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Liu Y, Chen Z, Wang L, Li B. Intestinal Langerhans cell histiocytosis presenting with symptoms similar to inflammatory bowel disease: a case report. Pathol Oncol Res 2024; 30:1611705. [PMID: 38605931 PMCID: PMC11007090 DOI: 10.3389/pore.2024.1611705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 03/15/2024] [Indexed: 04/13/2024]
Abstract
Background Langerhans cell histiocytosis is a rare disease characterized by the abnormal proliferation of Langerhans cells within a single organ or multiple organs. This case report aims to improve the knowledge of the presentation of gastrointestinal Langerhans cell histiocytosis to facilitate the diagnosis and management of this rare disorder. Case presentation A 19-month-old female presented with repeatedly mucinous bloody stools. The abdominal ultrasound revealed a slightly enlarged spleen. The initial colonoscopy revealed chronic enteritis with a very early onset inflammatory bowel disease. After anti-inflammatory treatment without improvement, an intestinal biopsy was performed at The Forth Affiliated Hospital of Zhejiang University. The final intestinal biopsy and histopathology examination confirmed the presence of Langerhans cell histiocytosis. After diagnosis, additional lung and head imaging examinations revealed no abnormalities. Her condition improved gradually after being treated with chemotherapy (vincristine and prednisone) and molecular-targeted drug(dalafinil) treatment. Conclusion The clinical symptoms of Langerhans cell histiocytosis involving the gastrointestinal tract are not specific and may resemble symptoms observed in inflammatory bowel disease and other primary gastrointestinal tumors. Therefore, in cases of infants presenting with inflammatory gastrointestinal symptoms that do not resolve after treatment, a biopsy is essential to obtain a differential diagnosis.
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Affiliation(s)
| | | | | | - Baizhou Li
- Department of Pathology, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, Zhejiang, China
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Affiliation(s)
- Ahmet Ozen
- From the Department of Pediatrics, Division of Allergy and Immunology, Marmara University, School of Medicine, the Istanbul Jeffrey Modell Diagnostic Center for Primary Immunodeficiency Diseases, and the Isil Berat Barlan Center for Translational Medicine - all in Istanbul, Turkey (A.O.); and the Molecular Development of the Immune System Section, Laboratory of Immune System Biology, Clinical Genomics Program, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (M.J.L.)
| | - Michael J Lenardo
- From the Department of Pediatrics, Division of Allergy and Immunology, Marmara University, School of Medicine, the Istanbul Jeffrey Modell Diagnostic Center for Primary Immunodeficiency Diseases, and the Isil Berat Barlan Center for Translational Medicine - all in Istanbul, Turkey (A.O.); and the Molecular Development of the Immune System Section, Laboratory of Immune System Biology, Clinical Genomics Program, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (M.J.L.)
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Yoon HS, Lee JH, Michlitsch J, Garcia-Carega M, Jeng M. Langerhans Cell Histiocytosis of the Gastrointestinal Tract: Evidence for Risk Organ Status. J Pediatr 2019; 212:66-72.e3. [PMID: 31279573 DOI: 10.1016/j.jpeds.2019.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the "risk status" of Langerhans cell histiocytosis (LCH) of the gastrointestinal tract. STUDY DESIGN Outcomes from 43 published cases of patients with LCH and gastrointestinal tract involvement were matched to 43 patients with LCH without gastrointestinal tract involvement cared for at our institution. Comparisons were made of the 5-year overall survival rates determined from Kaplan-Meier survival curves for the entire cohort of patients, as well as subgroups defined by lack of risk organ involvement and later era of treatment (to control for temporal changes in LCH treatment regimens). In addition, an association between LCH-gastrointestinal tract and risk organ involvement was investigated. RESULTS The 5-year overall survival for children with LCH-gastrointestinal tract (45.3%) was significantly worse than for those without gastrointestinal tract involvement (94.6%; P = .001). This difference remained significant after we excluded risk organ involvement (53.6%% vs 100%; P = .001), and analyzing subjects diagnosed after 2000 (75% vs 100%; P = .012). A 4-fold increase in risk organ involvement with LCH-gastrointestinal tract was observed (OR 4.359; 95% CI 1.75-10.82, P = .001). CONCLUSIONS This limited retrospective study suggests that patients with LCH-gastrointestinal tract involvement may have decreased survival, independent of risk organ involvement, and provides evidence to support a prospective study to evaluate risk organ status of LCH-gastrointestinal tract. LCH-gastrointestinal tract may be associated with a 4-fold risk for risk organ involvement. Attention to gastrointestinal symptoms and LCH-gastrointestinal tract in young children diagnosed with LCH is warranted.
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Affiliation(s)
- Hoi Soo Yoon
- Kyung Hee University Medical Center, Seoul, Korea; Stanford University School of Medicine, Stanford, CA
| | | | - Jennifer Michlitsch
- University of California, San Francisco Benioff Children's Hospital Oakland, Oakland, CA
| | | | - Michael Jeng
- Stanford University School of Medicine, Stanford, CA.
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Successful treatment with 2-chlorodeoxyadenosine of refractory pediatric Langerhans cell histiocytosis with initial involvement of the gastrointestinal tract. Int J Hematol 2019; 110:756-762. [PMID: 31350665 DOI: 10.1007/s12185-019-02711-0] [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: 01/08/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 10/26/2022]
Abstract
Gastrointestinal (GI) tract involvement in Langerhans cell histiocytosis (LCH) is extremely rare. Langerhans cell histiocytosis with GI tract involvement (GI-LCH) is frequently associated with multi-system disease, and usually presents with severe systemic symptoms, such as protein-losing enteropathy (PLE). Although the GI tract is not included among the organs at risk, the prognosis of GI-LCH is poor, and no effective chemotherapeutic regimen has been identified. Here, we report an infant case of primary refractory GI-LCH with PLE that showed marked improvement in response to 2-chlorodeoxyadenosine (2-CdA) therapy with no severe adverse events, even under conditions of deteriorating general health. The present findings indicate that 2-CdA may be effective for refractory GI-LCH with PLE. Further studies are warranted to determine the optimal therapeutic strategies for GI-LCH with PLE.
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Andión Catalán M, Ruano Domínguez D, Azorín Cuadrillero D, de Rojas de Pablos T, Madero López L. Gastrointestinal involvement in Langerhans cell histiocytosis. An Pediatr (Barc) 2015. [DOI: 10.1016/j.anpede.2015.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Andión Catalán M, Ruano Domínguez D, Azorín Cuadrillero D, de Rojas de Pablos T, Madero López L. [Gastrointestinal involvement in Langerhans cell histiocytosis]. An Pediatr (Barc) 2015; 83:279-80. [PMID: 26033742 DOI: 10.1016/j.anpedi.2015.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 04/10/2015] [Accepted: 04/13/2015] [Indexed: 11/24/2022] Open
Affiliation(s)
- M Andión Catalán
- Servicio Hemato-Oncología y Trasplante hematopoyético, Hospital Infantil Universitario Niño Jesús, Madrid, España.
| | - D Ruano Domínguez
- Servicio Hemato-Oncología y Trasplante hematopoyético, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - D Azorín Cuadrillero
- Servicio Anatomía Patológica, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - T de Rojas de Pablos
- Servicio Hemato-Oncología y Trasplante hematopoyético, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - L Madero López
- Servicio Hemato-Oncología y Trasplante hematopoyético, Hospital Infantil Universitario Niño Jesús, Madrid, España
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Miller M, Iyer R, Bishop P, Nowicki M. Protein-losing enteropathy due to intestinal and colonic involvement with langerhans cell histiocytosis and review of the literature. Clin Pediatr (Phila) 2014; 53:89-94. [PMID: 23785060 DOI: 10.1177/0009922813492884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Matthew Miller
- 1University of Mississippi Medical Center, Jackson, MS, USA
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9
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Mete Ö, Doğan Ö, Kapran Y, Tihan D, Erbil Y, Ozarmağan S. Intestinal Langerhans cell histiocytosis-like lesion in an adult presented with diverticulitis: a reactive or neoplastic condition? Pathol Oncol Res 2010; 17:403-7. [PMID: 20976634 DOI: 10.1007/s12253-010-9313-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2010] [Accepted: 10/01/2010] [Indexed: 10/18/2022]
Abstract
The involvement of the gut by Langerhans cell histiocytosis (LCH) is very rare in adults; however this is usually observed with a disseminated disease in children. We report a 75-year-old male patient who underwent right hemicolectomy for a complicated intestinal diverticular disease. The surgical specimen revealed LCH-like proliferative lesion associated with diverticulitis. The overall morphological and immunohistochemical findings are indistinguishable from LCH. Systemic scans and subsequently performed bone marrow biopsies were free of disease. Although the HUMARA clonality assay cannot be assessed, the lack of evidence of LCH progression or disease elsewhere in the whole body strongly supported the possibility of an atypical reactive phenomenon probably due to the underlying intestinal diverticular disease. Therefore, it is important to avoid diagnosing such a unifocal Langerhans cell proliferation as LCH in patients with underlying pathologies in the absence of systemic involvement. Therefore, without knowledge of clonal status of a unifocal Langerhans cell proliferation, we recommend using the terminology of LCH-like lesion.
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Affiliation(s)
- Özgür Mete
- Istanbul Faculty of Medicine, Department of Pathology, Istanbul University, Temel Bilimler Binası, Capa, Istanbul, Turkey,
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Yadav SP, Kharya G, Mohan N, Sehgal A, Bhat S, Jain S, Kapoor G, Sachdeva A. Langerhans cell histiocytosis with digestive tract involvement. Pediatr Blood Cancer 2010; 55:748-53. [PMID: 20535829 DOI: 10.1002/pbc.22663] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Gastrointestinal tract (GIT) involvement in Langerhans cell histiocytosis (LCH) is not commonly described. We present two children presenting with GIT involvement with LCH, one successfully treated on standard protocol and other being treated on a protocol for relapsed disease. A review of literature showed almost 95% children were less than 2 years of age and 62% were females. Vomiting, abdominal pain, constipation, intractable diarrhea, malabsorption, bloody stools, protein-losing enteropathy, and even intestinal perforation are some of the reported symptoms. More than 50% patients died within 18 months from diagnosis.
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Affiliation(s)
- Satya P Yadav
- Pediatric Haematology and Oncology and Bone Marrow Transplantation Unit, Department of Pediatrics, Center for Child Health, Sir Ganga Ram Hospital, Delhi, India. satya
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Shima H, Takahashi T, Shimada H. Protein-losing enteropathy caused by gastrointestinal tract-involved Langerhans cell histiocytosis. Pediatrics 2010; 125:e426-32. [PMID: 20083519 DOI: 10.1542/peds.2009-1742] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Protein-losing enteropathy (PLE) is frequently complicated in patients with gastrointestinal tract-involved Langerhans cell histiocytosis (LCH); however, LCH per se is not generally included in the list of diseases that cause PLE. We report here a case of infantile PLE that presented with continuous diarrhea at the onset of LCH. She was initially diagnosed as having allergic gastroenteropathy and, thus, received intravenous prednisolone, which was thought to have induced immunodeficiency and consequently resulted in life-threatening cytomegalovirus-associated hemophagocytic syndrome and disseminated intravascular coagulation. Because chemotherapy for hemophagocytic syndrome was transiently effective for underlying LCH as well, the diagnosis of LCH was delayed until its recurrence. Gastrointestinal tract-involved LCH, a rare but highly fatal disease, should be considered for infants with refractory gastrointestinal symptoms, especially for those with PLE; endoscopic biopsy is strongly recommended for immediate diagnosis.
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Affiliation(s)
- Haruko Shima
- Keio University School of Medicine, Department of Pediatrics, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
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Prior AC, Selores M, Pina R, Dias JA, Costa FM, Vale L, Gomes L. Clinical quiz. J Pediatr Gastroenterol Nutr 2005; 41:483-4, 484. [PMID: 16205521 DOI: 10.1097/01.mpg.0000174847.75421.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- A C Prior
- Department of Pediatrics, Hospital Geral de Santo António, Portugal
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Choi SW, Bangaru BS, Wu CD, Finlay JL. Gastrointestinal involvement in disseminated Langerhans cell histiocytosis (LCH) with durable complete response to 2-chlorodeoxyadenosine and high-dose cytarabine. J Pediatr Hematol Oncol 2003; 25:503-6. [PMID: 12794533 DOI: 10.1097/00043426-200306000-00016] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Successful treatment of infants with gastrointestinal involvement in Langerhans cell histiocytosis (LCH) has been poor, with no specific chemotherapeutic regimen of clear benefit. An 8-month-old male, diagnosed with LCH by skin and gastrointestinal biopsies, was treated with several cycles of 2-chlorodeoxyadenosine, vinblastine and prednisone with only partial response. Ultimately, two cycles of 2-chlorodeoxyadenosine concomitant with high-dose cytarabine led to a durable complete response. Twenty-seven months since the last course of chemotherapy, the patient continues to thrive free of disease. Treatment with 2-chlorodeoxyadenosine and cytarabine should be considered for further study in patients with poor-prognosis LCH.
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Affiliation(s)
- Sung W Choi
- Department of Pediatrics, New York University Medical Center, New York, New York, USA
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