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Jeon I, Choi JH. Isolated thoracic intramedullary Erdheim-Chester disease presenting with paraplegia: a case report and literature review. BMC Musculoskelet Disord 2021; 22:270. [PMID: 33711983 PMCID: PMC7955615 DOI: 10.1186/s12891-021-04061-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 02/08/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Erdheim-Chester disease (ECD) is a rare, idiopathic, systemic non-Langerhans cell histiocytosis involving long bone and visceral organs. Central nervous system (CNS) involvement is uncommon and most cases develop as a part of systemic disease. We present a rare case of variant ECD as an isolated intramedullary tumor. CASE PRESENTATION A 75-year-old female patient with a medical history of diabetes and hypertension presented with sudden-onset flaccid paraparesis for 1 day. Neurological examination revealed grade 2-3 weakness in both legs, decreased deep tendon reflex, loss of anal tone, and numbness below T4. Leg weakness deteriorated to G1 before surgery. Preoperative magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) showed an intramedullary mass lesion at T2-T4 with no systemic lesion, which was heterogeneous enhancement pattern with cord swelling and edema from C7 to T6. Gross total removal was achieved for the white-gray-colored and soft-natured intramedullary mass lesion with an ill-defined boundary. Histological finding revealed benign histiocytic proliferation with foamy histiocytes and uniform nuclei. We concluded it as an isolated intramedullary ECD. The patient showed self-standing and walkable at 18-month with no evidence of recurrence and new lesion on spine MRI and whole-body FDG-PET/CT until sudden occurrence of unknown originated thoracic cord infarction. CONCLUSIONS We experienced an extremely rare case of isolated intramedullary ECD, which was controlled by surgical resection with no adjuvant therapy. Histological examination is the most important for final diagnosis, and careful serial follow-up after surgical resection is required to identify the recurrence and progression to systemic disease.
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Affiliation(s)
- Ikchan Jeon
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Hyeonchung street 170, 42415, Daegu, South Korea.
| | - Joon Hyuk Choi
- Department of Pathology, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, South Korea
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Sakr HI, Buckley K, Baiocchi R, Zhao WJ, Hemminger JA. Erdheim Chester disease in a patient with Burkitt lymphoma: a case report and review of literature. Diagn Pathol 2018; 13:94. [PMID: 30474563 PMCID: PMC6260675 DOI: 10.1186/s13000-018-0772-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/12/2018] [Indexed: 01/18/2023] Open
Abstract
Background Erdheim Chester disease (ECD) is a rare, non-Langerhans cell histiocytosis characterized by widespread tissue infiltration by CD68-positive, CD1a-negative foamy histiocytes. ECD can be difficult to identify, and diagnosis relies on the presence of histiocytes with certain histologic and immunophenotypic features in an appropriate clinical and radiologic setting. Clinical signs and symptoms are variable depending on which organ systems are involved. Most patients have at least skeletal involvement with bone pain as well as fatigue. Other common manifestations include diabetes insipidus, cardiac, periaortic, or retro-orbital infiltration/fibrosis, kidney impairment, xanthelasmas, among others. Case presentation Herein, we describe a case of BRAF-mutation positive ECD in a patient with Burkitt lymphoma, and we review recent literature. Conclusion Underlying BRAF and other MAPK pathway mutations are identified in approximately 50% of cases of ECD, which aids in diagnosis as well as enables novel targeted treatments. ECD patients have an increased risk of myeloid neoplasms; however, unlike other histiocytoses, an association with lymphoproliferative disorders has not been recognized.
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Affiliation(s)
- Hany I Sakr
- Department of Pathology, The Ohio State University Wexner Medical Center, 410 W. 10th Ave, N#308, Columbus, OH, 43210, USA
| | - Kaila Buckley
- Department of Pathology, The Ohio State University Wexner Medical Center, 410 W. 10th Ave, N#308, Columbus, OH, 43210, USA.
| | - Robert Baiocchi
- Department of Internal Medicine (Hematology), The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Weiqiang John Zhao
- Department of Pathology, The Ohio State University Wexner Medical Center, 410 W. 10th Ave, N#308, Columbus, OH, 43210, USA
| | - Jessica A Hemminger
- Department of Pathology, The Ohio State University Wexner Medical Center, 410 W. 10th Ave, N#308, Columbus, OH, 43210, USA
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Gumeler E, Onur MR, Karaosmanoglu AD, Ozmen M, Akata D, Karcaaltincaba M. Computed tomography and magnetic resonance imaging of peripelvic and periureteric pathologies. Abdom Radiol (NY) 2018; 43:2400-11. [PMID: 29285599 DOI: 10.1007/s00261-017-1444-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Peripelvic and periureteric areas are frequently overlooked in the imaging evaluations of the urinary system on computed tomography and magnetic resonance imaging. Several neoplastic and non-neoplastic disorders and diseases including lipomatosis, angiomyolipoma and angiolipomatous proliferation, vascular lesions, lymphangiomatosis, Rosai-Dorfman disease, Erdheim-Chester disease, extramedullary hematopoiesis, IgG4-related disease, lymphoma, mesenchymal tumors, trauma, and Antopol-Goldman lesion may involve these areas. Differentiation of these benign or malignant pathologies among themselves and from primary renal pathologies is of utmost importance to expedite the triage of patients for correct treatment approach. In this article, we aim to increase the awareness of the imaging specialists to the typical and atypical imaging features of the entities affecting these areas.
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Abstract
Histiocytic disorders of the chest comprise a broad spectrum of diseases. The lungs may be involved in isolation or as part of systemic disease. Some of these disorders are primary and have unknown etiology, and others result from a histiocytic response to a known cause. Among primary histiocytic disorders, pulmonary Langerhans cell histiocytosis (PLCH) is the most common; others include Erdheim-Chester disease and Rosai-Dorfman disease. Adult PLCH occurs almost exclusively in adults aged 20-40 years who smoke. Pediatric PLCH is extremely rare and typically occurs as part of multisystemic disease. Erdheim-Chester disease affects middle-aged and older adults; thoracic involvement usually occurs as part of systemic disease. Rosai-Dorfman disease affects children and young adults and manifests as painless cervical lymphadenopathy. Examples of secondary histiocytic disorders are storage diseases such as Gaucher disease, Niemann-Pick disease, and Fabry disease; pneumoconiosis such as silicosis and coal workers' pneumoconiosis; and infections such as Whipple disease and malakoplakia. These disorders are characterized at histopathologic examination on the basis of infiltration of alveoli or the pulmonary interstitium by histiocytes, which are a group of cells that includes macrophages and dendritic cells. Dendritic cells are a heterogeneous group of nonphagocytic antigen-presenting immune cells. Immunohistochemical markers help to distinguish among various primary histiocytic disorders. Characteristic radiologic findings in the appropriate clinical context may obviate biopsy to establish a correct diagnosis. However, in the absence of these findings, integration of clinical, pathologic, and radiologic features is required to establish a diagnosis.
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Affiliation(s)
- Jitesh Ahuja
- From the Departments of Radiology (J.A., S.N.J.P., J.O.S., J.D.G.) and Pathology (R.A.S.), University of Washington, 1959 NE Pacific St, UW Mailbox 357115, Seattle, WA 98195; and Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, Wis (J.P.K., C.A.M.)
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Yelfimov DA, Lightner DJ, Tollefson MK. Urologic Manifestations of Erdheim-Chester Disease. Urology 2014; 84:218-21. [DOI: 10.1016/j.urology.2013.10.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 10/15/2013] [Accepted: 10/18/2013] [Indexed: 11/25/2022]
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Abstract
Diagnosis and treatment of patients who present with respiratory compromise are challenging. What happens when these patients do not respond to your intervention, and their condition declines rapidly? Having a variety of differential diagnoses is key. An addition to your differential list can include a rare disorder of non-Langerhans cells histiocytosis also known as Erdheim-Chester disease. This disease often presents as an interstitial lung disease that fails many different treatment modalities. A full understanding of how this disease process works is still being investigated. Provided are a literature review and case study for better understanding of this disease.
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Yamaguchi M, Shiota T, Kobashi Y. Erdheim-Chester disease presenting with pneumothorax. Respiration 2011; 82:552-6. [PMID: 21934273 DOI: 10.1159/000329872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 05/30/2011] [Indexed: 12/15/2022] Open
Abstract
Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis most commonly characterized by symmetrical skeletal involvement and may present with pulmonary involvement leading to chronically progressive pulmonary symptoms. Characteristics on chest radiography include non-specific findings of diffuse interstitial and pleural thickening, micronodules, ground-glass opacities and parenchymal condensation as a result of infiltration by lipid-laden histiocytes. We present the case of a 50-year-old man with ECD presenting with acute pulmonary symptoms due to rupture of a large cystic lesion with resultant pneumothorax. He was brought by ambulance to our hospital, complaining of acute anterior chest pain and severe dyspnea. Chest radiography showed right-sided pneumothorax with a collapsed lung, a large, left-sided cystic lesion in the upper lung field and accentuated interstitial markings. Bullectomy and surgical biopsy were performed, demonstrating histologically histiocytic infiltrates that were strongly positive for CD68, but negative for S-100 protein and CD1a. Subsequent systemic examinations indicated widespread symmetrical skeletal involvement, leading to a definitive diagnosis of ECD.
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Affiliation(s)
- Masafumi Yamaguchi
- Division of Respiratory Medicine, Ako City Hospital, Ako, Japan. myama3265 @ gmail.com
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Conley A, Manjila S, Guan H, Guthikonda M, Kupsky WJ, Mittal S. Non-Langerhans cell histiocytosis with isolated CNS involvement: an unusual variant of Erdheim-Chester disease. Neuropathology 2011; 30:634-47. [PMID: 20337948 DOI: 10.1111/j.1440-1789.2010.01104.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Benign histiocytic proliferations are identified by their component cells and classified as either Langerhans cell histiocytosis or non-Langerhans cell histiocytosis. We report a 58-year-old Caucasian woman who presented with diabetes insipidus and was found to harbor a large suprasellar mass. Histopathological analysis was consistent with non-LCH. The differential diagnoses included juvenile xanthogranuloma, adult-onset xanthogranuloma, xanthoma disseminatum, Rosai-Dorfman disease, and Erdheim-Chester disease. Immunohistochemical examination demonstrated a proliferation of large lipid-laden histiocytic cells which were positive for CD68, negative for S100 protein, and showed only faint, background staining for CD1a. We present a case of an autopsy-confirmed non-Langerhans cell histiocytosis limited to the central nervous system and evaluated with both immunohistochemical and ultrastructural studies. Based on the multifocality, anatomic distribution, and immunostaining features, a diagnosis of Erdheim-Chester disease was made. This is only the second reported case of Erdheim-Chester disease with intracranial involvement but absence of extracerebral manifestations. Given the overlapping clinicopathologic, radiographic, and immunohistochemical profiles, differentiating between these rare histiocytic disorders can often present a significant diagnostic challenge. A systematic approach using all available clinical, laboratory, radiographic, histologic, immunohistochemical and ultrastructural data is essential for proper discrimination between the numerous histiocytoses.
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Affiliation(s)
- Alexandria Conley
- Department of Neurosurgery, Wayne State University, and Detroit Medical Center, Detroit, MI, USA
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Maffessanti M, Dalpiaz G. Computed Tomography of Diffuse Lung Diseases and Solitary Pulmonary Nodules. Practical Pulmonary Pathology: A Diagnostic Approach 2011:27-89. [DOI: 10.1016/b978-1-4160-5770-3.00003-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Brun A, Touitou-gottenberg D, Haroche J, Toledano D, Cluzel P, Beigelman-aubry C, Piette J, Amoura Z, Grenier PA. Erdheim-Chester disease: CT findings of thoracic involvement. Eur Radiol 2010; 20:2579-87. [DOI: 10.1007/s00330-010-1830-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 03/24/2010] [Accepted: 04/08/2010] [Indexed: 10/19/2022]
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Medoff BD, Abbott GF, Louissaint A. Case records of the Massachusetts General Hospital. Case 16-2010. A 48-year-old man with a cough and pain in the left shoulder. N Engl J Med 2010; 362:2013-22. [PMID: 20505181 DOI: 10.1056/nejmcpc1002114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Benjamin D Medoff
- Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston, USA
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Park JW, Chung CU, Shin JY, Jung SY, Yoo SJ, Lee JE, Jung SS, Kim JO, Kim SY, Park HS. Erdheim-Chester Disease with Hepatitis, Glomerulonephritis, Aplastic Anemia and Lung Involvement. Tuberc Respir Dis (Seoul) 2009. [DOI: 10.4046/trd.2009.67.4.345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ji Won Park
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Chae Uk Chung
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Ji Young Shin
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Sun Young Jung
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Su Jin Yoo
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Jeong Eun Lee
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Sung Soo Jung
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Ju Ock Kim
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Sun Young Kim
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Hee Sun Park
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
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Abstract
CONTEXT Pulmonary Langerhans cell histiocytosis is the most common and best known pulmonary histiocytic lesion; however, the realm of pulmonary histiocytic lesions also includes an assortment of uncommon diseases that may exhibit pulmonary involvement. OBJECTIVE To review pulmonary Langerhans cell histiocytosis and other pulmonary histiocytoses to better ensure correct diagnosis and optimal assessment of prognosis and treatment. DATA SOURCES Literature review and primary material from the author's institution. CONCLUSIONS This review discusses the most common pulmonary histiocytosis, pulmonary Langerhans cell histiocytosis, and also reviews the uncommon pulmonary histiocytic lesions, which are distinct from pulmonary Langerhans cell histiocytosis.
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Affiliation(s)
- Timothy Craig Allen
- Department of Pathology, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA.
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Kim JE, Lee HJ, Rhee CK, Yoon HK, Song JS. A Case of Erdheim-Chester Disease Who Has Policythemia Vera. Tuberc Respir Dis (Seoul) 2008. [DOI: 10.4046/trd.2008.64.3.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ji Eun Kim
- Division of Pulmonary Medicine, St. Mary's Hospital, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hyun Jeong Lee
- Division of Pulmonary Medicine, St. Mary's Hospital, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Chin Kook Rhee
- Division of Pulmonary Medicine, St. Mary's Hospital, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hyung Kyu Yoon
- Division of Pulmonary Medicine, St. Mary's Hospital, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jeong Sup Song
- Division of Pulmonary Medicine, St. Mary's Hospital, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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Bando JM, Santiago S. A UNIQUE PULMONARY PRESENTATION OF ERDHEIM-CHESTER DISEASE. Chest 2006. [DOI: 10.1378/chest.130.4_meetingabstracts.301s-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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