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Breppe NA, Gaviot P, Rodríguez DO, Ripa P. Langerhans cell histiocytosis in a patient with perianal lesion. A case report. ARCH ARGENT PEDIATR 2024; 122:e202310178. [PMID: 37917035 DOI: 10.5546/aap.2023-10178.eng] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Langerhans cell histiocytosis is an expression of myeloid dendritic cells, associated with a significant inflammatory component and varied systemic involvement. The most common age at presentation is between 1 and 4 years, and it prevails among male subjects. Here we describe the case of a 5-year-old boy who presented with a granulomatous lesion with perianal fistula and lung and external ear involvement. An interdisciplinary approach helped to make a diagnosis, provide the necessary interventions, and start an adequate treatment.
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Affiliation(s)
- Nicolás A Breppe
- Department of Pediatrics of Establecimiento Asistencial Dr. Lucio Molas, Santa Rosa, Argentina
| | - Paula Gaviot
- Department of Pediatrics of Establecimiento Asistencial Dr. Lucio Molas, Santa Rosa, Argentina
| | - Darío O Rodríguez
- Department of Pediatrics of Establecimiento Asistencial Dr. Lucio Molas, Santa Rosa, Argentina
| | - Paola Ripa
- Department of Pediatrics of Establecimiento Asistencial Dr. Lucio Molas, Santa Rosa, Argentina
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2
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Xu Y, Lu X, Wang W, Yang J. Coexistence of Langerhans Cell Histiocytosis and Ganglioneuroblastoma Revealed by 18 F-FDG PET/CT in a Pediatric Patient. Clin Nucl Med 2024; 49:371-372. [PMID: 38350091 DOI: 10.1097/rlu.0000000000005072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
ABSTRACT Coexistence of Langerhans cell histiocytosis and ganglioneuroblastoma is rare and seldom reported in the literature. A 3-year-old girl with Langerhans cell histiocytosis underwent 18 F-FDG PET/CT imaging for staging, which demonstrated significant 18 F-FDG accumulation in the mandibles. Unexpectedly, a mild hypermetabolic soft mass was detected in the upper retroperitoneum. Results of surgical pathology of the abdominal mass were consistent with ganglioneuroblastoma.
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Affiliation(s)
- Yanfeng Xu
- From the Department of Nuclear Medicine, Beijing Friendship Hospital of Capital Medical University, Beijing, China
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3
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Cao Y, Wu QQ, Yan WH, Lu LN, Tao YJ, Feng HX, Chu YJ, Cai W, Wang Y. Langerhans cell histiocytosis in children with refractory diarrhoea and hypoalbuminaemia as the initial presentation: two case reports and a literature review. BMC Pediatr 2024; 24:203. [PMID: 38519924 PMCID: PMC10958846 DOI: 10.1186/s12887-024-04612-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 02/01/2024] [Indexed: 03/25/2024] Open
Abstract
Langerhans cell histiocytosis (LCH) involving the gastrointestinal tract is a rare condition for which clinical experience is limited. We describe the cases of two patients who initially presented with chronic diarrhoea, hypoproteinaemia, and intermittent fever. These findings suggest that in cases of refractory diarrhoea accompanied by recurrent hypoalbuminaemia, especially with abdominal rash, LCH should be considered. Gastrointestinal endoscopy, biopsy, and imaging studies are essential for obtaining a definitive diagnosis. This approach might be helpful for the early recognition of gastrointestinal tract involvement in LCH.
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Affiliation(s)
- Yi Cao
- Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Rd, Shanghai, China
| | - Qing-Qing Wu
- Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Rd, Shanghai, China
| | - Wei-Hui Yan
- Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Rd, Shanghai, China
| | - Li-Na Lu
- Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Rd, Shanghai, China
| | - Yi-Jing Tao
- Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Rd, Shanghai, China
| | - Hai-Xia Feng
- Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Rd, Shanghai, China
| | - Yi-Jing Chu
- Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Rd, Shanghai, China
| | - Wei Cai
- Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Rd, Shanghai, China.
- Shanghai Institute for Pediatric Research, Shanghai, China.
- Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China.
| | - Ying Wang
- Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Rd, Shanghai, China.
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Cheng YF, Wang CC, Tsai PS, Lin DC, Huang WH. Langerhans cell histiocytosis of the thyroid mimicking thyroiditis in a boy: a case report and literature review. BMC Pediatr 2024; 24:66. [PMID: 38245681 PMCID: PMC10799516 DOI: 10.1186/s12887-023-04494-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/19/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Langerhans cell histiocytosis affecting the thyroid commonly presents with nonspecific clinical and radiological manifestations. Thyroid Langerhans cell histiocytosis is typically characterized by non-enhancing hypodense lesions with an enlarged thyroid on computed tomography medical images. Thyroid involvement in LCH is uncommon and typically encountered in adults, as is salivary gland involvement. Therefore, we present a unique pediatric case featuring simultaneous salivary and thyroid involvement in LCH. CASE PRESENTATION A 3-year-old boy with complaints of an anterior neck mass persisting for 1 to 2 months, accompanied by mild pain, dysphagia, and hoarseness. A physical examination revealed a 2.5 cm firm and tender mass in the left anterior neck. Laboratory examinations revealed normal thyroid function test levels. Ultrasonography revealed multiple heterogeneous hypoechoic nodules with unclear and irregular margins in both lobes of the thyroid. Contrast-enhanced neck computed tomography revealed an enlarged thyroid gland and bilateral submandibular glands with non-enhancing hypointense nodular lesions, and multiple confluent thin-walled small (< 1.5 cm) cysts scattered bilaterally in the lungs. Subsequently, a left thyroid excisional biopsy was performed, leading to a histopathological diagnosis of LCH. Immunohistochemical analysis of the specimen demonstrated diffuse positivity for S-100, CD1a, and Langerin and focal positivity for CD68. The patient received standard therapy with vinblastine and steroid, and showed disease regression during regular follow-up of neck ultrasonography. CONCLUSIONS Involvement of the thyroid and submandibular gland as initial diagnosis of Langerhans cell histiocytosis is extremely rare. It is important to investigate the involvement of affected systems. A comprehensive survey and biopsy are required to establish a definitive diagnosis.
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Affiliation(s)
- Yu Fan Cheng
- Department of Radiology, MacKay Memorial Hospital, Taipei City, 104, Taiwan
| | - Ching Che Wang
- Department of Radiology, MacKay Memorial Hospital, Taipei City, 104, Taiwan.
| | - Pei Shan Tsai
- Department of Radiology, MacKay Memorial Hospital, Taipei City, 104, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, 252, Taiwan
- Nursing and Management, Mackay Junior College of Medicine, New Taipei City, 112, Taiwan
| | - Dao Chen Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei City, Taiwan
- Division of Endocrine and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei City, 112, Taiwan
| | - Wen Hui Huang
- Department of Radiology, MacKay Memorial Hospital, Taipei City, 104, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, 252, Taiwan
- Nursing and Management, Mackay Junior College of Medicine, New Taipei City, 112, Taiwan
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei City, 112, Taiwan
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Kizmazoglu D, Ince D, Cecen E, Kizmazoglu C, Guleryuz H, Ozer E, Demiral A, Olgun N. Pediatric paravertebral tumors: analysis of 96 patients. Childs Nerv Syst 2024; 40:123-133. [PMID: 37452862 DOI: 10.1007/s00381-023-06064-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE The most important complication of paravertebral tumors is cord compression (CC), which is an oncologic emergency. Early and appropriate intervention is important in terms of reducing morbidity and mortality. Here, we report our clinical experience with paravertebral tumors. METHODS The files of patients who were followed up for benign/malignant paravertebral tumors between 1988 and 2022 were evaluated retrospectively. RESULTS There were 96 patients with paravertebral tumors. The median age at diagnosis was 5 years (1 month-17 years). The male/female ratio was 1.13. The median time to diagnosis was 4 weeks (0-28 weeks). The most common presenting complaint was pain (62.5%). The diagnosis distribution was as follows: sympathetic nervous system (SNS) tumors (n: 38), soft tissue sarcomas (STS) (n: 23), Langerhans cell histiocytosis (LCH) (n: 12), central nervous system (CNS) tumors (n: 9), germ cell tumor (n: 6), lymphomas (n: 4), and benign tumors (n: 4). Sixty-five patients (67.7%) had CC, 40% of whom received chemotherapy as first-line treatment. Decompression surgery was performed in 58.5% of the patients. For patients with CC, 26 patients had advanced disease at admission. Serious neurologic sequelae were observed in seventeen (17.7%) patients. CONCLUSION Pain and neurological findings in childhood are warning signs for paravertebral tumors and CC. A detailed neurologic examination and radiodiagnostic imaging should be performed, and a definitive diagnosis should be made quickly. Anticancer treatment should be planned multidisciplinary. Decompression surgery should be discussed for patients with severe neurological deficits. Childhood cancers are chemosensitive; if possible, treatment should be initiated with chemotherapy to avoid neurological sequelae.
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Affiliation(s)
- Deniz Kizmazoglu
- Department of Pediatric Oncology, Dokuz Eylul University Institute of Oncology, 35340, Balcova, Izmir, Turkey
| | - Dilek Ince
- Department of Pediatric Oncology, Dokuz Eylul University Institute of Oncology, 35340, Balcova, Izmir, Turkey.
| | - Emre Cecen
- Department of Pediatric Oncology, Dokuz Eylul University Institute of Oncology, 35340, Balcova, Izmir, Turkey
| | - Ceren Kizmazoglu
- Department of Neurosurgery, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Handan Guleryuz
- Department of Radiology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Erdener Ozer
- Department of Pathology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Ayse Demiral
- Department of Radiation Oncology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Nur Olgun
- Department of Pediatric Oncology, Dokuz Eylul University Institute of Oncology, 35340, Balcova, Izmir, Turkey
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Beckmann S, Kliffen M, Huijben A, Dubbink HJ, Sandberg Y. Concurrent Langerhans Cell Histiocytosis and Acute Myeloid Leukemia Without Clonal Relationship. JAMA Dermatol 2024; 160:115-116. [PMID: 37966814 DOI: 10.1001/jamadermatol.2023.4360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
This case report describes a woman in her 30s who had been treated with chemotherapy and presented with Langerhans cell histiocytosis and acute myeloid leukemia (AML).
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Affiliation(s)
- Sebastian Beckmann
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands
| | - Mike Kliffen
- Department of Pathology, Maasstad Hospital, Rotterdam, the Netherlands
| | - Auke Huijben
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands
| | | | - Yorick Sandberg
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands
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Aoyama S, Fukuoka K, Kubota H, Narita K, Kudo K, Mitani Y, Oshima K, Mori M, Arakawa Y, Ichimura K, Terui K, Tanami Y, Kawashima H, Nakazawa A, Niitsu T, Takahashi Y, Koh K. Early chemotherapeutic intervention to avoid thyroidectomy in pediatric Langerhans cell histiocytosis with thyroid involvement accompanying tracheal stenosis: a report of two cases. Int J Hematol 2024; 119:99-103. [PMID: 37740816 DOI: 10.1007/s12185-023-03662-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/31/2023] [Accepted: 09/11/2023] [Indexed: 09/25/2023]
Abstract
Thyroid involvement is rare in pediatric Langerhans cell histiocytosis (LCH). It may cause airway narrowing, leading to acute-onset respiratory distress. Severe cases may require emergent surgical interventions such as thyroidectomy, which should be avoided in children due to higher rates of complication, particularly in infancy. There is currently no consensus on the indications for surgical treatment in LCH with thyroid involvement. In this report, we describe the cases of two children who presented with tracheal stenosis caused by thyroid LCH, both of which were successfully treated by early induction of chemotherapy, and one of which was also treated for a shorter duration. Mutation analysis detected in-frame deletions of BRAF exon 12 in both cases. These cases suggest that timely diagnosis and administration of chemotherapy may alleviate severe airway obstruction and reduce the need for thyroidectomy in pediatric patients with thyroid LCH.
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Affiliation(s)
- Shuhei Aoyama
- Department of Hematology/Oncology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, 330-8777, Japan
| | - Kohei Fukuoka
- Department of Hematology/Oncology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, 330-8777, Japan.
| | - Hirohito Kubota
- Department of Hematology/Oncology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, 330-8777, Japan
| | - Kotaro Narita
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ko Kudo
- Department of Pediatrics, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuichi Mitani
- Department of Hematology/Oncology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, 330-8777, Japan
| | - Koichi Oshima
- Department of Hematology/Oncology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, 330-8777, Japan
| | - Makiko Mori
- Department of Hematology/Oncology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, 330-8777, Japan
| | - Yuki Arakawa
- Department of Hematology/Oncology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, 330-8777, Japan
| | - Kayoko Ichimura
- Department of Pathology, Saitama Children's Medical Center, Saitama, Japan
| | - Kiminori Terui
- Department of Pediatrics, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yutaka Tanami
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroshi Kawashima
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Atsuko Nakazawa
- Department of Pathology, Saitama Children's Medical Center, Saitama, Japan
| | - Takehiro Niitsu
- Department of Critical Care Medicine, Saitama Children's Medical Center, Saitama, Japan
| | - Yoshiyuki Takahashi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Katsuyoshi Koh
- Department of Hematology/Oncology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, 330-8777, Japan
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Sedky M, Gohar S, Ahmed S, Zaky I, Salama A, Hassanein O, Maher E, ElHaddad A. Pediatric pulmonary multisystem langerhans cell histiocytosis: does lung lesion severity affect the outcome? Orphanet J Rare Dis 2023; 18:361. [PMID: 37978394 PMCID: PMC10655418 DOI: 10.1186/s13023-023-02970-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The pediatric pulmonary multisystem Langerhans cell histiocytosis (PPM LCH) is associated with either low risk or high risk organ(s). The nodulo-cystic lung lesions although pathognomonic, yet are very variable in severity and remain a source of controversy in certifying pulmonary LCH diagnosis. The study aimed to examine the prognostic value of clinical respiratory manifestations and radiological lung lesions severity. This is through associating a CT chest triad of bilateral, extensive and diffuse lesions. It is a retrospective study of 350 LCH patients who received systemic treatment at Children's Cancer Hospital Egypt during the period from 2007 to 2020. RESULTS Sixty-seven patients (67/350-19.1%) had PPM LCH at presentation. Severe lung lesions were present in 24 of them. The median follow-up period was 61 months (IQR: 3.4-8.3). The 5-year overall survival (OS) and event free survival (EFS) was 89% and 56.6% respectively. The EFS, for severe radiological lesions triad was 38% ± 20.7 versus 66% ± 16.2 for non-severe lesions triad p 0.002, while for presence of chest X-ray changes 27% ± 22.344 versus absence of chest X ray changes 66% ± 14.7 p 0.001, for clinical respiratory manifestations 13% ± 13.9 versus none 62% ± 22.9 p < 0.001, for RO- with severe lung lesions 47% ± 30.4 versus RO- without severe lung lesions 69% ± 5.9 p 0.04. There was a tendency for the independent prognostic impact of severe lung involvement; aHR = 1.7 (95% CI 0.92-3.13, p = 0.09). CONCLUSION Although the lung is a low -risk organ per se in LCH, our study demonstrates a non negligeable prognostic impact of severe lung involvement in the risk stratification of pediatric LCH. This warrants further study and external validation.
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Affiliation(s)
- Mohamed Sedky
- Department of Pediatric Oncology, Children Cancer Hospital Egypt 57357 1 (11617), Sekket Al-Imam St., Al Sayyeda Zeinab, Cairo, 11617, Egypt.
- Department of Pediatrics, National Research Centre, Cairo, Egypt.
| | - Seham Gohar
- Department of Pediatric Oncology, Children Cancer Hospital Egypt 57357 1 (11617), Sekket Al-Imam St., Al Sayyeda Zeinab, Cairo, 11617, Egypt
| | - Sonia Ahmed
- Department of Pediatric Oncology, Children Cancer Hospital Egypt 57357 1 (11617), Sekket Al-Imam St., Al Sayyeda Zeinab, Cairo, 11617, Egypt
- Department of Pediatric Oncology National Cancer Institute, Cairo University, Cairo, Egypt
| | - Iman Zaky
- Department of Radiology, Children Cancer Hospital Egypt 57357 (11617), Cairo, Egypt
- Department of Radiology National Cancer Institute, Cairo University, Cairo, Egypt
| | - Asmaa Salama
- Department of Pathology, Children's Cancer Hospital 57357 (11617), Cairo, Egypt
- Department of Pathology National Cancer Institute, Cairo University, Cairo, Egypt
| | - Omayma Hassanein
- Department of Clinical Research, Children's Cancer Hospital 57357 (11617), Cairo, Egypt
| | - Eslam Maher
- Department of Clinical Research, Children's Cancer Hospital 57357 (11617), Cairo, Egypt
| | - Alaa ElHaddad
- Department of Pediatric Oncology, Children Cancer Hospital Egypt 57357 1 (11617), Sekket Al-Imam St., Al Sayyeda Zeinab, Cairo, 11617, Egypt
- Department of Pediatric Oncology National Cancer Institute, Cairo University, Cairo, Egypt
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Taillandier A, Chantreau PL, David C, Kerdraon R, Richard S, Michenet P. [Story of a generalized histiocytosis]. Ann Pathol 2023; 43:507-510. [PMID: 37169641 DOI: 10.1016/j.annpat.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/12/2023] [Accepted: 04/16/2023] [Indexed: 05/13/2023]
Affiliation(s)
- Antoine Taillandier
- Service d'anatomie et cytologie pathologiques, centre hospitalier régional d'Orléans, 45100 Orléans, La Source, France
| | - Paul-Louis Chantreau
- Service d'anatomie et cytologie pathologiques, centre hospitalier régional d'Orléans, 45100 Orléans, La Source, France
| | - Claire David
- Service d'anatomie et cytologie pathologiques, centre hospitalier régional d'Orléans, 45100 Orléans, La Source, France
| | - Remy Kerdraon
- Service d'anatomie et cytologie pathologiques, centre hospitalier régional d'Orléans, 45100 Orléans, La Source, France
| | - Sophie Richard
- Service d'anatomie et cytologie pathologiques, centre hospitalier régional d'Orléans, 45100 Orléans, La Source, France
| | - Patrick Michenet
- Service d'anatomie et cytologie pathologiques, centre hospitalier régional d'Orléans, 45100 Orléans, La Source, France.
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11
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Mo JT, Darrow MA, Sharma JD. Langerhans cell histiocytosis with aneurysmal bone cyst-like changes: a case-based literature review. Childs Nerv Syst 2023; 39:3057-3064. [PMID: 37522932 PMCID: PMC10643349 DOI: 10.1007/s00381-023-06108-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 07/27/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a neoplastic transformation of myeloid precursors that commonly presents as an osteolytic lesion of the long or flat bones in children. Aneurysmal bone cysts (ABC) are benign neoplasms that frequently affect the metaphysis of long bones and the spine, often revealing a rapidly expansile lesion with fluid-fluid levels. LCH with secondary ABC-like changes is a rare condition that has only been reported five times, with two presentations in the cranium. The aim of this paper is to review the etiology, clinical and radiographic presentations, and treatment of this condition, as well as to present a novel case on the topic. CASE DESCRIPTION We describe a 5-year-old boy with a rapidly growing head mass and eye pain resulting in a diagnosis of LCH with secondary ABC-like changes. Radiography demonstrated an expansile, lytic lesion of the left parietal bone with fluid-fluid levels. A confirmatory diagnosis was made through histopathology, demonstrating an inflammatory, histiocytic infiltrate staining positive for CD1a, CD68, CD207 (Langerin), and S-100. The lesion was surgically excised, and the patient recovered without any complications. CONCLUSION We present a novel case of LCH with secondary ABC-like changes managed with surgical excision. While a radiographic workup with multiple imaging modalities is helpful for diagnosis, a thorough immunohistochemical analysis is essential as imaging characteristics are variable and nonspecific. Furthermore, surgical excision should be considered first-line treatment for lesions involving the skull in surgically accessible areas as it is curative, alleviates symptoms, and allows for histopathological diagnosis.
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Affiliation(s)
- Jonathan Tomonaga Mo
- Department of Neurosurgery, UC Davis Medical Center, 3160 Folsom Blvd Suite 3900, Sacramento, CA, 95816, USA.
| | - Morgan Angus Darrow
- Department of Pathology and Laboratory Medicine, UC Davis Medical Center, 4400 V St, Sacramento, CA, 95817, USA
| | - Julia Devi Sharma
- Department of Neurosurgery, UC Davis Medical Center, 3160 Folsom Blvd Suite 3900, Sacramento, CA, 95816, USA
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Peng X, Liu H, Zhang X, Huo H, Liu T. Single-system pulmonary langerhans cell histiocytosis with only tracheobronchial involvement: a case report. BMC Pulm Med 2023; 23:412. [PMID: 37898805 PMCID: PMC10613386 DOI: 10.1186/s12890-023-02614-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/27/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Pulmonary Langerhans cell histiocytosis (PLCH) only with airway involvement manifested as diffuse thickening of the tracheobronchial walls is rare. CASE REPORT A 26-year-old male was admitted to the hospital with progressive wheezing, cough, and a source of blood in sputum after activity. He had no history of smoking. Chest computed tomography showed airway stenosis of different degrees with tracheobronchial wall thickening, and fiberoptic bronchoscopy demonstrated multiple nodular neoplasms in tracheobronchial, while the pulmonary parenchyma was normal. The patient's condition partially improved after excision of partial lesions by fiberoptic bronchoscope. Histopathological results showed that CD1a and S-100 immunohistochemical staining was positive, and the molecular pathological results suggested that the BRAF V600E mutation, thus confirming the diagnosis of PLCH. The treatment of partial resection and systemic chemotherapy is effective. CONCLUSIONS The possibility of PLCH needs to be considered when diffuse tracheobronchial lesions without lung parenchyma involvement are encountered, which provides experience for early clinical diagnosis and adequate treatment.
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Affiliation(s)
- Xin Peng
- Department of Radiology, The Third People's Hospital of Chengdu, Chengdu, 610031, China
- Department of Radiology, The First Hospital of China Medical University, 155 Nanjing Bei Street, Heping, Shenyang, 110001, China
| | - Hui Liu
- Department of Radiology, The First Hospital of China Medical University, 155 Nanjing Bei Street, Heping, Shenyang, 110001, China
| | - Xinyu Zhang
- Department of Geriatrics, The First Hospital of China Medical University, 155 Nanjing Bei Street, Heping, Shenyang, 110001, China.
| | - Huaibi Huo
- Department of Radiology, The First Hospital of China Medical University, 155 Nanjing Bei Street, Heping, Shenyang, 110001, China.
| | - Ting Liu
- Department of Radiology, The First Hospital of China Medical University, 155 Nanjing Bei Street, Heping, Shenyang, 110001, China.
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Lin TE, Chu YY, Chang TY, Liao HT. Craniofacial involvement in Langerhans cell histiocytosis: A review of 44 cases at a single medical center. J Plast Reconstr Aesthet Surg 2023; 82:12-20. [PMID: 37148805 DOI: 10.1016/j.bjps.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 02/27/2023] [Accepted: 03/15/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Craniofacial bones are the most commonly involved site of Langerhans cell histiocytosis (LCH). The main purpose of this study was to clarify the relation between subsites of craniofacial bone and clinical presentation, treatment modalities, outcomes, and permanent consequences (PCs) in patients with LCH. METHODS Forty-four patients diagnosed with LCH involving the craniofacial region presenting at a single medical center during 2001-2019 were collected and divided into four groups: single system with unifocal bone lesion (SS-LCH, UFB); single system with multifocal bone lesions (SS-LCH, MFB); multisystem without risk organ involvement (MS-LCH, RO-); and multisystem with risk organ involvement (MS-LCH, RO+). Data including demographics, clinical presentation, treatments, outcomes, and the development of PC were retrospectively reviewed. RESULTS Temporal bone (66.7% versus 7.7%, p = 0.001), occipital bone (44.4% versus 7.7%, p = 0.022), and sphenoid bone (33.3% versus 3.8%, p = 0.041) involvement were more common in SS-LCH, MFB than they were in SS-LCH, UFB. No difference of reactivation rate was noted among the four groups. The most common PC is diabetes insipidus (DI), reported in 9 of the 16 (56.25%) patients with PC. The single system group was reported with the lowest incidence of DI (7.7%, p = 0.035). The reactivation rate was also higher in patients with PC (33.3% versus 4.0%, p = 0.021) or DI (62.5% versus 3.1%, p < 0.001). CONCLUSION An increased risk of multifocal or multisystem lesions was associated with temporal bone, occipital bone, sphenoid bone, maxillary bone, eye, ear, and oral involvement, which may indicate poor outcomes. Longer follow-up may be indicated if there is the presence of PC or DI due to the high risk of reactivation. Therefore, multidisciplinary evaluation and treatment according to risk stratification are vital for patients diagnosed with LCH involving the craniofacial region.
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Affiliation(s)
- Tzu-En Lin
- Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Ying Chu
- Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital, College of Medicine, Taiwan; Chang Gung University, Taoyuan, Taiwan
| | - Tsung-Yen Chang
- Division of Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Han-Tsung Liao
- Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital, College of Medicine, Taiwan; Chang Gung University, Taoyuan, Taiwan; Department of Plastic Surgery, Xiamen Chang Gung Memorial Hospital, China.
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Kuang GM, Loo NN, Gao Q, Li J, Luo L, Chen S, Cheung JPY, Cheung KMC. A solitary osteolytic lesion with pathological fracture in the cervical spine - a case report. BMC Musculoskelet Disord 2023; 24:436. [PMID: 37254107 PMCID: PMC10228027 DOI: 10.1186/s12891-023-06543-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 05/16/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a rare disorder. The treatment options vary depending on how many organs are involved and how extensive the disease is. In this report, a case of LCH with isolated 6th cervical vertebra (C6) collapse was presented. This case was treated with anterior corpectomy and instrumented fusion, followed by local radiotherapy (RT), with a good clinical outcome up to postoperative six months. CASE PRESENTATION This was a 47-year-old female patient with a complaint of neck pain and bilateral shoulder pain for two months before consultation. She was initially treated with analgesics, but the pain was persistent. Further radiological evaluations revealed an osteolytic lesion within the C6 vertebral body with a pathological fracture. Magnetic resonance imaging (MRI) with contrast of the cervical spine revealed diffused hypointense signal changes on the T1-weighted images and hyperintense signal changes on the T2-weighted images in the C6 vertebral body, with significant contrast-enhanced infiltration signals. Furthermore, in positron emission tomography-computed tomography (PET-CT), focal hypermetabolism and abnormal uptake signals were seen only in the C6 vertebral body. The patient underwent an anterior cervical corpectomy with instrumented fusion. The histopathological results confirmed the diagnosis of LCH. The patient reported significant pain relief on postoperative day one. Moreover, she was treated by local RT at postoperative one month. Good clinical outcomes were achieved in the form of no pain and recovery in neck mobility up to postoperative six months. No evidence of recurrence was observed at the final follow-up. CONCLUSIONS This case report describes a treatment option for a solitary C6 collapse with LCH managed by anterior corpectomy and instrumented fusion, followed by local RT, with a good clinical outcome at postoperative six months. More studies are needed to elucidate whether such a treatment strategy is superior to surgery or RT alone.
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Affiliation(s)
- Guan-Ming Kuang
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
| | - Nga-Nuen Loo
- International school, Jinan University, Guangzhou, Guangdong, China
| | - Qingpeng Gao
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Jishi Li
- Department of Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Lin Luo
- Department of Radiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Shuang Chen
- Department of Pathology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Kenneth M C Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
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Koslow M, Lynch DA, Cool CD, Groshong SD, Downey GP. Lymphangioleiomyomatosis and Other Cystic Lung Diseases. Immunol Allergy Clin North Am 2023; 43:359-377. [PMID: 37055093 PMCID: PMC10863428 DOI: 10.1016/j.iac.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Cysts and cavities in the lung are commonly encountered on chest imaging. It is necessary to distinguish thin-walled lung cysts (≤2 mm) from cavities and characterize their distribution as focal or multifocal versus diffuse. Focal cavitary lesions are often caused by inflammatory, infectious, or neoplastic processes in contrast to diffuse cystic lung diseases. An algorithmic approach to diffuse cystic lung disease can help narrow the differential diagnosis, and additional testing such as skin biopsy, serum biomarkers, and genetic testing can be confirmatory. An accurate diagnosis is essential for the management and disease surveillance of extrapulmonary complications.
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Affiliation(s)
- Matthew Koslow
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, 1400 Jackson St, Denver, CO 80206, USA; Department of Medicine, National Jewish Health, 1400 Jackson St, Denver, CO 80206, USA.
| | - David A Lynch
- Department of Radiology, National Jewish Health, 1400 Jackson St, Denver, CO 80206, USA
| | - Carlyne D Cool
- Department of Pathology, University of Colorado School of Medicine Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, USA; Division of Pathology, Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Steve D Groshong
- Department of Medicine, National Jewish Health, 1400 Jackson St, Denver, CO 80206, USA
| | - Gregory P Downey
- Department of Medicine, National Jewish Health, 1400 Jackson St, Denver, CO 80206, USA; Department of Pediatrics, National Jewish Health; Department of Immunology and Genomic Medicine, National Jewish Health
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Shaker N, Sangueza OP. Langerhans Cell Histiocytosis Evolving into Juvenile Xanthogranuloma: Two Linked Entities. Am J Dermatopathol 2023; 45:259-263. [PMID: 36801831 DOI: 10.1097/dad.0000000000002394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) represents a myeloid clonal proliferation that involves the skin and other organs. Occasionally, cases of LCH evolve into juvenile xanthogranuloma (JXG). CASE PRESENTATION A 7-month-old boy presented with an itchy, flaky rash resembling seborrheic dermatitis affecting the scalp and eyebrows. The lesions started at 2 months old. On physical examination, there were reddish/brown lesions on the trunk, denuded areas on the groin and neck, and a large lesion behind his bottom teeth. In addition, there were thick white plaques in his mouth and thick whitish material in both ears. A skin biopsy showed features of LCH. Radiologic examination demonstrated several osteolytic lesions. Chemotherapy produced marked improvement. A few months later, the patient developed lesions with clinical and histologic features of XG. CONCLUSION A possible association between LCH and XG is explained by lineage maturation development. Chemotherapy may play a role in modifying the production of cytokines that enhance the transformation or 'maturation' of Langerhans cells into multinucleated macrophages (Touton cells) characteristic of a more favorable proliferative inflammatory condition.
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Affiliation(s)
- Nada Shaker
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH; and
| | - Omar P Sangueza
- Department of Pathology and Dermatology, Wake Forest University, Winston-Salem, NC
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Tokutsu A, Okada Y, Kurozumi A, Tanaka K, Kubo S, Tanaka Y. Possible involvement of CXCR3-CXCR6 + CD4 + T cells in Langerhans cell histiocytosis. J Bone Miner Metab 2023; 41:212-219. [PMID: 36629910 DOI: 10.1007/s00774-022-01397-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 12/22/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Langerhans cell histiocytosis (LCH) is a condition characterized by proliferation of Langerhans cells and wide-range pathologies, ranging from single granulomatous lesions to multi-organ involvement, associated with tissue destruction. LCH pathogenesis remains obscure although association with interleukin (IL)-17A has been reported. We report here a case that illustrates the potential pathogenic role of helper T17 (Th17) cells in LCH-related bone destruction. MATERIALS AND METHODS The patient was a 66-year-old woman. The clinical course included craniectomy and bone mass excision in X-9, diagnosis of LCH confirmed by histopathology, followed by 26-month chemotherapy. In August X, the patient was diagnosed with complete central diabetes insipidus. Symptoms improved after treatment with desmopressin. Pituitary magnetic resonance imaging showed swelling extending from the suprasellar region to the pituitary stalk, suggestive of LCH recurrence. This was followed by chemotherapy combined with mercaptopurine hydrate. RESULTS: Subsequent peripheral blood lymphocyte analysis showed marked increase in activated Th17 cells (CXCR3-CXCR6+ CD4+ T cells). Double staining for CD4 and IL-17 by immunofluorescence of pathological tissue samples obtained during temporal bone mass excision, which confirmed the diagnosis of LCH in X-9, showed areas of combined presence of CD4-positive cells and IL-17-positive cells. Chemotherapy resulted in size reduction of the pituitary lesion and decrease in peripheral blood-activated Th17 cells. CONCLUSIONS We found abundant peripheral blood-activated Th17 cells and high percentages of IL-17-producing cells in osteolytic bone lesions in LCH. This finding, together with the decrease in peripheral blood-activated Th17 cells following chemotherapy, suggests the potential involvement of activated Th17 cells in LCH-related osteolysis.
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Affiliation(s)
- Akemi Tokutsu
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushyu-shi, Kitakyushu, 807-8555, Japan
| | - Yosuke Okada
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushyu-shi, Kitakyushu, 807-8555, Japan
| | - Akira Kurozumi
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushyu-shi, Kitakyushu, 807-8555, Japan
| | - Kenichi Tanaka
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushyu-shi, Kitakyushu, 807-8555, Japan
| | - Satoshi Kubo
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushyu-shi, Kitakyushu, 807-8555, Japan
| | - Yoshiya Tanaka
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushyu-shi, Kitakyushu, 807-8555, Japan.
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Banks SA, Bhatti MT, Go RS, Abeykoon JP, Acosta-Medina AA, Hazim AZ, Goyal G, Young JR, Koster MJ, Vassallo R, Ryu JH, Davidge-Pitts CJ, Ravindran A, Sartori Valinotti JC, Bennani NN, Shah MV, Rech KL, Garrity JA, Tobin WO. Ophthalmologic Involvement in Adults with Histiocytic Disorders: Clinical Presentation and Treatment Outcomes. Ophthalmology 2023; 130:77-86. [PMID: 35932838 DOI: 10.1016/j.ophtha.2022.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/08/2022] [Accepted: 07/28/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To evaluate the clinical presentation, treatment, and outcomes in adult patients with histiocytic disorders with ocular, orbital, optic nerve, or cavernous sinus involvement. DESIGN Observational, retrospective chart review. PARTICIPANTS Adult patients (age ≥ 18 years) at Mayo Clinic from January 1, 1996, to July 1, 2021, with histiocytic disorders. Inclusion criteria were (1) histiocytic disorder by biopsy and appropriate clinical phenotype; (2) available medical records; and (3) ocular, orbital, optic nerve, or cavernous sinus involvement. METHODS Retrospective chart review. MAIN OUTCOME MEASURES Response to therapy, measured in clinical and radiographic impact. RESULTS Thirty-two patients were identified: 7 with Langerhans cell histiocytosis (LCH); 15 with Erdheim-Chester disease (ECD); 1 with mixed LCH/ECD phenotype; 8 with Rosai-Dorfman disease (RDD); and 1 with mixed RDD/ECD phenotype. Ophthalmologic involvement was part of the initial presentation in 69% of patients (22/32). Eyelid edema (13/32, 41%) and proptosis (12/32, 38%) were the most frequent presentations. Isolated orbital or cavernous sinus involvement was present in 3 of 7 patients with LCH and 1 of 8 patients with RDD. Optic nerve sheath involvement was present in 2 of 7 LCH patients, 14 of 15 ECD patients, and 1 RDD/ECD patient. Diffuse (> 75%) orbital involvement was seen in 12 of 15 ECD patients and 1 of 7 LCH patients. Ocular involvement was seen in 1 of 15 ECD patients, 6 of 8 RDD patients, and 1 of 1 mixed RDD/ECD patient. The cavernous sinuses were involved in 1 of 7 LCH patients, 5 of 15 ECD patients, and both mixed phenotype patients. Visual acuity was affected in 14 patients (14/24, 58%) with a median logarithm of the minimum angle of resolution visual acuity of 0.1 (range, -0.12 to 3). BRAF V600E mutations were found in 75% (3/4) of LCH patients and 91% (10/11) of ECD patients. Patients received a variety of treatment, and response was variable across disease types. CONCLUSIONS Orbital involvement was more commonly seen in LCH and ECD, whereas ocular involvement was more common in RDD. Visual acuity may be impacted from ocular involvement or compression of the optic nerve with diffuse orbital involvement.
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Affiliation(s)
- Samantha A Banks
- Division of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - M Tariq Bhatti
- Division of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota; Division of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Ronald S Go
- Division of Hematology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Jithma P Abeykoon
- Division of Hematology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Aldo A Acosta-Medina
- Division of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Antonious Z Hazim
- Division of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Gaurav Goyal
- Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jason R Young
- Division of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Matthew J Koster
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Robert Vassallo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Caroline J Davidge-Pitts
- Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Aishwarya Ravindran
- Division of Hematopathology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | | | - N Nora Bennani
- Division of Hematology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Mithun V Shah
- Division of Hematology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Karen L Rech
- Division of Hematopathology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - James A Garrity
- Division of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - W Oliver Tobin
- Division of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota.
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Urer HN, Dincer H. Evaluation of the Interstitial Histological Lesions in Pulmonary Langerhans Cell Histiocytosis. Turk Patoloji Derg 2023; 39:179-184. [PMID: 36178286 PMCID: PMC10521198 DOI: 10.5146/tjpath.2022.01591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/23/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Pulmonary Langerhans cell histiocytosis is a cystic lung disease characterized by the proliferation of parenchymal dendritic cells. The disease can become chronic or even cause pulmonary fibrosis. Our aim in this study was to investigate the typical histological findings and interstitial fibrosis in pulmonary Langerhans cell histiocytosis cases. MATERIAL AND METHOD In the study, cases that had undergone diagnostic resection were screened. Smoking, histological stage (subacute, subacute-chronic), and cystic and eosinophilic granulomas were confirmed in the cases. In addition to emphysema, chronic nonspecific bronchiolitis, interstitial fibrosis (subpleural-paraseptal fibrosis, peribronchial fibrosis, fibrotic nonspecific interstitial pneumonia), honeycomb-type fibrocysts, and unexpected lesions were investigated. Descriptive and comparative (Fisher exact test) statistical analyses were used in the study (p < 0.05). RESULTS A total of 27 cases were detected; age distribution was 17-68 (36.4). Smoking was present in 15 (55.5%) cases. Six (22.2%) cases were subacute, and 21 (7.7%) cases were subacute-chronic histological stage. A cystic lesion was present in 22 (81.4%) cases. All cases had emphysema accompanying the underlying lesions. Chronic nonspecific bronchiolitis was detected in 14 (51.8%) cases. Interstitial fibrosis was detected in 8 (29.6%) patients. Compared to interstitial fibrosis and nonfibrosis, there was no significant difference between being younger than 39 years, gender, smoking, and histological stage (p=0.41; 1; 0.69; 0.63, respectively). CONCLUSION There is a risk of developing interstitial fibrosis patterns and honeycomb-type fibrocysts in the progression of pulmonary Langerhans cell histiocytosis. Histopathological evaluation can play an important role in the detection of risk groups.
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Affiliation(s)
- Halide Nur Urer
- Department of Pathology, University of Health Sciences Turkey, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Hatice Dincer
- University of Health Sciences Turkey, Istanbul Training and Research Hospital, Istanbul, Turkey
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Qanneta R, Raventos-Estelle A. Pulmonary Langerhans-Cell Histiocytosis. N Engl J Med 2022; 387:2449. [PMID: 36573701 DOI: 10.1056/nejmicm2203885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/25/2022]
Affiliation(s)
- Rami Qanneta
- Hospital Sociosanitari Francoli, Tarragona, Spain
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Menon J, Rammohan A, Vij M, Shanmugam N, Rela M. Current perspectives on the role of liver transplantation for Langerhans cell histiocytosis: A narrative review. World J Gastroenterol 2022; 28:4044-4052. [PMID: 36157108 PMCID: PMC9403430 DOI: 10.3748/wjg.v28.i30.4044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/30/2022] [Accepted: 07/22/2022] [Indexed: 02/06/2023] Open
Abstract
Langerhans cell histiocytosis (LCH) is a malignant disease of the histiocytes involving various organ systems. The spectrum of liver involvement in LCH ranges from mild transaminitis to end-stage liver disease. The hallmark of hepatic LCH is secondary sclerosing cholangitis, which manifests due to a progressive destruction of the biliary tree by malignant histiocytes. Chemotherapy remains the mainstay of treatment for active LCH. Early recognition, diagnosis and a systematic approach to the management of LCH can ameliorate the disease process. Nonetheless, the liver involvement in these patients may progress despite the LCH being in remission. Liver transplantation (LT) remains central in the management of such patients. Various facets of the management of LCH, especially those with liver involvement remain unclear. Furthermore, aspects of LT in LCH with regards to the indication, timing and post-LT management, including immunosuppression and adjuvant therapy, remain undefined. This review summarises the current evidence and discusses the practical aspects of the role of LT in the management of LCH.
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Affiliation(s)
- Jagadeesh Menon
- Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai 600044, India
| | - Ashwin Rammohan
- Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai 600044, India
| | - Mukul Vij
- Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai 600044, India
| | - Naresh Shanmugam
- Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai 600044, India
| | - Mohamed Rela
- Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai 600044, India
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Feng X, Zhang L, Chen F, Yuan G. Multi-System Langerhans Cell Histiocytosis as a Mimic of IgG4-Related Disease: A Case Report and Literature Review. Front Endocrinol (Lausanne) 2022; 13:896227. [PMID: 35937835 PMCID: PMC9353717 DOI: 10.3389/fendo.2022.896227] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/06/2022] [Indexed: 11/24/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare disease characterized by the clonal accumulation and/or proliferation of specific dendritic cells resembling normal epidermal Langerhans cells (LCs). Clinical manifestations are variable, depending on the affected tissues or organs, however, LCH with elevated serum IgG4 has not been reported. Herein, we reported a 26-year-old Chinese female multi-system LCH (MS-LCH) who first presented with central diabetes insipidus (CDI), accompanied by panhypopituitarism and hepatic dysfunction. Diagnostic investigations were strongly suspicious of IgG4-RD because of elevated serum IgG4 levels during the process. Furtherly, thyroid and lymph node involvement and biopsy led to the diagnosis of MS-LCH; the strongly positive staining of CD1a, S100, CD207 (langerin), and Ki67 was found. Moreover, after systemic treatment with five cycles of chemotherapy, many lesions were greatly improved. Since both LCH and IgG4-RD are orphan diseases that can affect any organ, the differential diagnosis is challenging, especially when LCH is associated with unexplained serum IgG4 elevation. In this article, the case of a young woman suffering from MS-LCH that affected organs including the pituitary, thyroid, lymph node, and liver was summarized, and relevant literature was reviewed to better equip the diagnosis and treatment in its early stages.
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Li Y, Chang L, Chai X, Liu H, Yang H, Xia Y, Huo L, Zhang H, Li N, Lian X. Analysis of thyroid involvement in children and adult Langerhans cell histiocytosis: An underestimated endocrine manifestation. Front Endocrinol (Lausanne) 2022; 13:1013616. [PMID: 36246871 PMCID: PMC9562644 DOI: 10.3389/fendo.2022.1013616] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 09/15/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a rare disease caused by the clonal expansion of CD1a+/CD207+ LCH cells. The thyroid involvement in LCH has mostly been described in case reports. METHODS We retrospectively evaluated the clinical characteristics, diagnosis, and treatment of 27 children and adult patients with thyroid LCH in our center between 2010 and 2021. RESULTS The incidence of thyroid LCH was 14.00% (7/50) in children and 10.10% (20/198) in adults, respectively. Among patients with thyroid involvement, 81.5% presented with diabetes insipidus (DI) as the first symptom, and 51.9% complained of neck swelling or mass. Children and adults with thyroid LCH had higher frequencies of the hypothalamic-pituitary axis (HPA) (children: 100% vs. 62.8%, P=0.05; adult: 95% vs. 42.1%, P<0.001), the lung (children: 85.7% vs. 25.6%, P=0.004; adult: 70% vs. 50.6%, P=0.099), and a lower frequency of bone (children: 14.3% vs. 55.8%, P=0.049; adult: 45% vs. 73.6%, P=0.008) involvement than patients without thyroid involvement. Patients with thyroid LCH had a higher frequency of primary hypothyroidism and a lower frequency of euthyroidism than patients without it. The two major types of ultrasound imaging were diffuse (55%) and nodular type (45%). The standardized uptake value of thyroid on 18-F-fluorodeoxyglucose positron emission tomography/computed tomography was 5.3-12.8. The diagnoses were confirmed using thyroid aspiration (54.5%) or surgery (45.5%). In addition, thyroid LCH combined with papillary thyroid carcinoma was not rare (2/27). CONCLUSION Thyroid involvement in LCH is not rare. Furthermore, identifying thyroid involvement can facilitate the pathological diagnosis of LCH. Therefore, the possibility of thyroid LCH should be fully investigated in patients with DI, primary hypothyroidism, abnormal thyroid ultrasound results, and multi-system disease. In addition, thyroid aspiration can confirm suspected thyroid LCH. Finally, special attention should be paid to evaluating HPA and pulmonary involvement in thyroid LCH.
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Affiliation(s)
- Yuanmeng Li
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and 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 and Peking Union Medical College, Beijing, China
| | - Long Chang
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaofeng Chai
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and 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 and Peking Union Medical College, Beijing, China
| | - He Liu
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and 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 and Peking Union Medical College, Beijing, China
| | - Hongbo Yang
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and 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 and Peking Union Medical College, Beijing, China
| | - Yu Xia
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Huo
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Zhang
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Clinical Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Naishi Li
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and 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 and Peking Union Medical College, Beijing, China
- *Correspondence: Naishi Li, ; Xiaolan Lian,
| | - Xiaolan Lian
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and 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 and Peking Union Medical College, Beijing, China
- *Correspondence: Naishi Li, ; Xiaolan Lian,
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24
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Martínez I Cózar V, Llavador Ros M, Évole Buselli M, Andrés Moreno MDM, Polo Miquel B, Pérez Rojas J. [Infantile hepatic cholestatis: An unusual case of Langerhans cells histiocytosis associated with advanced fibrosis]. Rev Esp Patol 2022; 55:63-67. [PMID: 34980444 DOI: 10.1016/j.patol.2019.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/28/2019] [Accepted: 03/14/2019] [Indexed: 06/14/2023]
Abstract
Neonatal cholestasis is a clinical metabolic alteration requiring investigation of its eitiology. It is characterized by elevation of liver enzymes with cholestasis pattern and, in some cases, with acute liver failure. Its etiology is variable although the most frequent cause is atresia of extrahepatic bile ducts. We present a case of a 23-month-old boy who presented with cholestasis and was finally diagnosed with systemic Langerhans cell histiocytosis.
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Affiliation(s)
- Vicent Martínez I Cózar
- Servicio de Anatomía Patológica, Hospital Universitari i Politècnic La Fe, València, España.
| | - Margarita Llavador Ros
- Servicio de Anatomía Patológica, Hospital Universitari i Politècnic La Fe, València, España
| | | | | | - Begoña Polo Miquel
- Servicio de Pediatría, Hospital Universitari i Politècnic La Fe, València, España
| | - Judith Pérez Rojas
- Servicio de Anatomía Patológica, Hospital Universitari i Politècnic La Fe, València, España
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25
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Affiliation(s)
| | - Vikram S Kumar
- Subbaiah Institute of Medical Sciences and Research Centre, Shivamogga, India
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26
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Abstract
The skin manifestations of Langerhans cell histiocytosis (LCH) in the neonate have a heterogenous presentation and can mimic other causes of neonatal rashes. We report an uncommon case of LCH in a term female neonate presenting with non-specific papules and vesicles from the first day of life. There was a maternal history of genital herpes simplex virus (HSV) infection in the third trimester. Blood, cerebrospinal fluid, surface swabs and vesicular fluid were negative for HSV by PCR, and a skin biopsy confirmed the diagnosis of LCH. Further investigations for systemic involvement returned negative. Our case emphasises the variable and non-specific presentation of neonatal cutaneous LCH, which can progress to or be part of multisystem disease.
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Affiliation(s)
| | - Alvin Ngeow
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - Mark Koh
- Department of Dermatology, KK Women's and Children's Hospital, Singapore
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27
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Beatty C, Okal R, Lynch MC. Cutaneous Langerhans Cell Histiocytosis as Presenting Sign of Systemic B-Cell Lymphoma. Am J Dermatopathol 2021; 43:990-992. [PMID: 33989222 DOI: 10.1097/dad.0000000000001974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Langerhans cell histiocytosis (LCH) is a rare clonal proliferative disorder most commonly involving the bone and skin; however, it can arise in many other locations. It is predominantly a pediatric disease, but adult cases occur. Here, we present a case of adult-onset cutaneous LCH with systemic symptoms, believed to represent disseminated LCH. Further evaluation, however, revealed concomitant bone marrow involvement by a small B-cell lymphoma. An association between B-cell lymphoma and cutaneous LCH has only rarely been previously reported. This report adds to the growing body of literature, however, on associations of cutaneous LCH with hematologic malignancies, and it illustrates the need for a complete systemic evaluation including a bone marrow biopsy in suspected cases of disseminated LCH.
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Affiliation(s)
- Colleen Beatty
- Department of Dermatology, West Virginia University, Morgantown, WV
| | - Ryan Okal
- Department of Pathology, Penrose-St. Francis Health Services, Colorado Springs, CO; and
| | - Michael C Lynch
- Department of Pathology, Kaiser Permanente Washington, Seattle, WA
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28
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Erat T, An I, Kıral E, Zengin Ersoy G, Ilhan Turkel F, Otar Yener G. A rare cause of haemorrhagic vesicular lesions in childhood: Langerhans cell histiocytosis. Int J Clin Pract 2021; 75:e14716. [PMID: 34670348 DOI: 10.1111/ijcp.14716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 11/14/2020] [Revised: 02/20/2021] [Accepted: 08/08/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Tugba Erat
- Department of Pediatric Infectious Diseases, Sanlıurfa Training and Research Hospital, Sanlıurfa, Turkey
| | - Isa An
- Department of Dermatology, Sanlıurfa Training and Research Hospital, Sanlıurfa, Turkey
| | - Eylem Kıral
- Department of Pediatric Intensive Care Unit, Sanlıurfa Training and Research Hospital, Sanlıurfa, Turkey
| | - Gizem Zengin Ersoy
- Department of Pediatric Hematology and Oncology, Sanlıurfa Training and Research Hospital, Sanlıurfa, Turkey
| | - Filiz Ilhan Turkel
- Department of Pathology, Sanlıurfa Training and Research Hospital, Sanlıurfa, Turkey
| | - Gulcin Otar Yener
- Department of Pediatric Rheumatology, Sanlıurfa Training and Research Hospital, Sanlıurfa, Turkey
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Hashimoto K, Nishimura S, Sakata N, Inoue M, Sawada A, Akagi M. Characterization of PD-1/PD-L1 immune checkpoint expression in the pathogenesis of musculoskeletal Langerhans cell histiocytosis: A retrospective study. Medicine (Baltimore) 2021; 100:e27650. [PMID: 34713856 PMCID: PMC8556058 DOI: 10.1097/md.0000000000027650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/12/2021] [Indexed: 01/05/2023] Open
Abstract
Recent data suggest that programmed cell death -1 (PD-1) and programmed cell death ligand-1 (PD-L1) are involved in the pathogenesis of Langerhans cell histiocytoma (LCH); however, their contributions are not well established. Also, the involvement of PD-1/PD-L1 molecules in musculoskeletal LCH remains particularly unclear. The current study aims to characterize the involvement of PD-1/PD-L1 immune checkpoint system in the pathogenesis of musculoskeletal LCH. PD-1/PD-L1 expression was evaluated in 6 patients, 3 men and 3 women with a mean age of 13.5 years, with musculoskeletal LCH who were treated at Kindai University Hospital and Osaka Women's and Children's Hospital between November 2005 and December 2020. The median follow-up period for all patients with musculoskeletal LCH was 41 months. We surveyed symptoms, number of lesions, treatment modality, and outcomes. Immunostaining for CD4, CD8, PD-1, and PD-L1 was also performed on pathological specimens obtained by biopsy. Multiple lesions were observed in 5 cases, and a single lesion was observed in 1 case. The chief complaint in 5 cases was pain. Four patients underwent spontaneous regression. The other 2 patients received chemotherapy. The outcomes included continuous disease-free (n = 5) and alive with the disease (n = 1). The CD4-, CD8-, PD-1-, and PD-L1-positive rates among all specimens were 100%, 100%, 16.6%, and 83.3%, respectively. The CD4/PD-L1, CD8/PD-L1, and PD-1/PD-L1 positive rates in all the specimens were 83.3%, 83.3%, and 16.6%, respectively. We believe that the PD-1/PD-L1 immune checkpoint molecules may play some role in the microenvironment of musculoskeletal LCH.
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Affiliation(s)
- Kazuhiko Hashimoto
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka-Sayama City, Osaka, Japan
| | - Shunji Nishimura
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka-Sayama City, Osaka, Japan
| | - Naoki Sakata
- Department of Pediatrics, Kindai University Hospital, Osaka-Sayama City, Osaka, Japan
| | - Masami Inoue
- Department of Hematology/Oncology, Osaka Women's and Children's Hospital, Izumi City, Osaka, Japan
| | - Akihisa Sawada
- Department of Hematology/Oncology, Osaka Women's and Children's Hospital, Izumi City, Osaka, Japan
| | - Masao Akagi
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka-Sayama City, Osaka, Japan
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30
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Ippolito D, Ragusi M, Maino C, Pecorelli A, Giandola T, Franzesi CT, Sironi S. Erdheim-Chester Disease and Langerhans Cell Histiocytosis: A Case of Overlap Syndrome. Oncologist 2021; 26:e345-e346. [PMID: 33111453 PMCID: PMC7873331 DOI: 10.1002/onco.13579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/13/2020] [Indexed: 02/05/2023] Open
Abstract
Only 500 cases of Erdheim‐Chester disease have been reported in the literature to date. To increase awareness of this rare disease, this letter to the editor describes the unusual case of a woman who was diagnosed with mixed histiocytosis: Erdheim‐Chester disease and Langerhans cell histiocytosis.
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Affiliation(s)
- Davide Ippolito
- Department of Diagnostic Radiology, "San Gerardo" Hospital, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Monza, MB, Italy
| | - Maria Ragusi
- Department of Diagnostic Radiology, "San Gerardo" Hospital, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Monza, MB, Italy
| | - Cesare Maino
- Department of Diagnostic Radiology, "San Gerardo" Hospital, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Monza, MB, Italy
| | - Anna Pecorelli
- Department of Diagnostic Radiology, "San Gerardo" Hospital, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Monza, MB, Italy
| | - Teresa Giandola
- Department of Diagnostic Radiology, "San Gerardo" Hospital, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Monza, MB, Italy
| | - Cammillo Talei Franzesi
- Department of Diagnostic Radiology, "San Gerardo" Hospital, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Monza, MB, Italy
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Monza, MB, Italy
- Department of Diagnostic Radiology, H Papa Giovanni XXIII, Bergamo, BG, Italy
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31
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Kumar C, Jain G, Boro H, Pushpam D, Yadav M, Bakhshi S, Mathur S, Tanwar P. Langherhans cell histiocytosis presenting as primary infertility in a young male. Gulf J Oncolog 2021; 1:86-91. [PMID: 33716218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2021] [Indexed: 06/12/2023]
Abstract
Langerhans cell histiocytosis (LCH) is a rare clonal neoplastic disorder of Langerhans cells, with an incidence rate of 5 per million individuals. In adults LCH usually affects bone followed by lung, skin, pituitary gland, liver, spleen, and orbits. LCH presenting with endocrinopathy is rare and commonly involves posterior pituitary with central diabetes insipidus (DI). Here, we present a rare case of LCH involving posterior pituitary but presenting as infertility in a 25-year-old married man. Later the thyroid gland was also found to be involved in the form of multiple nodules. Fine needle aspiration cytology (FNAC) from right lobe of thyroid showed sheets of Langerhans cells along with entrapped residual thyroid follicular cells which were further confirmed by immunocytochemistry as well as cell block preparation followed by immunohistochemistry. A final diagnosis of LCH involving pituitary and thyroid was made and patient was then started on treatment according to LCH treatment protocol LCH III-6 consisting of prednisolone and vinblastine (6 weeks with daily 40 mg/m2 oral prednisolone, and 6 mg/m2 i.v. vinblastine every 7 days). Patient is responding well to the therapy and is on follow up.
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Affiliation(s)
- Chandan Kumar
- Laboratory Oncology Unit, Dr B.R.A. Institute Rotatory Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Garima Jain
- Laboratory Oncology Unit, Dr B.R.A. Institute Rotatory Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Hiya Boro
- Department of Endocrinology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Deepam Pushpam
- Department of Medical Oncology, Dr B.R.A. Institute Rotatory Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Mukesh Yadav
- Department of Radiology, Dr B.R.A. Institute Rotatory Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Sameer Bakhshi
- Department of Endocrinology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Sandeep Mathur
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Pranay Tanwar
- Department of Endocrinology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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Abstract
Langerhans cell histiocytosis (LCH) is a rare inflammatory myeloid neoplasia that can affect any organ or system in the human body. It is usually diagnosed during childhood but can also affect adults. Recent studies have demonstrated involvement of the hypothalamo-pituitary axis (HPA) in a significant proportion of patients with deficiencies in both anterior and posterior pituitary function that in the majority of cases are permanent and require specific hormone replacement regimes. Central diabetes insipidus is considered the most frequent abnormality of HPA involvement in LCH and can be encountered either as isolated deficiency or along with other pituitary deficiencies. Complete hormonal evaluation of pituitary hormones and long-term follow-up of LCH patients are strongly recommended, especially when pituitary involvement is established.
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Affiliation(s)
- Maria P Yavropoulou
- Endocrinology Unit, First Department of Propaedeutic and Internal Medicine, National and Kapodistrian Universtiy of Athens, Medical School, LAIKO General Hospital of Athens, Athens, Greece; Department of Medical Research, LCH Adult Clinic, Hellenic Air Force and VA General Hospital, Athens, Greece.
| | - Marina Tsoli
- Endocrinology Unit, First Department of Propaedeutic and Internal Medicine, National and Kapodistrian Universtiy of Athens, Medical School, LAIKO General Hospital of Athens, Athens, Greece; Department of Medical Research, LCH Adult Clinic, Hellenic Air Force and VA General Hospital, Athens, Greece
| | - Gregory Kaltsas
- Endocrinology Unit, First Department of Propaedeutic and Internal Medicine, National and Kapodistrian Universtiy of Athens, Medical School, LAIKO General Hospital of Athens, Athens, Greece; Department of Medical Research, LCH Adult Clinic, Hellenic Air Force and VA General Hospital, Athens, Greece
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33
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Hinson AR, Patel N, Kaplan J. Hemophagocytic Lymphohistiocytosis in Langerhans Cell Histiocytosis: A Case Report and Review of the Literature. J Pediatr Hematol Oncol 2021; 43:24-27. [PMID: 31725543 PMCID: PMC7737855 DOI: 10.1097/mph.0000000000001652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/13/2019] [Indexed: 11/26/2022]
Abstract
A toddler undergoing treatment for refractory Langerhans cell histiocytosis (LCH) developed concurrent hemophagocytic lymphohistiocytosis (HLH). These are thought to be distinct histiocytic disorders, with different pathophysiologies, diagnostic criteria, and treatments. HLH in a patient with LCH is thought to be quite rare. In this report, we review the presentation of our patient, as well as review the existing literature of other pediatric patients who have been diagnosed with both LCH and HLH.
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Affiliation(s)
- Ashley R.P. Hinson
- Division of Pediatric Cancer and Blood Disorders
- Atrium Health, Levine Children’s Hospital, Charlotte, NC
| | - Niraj Patel
- Division of Immunology and Infectious Diseases
- Atrium Health, Levine Children’s Hospital, Charlotte, NC
| | - Joel Kaplan
- Division of Pediatric Cancer and Blood Disorders
- Atrium Health, Levine Children’s Hospital, Charlotte, NC
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34
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Zhang J, Wang C, Lin C, Bai B, Ye M, Xiang D, Li Z. Spontaneous Thyroid Hemorrhage Caused by Langerhans Cell Histiocytosis: A Case Report and Literature Review. Front Endocrinol (Lausanne) 2021; 12:610573. [PMID: 34093427 PMCID: PMC8170468 DOI: 10.3389/fendo.2021.610573] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 04/30/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Langerhans cell histiocytosis (LCH) is a rare clonal disorder of Langerhans antigen-presenting cells. However, thyroid LCH involvement is relatively rare. We present the first case of spontaneous thyroid hemorrhage due to LCH progression and discuss the clinical features, diagnosis, and treatments of thyroid LCH in a literature review. METHODS Clinical data were collected. Previously published articles on thyroid LCH involvement were reviewed to assess the clinical features, diagnosis, and treatments for thyroid LCH. RESULTS A 54-year-old female presented with a multi-system LCH, affecting the uterus, liver, pituitary gland, and thyroid gland. Clinical stability was achieved after systemic chemotherapy. After 7 years of regular follow up, the patient complained of a sudden painful neck swelling and progressive dyspnea. Computed Tomography revealed bilateral goiter with hematoma, and the patient was diagnosed with spontaneous thyroid bleeding based on her clinical symptoms and radiological findings. The patient was incubated to relieve airway compromise and partial thyroidectomy was performed for definitive treatment. Pathological evaluation further confirmed the diagnosis of thyroid LCH. The patient recovered well after surgery. CONCLUSION Spontaneous thyroid bleeding due to thyroid LCH progression is extremely rare. Treatments for LCH vary depending on the severity of the disease. We suggest that, for patients with multi-system LCH with thyroid lesion, long-term active surveillance of thyroid hormone concentrations, and thyroid gland volume is required. Physicians should be alert of the potentially life-threatening spontaneous thyroid hemorrhage when aggravated diffuse goiter and hypothyroidism appear. Further investigation is required to establish the guidelines for thyroid LCH treatment.
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Affiliation(s)
- Jingying Zhang
- Department of Thyroid Surgery, School of Medicine, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Chengchen Wang
- Department of General Surgery, Hangzhou Mingzhou Hospital, Hangzhou, China
| | - Chuanshuai Lin
- Department of Thyroid Surgery, School of Medicine, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Binglong Bai
- Department of Thyroid Surgery, School of Medicine, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Mao Ye
- Department of Thyroid Surgery, School of Medicine, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Dapeng Xiang
- Department of Thyroid Surgery, School of Medicine, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Zhiyu Li
- Department of Thyroid Surgery, School of Medicine, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
- *Correspondence: Zhiyu Li,
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Zuo T, Jiang P, Yu J, Zhao K, Liu Y, Chen B. Langerhans cell histiocytosis of the rib presenting with pathological fracture: a case report. J Cardiothorac Surg 2020; 15:332. [PMID: 33225947 PMCID: PMC7682065 DOI: 10.1186/s13019-020-01368-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/28/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Langerhans cell histiocytosis (LCH) is a rare neoplastic hyperplasia with an unknown etiology. It is clinically rare for patients with solitary rib lesion and pathological fracture; moreover, its diagnosis and treatment are quite difficult. The purpose of this study is to present a case for the pathogenesis, clinical features, imaging, and treatment of this disease. CASE PRESENTATION A 52-year-old female patient complained of left chest pain for one week. CT showed a fracture in the left 5th rib. The rib tumor was then resected and the surrounding muscles and soft tissues were accordingly resected. The patient was diagnosed with pathological rib fracture, and the patient was pathologically diagnosed with LCH. After surgery, no local recurrence or distant metastasis was reported during the two-year follow-up. CONCLUSIONS LCH should be treated by observation, chemotherapy, radiotherapy, or surgery, or using a combination of several methods. Moreover, primary tumor should be considered when rib fracture without trauma and tumor metastasis.
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Affiliation(s)
- Tao Zuo
- grid.33199.310000 0004 0368 7223Department of Thoracic Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Jiang
- grid.413247.7Department of ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Junjie Yu
- grid.33199.310000 0004 0368 7223Department of Thoracic Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ke Zhao
- grid.33199.310000 0004 0368 7223Department of Thoracic Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Liu
- grid.33199.310000 0004 0368 7223Department of Thoracic Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Baojun Chen
- grid.33199.310000 0004 0368 7223Department of Thoracic Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Abstract
Central diabetes insipidus (CDI) is a complex disorder in which large volumes of dilute urine are excreted due to arginine-vasopressin deficiency, and it is caused by a variety of conditions (genetic, congenital, inflammatory, neoplastic, traumatic) that arise mainly from the hypothalamus. The differential diagnosis between diseases presenting with polyuria and polydipsia is challenging and requires a detailed medical history, physical examination, biochemical approach, imaging studies and, in some cases, histological confirmation. Magnetic resonance imaging is the gold standard method for evaluating the sellar-suprasellar region in CDI. Pituitary stalk size at presentation is variable and can change over time, depending on the underlying condition, and other brain areas or other organs - in specific diseases - may become involved during follow up. An early diagnosis and treatment are preferable in order to avoid central nervous system damage and the risk of dissemination of germ cell tumor, or progression of Langerhans Cell Histiocytosis, and in order to start treatment of additional pituitary defects without further delay. This review focuses on current diagnostic work-up and on the role of neuroimaging in the differential diagnosis of CDI in children and adolescents. It provides an update on the best approach for diagnosis - including novel biochemical markers such as copeptin - treatment and follow up of children and adolescents with CDI; it also describes the best approach to challenging situations such as post-surgical patients, adipsic patients, patients undergoing chemotherapy and/or in critical care.
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MESH Headings
- Adolescent
- Age of Onset
- Biomarkers/analysis
- Brain/diagnostic imaging
- Brain/pathology
- Child
- Diabetes Insipidus, Neurogenic/diagnosis
- Diabetes Insipidus, Neurogenic/epidemiology
- Diabetes Insipidus, Neurogenic/etiology
- Diabetes Insipidus, Neurogenic/therapy
- Diagnosis, Differential
- Diagnostic Imaging/methods
- Diagnostic Imaging/trends
- Diagnostic Techniques, Endocrine/trends
- Histiocytosis, Langerhans-Cell/complications
- Histiocytosis, Langerhans-Cell/diagnosis
- Histiocytosis, Langerhans-Cell/epidemiology
- Histiocytosis, Langerhans-Cell/therapy
- Humans
- Magnetic Resonance Imaging
- Polydipsia/diagnosis
- Polydipsia/epidemiology
- Polydipsia/etiology
- Polydipsia/therapy
- Polyuria/diagnosis
- Polyuria/epidemiology
- Polyuria/etiology
- Polyuria/therapy
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Affiliation(s)
- Giuseppa Patti
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Anastasia Ibba
- SSD Endocrinologia Pediatrica, Ospedale Pediatrico Microcitemico "A. Cao", AO Brotzu, Cagliari, Italy
| | - Giovanni Morana
- Department of Neurosciences, University of Turin, Turin, Italy; Department of Neuroradiology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Flavia Napoli
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Daniela Fava
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Natascia di Iorgi
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Mohamad Maghnie
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy.
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Abstract
RATIONALE Spinal involvement in adult Langerhans cell histiocytosis (LCH) is rare, and epidural involvement is unusual. LCH is mostly indistinguishable from other spinal lesions such as infection, lymphoma, and metastasis. So, it could be easily misdiagnosed without suspicion. PATIENT CONCERNS We report a case of a 33-year-old man who complained of gait disturbance with weakness in both legs and severe back pain. DIAGNOSES A continuous enhancing epidural lesion with cord compression from the T7 to L1 level was detected in magnetic resonance imaging. Laboratory analysis indicated the possibility of spinal infectious disease. We assumed that the lesion could be tuberculous spondylitis. INTERVENTIONS AND OUTCOMES The patient underwent posterior laminectomy with marginal excision of the epidural mass to relieve cord compression. Pathological examination confirmed the diagnosis of LCH. The 12-month follow-up evaluation revealed that the patient was neurologically intact and had no gait disturbance. LESSONS This case report presents a patient with epidural LCH of the thoracic spinal cord, which can mimic spinal infections such as tuberculous spondylitis with abscess formation. Therefore, LCH could be considered as a possible diagnosis when a patient presents with features of infectious spondylitis with vertebral involvement.
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Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a rare disease that mainly affects children, but this disease is significantly rarer in patients who are older than 15 years. In this disease, any organ can be involved. The skeleton, skin and lung are commonly affected, and isolated hypothalamic-pituitary (HP) involvement is relatively rare. Here we report a 17-year-old adolescent with isolated HP-LCH of enlarged pituitary stalk presented with central diabetes insipidus (CDI). CASE PRESENTATION A 17-year-old male adolescent with polydipsia and polyuria accompanied with elevated serum sodium level and low urine osmolality for 3 weeks was referred to our hospital. After admission, hormonal evaluation showed that his growth hormone (GH) was slightly elevated, and serum osmolality and glucose were normal. The fluid deprivation-vasopressin test demonstrated CDI. Imaging examination showed an obvious thickening of the pituitary stalk. Lymphocytic hypophysitis, sarcoidosis and granulation tissue lesions were suspected. After oral 1-deamino-8-Darginine vasopressin (DDAVP) and prednisone were administered for 2 months, symptoms were relieved, and he discontinued taking the drugs by himself. On reexamination, imaging revealed changes in the size and shape of the pituitary stalk, with thickened nodules. Then, a diagnostic biopsy of the pituitary stalk lesion was performed. Immunohistochemistry confirmed the definitive diagnosis of LCH. The clinical symptoms subsided with oral hormone replacements. CONCLUSION CDI is a rare symptom in children and adolescents. Most of the causes are idiopathic, while others are caused by central nervous system (CNS) disorders. Meanwhile, lymphocytic hypophysitis, germinoma, LCH and other CNS disorders can all present as thickening of the pituitary stalk, diffuse enlargement of the pituitary gland, and weakening of high signal intensity in the neurohypophysis on magnetic resonance imaging (MRI). The differential diagnosis among these diseases depends on immunohistochemistry evidence.
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Affiliation(s)
- Weibin Zhou
- Department of Endocrinology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003 Zhejiang China
| | - Jia Rao
- Department of Endocrinology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003 Zhejiang China
| | - Chengjiang Li
- Department of Endocrinology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003 Zhejiang China
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Liu X, Liu L, Zhang L, Zhuo M, Xiao R, Lin D, Fang Z. A Case of Unicentric Castleman Disease and Langerhans Cell Histiocytosis: Two Entities in One Lymph Node. Clin Lab 2019; 64. [PMID: 30549992 DOI: 10.7754/clin.lab.2018.180547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
<i>Background:</i> Castleman disease (CD) is a lymphoproliferative disorder and Langerhans cell histiocytosis (LCH) is a clonal disease of the monocyte-macrophage system. The authors describe a rare case of CD coexistent with LCH at diagnosis in one lymph node. <i>Methods:</i> Hematologic investigation and intrapulmonary mass biopsy were performed. <i>Results:</i> The patient achieved complete remission and, up to now, no signs of recurrence were found. <i>Conclusions:</i> The report about co-existence with CD and LCH will promote correct diagnosis because of the recognition of this rare morphologic combination. An adequate amount of tissue should be obtained to avoid missing the diagnosis.
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Algahtani H, Shirah B, Bajunaid M, Subahi A, Al-Maghraby H. Clinicoradiological Discrepancy in Multisystem Langerhans Cell Histiocytosis with Central Nervous System Involvement. Gulf J Oncolog 2019; 1:72-77. [PMID: 31591994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2019] [Indexed: 06/10/2023]
Abstract
Langerhans cell histiocytosis (LCH) is a rare neoplasm that is caused by an uncontrolled proliferation of Langerhans cells. The clinical presentation of LCH is heterogeneous and can manifest as single or multiple osteolytic lesions, skin ulcerations, and involvement of single or multiple systems. Central nervous system (CNS) involvement is reported in 3.4-57% of patients with multisystem disease. In this article, we present the case of a young man with single system involvement (bone) of LCH who presented with seizures, headache, papilledema, and tinnitus. His magnetic resonance imaging (MRI) of the brain findings were reported as a normal study. The subtle signs of CNS involvement were missed by the radiologist. However, the high index of suspicion resulted in early diagnosis and treatment. The presence of empty sella turcica in neuroimaging could be the first sign of intracranial disease with chronic intracranial hypertension associated with LCH. This is especially correct if previous computed tomography (CT) scan of the brain was normal with normal appearance of the pituitary gland and the sella. Neuroimaging films should be reviewed by an expert neuroradiologist. In patients with new neurological symptoms who were diagnosed previously with LCH, intracranial disease has to be excluded. The workup in such case should include an MRI of the brain, CT of the brain and temporal bones, bone scan, cerebrospinal fluid analysis, ophthalmological assessment, and measurement of intracranial pressure. In patients with LCH who present with symptoms and signs of raised intracranial pressure, the term idiopathic intracranial hypertension should not be applied until an intracranial disease has been excluded totally. Keywords: Langerhans Cell Histiocytosis; Central Nervous System Involvement; Neuroimaging; Intracranial Hypertension.
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Affiliation(s)
- Hussein Algahtani
- King Abdulaziz Medical City / King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Bader Shirah
- King Abdullah International Medical Research Center / King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Mohammed Bajunaid
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Ahmad Subahi
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Hatim Al-Maghraby
- Department of Pathology and Lab Medicine, King Abdulaziz Medical City, Jeddah, Saudi Arabia
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Rotunno R, Diociaiuti A, De Vito R, Gaspari S, Carnevale C, Giancristoforo S, El Hachem M. Agminated Spitzoid Naevi after Remission of Langerhans Cell Histiocytosis: First Italian Case and Literature Review. Acta Derm Venereol 2019; 99:824-825. [PMID: 30809687 DOI: 10.2340/00015555-3156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Roberta Rotunno
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, IT-00165 Rome, Italy.
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Mani S, Thomas R, Mathew R, Michael R. Langerhan's cell Histiocytosis of Sphenoid Sinus causing Vision Loss: A Case Report. JNMA J Nepal Med Assoc 2019; 57:281-284. [PMID: 32323665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
Langerhan's cell histiocytosis is an uncontrolled proliferation of dendritic cells. The involvement of skull base is rare. Variable clinical presentation and multi organ involvement often warrant a multidisciplinary approach for a successful diagnosis. We are reporting a case of 16-year-old male with sphenoid sinus Langerhan's cell histiocytosis which presented as a sudden and painless loss of vision. It is a rare entity in the diagnosis of blindness. Delayed diagnosis and treatment can result in serious complications. The radiological features and management options are discussed with a review of the pertinent literature. Keywords: : blindness; histiocytosis; langerhans-cell; sphenoid sinus.
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Affiliation(s)
- Suresh Mani
- Department of ENT, Christian Medical College, Vellore, India
| | - Regi Thomas
- Department of ENT, Christian Medical College, Vellore, India
| | - Regi Mathew
- Department of ENT, Christian Medical College, Vellore, India
| | - Rajiv Michael
- Department of ENT, Christian Medical College, Vellore, India
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Abstract
RATIONALE Langerhans cell sarcoma (LCS) is a rare, high-grade neoplasm characterized by overtly malignant cytologic features and a poor prognosis. Herein, we present a rare case of langerhans cell histiocytosis (LCH) that later transformed into langerhans cell sarcoma 11 months after the benign mass was excised from soft tissue in the right groin. PATIENT CONCERNS A 41-year-old patient who presented with a mass in the right groin for 3 years earlier after being bitten by ants. DIAGNOSES The patient was diagnosed with langerhans cell sarcoma arising from antecedent langerhans cell histiocytosis. INTERVENTIONS The patient underwent with 6 cycles of a modified etoposide, cyclophosphamide, vindesine, dexamethasone (E-CHOP) regimen. OUTCOMES The patient is currently receiving follow-up care. LESSONS LCH transformed into LCS is a rare case. E-CHOP as an effective first-line therapy to treat LCS cases, but, the mechanism is unclear. Due to their rarity, further data on clinical outcomes are necessary to establish the optimal treatment strategy for LCS.
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Affiliation(s)
- Wu Yi
- Department of Haematology
| | | | | | | | - Wen-na Liang
- Department of Nephrology, Zhejiang Provincial People's Hospital, People's Hospital Of Hangzhou Medical College, Hangzhou, China
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Zhu H, Ma Y, Sun L, Zhang R, Lv L, Wang A. Langerhans Cell Histiocytosis with Lymph Node Involvement Presenting as Erythroderma. Acta Derm Venereol 2019; 99:99-100. [PMID: 30182134 DOI: 10.2340/00015555-3030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Huiqin Zhu
- Department of Dermatology, The Second Hospital of Dalian Medical University, Dalian 116027, China
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Abstract
RATIONALE X-linked lymphoproliferative syndromes (XLPs) are rare, yet often fatal primary immunodeficiency diseases, which rarely manifest as Langerhans cell histiocytosis (LCH) complicated with hemophagocytic lymphohistiocytosis (HLH). Clinical data of a case of XLP-2 manifesting as LCH complicated with HLH was retrospectively analyzed to determine the etiology and causal gene. PATIENT CONCERNS AND DIAGNOSIS The diagnosis of multisystem LCH was confirmed by skin biopsy and other examinations in a 13-month boy with recurrent ear discharge, fever and hemorrhagic papules for 3 months. A good therapeutic response to LCH-III protocol-directed induction chemotherapy was achieved but unremitting HLH developed 6 weeks after the initiation of induction chemotherapy. To identify possible underlying genetic causes, gene mutation analysis was undertaken. A novel XIAP gene mutation (c.99delT, p.F33fsX37) was documented. INTERVENTIONS After the diagnosis of HLH had been confirmed, HLH-2004-directed chemotherapy was instituted. OUTCOMES The clinical condition of the patient had become progressively deteriorating after 8-week chemotherapy of HLH-2004 protocol, requiring frequent infusions of RBC suspensions and apheresis platelets. His parents decided to receive no further therapy, and the patient died soon after discharge. LESSONS Meticulous laboratory investigations including genetic studies should be undertaken in young children with LCH complicated with HLH and poor therapeutic response.
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Borowska E, Radzikowska E, Maksymiuk B, Jakubowska L. Pneumothorax in a young nonsmoking patient: a manifestation of Langerhans cell histiocytosis. Pol Arch Intern Med 2018; 128:619-620. [PMID: 30233081 DOI: 10.20452/pamw.4335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Therrien A, El Haffaf Z, Wartelle-Bladou C, Côté-Daigneault J, Nguyen BN. Langerhans cell histiocytosis presenting as Crohn's disease: a case report. Int J Colorectal Dis 2018; 33:1501-1504. [PMID: 29737419 DOI: 10.1007/s00384-018-3066-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE We describe an exceptional case of Langerhans cell histiocytosis (LCH) that presented as Crohn's disease and primary sclerosing cholangitis. METHODS The patient's clinical, endoscopic, and histologic data from the Centre Hospitalier de l'Universite de Montreal were reviewed, as well as the literature on LCH involving the digestive tract and the liver, with a focus on the similarities with Crohn's disease and primary sclerosing cholangitis. RESULTS A 39 years-old man first presented with anal fissures and deep punctiform colonic ulcers. Histologic assessment of colon biopsies showed chronic active colitis, consistent with Crohn's disease. Mild cholestasis and endoscopic retrograde cholangiopancreatography (ERCP) showing multiple intra and extrahepatic biliary tract strictures also led to a diagnosis of sclerosing cholangitis. Perianal disease progressed despite conventional treatment with antibiotics and infliximab. Subsequent discovery of non-Langerhans cutaneous xanthogranulomas and panhypopituitarism raised the suspicion of LCH, and a second review of colon biopsies ultimately led to the diagnosis, with the identification of Langerhans cells depicting elongated, irregular nuclei with nuclear grooves as well as immunohistochemical reactivity for S100, CD1a and vimentin. BRAF V600E mutation was detected afterwards by DNA sequencing of a bile duct sample. CONCLUSION LCH may mimic inflammatory bowel disease (IBD) and must be suspected in the presence of other suggestive clinical signs, or when there is failure of conventional IBD treatment.
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Affiliation(s)
- Amelie Therrien
- Department of Medicine, Division of Gastroenterology, Centre Hospitalier de l'Universite de Montreal, 1051 rue Sanguinet, Montreal, QC, H2X 3E4, Canada.
| | - Zaki El Haffaf
- Department of Medicine, Division of Genetic Medicine, Centre Hospitalier de l'Universite de Montreal, Tour Viger, 900 rue St-Denis, Montreal, QC, H2X 0A9, Canada
| | - Claire Wartelle-Bladou
- Department of Medicine, Division of Hepatology, Centre Hospitalier de l'Universite de Montreal, 1051 rue Sanguinet, Montreal, QC, H2X 3E4, Canada
| | - Justin Côté-Daigneault
- Department of Medicine, Division of Gastroenterology, Centre Hospitalier de l'Universite de Montreal, 1051 rue Sanguinet, Montreal, QC, H2X 3E4, Canada
| | - Bich N Nguyen
- Department of Pathology, Centre Hospitalier de l'Universite de Montreal, 1100 rue Sanguinet, Pavillon F, Montreal, QC, H2X 0C2, Canada
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Abstract
RATIONALE Langerhans cell histiocytosis (LCH) is a relatively rare disorder characterized by the proliferation of abnormal Langerhans cells. Splenic involvement usually presents in children with multisystem LCH, and isolated LCH of the spleen is a very rare disease. Herein, we report a case of isolated splenic LCH in an adult man. PATIENT CONCERNS We report a case of isolated splenic LCH that first manifested with recurrent left upper abdominal pain. DIAGNOSIS Unenhanced CT revealed multiple nodular lesions located at the spleen. Magnetic resonance imaging speculated that these lesions were lymphomas. On the basis of histopathological and immunohistochemical findings, the diagnosis of isolated splenic LCH was confirmed. INTERVENTION AND OUTCOMES The patient underwent splenectomy. Histopathologic examination revealed the proliferation of Langerhans cell. Immunohistochemical staining revealed that cells of the tumor were positive for S-100, CD1a, CD45RO, and Vimentin. The patient is alive without recurrence 9 years after operation. LESSONS Isolated LCH of the spleen may have a favorable prognosis and splenectomy is an effective therapeutic method.
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Affiliation(s)
- Le Hong
- Department of General Surgery
| | - Gen Sun
- Department of General Surgery
| | | | - Yi Tu
- Department of Pathology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yong Li
- Department of General Surgery
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Abstract
RATIONALE Langerhans cell histiocytosis (LCH) involving non-endocrine organs has been frequently reported, whereas LCH involving endocrine organs is rare and the mechanism is unclear. PATIENT CONCERNS We report a case of multiple-systemic Langerhans cell histiocytosis (LCH) that first manifested with thyroid goiter, followed by pituitary and liver involvement. DIAGNOSES The diagnosis was confirmed based on immunohistochemistry of the thyroid and liver. INTERVENTIONS The patient was treated with thyroidectomy combined with chemotherapy and radiation therapy for thyroid and liver, respectively. OUTCOMES Surprisingly, the patient presented with clinical remission and no new lesion of LCH was found during follow-up over 10 years. LESSONS LCH involving the endocrine system is unusual and easily misdiagnosed or delayed, especially when the thyroid and pituitary glands are involved. Pathological examination is necessary for a definitive diagnosis. Regular examinations, such as anterior and posterior pituitary hormones, should be especially evaluated annually in the patients with LCH involving endocrine system.
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Affiliation(s)
| | | | - Yi Tang
- Department of Hemotology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Montefusco L, Harari S, Elia D, Rossi A, Specchia C, Torre O, Adda G, Arosio M. Endocrine and metabolic assessment in adults with Langerhans cell histiocytosis. Eur J Intern Med 2018; 51:61-67. [PMID: 29198444 DOI: 10.1016/j.ejim.2017.11.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 11/26/2017] [Accepted: 11/27/2017] [Indexed: 12/22/2022]
Abstract
CONTEXT Diabetes insipidus (DI) is one of most common complications of Langerhans cell histiocytosis (LCH) but prevalence of anterior pituitary deficiencies and metabolic alterations have not been clearly defined yet. OBJECTIVES Evaluate prevalence of endocrine and metabolic manifestations in a cohort of patients affected by Pulmonary LCH. METHODS Observational cross-sectional study on 18 adults (7 M/11 F, 42±12years) studied for complete basal and dynamic endocrine lab tests and glucose metabolism. RESULTS Hypothalamic-pituitary endocrine alterations were found in 9 patients: 9 had DI, 5 Growth Hormone Deficiency (GHD), 5 central hypogonadism, 3 central hypothyroidism and 1 central hypoadrenalism. Hyperprolactinemia and hypothalamic syndrome were found in 2 patients each. All these central endocrine alterations were always associated to DI. Five of the 10 MRI performed showed abnormalities. Prevalence of obesity and glucose alterations (either DM or IFG/IGT) were respectively 39% and 33%, higher than expected basing on epidemiological data on general Italian population. Multi-system-LCH without risk-organ involvement (LCH MS-RO-) seems to have slightly higher prevalence of insulin resistance, glucose alterations and metabolic syndrome than LCH with isolated lung involvement (LCH SS lung+). A papillary BRAFV600E positive thyroid carcinoma was diagnosed in one patient. CONCLUSIONS The presence of anterior pituitary deficiencies should be systematically sought in all LCH patients with DI both at diagnosis and during the follow-up by basal and dynamic hormonal assessment. Patients with pulmonary LCH, particularly those with MS disease, have a worse metabolic profile than general population. Occurrence of papillary thyroid carcinoma has been reported.
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Affiliation(s)
- L Montefusco
- U.O. di Malattie Endocrine e Diabetologia, Ospedale San Giuseppe Multimedica, Milan, Italy; MultiMedica IRCCS, Milan, Italy
| | - S Harari
- MultiMedica IRCCS, Milan, Italy; U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria - Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe Multimedica, Milan, Italy.
| | - D Elia
- MultiMedica IRCCS, Milan, Italy; U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria - Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe Multimedica, Milan, Italy
| | - A Rossi
- U.O. di Malattie Endocrine e Diabetologia, Ospedale San Giuseppe Multimedica, Milan, Italy; MultiMedica IRCCS, Milan, Italy
| | - C Specchia
- MultiMedica IRCCS, Milan, Italy; Dipartimento di Medicina Molecolare e Traslazionale, Università di Brescia, Italy
| | - O Torre
- MultiMedica IRCCS, Milan, Italy; U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria - Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe Multimedica, Milan, Italy
| | - G Adda
- U.O. di Malattie Endocrine e Diabetologia, Ospedale San Giuseppe Multimedica, Milan, Italy; MultiMedica IRCCS, Milan, Italy
| | - M Arosio
- U.O. di Endocrinologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Milan, Italy
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