presentations, Evaluation, and Management. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2017.03.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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14
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Adens A, Landy P, Terriou L, Baillet C, Beron A, Lambert M, Launay D, Huglo D. [Usefulness of nuclear medicine in Erdheim-Chester disease: A Lille experience]. Rev Med Interne 2017; 38:235-242. [PMID: 28268124 DOI: 10.1016/j.revmed.2016.10.386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 09/30/2016] [Accepted: 10/20/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Erdheim-Chester disease is a rare form of non-langerhans histiocytosis and its etiology is still not well established. The aims of the study were to assess the value of the bone scintigraphy and the 18F-FDG PET/CT for the diagnostic and for the latter in the therapeutic evaluation. METHODS We retrospectively reviewed 49 patients suspected of Erdheim-Chester disease between 2004 and 2016. Bone scintigraphy was compared with histopathology and PET-CT to conventional morphological examinations and bone scintigraphy. For therapeutic evaluation, thresholds similar to PERCIST 1.0 were used. RESULTS Forty-nine bone scintigraphy were evaluated with a sensitivity of 100%, a specificity 97%, a positive predictive value 90% and a negative predictive value of 100%. Eight patients had at least an initial PET-CT. The sensitivity compared to conventional morphological examinations differed from the location but was excellent for orbital, bone and vascular involvements. Specificity was comparable between the different examinations. Six patients treated with interferon® and three with vemurafenib® were followed by PET-CT. PET-CT, in agreement to clinicobiological data, identified 4 partial responses and one complete response with interferon® et two partial responses and one complete response with vemurafenib®. CONCLUSION Our retrospective study suggests that bone scintigraphy and 18F-FDG PET/CT could be useful in the initial assessment of Erdheim-Chester disease but also for the latter in the therapeutic evaluation.
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Affiliation(s)
- A Adens
- Service de médecine nucléaire, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonowski, 59000 Lille, France; Département de biophysique, faculté de médecine Henri-Warembourg, université de Lille 2, 59120 Loos, France.
| | - P Landy
- Service de médecine nucléaire, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonowski, 59000 Lille, France; Département de biophysique, faculté de médecine Henri-Warembourg, université de Lille 2, 59120 Loos, France.
| | - L Terriou
- Service de médecine interne, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonowski, 59000 Lille, France.
| | - C Baillet
- Service de médecine nucléaire, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonowski, 59000 Lille, France.
| | - A Beron
- Service de médecine nucléaire, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonowski, 59000 Lille, France.
| | - M Lambert
- Service de médecine interne, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonowski, 59000 Lille, France; Département de médecine interne, faculté de médecine Henri-Warembourg, université de Lille 2, 59120 Loos, France.
| | - D Launay
- Service de médecine interne, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonowski, 59000 Lille, France; Département de médecine interne, faculté de médecine Henri-Warembourg, université de Lille 2, 59120 Loos, France.
| | - D Huglo
- Service de médecine nucléaire, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonowski, 59000 Lille, France; Département de biophysique, faculté de médecine Henri-Warembourg, université de Lille 2, 59120 Loos, France.
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Ortiz Salvador JM, Subiabre Ferrer D, Pérez Ferriols A. Adult Xanthogranulomatous Disease of the Orbit: Clinical Presentations, Evaluation, and Management. ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:400-406. [PMID: 28262109 DOI: 10.1016/j.ad.2016.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 11/10/2016] [Accepted: 12/02/2016] [Indexed: 01/18/2023] Open
Abstract
Adult xanthogranulomatous disease of the orbit refers to a heterogeneous group of clinical syndromes with differing degrees of systemic involvement and distinct prognoses. The different syndromes all present clinically with progressively enlarging, yellowish lesions of the orbit. Histologically, the lesions are characterized by an inflammatory infiltrate of foam cells and Touton-type multinucleated giant cells. The xanthomatized histiocytes are CD68+, S100-, and CD1a-. There are 4 clinical forms of xanthogranulomatous disease of the orbit: adult xanthogranulomatous disease of the orbit, adult onset asthma and periocular xanthogranuloma, necrobiotic xanthogranuloma, and Erdheim-Chester disease. The treatment of local lesions are treated with systemic corticosteroids and other immunosuppressors. Vemurafenib, tocilizumab, and sirolimus have shown promising results in systemic disease.
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Affiliation(s)
- J M Ortiz Salvador
- Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, España.
| | - D Subiabre Ferrer
- Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, España
| | - A Pérez Ferriols
- Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, España
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16
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Rousselin C, Pontana F, Puech P, Lambert M. Diagnostics différentiels des aortites inflammatoires. Rev Med Interne 2016; 37:256-63. [DOI: 10.1016/j.revmed.2016.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/04/2016] [Indexed: 12/24/2022]
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Néel A, Artifoni M, Donadieu J, Lorillon G, Hamidou M, Tazi A. Histiocytose langerhansienne de l’adulte. Rev Med Interne 2015; 36:658-67. [DOI: 10.1016/j.revmed.2015.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 01/30/2015] [Accepted: 04/30/2015] [Indexed: 12/21/2022]
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18
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Lioger B, Yahiaoui Y, Kahn JE, Fakhouri F, Belenfant X, Papo T, Magnant J, Maillot F, Vordos D, Godeau B, Michel M. [Retroperitoneal fibrosis in adults: Main characteristics and relevance of the diagnostic procedures based on a retrospective multicenter study on 77 cases]. Rev Med Interne 2015; 37:387-93. [PMID: 26415922 DOI: 10.1016/j.revmed.2015.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 06/21/2015] [Accepted: 08/20/2015] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Retroperitoneal fibrosis (RPF) is a rare disorder characterized by the sheathing of retroperitoneal structures by fibro-inflammatory process. It can be either isolated or associated with an underlying disease or condition. In the absence of consistent and consensual approach, the objective of this study was to assess the relevance of diagnostic tests performed during the diagnostic work-up of RPF. METHODS Seventy-seven patients were included in this retrospective multicenter study. The diagnosis of RPF was defined by the presence of a thickened circumferential homogeneous tissue unsheathing the infrarenal aorta, excluding peri-aneurysmal fibrosis and a clear evidence of a cancer. RESULTS In 62 cases (80.5%), the RPF was considered as being primary or "idiopathic". Surgical (n=31) or CT-guided (n=9) biopsies of the RPF were performed in half of the patients showing some fibrotic or non-specific inflammatory lesions in 98% of cases. A bone marrow biopsy was performed in 23 patients leading to diagnosis of low grade B cell non-Hodgkin lymphoma in a single patient who also had a monoclonal gammopathy IgM. The systematic search for autoantibodies or serum tumor markers was of no diagnostic value. CONCLUSIONS Although the diagnostic procedure was heterogeneous, no cause or associated disease was found in the majority of cases of FRP in this series. In the absence of any clinical or paraclinical evidence suggesting an underlying disease or any atypical features at presentation, a number of non-invasive tests (autoantibodies, tumor markers, bone scintigraphy) and also more invasive diagnostic tests (bone marrow and RPF biopsies) seem of little relevance.
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Affiliation(s)
- B Lioger
- Service de médecine interne, université Francois-Rabelais, hôpital Bretonneau, CHU de Tours, 2, boulevard Tonnelé, 37044 Tours cedex 9, France.
| | - Y Yahiaoui
- Service de néphrologie, hôpital du Kremlin-Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - J-E Kahn
- Service de médecine interne, hôpital Foch, 40, rue Worth, 92151 Suresnes cedex, France
| | - F Fakhouri
- Service de néphrologie et immunologie clinique, ITUN and Inserm UMR S-1064, CHU de Nantes, 44000 Nantes, France
| | - X Belenfant
- Service de néphrologie dialyse, hôpital André-Grégoire, 93100 Montreuil-sous-Bois, France
| | - T Papo
- Service de médecine interne, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France
| | - J Magnant
- Service de médecine interne, université Francois-Rabelais, hôpital Bretonneau, CHU de Tours, 2, boulevard Tonnelé, 37044 Tours cedex 9, France
| | - F Maillot
- Service de médecine interne, université Francois-Rabelais, hôpital Bretonneau, CHU de Tours, 2, boulevard Tonnelé, 37044 Tours cedex 9, France
| | - D Vordos
- Service d'urologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil cedex, France
| | - B Godeau
- Service de médecine interne, centre de référence des cytopénies auto-immunes de l'adulte, université Paris-Est Créteil, hôpital Henri-Mondor, Assistance publique des Hôpitaux de Paris, 94000 Créteil, France
| | - M Michel
- Service de médecine interne, centre de référence des cytopénies auto-immunes de l'adulte, université Paris-Est Créteil, hôpital Henri-Mondor, Assistance publique des Hôpitaux de Paris, 94000 Créteil, France
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Ruiz JB, El Yaagoubi Y, Revel C, Travers JY. [Abnormal bone scintigraphy]. Rev Med Interne 2015; 37:66-7. [PMID: 26051187 DOI: 10.1016/j.revmed.2015.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 05/05/2015] [Indexed: 10/23/2022]
Affiliation(s)
- J-B Ruiz
- Service de radiologie, CHU de la Réunion, allée des Topazes, 97400 Saint-Denis, Réunion.
| | - Y El Yaagoubi
- Service de radiologie, CHU de la Réunion, allée des Topazes, 97400 Saint-Denis, Réunion
| | - C Revel
- Service de médecine nucléaire, CHU de la Réunion, allée des Topazes, 97400 Saint-Denis, Réunion
| | - J-Y Travers
- Service de radiologie, CHU de la Réunion, allée des Topazes, 97400 Saint-Denis, Réunion
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