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Pegoraro F, Papo M, Cohen-Aubart F, Peyronel F, Lugli G, Trambusti I, Baulier G, de Menthon M, Le Scornet T, Oziol E, Ferreira-Maldent N, Hermine O, Faucher B, Koschel D, Straetmans N, Abisror N, Terrier B, Lifermann F, Razanamahery J, Allenbach Y, Keraen J, Bulifon S, Hervier B, Buccoliero A, Charlotte F, Monzani Q, Boussouar S, Shor N, Tondo A, Barete S, Idbaih A, Tazi A, Sieni E, Amoura Z, Emile JF, Vaglio A, Haroche J. Long-term outcome and prognosis of mixed histiocytosis (Erdheim-Chester disease and Langerhans Cell Histiocytosis). EClinicalMedicine 2024; 73:102658. [PMID: 38841707 PMCID: PMC11152896 DOI: 10.1016/j.eclinm.2024.102658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 06/07/2024] Open
Abstract
Background Erdheim-Chester disease (ECD) is a rare histiocytosis that may overlap with Langerhans Cell Histiocytosis (LCH). This "mixed" entity is poorly characterized. We here investigated the clinical phenotype, outcome, and prognostic factors of a large cohort of patients with mixed ECD-LCH. Methods This retrospective study was performed at two referral centers in France and Italy (Pitié-Salpêtrière Hospital, Paris; Meyer Children's Hospital, Florence). We included children and adults with ECD diagnosed in 2000-2022 who had biopsy-proven LCH, available data on clinical presentation, treatment and outcome, and a minimum follow-up of one year. Outcomes included differences in clinical presentation and survival between mixed ECD-LCH and isolated ECD; we also investigated response to treatments and predictors of survival in the mixed cohort. Survival was analyzed using the Kaplan-Maier method and differences in survival with the long-rank test. Cox regression models were used to evaluate the potential impact of age and gender on survival and to identify predictors of non-response and survival. Findings Out of a cohort of 502 ECD patients, 69 (14%) had mixed ECD-LCH. Compared to isolated ECD, mixed ECD-LCH occurred more frequently in females (51 vs. 26%, p < 0.001) and in patients with multisystem disease (≥4 sites). Mixed ECD-LCH more frequently involved long bones (91 vs. 79%, p = 0.014), central nervous system (51 vs. 34%, p = 0.007), facial/orbit (52 vs. 38%, p = 0.031), lungs (43 vs. 28%, p = 0.009), hypothalamic/pituitary axis (51 vs. 26%, p < 0.001), skin (61 vs. 29%, p < 0.001), and lymph nodes (15 vs. 7%, p = 0.028); the BRAFV600E mutation was also more frequent in mixed ECD-LCH (81 vs. 59%, p < 0.001). Targeted treatments (BRAF and/or MEK inhibitors) induced response more frequently than conventional therapies (interferon-α, chemotherapy), either as first-line (77 vs. 29%, p < 0.001) or as any line (75 vs. 24%, p < 0.001). After a median follow-up of 71 months, 24 patients (35%) died. Survival probability was comparable between ECD alone and mixed ECD-LCH (log-rank p = 0.948). At multivariable analysis, age at diagnosis (HR 1.052, 95% CI 1.008-1.096), associated hematologic conditions (HR 3.030, 95% CI 1.040-8.827), and treatment failure (HR 9.736, 95% CI 2.919-32.481) were associated with an increased risk of death, while lytic bone lesions with a lower risk (HR 0.116, 95% CI 0.031-0.432). Interpretation Mixed ECD-LCH is a multisystem disease driven by the BRAFV600E mutation and targeted treatments are effective. Age at diagnosis, bone lesion patterns, associated hematologic conditions, and treatment failure are the main predictors of death in mixed ECD-LCH. Funding None.
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Affiliation(s)
- Francesco Pegoraro
- Sorbonne University, Internal Medicine Department 2, Institut E3M, French Reference Centre for Histiocytosis, Pitié-Salpȇtrière Hospital, CIMI INSERM-UMRS 1135, Assistance Publique-Hôpitaux de Paris, Paris, France
- Hematology and Oncology Department, Meyer Children’s Hospital IRCCS, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Matthias Papo
- Sorbonne University, Internal Medicine Department 2, Institut E3M, French Reference Centre for Histiocytosis, Pitié-Salpȇtrière Hospital, CIMI INSERM-UMRS 1135, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fleur Cohen-Aubart
- Sorbonne University, Internal Medicine Department 2, Institut E3M, French Reference Centre for Histiocytosis, Pitié-Salpȇtrière Hospital, CIMI INSERM-UMRS 1135, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Francesco Peyronel
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Nephrology and Dialysis Unit, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Gianmarco Lugli
- Rare Disease Center, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Irene Trambusti
- Hematology and Oncology Department, Meyer Children’s Hospital IRCCS, Florence, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gildas Baulier
- Internal Medicine and Clinical Immunology Department, Périgueux University Hospital, Périgueux, France
| | - Mathilde de Menthon
- Paris-Saclay University, Internal Medicine and Clinical Immunology Department, Bicetre Hospital, Assistance Publique - Hôpitaux de Paris, Le Kremlin Bicêtre, France
| | - Tanguy Le Scornet
- Internal Medicine Department, Hotel Dieu, Nantes University Hospital, Nantes, France
| | - Eric Oziol
- Internal Medicine Department, Béziers Hospital, Béziers, France
| | | | - Olivier Hermine
- Hematology Department, Hôpital Necker - Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benoit Faucher
- Internal Medicine Department, La Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Dirk Koschel
- Internal Medicine and Pneumology Department, Fachkrankenhaus Coswig, Lung Center, Coswig and Medical Department I, Division of Pneumology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Nicole Straetmans
- Hematology Department, University Hospital Saint-Luc, Brussels, Belgium
| | - Noémie Abisror
- Internal Medicine Department, Saint Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benjamin Terrier
- Internal Medicine Department, Referral Center for Rare Autoimmune and Systemic Diseases, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Jerome Razanamahery
- Internal Medicine and Clinical Immunology Department, Dijon University Hospital, Dijon, France
| | - Yves Allenbach
- Internal Medicine Department, Sorbonne University, INSERM UMRS 974, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jeremy Keraen
- Internal Medicine and Immunology Department, Cornouaille Hospital Center, Quimper, France
| | - Sophie Bulifon
- Paris-Saclay University, Faculty of Medicine, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, Le Kremlin-Bicêtre, France
- Respiratory and Intensive Care Medicine Department, Pulmonary Hypertension National Referral Center, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Baptiste Hervier
- Internal Medicine Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Frederic Charlotte
- Pathology Department, Pitié-Salpêtrière Hospital, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Quentin Monzani
- Polyvalent and Oncologic Radiology Department–Musculoskeletal Unit, Pitié-Salpêtrière Hospital, Paris, France
| | - Samia Boussouar
- Cardiovascular and Thoracic Imaging Unit, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Natalia Shor
- Neuro-Radiology Department, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Annalisa Tondo
- Hematology and Oncology Department, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Stephane Barete
- Sorbonne University, Dermatology Unit, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ahmed Idbaih
- Sorbonne University, Neuro-Oncology Department, Paris Brain Institute - ICM, Inserm, CNRS, Pitié-Salpêtrière Hospital, DMU Neurosciences, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Abdellatif Tazi
- UFR de Médecine, Paris Cité University, Paris, France
- INSERM UMR 976 Saint Louis Research Institute, Paris, France
- Pneumology Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Elena Sieni
- Hematology and Oncology Department, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Zahir Amoura
- Sorbonne University, Internal Medicine Department 2, Institut E3M, French Reference Centre for Histiocytosis, Pitié-Salpȇtrière Hospital, CIMI INSERM-UMRS 1135, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-François Emile
- EA4340 BECCOH, Versailles SQY University, Pathology Department, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne, France
| | - Augusto Vaglio
- Nephrology and Dialysis Unit, Meyer Children’s Hospital IRCCS, Florence, Italy
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Julien Haroche
- Sorbonne University, Internal Medicine Department 2, Institut E3M, French Reference Centre for Histiocytosis, Pitié-Salpȇtrière Hospital, CIMI INSERM-UMRS 1135, Assistance Publique-Hôpitaux de Paris, Paris, France
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Golagha M, Dehghani Firouzabadi F, Millo C, Nikpanah M, Ahlman MA, Dave RH, Estrada-Veras JI, O'Brien K, Malayeri AA. Erdheim-Chester disease with tendon and muscle involvement: Reports of a rare presentation. Radiol Case Rep 2024; 19:1866-1871. [PMID: 38425778 PMCID: PMC10901690 DOI: 10.1016/j.radcr.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 03/02/2024] Open
Abstract
Erdheim-Chester disease (ECD) is a rare histiocytic disease that affects multiple systems in the body. While it typically targets long bones, cardiovascular structures, the retroperitoneum, and the central nervous system, reports of tendon and skeletal muscle involvement are scarce. This review presents 2 cases: a case of ECD involving the left Achilles tendon and left abductor hallucis, as well as an unusual manifestation of ECD in the thigh musculature. In Case 1, studies involved a 39-year-old man who initially presented with bone and pituitary involvement. An order for 18F-FDG PET/CT imaging was placed by marked swelling in the patient's left ankle and observed soft tissue fullness on foot radiographs, which revealed a soft tissue mass involving the left Achilles tendon, which arose along the tendon-muscle junction and involved the left abductor hallucis muscle. In Case 2, studies involved a 41-year-old man who initially presented with involvement of the cardiovascular system and retroperitoneum. 18F-FDG PET/CT scan showed an infiltrative right atrial mass and hypermetabolic lesion in the left external obturator muscle, extending to the left pectineus and right quadratus femoris muscle. Involvement of the Achilles tendon and skeletal muscle involvement, including left abductor hallucis muscle and medial thigh muscles, is one of the rare manifestations of ECD. Diagnostic delays were frequent due to the condition's rarity and nonspecific multisystemic symptoms. This should be considered in patients who present with myositis, tendinopathy, and bone pain and have other unexplained multisystemic problems.
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Affiliation(s)
- Mahshid Golagha
- Urologic Oncology Branch, National Cancer Institute (NCI), National Institutes of Health, Bethesda, MD, USA
| | | | - Corina Millo
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Moozhan Nikpanah
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mark A. Ahlman
- Department of Radiology and Imaging, Augusta University, Augusta, GA, USA
| | - Rahul H. Dave
- MS & Neuroimmunology Center, INOVA Neurosciences Institute, Fairfax, VA, USA
- National Human Genome Research Institute, Medical Genetics Branch, Office of the Clinical Director, National Institutes of Health, Bethesda, MD, USA
| | - Juvianee I. Estrada-Veras
- National Human Genome Research Institute, Medical Genetics Branch, Office of the Clinical Director, National Institutes of Health, Bethesda, MD, USA
| | - Kevin O'Brien
- National Human Genome Research Institute, Medical Genetics Branch, Office of the Clinical Director, National Institutes of Health, Bethesda, MD, USA
| | - Ashkan A. Malayeri
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
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Morimoto A, Sakamoto K, Kudo K, Shioda Y. [Central nervous system disorders secondary to histiocytoses: neurodegeneration with potential for improvement]. Rinsho Shinkeigaku 2024; 64:85-92. [PMID: 38281751 DOI: 10.5692/clinicalneurol.cn-001899] [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: 01/30/2024]
Abstract
Histiocytoses, including Langerhans cell histiocytosis (LCH) and Erdheim-Chester disease (ECD), are inflammatory myeloid tumors in which monocyte lineage cells aggregate in various organs, causing tissue damage. Most of these tumors harbor oncogenic mutations in mitogen-activated protein kinase (MAPK) pathway genes, typified by BRAFV600E. Some patients with LCH develop bilateral symmetrical cerebellar lesions and brain atrophy several years after diagnosis when the initial symptoms disappear, leading to cerebellar ataxia and higher cerebral dysfunction. A similar neurological disorder has also been reported in ECD. This neurological disorder can be improved with MAPK inhibitors. When patients with this neurological disorder are identified among neurodegeneration of unknown etiology or histiocytosis patients and treated early with MAPK inhibitors, the disorder can be reversible.
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Affiliation(s)
| | | | - Ko Kudo
- Department of Pediatrics, Hirosaki University School of Medicine
| | - Yoko Shioda
- Children's Cancer Center, National Center for Child Health and Development
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4
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Yuen CA, Bao S, Aung MS, Shishodia R, Kong XT. Dabrafenib and steroids for the treatment of Erdheim-Chester disease with extensive CNS involvement: a case report. Per Med 2024; 21:71-78. [PMID: 38275171 DOI: 10.2217/pme-2023-0137] [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: 11/23/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024]
Abstract
Erdheim-Chester disease (ECD) is an exceedingly rare non-Langerhans cell CD68+ CD1a- S100- histiocytic multi-organ disease. Diagnosis of ECD is often delayed due to non-specific radiographic findings and heterogeneous lesional tissue. Increasingly, the role of genomic alterations is being recognized for both diagnosis and treatment of ECD. More than half of ECD patients harbor the BRAFV600E mutation. Evaluation for this mutation be can falsely negative on immunohistochemical staining and confirmation with molecular analyses is recommended. We present a case of the 44 year-old male with BRAFV600E-positive ECD treated successfully with steroids followed by single-agent dabrafenib.
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Affiliation(s)
- Carlen A Yuen
- Department of Neuro-Oncology, University of California, Irvine, CA 92868-3201, USA
| | - Silin Bao
- Department of Internal Medicine. Community Regional Medical Center, Fresno, CA 93721, USA
| | - Mya Sandi Aung
- California Health Sciences University, College of Osteopathic Medicine, Clovis, CA 93611, USA
| | - Rhea Shishodia
- California Health Sciences University, College of Osteopathic Medicine, Clovis, CA 93611, USA
| | - Xiao-Tang Kong
- Department of Neuro-Oncology, University of California, Irvine, CA 92868-3201, USA
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5
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Pieri V, Berzero G, Paterra R, Ferré L, Tomelleri A, Campochiaro C, Esposito F, Calimeri T, Cangi MG, Tenace NP, Ferreri AJM, Castellano A, Barbera M, Anzalone N, Gay LG, Bello L, Colecchia M, Ponzoni M, Finocchiaro G, Filippi M. Liquid biopsy of cerebrospinal fluid enabling the detection and therapeutic targeting of the BRAF V600E mutation in a patient with overlapping Erdheim-Chester/Rosai-Dorfman disease. J Neurol 2024; 271:575-579. [PMID: 37725109 DOI: 10.1007/s00415-023-11983-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023]
Affiliation(s)
- Valentina Pieri
- Neurology Unit, IRCCS Ospedale San Raffaele, Via Olgettina, 60, 21032, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Giulia Berzero
- Neurology Unit, IRCCS Ospedale San Raffaele, Via Olgettina, 60, 21032, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Rosina Paterra
- Unit of Neuroncology - Laboratory of Neuro-Oncology Genetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Laura Ferré
- Neurology Unit, IRCCS Ospedale San Raffaele, Via Olgettina, 60, 21032, Milan, Italy
| | - Alessandro Tomelleri
- Vita-Salute San Raffaele University, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Corrado Campochiaro
- Vita-Salute San Raffaele University, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federica Esposito
- Neurology Unit, IRCCS Ospedale San Raffaele, Via Olgettina, 60, 21032, Milan, Italy
- Laboratory of Human Genetics of Neurological Disorders, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | | | - Nazario Pio Tenace
- Vita-Salute San Raffaele University, Milan, Italy
- Pathology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Antonella Castellano
- Vita-Salute San Raffaele University, Milan, Italy
- Neuroradiology Unit and CERMAC, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Maurizio Barbera
- Neuroradiology Unit and CERMAC, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nicoletta Anzalone
- Vita-Salute San Raffaele University, Milan, Italy
- Neuroradiology Unit and CERMAC, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Lorenzo Gabriel Gay
- Neurosurgical Oncology Unit, Oncology and Hematology Department, Università degli Studi di Milano, Milan, Italy
| | - Lorenzo Bello
- Neurosurgical Oncology Unit, Oncology and Hematology Department, Università degli Studi di Milano, Milan, Italy
| | - Maurizio Colecchia
- Vita-Salute San Raffaele University, Milan, Italy
- Pathology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Maurilio Ponzoni
- Vita-Salute San Raffaele University, Milan, Italy
- Lymphoma Unit, IRCCS Ospedale San Raffaele, Milan, Italy
- Pathology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Gaetano Finocchiaro
- Neurology Unit, IRCCS Ospedale San Raffaele, Via Olgettina, 60, 21032, Milan, Italy
| | - Massimo Filippi
- Neurology Unit, IRCCS Ospedale San Raffaele, Via Olgettina, 60, 21032, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy.
- Neurorehabilitation Unit, IRCCS Ospedale San Raffaele, Milan, Italy.
- Neurophysiology Service, IRCCS Ospedale San Raffaele, Milan, Italy.
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Dai JW, Lin H, Chang L, Li J, Zhou DB, Cao XX. The clinical spectrum and prognostic factors of Erdheim-Chester disease and mixed Langerhans cell histiocytosis and Erdheim-Chester disease. Ann Hematol 2023; 102:3335-3343. [PMID: 37922006 DOI: 10.1007/s00277-023-05501-1] [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: 06/07/2023] [Accepted: 10/08/2023] [Indexed: 11/05/2023]
Abstract
Erdheim-Chester disease (ECD) is a rare and probably fatal multisystemic non-Langerhans cell histiocytosis (LCH). To comprehensively investigate the clinical features, genomic analysis, treatments, and prognostic factors of ECD, we retrospectively analyzed the clinical data of 75 ECD patients and 10 mixed LCH and ECD patients in our center. The median age at diagnosis was 46 years (range, 5-70). ECD patients were older at diagnosis (p = 0.006) and had more cardiac involvement (p = 0.011) as well as vascular (p = 0.031) involvement compared to mixed LCH and ECD patients. 64.8% of ECD patients and 87.5% of mixed LCH and ECD patients carried BRAFV600E mutation. The BRAFV600E mutation correlated with a greater number of affected organs (p = 0.030) and was associated with lung involvement (p = 0.033) as well as pleural involvement (p = 0.002). The median follow-up time was 38 months (range, 1-174). The estimated 5-year progression-free survival (PFS) and overall survival (OS) were 48.9% and 84.7%, respectively. In a multivariate analysis, right atrial pseudotumor (p = 0.013) and pancreatic involvement (p = 0.005) predicted worse OS, while pleural (p = 0.042) and central nervous system (CNS) involvement (p = 0.043) predicted worse PFS. Our study described the clinical spectrum of ECD and mixed LCH and ECD, while also revealed the prognostic value of right atrial pseudotumor and pancreatic, pleural, and CNS involvement for worse survival.
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Affiliation(s)
- Jia-Wen Dai
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - He Lin
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Long Chang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jian Li
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Dao-Bin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xin-Xin Cao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
- State Key Laboratory of Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Romano G, Cirillo M, Bonavita S, Toro G, Di Pietro A, Lavorgna L, Maida E, Pagliuca F, Urraro F, Coppola C, Lus G, Signoriello E. Apparently isolated CNS involvement in Erdheim-Chester disease: Case report. Radiol Case Rep 2023; 18:4431-4434. [PMID: 37840893 PMCID: PMC10570539 DOI: 10.1016/j.radcr.2023.09.033] [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] [Received: 02/27/2023] [Revised: 08/28/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
We present the case of a 48-year-old-woman with apparently isolated central nervous system Erdheim-Chester disease characterized by brainstem involvement. Erdheim-Chester disease is extremely rare and multisystem impairment should always be sought in the suspicion of such pathology.
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Affiliation(s)
- Giuseppe Romano
- Second Division of Neurology, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Mario Cirillo
- MRI Research Center SUN-FISM, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Simona Bonavita
- Second Division of Neurology, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Andrea Di Pietro
- Second Division of Neurology, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Luigi Lavorgna
- First Division of Neurology, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Elisabetta Maida
- Second Division of Neurology, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Francesca Pagliuca
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, “Luigi Vanvitelli”, Naples, Italy
| | - Fabrizio Urraro
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Cinzia Coppola
- Second Division of Neurology, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giacomo Lus
- Second Division of Neurology, University of Campania “Luigi Vanvitelli”, Naples, Italy
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8
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Tan HEI, Lakshmanan R, Warne R, Walwyn T, Roebuck D. Neuroimaging manifestations of paediatric histiocytoses. J Med Imaging Radiat Oncol 2023. [PMID: 37964685 DOI: 10.1111/1754-9485.13602] [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: 09/28/2023] [Accepted: 10/23/2023] [Indexed: 11/16/2023]
Abstract
Histiocytoses are rare multi-system disorders marked by abnormal histiocyte cell proliferation, affecting children with diverse clinical presentations. Classified into five groups in 2016, including Langerhans-related (L), cutaneous (C), malignant (M), Rosai-Dorfman disease (R) and haemophagocytic lymphohistiocytosis (H), newer entities such as ALK-positive histiocytosis have also emerged, heralding the era of molecular (sub)classification. Common entities include Langerhans cell histiocytosis (LCH), Erdheim-Chester disease (ECD), Rosai-Dorfman disease (RDD) and haemophagocytic lymphohistiocytosis (HLH). This pictorial essay aids radiologists in recognising and differentiating paediatric histiocytoses based on unique neuroimaging features.
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Affiliation(s)
- Hsern Ern Ivan Tan
- Department of Medical Imaging, Perth Children's Hospital, Perth, Western Australia, Australia
- Department of Medical Imaging, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Rahul Lakshmanan
- Department of Medical Imaging, Perth Children's Hospital, Perth, Western Australia, Australia
- University of Western Australia, Perth, Western Australia, Australia
| | - Richard Warne
- Department of Medical Imaging, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Thomas Walwyn
- University of Western Australia, Perth, Western Australia, Australia
- Department of Oncology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Derek Roebuck
- Department of Medical Imaging, Perth Children's Hospital, Perth, Western Australia, Australia
- University of Western Australia, Perth, Western Australia, Australia
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9
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Fan X, Liu T, Zhang Z, Sun J, Niu N, Mao C, Wang F, Li J, Zhou D, Cao X, Jin Z, Feng F. Comparison of neuroimaging features of histiocytic neoplasms with central nervous system involvement: a retrospective study of 121 adult patients. Eur Radiol 2023; 33:8031-8042. [PMID: 37191919 PMCID: PMC10598130 DOI: 10.1007/s00330-023-09724-8] [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: 11/01/2022] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES To compare neuroimaging characteristics of three types of histiocytoses, namely Langerhans cell histiocytosis (LCH), Erdheim-Chester disease (ECD), and Rosai-Dorfman disease (RDD), with central nervous system (CNS) involvement. METHODS A total of 121 adult patients with histiocytoses (77 LCH, 37 ECD, and 7 RDD) and CNS involvement were retrospectively included. Histiocytoses were diagnosed based on histopathological findings combined with suggestive clinical and imaging features. Brain and dedicated pituitary MRIs were systematically analyzed for tumorous, vascular, degenerative lesions, sinus, and orbital involvement and for hypothalamic pituitary axis involvement. RESULTS Endocrine disorders, including diabetes insipidus and central hypogonadism, were more common in LCH patients than in ECD and RDD patients (p < 0.001). In LCH, tumorous lesions were mostly solitary (85.7%), located in the hypothalamic pituitary region (92.9%), and without peritumoral edema (92.9%), while in ECD and RDD, tumorous lesions were often multiple (ECD: 81.3%, RDD: 85.7%), their distribution was more widespread with meninges mostly involved (ECD: 75%, RDD: 71.4%), and they most likely presented with peritumoral edema (ECD: 50%, RDD: 57.1%; all p ≤ 0.020). Vascular involvement was an exclusive imaging characteristic of ECD (17.2%), which was not observed in LCH or RDD; this was also associated with a higher risk of death (p = 0.013, hazard ratio = 11.09). CONCLUSION The typical characteristic of adult CNS-LCH was endocrine disorders with radiological findings limited to the hypothalamic pituitary axis. The pattern of multiple tumorous lesions with predominant involvement of meninges was the main manifestation of CNS-ECD and CNS-RDD, while vascular involvement was pathognomonic for ECD and associated with poor prognosis. CLINICAL RELEVANCE STATEMENT Involvement of the hypothalamic-pituitary axis is the typical imaging characteristic of Langerhans cell histiocytosis. Multiple tumorous lesions, predominantly involving but not limited to meninges, occur in most Erdheim-Chester disease and Rosai-Dorfman disease patients. Vascular involvement occurs only in Erdheim-Chester disease patients. KEY POINTS • The different distribution patterns of brain tumorous lesions can help differentiate among LCH, ECD, and RDD. • Vascular involvement was an exclusive imaging finding of ECD and was associated with high mortality. • Some cases with atypical imaging manifestations were reported to further expand the knowledge on these diseases.
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Affiliation(s)
- Xiaoyuan Fan
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ting Liu
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiwen Zhang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Sun
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Na Niu
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chenhui Mao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengdan Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Jian Li
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Daobin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinxin Cao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
- State Key Laboratory of Difficult, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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10
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Banks SA, Sartori Valinotti JC, Go RS, Abeykoon JP, Goyal G, Young JR, Koster MJ, Vassallo R, Ryu JH, Davidge-Pitts CJ, Ravindran A, Bennani NN, Shah MV, Rech KL, Tobin WO. Neurological Manifestations of Histiocytic Disorders. Curr Neurol Neurosci Rep 2023; 23:277-286. [PMID: 37209319 DOI: 10.1007/s11910-023-01272-4] [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] [Accepted: 04/04/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE OF REVIEW Histiocytic disorders, including Erdheim-Chester disease (ECD), Langerhans cell histiocytosis (LCH), and Rosai-Dorfman disease (RDD), are rare neoplasms that may present with a spectrum of neurologic involvement. Diagnostic delay is common due to heterogeneity in presentation and challenging pathology. RECENT FINDINGS Recent advances in the treatment of these diseases targeted towards mutations in the MAP kinase pathway have led to an improved prognosis in these patients with neurologic involvement. It is critical for clinicians to have a high index of suspicion to allow for early targeted treatment and optimize neurologic outcomes. A systematic approach to diagnosis is presented in this article to allow for accurate diagnosis of these rare diseases.
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Affiliation(s)
- Samantha A Banks
- Department of Neurology, Mayo Clinic Rochester, 200 First St SW, Rochester, MN, 55905, USA
| | | | - Ronald S Go
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN, USA
| | | | - Gaurav Goyal
- Division of Hematology-Oncology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jason R Young
- Department of Radiology, Mayo Clinic in Jacksonville, Jacksonville, FL, USA
| | - Matthew J Koster
- Division of Rheumatology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Robert Vassallo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic Rochester, Rochester, MN, USA
| | - Jay H Ryu
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN, USA
| | | | - Aishwarya Ravindran
- Division of Laboratory Medicine-Hematopathology, Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - N Nora Bennani
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Mithun V Shah
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Karen L Rech
- Division of Hematopathology, Mayo Clinic Rochester, Rochester, MN, USA
| | - W Oliver Tobin
- Department of Neurology, Mayo Clinic Rochester, 200 First St SW, Rochester, MN, 55905, USA.
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11
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Benson JC, Vaubel R, Ebne BA, Mark IT, Peris Celda M, Hook CC, Tobin WO, Giannini C. Erdheim-Chester Disease. AJNR Am J Neuroradiol 2023; 44:505-510. [PMID: 36997288 PMCID: PMC10171379 DOI: 10.3174/ajnr.a7832] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/23/2023] [Indexed: 04/01/2023]
Abstract
Erdheim-Chester disease is a rare non-Langerhans cell histiocytosis. The disease is widely variable in its severity, ranging from incidental findings in asymptomatic patients to a fatal multisystem illness. CNS involvement occurs in up to one-half of patients, most often leading to diabetes insipidus and cerebellar dysfunction. Imaging findings in neurologic Erdheim-Chester disease are often nonspecific, and the disease is commonly mistaken for close mimickers. Nevertheless, there are many imaging manifestations of Erdheim-Chester disease that are highly suggestive of the disease, which an astute radiologist could use to accurately indicate this diagnosis. This article discusses the imaging appearance, histologic features, clinical manifestations, and management of Erdheim-Chester disease.
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Affiliation(s)
- J C Benson
- From the Departments of Radiology (J.C.B., I.T.M.)
| | - R Vaubel
- Laboratory Medicine and Pathology (R.V., B.A.E., C.G.)
| | - B A Ebne
- Laboratory Medicine and Pathology (R.V., B.A.E., C.G.)
| | - I T Mark
- From the Departments of Radiology (J.C.B., I.T.M.)
| | | | - C C Hook
- Hematology and Oncology (C.C.H.)
| | - W O Tobin
- Neurology (W.O.T.), Mayo Clinic, Rochester, Minnesota
| | - C Giannini
- Laboratory Medicine and Pathology (R.V., B.A.E., C.G.)
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12
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Soumet-Leman C, Rotge JY, Delavaud P, Amoura Z, Cohen-Aubart F, Haroche J. Psychiatric disorders, personality and neuropsychological alterations in Erdheim-Chester disease. Orphanet J Rare Dis 2023; 18:9. [PMID: 36631837 PMCID: PMC9832607 DOI: 10.1186/s13023-022-02609-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 12/29/2022] [Indexed: 01/13/2023] Open
Abstract
Although neurological manifestations and changes in brain volumes have been described in Erdheim-Chester disease (ECD), it remains unknown whether ECD may be associated with psychiatric symptoms and cognitive dysfunctions. We assessed the presence of psychiatric disorders, changes in temperaments and characters, and neuropsychological performances in 32 ECD patients (mean age = 59) younger than 70, not treated with interferon alpha during the last 6 months, and without other serious illnesses. ECD patients exhibited high level of past depressive disorder (80%) and anxiety disorder, especially agoraphobia (29%). They revealed personality changes, especially with high agreeableness (t = 3.18, p < 0.005) and high conscientiousness (t = 3.81, p < 0.001). Neuropsychological assessments showed impairments in attention (GZ: t = 16.12, p < 0.0001, KL: t = 37.01, p < 0.0001) and episodic memory performances (STIR: t = - 3.01, p = 0.006, LTFR: t = - 2.87, p = 0.008, LTIR: t = - 3.63, p = 0.001). Executive functions, such as flexibility, inhibitory control, were unimpaired. Although it remains to be clarified whether these psychiatric symptoms and cognitive impairments may impact the daily functioning and the quality of life, the present study highlights the need to consider cognitive and emotional states in ECD management.
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Affiliation(s)
- Charlotte Soumet-Leman
- ICP (EA7403), équipe VCR, Paris, France. .,Université de Lorraine, APEMAC, équipe EPSAM, Metz, France. .,Department of Adult Psychiatry, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.
| | - Jean-Yves Rotge
- grid.411439.a0000 0001 2150 9058Department of Adult Psychiatry, Pitié-Salpêtrière Hospital, AP-HP, Paris, France ,grid.411439.a0000 0001 2150 9058Inserm U 1127, CNRS UMR 7225, Brain and Spine Institute (Institut du Cerveau et de la Moelle Epinière), ICM, Paris, France ,grid.462844.80000 0001 2308 1657Sorbonne Université, Paris, France
| | - Pauline Delavaud
- grid.411439.a0000 0001 2150 9058Department of Adult Psychiatry, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Zahir Amoura
- grid.462844.80000 0001 2308 1657Sorbonne Université, Paris, France ,grid.462844.80000 0001 2308 1657Internal Medicine Department 2, Pitié-Salpêtrière Hospital, French National Centre for Histiocytoses, AP-HP, Sorbonne Université, Paris, France
| | - Fleur Cohen-Aubart
- grid.462844.80000 0001 2308 1657Sorbonne Université, Paris, France ,grid.462844.80000 0001 2308 1657Internal Medicine Department 2, Pitié-Salpêtrière Hospital, French National Centre for Histiocytoses, AP-HP, Sorbonne Université, Paris, France
| | - Julien Haroche
- grid.462844.80000 0001 2308 1657Sorbonne Université, Paris, France ,grid.462844.80000 0001 2308 1657Internal Medicine Department 2, Pitié-Salpêtrière Hospital, French National Centre for Histiocytoses, AP-HP, Sorbonne Université, Paris, France
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13
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Chazal T, Pegoraro F, Manari G, Bettiol A, Maniscalco V, Gelain E, Charlotte F, Mazor RD, Renard-Penna R, Amoura Z, Cohen-Aubart F, Haroche J, Izzedine H, Vaglio A. Clinical phenotypes and long-term outcome of kidney involvement in Erdheim-Chester histiocytosis. Kidney Int 2023; 103:177-186. [PMID: 36374823 DOI: 10.1016/j.kint.2022.09.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/10/2022] [Accepted: 09/01/2022] [Indexed: 11/07/2022]
Abstract
Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis that frequently infiltrates the peri-kidney space ("hairy kidney" appearance), kidney pelvis and proximal ureters, leading to obstructive uropathy. Here, we analyzed the clinical characteristics, imaging findings and long-term kidney outcome of a large multicenter cohort comprising 195 consecutive patients with ECD. Retroperitoneal peri-kidney or peri-ureteral involvement was detected at diagnosis in 147 patients. Of them, 70 had hydronephrosis (bilateral in 47), and 16 with kidney atrophy (unilateral in 14). Kidney vascular peduncle infiltration was found in 60 patients, and kidney artery stenosis in 31. The estimated glomerular filtration rate (eGFR) at diagnosis was significantly lower in patients with than in those without peri-kidney involvement (median 74 vs. 98 mL/min/1.73 m2). Ureteral stenting often failed to achieve kidney function recovery. A total of 181 patients received medical therapies: first-line treatments included interferon-α (61%), BRAF-inhibitors (17%), mTOR-inhibitors (7%), or other drugs (15%). These therapies were efficacious for ECD but rarely induced kidney function improvement (one-year eGFR increase over 25% in under 10% of patients). After a median of 43 months, 19% of patients died and 5% developed kidney failure. Among patients with peri-kidney involvement, 44% developed chronic kidney disease (CKD) 3-5 at five years vs. 5% of those without. Unadjusted predictors of advanced CKD and kidney failure/death were age over 50 years, hypertension, BRAFV600E mutation, and baseline eGFR. At multivariable analysis, cardiovascular comorbidities were associated with advanced CKD, and age over 50 years with kidney failure/death. Thus, kidney involvement is common in ECD and can lead to CKD or kidney failure despite effective medical therapies or urological procedures.
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Affiliation(s)
- Thibaud Chazal
- Service de Médecine Interne, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Maladies Auto-Immunes et Systémiques, Centre National de Référence des Histiocytoses, Hôpital Pitié-Salpêtrière, Paris, France; Internal Medicine Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | | | - Gaia Manari
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | | | - Elena Gelain
- Nephrology and Dialysis Unit, Meyer Children's Hospital, Firenze, Italy
| | - Frédéric Charlotte
- Service d'Anatomie Pathologique, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Roei D Mazor
- Clinic of Histiocytic Neoplasms, Institute of Hematology, Assuta Medical Center, Tel Aviv, Israel
| | - Raphaele Renard-Penna
- Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Zahir Amoura
- Service de Médecine Interne, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Maladies Auto-Immunes et Systémiques, Centre National de Référence des Histiocytoses, Hôpital Pitié-Salpêtrière, Paris, France
| | - Fleur Cohen-Aubart
- Service de Médecine Interne, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Maladies Auto-Immunes et Systémiques, Centre National de Référence des Histiocytoses, Hôpital Pitié-Salpêtrière, Paris, France
| | - Julien Haroche
- Service de Médecine Interne, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Maladies Auto-Immunes et Systémiques, Centre National de Référence des Histiocytoses, Hôpital Pitié-Salpêtrière, Paris, France.
| | - Hassan Izzedine
- Department of Nephrology, Peupliers Hospital, Paris, France; Department of Nephrology, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Augusto Vaglio
- Nephrology and Dialysis Unit, Meyer Children's Hospital, Firenze, Italy; Department of Biomedical, Experimental and Clinical Sciences "Mario Serio," University of Firenze, Firenze, Italy.
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14
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Neurological Erdheim-Chester Disease Manifesting with Subacute or Progressive Cerebellar Ataxia: Novel Case Series and Review of the Literature. Brain Sci 2022; 13:brainsci13010026. [PMID: 36672008 PMCID: PMC9856726 DOI: 10.3390/brainsci13010026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022] Open
Abstract
Neurological involvement is relatively common in Erdheim-Chester disease (ECD), a rare clonal disorder of histiocytic myeloid precursors characterized by multisystem involvement. In ECD patients, neurological symptoms can occur either at onset or during the disease course and may lead to various degrees of neurological disability or affect patients' life expectancy. The clinical neurological presentation of ECD often consists of cerebellar symptoms, showing either a subacute or progressive course. In this latter case, patients manifest with a slowly progressive cerebellar ataxia, variably associated with other non-specific neurological signs, infratentorial leukoencephalopathy, and cerebellar atrophy, possibly mimicking either adult-onset degenerative or immune-mediated ataxia. In such cases, diagnosis of ECD may be particularly challenging, yet some peculiar features are helpful to address it. Here, we retrospectively describe four novel ECD patients, all manifesting cerebellar symptoms at onset. In two cases, slow disease progression and associated brain MRI features simulated a degenerative cerebellar ataxia. Three patients received a definite diagnosis of histiocytosis, whereas one case lacked histology confirmation, although clinical diagnostic features were strongly suggestive. Our findings regarding existing literature data focused on neurological ECD will be also discussed to highlight those diagnostic clues helpful to address diagnosis.
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15
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Wadayama T, Shimizu M, Kimura I, Baba K, Beck G, Nagano S, Morita R, Nakagawa H, Shirano M, Goto T, Norose K, Hikosaka K, Murayama S, Mochizuki H. Erdheim-Chester Disease Involving the Central Nervous System with Latent Toxoplasmosis. Intern Med 2022; 61:2661-2666. [PMID: 35135916 PMCID: PMC9492489 DOI: 10.2169/internalmedicine.8564-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/02/2021] [Indexed: 12/25/2022] Open
Abstract
Erdheim-Chester disease (ECD) is a rare, non-Langerhans cell histiocytosis characterized by the infiltration of foamy histiocytes into multiple organs. We herein report a case of ECD with central nervous system (CNS) involvement in a 63-year-old man who also presented a positive result for Toxoplasma gondii nested polymerase chain reaction testing of cerebrospinal fluid. Since anti-Toxoplasma treatment proved completely ineffective, we presumed latent infection of the CNS with T. gondii. This case suggests the difficulty of distinguishing ECD with CNS involvement from toxoplasmic encephalitis and the possibility of a relationship between the pathogeneses of ECD and infection with T. gondii.
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Affiliation(s)
- Tomoya Wadayama
- Department of Neurology, Osaka University Graduate School of Medicine, Japan
| | - Mikito Shimizu
- Department of Neurology, Osaka University Graduate School of Medicine, Japan
| | - Ikko Kimura
- Graduate School of Frontier Biosciences, Osaka University, Japan
| | - Kousuke Baba
- Department of Neurology, Osaka University Graduate School of Medicine, Japan
| | - Goichi Beck
- Department of Neurology, Osaka University Graduate School of Medicine, Japan
| | - Seiichi Nagano
- Department of Neurology, Osaka University Graduate School of Medicine, Japan
| | - Ryo Morita
- Department of Infectious Diseases, Osaka City General Hospital, Japan
| | - Hidenori Nakagawa
- Department of Infectious Diseases, Osaka City General Hospital, Japan
| | - Michinori Shirano
- Department of Infectious Diseases, Osaka City General Hospital, Japan
| | - Tetsushi Goto
- Department of Infectious Diseases, Osaka City General Hospital, Japan
| | - Kazumi Norose
- Department of Infection and Host Defense, Graduate School of Medicine, Chiba University, Japan
| | - Kenji Hikosaka
- Department of Infection and Host Defense, Graduate School of Medicine, Chiba University, Japan
| | - Shigeo Murayama
- Department of Neurology, Osaka University Graduate School of Medicine, Japan
| | - Hideki Mochizuki
- Department of Neurology, Osaka University Graduate School of Medicine, Japan
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16
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Razanamahery J, Abdallahoui M, Chabridon G, Fromont A, Tarris G, Idbaih A, Comby PO, Godard F, Haroche J, Audia S, Bonnotte B. Dramatic Efficacy of Interferon and Vemurafenib on Psychiatric Symptoms Revealing BRAFV600E -Mutated Erdheim-Chester Disease: A Case Report. Front Immunol 2022; 13:918613. [PMID: 35874752 PMCID: PMC9299438 DOI: 10.3389/fimmu.2022.918613] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/08/2022] [Indexed: 12/02/2022] Open
Abstract
Erdheim–Chester disease (ECD) is a rare condition with underestimated neurological involvement. Mild psychiatric symptoms such as mood swings have been rarely described in the clinical spectrum of neuro-ECD. We here describe the first patient with psychiatric manifestations of delirium revealing ECD with neurological involvement with favorable evolution under interferon followed by BRAF inhibitor monotherapy. An 81-year-old woman was referred to the hospital because of delirium and severe cognitive impairment associated with a cerebellar syndrome. Brain magnetic resonance imaging showed “FLAIR-changes” lesions in the pons and upper cerebellum peduncles. Blood and cerebrospinal fluid (CSF) analyses showed normal results except for an elevated neopterin level in the CSF. Whole-body CT scan (18FDG-PET) showed peri-nephric fat infiltration and aorta adventitia sheathing with radiotracer uptake in the pons, vessels, peri-nephric fat, and bone lesions, which was characteristic of ECD. The diagnosis was confirmed on perirenal tissue biopsy, which also showed a BRAFV600E mutation. Treatment with interferon resulted in the resolution of delirium, and treatment with BRAF inhibitor subsequently resulted in a partial remission of all active sites. This case highlights that delirium can be the first manifestation of neurodegenerative ECD. ECD should be screened in unexplained psychiatric features as interferon and targeted therapy appear to be effective in this situation.
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Affiliation(s)
- Jérôme Razanamahery
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Maroua Abdallahoui
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | | | - Agnès Fromont
- Department of Neurology, Dijon University Hospital, Dijon, France
| | - Georges Tarris
- Department of Pathology, Dijon University Hospital, Dijon, France
| | - Ahmed Idbaih
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital Universitaire La Pitié Salpêtrière, DMU Neurosciences, Paris, France
| | | | - Francois Godard
- Nuclear Medicine Department, Centre Georges Francois Leclerc, Dijon, France
| | - Julien Haroche
- Department of Internal Medicine 2, National Reference Center for Histiocytosis, Pitié-Salpétrière Hospital, Paris, France
| | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
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17
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Kulcsarova K, Baloghova J, Necpal J, Skorvanek M. Skin Conditions and Movement Disorders: Hiding in Plain Sight. Mov Disord Clin Pract 2022; 9:566-583. [PMID: 35844274 PMCID: PMC9274368 DOI: 10.1002/mdc3.13436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/17/2022] [Accepted: 03/07/2022] [Indexed: 11/09/2022] Open
Abstract
Skin manifestations are well-recognized non-motor symptoms of Parkinson's disease (PD) and other hypokinetic and hyperkinetic movement disorders. Skin conditions are usually well visible during routine clinical examination and their recognition may play a major role in diagnostic work-up. In this educational review we: (1) briefly outline skin conditions related to Parkinson's disease, including therapy-related skin complications and their management; (2) discuss the role of skin biopsies in early diagnosis of PD and differential diagnosis of parkinsonian syndromes; and focus more on areas which have not been reviewed in the literature before, including (3) skin conditions related to atypical parkinsonism, and (4) skin conditions related to hyperkinetic movement disorders. In case of rare hyperkinetic movement disorders, specific dermatological manifestations, like presence of angiokeratomas, telangiectasias, Mongolian spots, lipomas, ichthyosis, progeroid skin changes and others may point to a very specific group of disorders and help guide further investigations.
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Affiliation(s)
- Kristina Kulcsarova
- Department of Neurology, Medical FacultyUniversity of Pavol Jozef SafarikPavolSlovak Republic
- Department of NeurologyUniversity Hospital L. PasteurKosiceSlovak Republic
| | - Janette Baloghova
- Department of DermatovenerologyMedical Faculty, University of Pavol Jozef SafarikKosiceSlovak Republic
- Department of DermatovenerologyUniversity Hospital L. PasteurKosiceSlovak Republic
| | - Jan Necpal
- Department of NeurologyZvolen HospitalZvolenSlovak Republic
| | - Matej Skorvanek
- Department of Neurology, Medical FacultyUniversity of Pavol Jozef SafarikPavolSlovak Republic
- Department of NeurologyUniversity Hospital L. PasteurKosiceSlovak Republic
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Prasad RN, Kobalka PJ, Perlow HK, Prevedello DM, Blakaj DM, Raval RR, Palmer JD. Craniospinal irradiation for respiratory failure secondary to central nervous system Erdheim-Chester disease. Radiat Oncol J 2022; 40:162-168. [PMID: 35796119 PMCID: PMC9262703 DOI: 10.3857/roj.2021.01074] [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: 12/08/2021] [Accepted: 03/17/2022] [Indexed: 12/01/2022] Open
Abstract
Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis typically featuring lower extremity osteosclerosis (96%) from Langerin-negative histiocytes with fibrosis. Central nervous system (CNS)-only disease is extremely rare, and particularly difficult to diagnose and manage. Neurologic complaints may be refractory to systemic therapy (ST), and the role of radiation therapy (RT) is undefined. We present a patient with ECD of the medulla complicated by respiratory failure and strength deficits with disseminated leptomeningeal disease (LMD) but not systemic disease, representing the first report of CNS-limited ECD with LMD. He received upfront craniospinal irradiation (CSI), representing a rare account of CSI for ESD, with marked clinical improvement resulting in extubation and improved strength. CSI facilitated excellent preservation of quality of life, and no treatment-related toxicity was observed prior to eventual, unrelated cardiopulmonary arrest. Thus, palliative CSI may augment ST by safely offering improved local control and symptomatic relief for CNS ECD.
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Affiliation(s)
- Rahul N. Prasad
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Peter J. Kobalka
- Department of Neuropathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Haley K. Perlow
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Daniel M. Prevedello
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Dukagjin M. Blakaj
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Raju R. Raval
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Joshua D. Palmer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Correspondence: Joshua D. Palmer Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W 10th Ave, Columbus, OH 43210, USA. Tel: +1-614-685-9707 E-mail:
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Nasany RA, Reiner AS, Francis JH, Abla O, Panageas KS, Diamond EL. Rosai-Dorfman-Destombes disease of the nervous system: a systematic literature review. Orphanet J Rare Dis 2022; 17:92. [PMID: 35236371 PMCID: PMC8889645 DOI: 10.1186/s13023-022-02220-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 02/06/2022] [Indexed: 12/28/2022] Open
Abstract
Background Rosai–Dorfman–Destombes disease (RDD) is a rare histiocytic disorder with heterogeneous clinical manifestations and rare neurologic involvement. The existing clinical literature about neurologic RDD has yet to be critically examined.
Methods We performed a four-database English-language systematic literature search for cases of RDD neurohistiocytosis, excluding secondary literature. Individual patient data for neurologic symptoms, disease sites, treatments, and responses were captured. Responses to first-line and second-line surgical interventions, post-surgical radiotherapy, and systemic therapies were analyzed. Results Among 4769 articles yielded by literature search, 154 articles were fully reviewed, containing data on 224 patients with neurologic RDD. 128 (83.1%) articles were single case reports. 149 (66.5%) patients were male, 74 (33.5%) female, with a median age of 37.6 years (range 2–79). Presenting neurologic symptoms included headache (45.1%), focal neurological deficits (32.6%), visual symptoms (32.1%), and seizures (24.6%). RDD involvement was multifocal in 32 (14.3%) cases. First-line treatment involved resection in 200 (89.6%) patients, with subsequent progression in 52 (26%), including 41 (78.8%) with unifocal disease. No difference was observed in progression-free survival comparing post-operative radiotherapy to no radiotherapy following partial resection. Chemotherapy given alone as first-line treatment led to complete or partial response in 3/7(43%) patients. Second-line treatments led to complete or partial response in 18/37(37.5%) patients. Mutational data were reported on 10 patients (4.46%). Conclusions This review highlights the limited published data about neurologic RDD, which presents with varied symptomatology and outcome. Further study is needed about its mutational landscape, and more effective therapies are needed for recurrent and refractory disease. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02220-0.
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Affiliation(s)
- Ruham Alshiekh Nasany
- Department of Neurology, Memorial Sloan Kettering Cancer Center, 160 East 53rd Street, 2nd Floor, New York, NY, 10022, USA
| | - Anne S Reiner
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jasmine H Francis
- Ophthalmic Oncology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oussama Abla
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Katherine S Panageas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eli L Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, 160 East 53rd Street, 2nd Floor, New York, NY, 10022, USA.
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McClain KL, Bigenwald C, Collin M, Haroche J, Marsh RA, Merad M, Picarsic J, Ribeiro KB, Allen CE. Histiocytic disorders. Nat Rev Dis Primers 2021; 7:73. [PMID: 34620874 PMCID: PMC10031765 DOI: 10.1038/s41572-021-00307-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 12/18/2022]
Abstract
The historic term 'histiocytosis' meaning 'tissue cell' is used as a unifying concept for diseases characterized by pathogenic myeloid cells that share histological features with macrophages or dendritic cells. These cells may arise from the embryonic yolk sac, fetal liver or postnatal bone marrow. Prior classification schemes align disease designation with terminal phenotype: for example, Langerhans cell histiocytosis (LCH) shares CD207+ antigen with physiological epidermal Langerhans cells. LCH, Erdheim-Chester disease (ECD), juvenile xanthogranuloma (JXG) and Rosai-Dorfman disease (RDD) are all characterized by pathological ERK activation driven by activating somatic mutations in MAPK pathway genes. The title of this Primer (Histiocytic disorders) was chosen to differentiate the above diseases from Langerhans cell sarcoma and malignant histiocytosis, which are hyperproliferative lesions typical of cancer. By comparison LCH, ECD, RDD and JXG share some features of malignant cells including activating MAPK pathway mutations, but are not hyperproliferative. 'Inflammatory myeloproliferative neoplasm' may be a more precise nomenclature. By contrast, haemophagocytic lymphohistiocytosis is associated with macrophage activation and extreme inflammation, and represents a syndrome of immune dysregulation. These diseases affect children and adults in varying proportions depending on which of the entities is involved.
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Affiliation(s)
- Kenneth L McClain
- Texas Children's Cancer Center, Department of Paediatrics, Baylor College of Medicine, Houston, TX, USA.
| | - Camille Bigenwald
- Department of Oncological Sciences and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthew Collin
- Human Dendritic Cell Lab, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Julien Haroche
- Department of Internal Medicine, Institut E3M French Reference Centre for Histiocytosis, Pitié-Salpȇtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Rebecca A Marsh
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, and University of Cincinnati, Cincinnati, OH, USA
| | - Miriam Merad
- Department of Oncological Sciences and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jennifer Picarsic
- Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Karina B Ribeiro
- Faculdade de Ciȇncias Médicas da Santa Casa de São Paulo, Department of Collective Health, São Paulo, Brazil
| | - Carl E Allen
- Texas Children's Cancer Center, Department of Paediatrics, Baylor College of Medicine, Houston, TX, USA
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21
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Kanakis M, Petrou P, Lourida G, Georgalas I. Erdheim-Chester disease: a comprehensive review from the ophthalmologic perspective. Surv Ophthalmol 2021; 67:388-410. [PMID: 34081930 DOI: 10.1016/j.survophthal.2021.05.013] [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: 07/26/2020] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 01/18/2023]
Abstract
Erdheim-Chester disease (ECD) is a rare clonal histiocytic neoplasm with less than 1200 documented cases to date. The disease is life-threatening and difficult to recognize, although increasing awareness as well as the integration of clinical, imaging, pathology information , and genetic studies have led to a recent exponential increase in new reported cases. ECD affects multiple organs and systems, including skeletal, neurologic, and cardiovascular. Pulmonary, retroperitoneal, and cutaneous lesions have also been reported in various combinations. Until the discovery that more than half of ECD patients harbor the BRAF-V600E mutation or other mutations in the mitogen-activated protein kinase (MAPK) and RAS pathways, Interferon-a was the first-line treatment. Nowadays BRAF and MEK-inhibitors targeted therapies are the mainstay of treatment. Ophthalmologic involvement occurs in 25% -30% of ECD cases, usually in the form of orbital involvement presenting with exophthalmos and ophthalmoplegia. Other ophthalmologic manifestations include palpebral xanthelasmas, anterior uveitis and vitritis, optic disk edema, choroidal infiltration, recurrent serous retinal detachment, retinal drusen-like deposits and retinal pigment epithelial changes. ECD patients can also present with ocular symptoms as a result of adverse effects of the treatment regimens. In some cases with smoldering or protean symptoms, the emergence of eye manifestations triggered the diagnosis. Ophthalmologists have to be aware of the disease, recognize the constellation of ECD symptoms, and contribute to the diagnosis, treatment, and follow-up of ECD patients.
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Affiliation(s)
| | - Petros Petrou
- G. Genimatas General Hospital, National and Kapodistrian University of Athens, 1st University Eye Clinic, Athens, Greece
| | - Giota Lourida
- Department of Internal Medicine and Infectious Disease, Sotiria Hospital, Athens, Greece
| | - Ilias Georgalas
- G. Genimatas General Hospital, National and Kapodistrian University of Athens, 1st University Eye Clinic, Athens, Greece.
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Bay JO, Andre T, Bouleuc C, Gandemer V, Magne N, Orbach D, Pellier I, Penel N, Rodrigues M, Thariat J, Thiery-Villemin A, Wisley M, L'Allemain G, Robert J. [What should we remember from 2020?]. Bull Cancer 2021; 108:55-66. [PMID: 33419531 DOI: 10.1016/j.bulcan.2020.12.002] [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: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
The editorial committee of the Bulletin du Cancer is proud to comply with his annual analysis of some of the worldwide updates in oncology that emerge in 2020. We know that all new breakthroughs will not be addressed and apologise for not being comprehensive, but we hope that the topics deciphered herein will bring the reader interesting information in his daily practice in gyneco-oncology, uro-oncology, neuro-oncology, digestive oncology, pneumo-oncology, hemato-oncology, pediatric oncology, or in palliative care.
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Affiliation(s)
- Jacques-Olivier Bay
- CHU de Clermont-Ferrand, service de thérapie cellulaire et d'hématologie clinique adulte, UE7453 CHELTER, Inserm CIC-501, site Estaing, 63000 Clermont-Ferrand, France.
| | - Thierry Andre
- AP-HP, hôpital Saint-Antoine, service d'oncologie médicale, 75012 Paris, France
| | - Carole Bouleuc
- Sorbonne université, Paris, France; Institut Curie, département de soins de support, 26, rue d'Ulm, 75005 Paris, France
| | - Virginie Gandemer
- CHU de Rennes, service d'hémato-oncologie pédiatrique, 35000 Rennes, France
| | - Nicolas Magne
- Institut de cancérologie Lucien-Neuwirth, Department of Radiation Oncology, 108 bis, avenue Albert-Raimond, BP 60008, 42270 Saint-Priest-en-Jarez, France; University department of Research and Teaching, Institut de cancérologie Lucien-Neuwirth, 42270 Saint-Priest-en-Jarez, France; Laboratory of Molecular and Cellular Radiobiology, UMR CNRS5822/IN2P3, IPNL, PRISME, 69622 Villeurbanne, France
| | - Daniel Orbach
- Institut Curie, centre intégré de soins et de recherche en oncologie de l'enfant, adolescent et jeune adulte (SIREDO), 26, rue d'Ulm, 75005 Paris, France
| | | | - Nicolas Penel
- Lille University, Oscar Lambret Cancer Centre, Medical Oncology Department, 3, rue Frederic-Combemale, 59000 Lille, France
| | - Manuel Rodrigues
- PSL Research University, institut Curie, département d'oncologie médicale, 26, rue d'Ulm, 75005 Paris, France
| | - Juliette Thariat
- Centre François-Baclesse/ARCHADE, département de radiothérapie, 3, avenue General-Harris, 14000 Caen, France; Laboratoire de physique corpusculaire IN2P3/ENSICAEN - UMR6534, 14000 Caen, France; Normandie University, UNICAEN, 14000 Caen, France
| | - Antoine Thiery-Villemin
- CHRU Jean-Minjoz, department of medical oncology, 25030 Besançon cedex, France; Université de Franche-Comté, UMR1098, SFR IBCT, 25020 Besançon cedex, France; Inserm, UMR1098, 25020 Besançon cedex, France
| | - Marie Wisley
- Université de Paris, faculté de médecine, 75000 Paris, France; Centre de recherche des Cordeliers, Team « Inflammation, Complement and Cancer », Inserm, 75000 Paris, France; AP-HP Centre, hôpital Cochin, service de pneumologie, unité d'oncologie thoracique, 75000 Paris, France
| | - Gilles L'Allemain
- Institut biologie Valrose, université Côte d'Azur, Inserm U1091, CNRS 7277, 06108 Nice, France
| | - Jacques Robert
- Université de Bordeaux, Inserm U1218, 33000 Bordeaux, France
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