Difference between revisions of "Langerhans cell histiocytosis"

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==General==
==General==
LCH is really three diseases - that happen to share the same histology:<ref>{{Ref PCPBoD8|338-9}}</ref>
LCH is really four (or three) diseases (depending on how one classifies it) - that happen to share the same histology:<ref>{{Ref PCPBoD8|338-9}}</ref><ref name=pmid16295427>{{Cite journal  | last1 = Chhabra | first1 = UD. | last2 = Desai | first2 = SS. | last3 = Jambhekar | first3 = NA. | title = Langerhans' cell histiocytosis: a clinicopathological study of 50 cases. | journal = Indian J Pathol Microbiol | volume = 47 | issue = 3 | pages = 370-6 | month = Jul | year = 2004 | doi =  | PMID = 16295427 }}</ref>
{| class="wikitable sortable"
{| class="wikitable sortable"
! Disease
! Disease
Line 19: Line 19:
|-
|-
| Multifocal multisystem Langerhans cell histiocytosis
| Multifocal multisystem Langerhans cell histiocytosis
| Letterer-Siwe disease
| multisystem LCH, Letterer-Siwe disease
| outcome dependent on organ involved,<ref name=pmid21351807>{{Cite journal  | last1 = Minkov | first1 = M. | title = Multisystem Langerhans cell histiocytosis in children: current treatment and future directions. | journal = Paediatr Drugs | volume = 13 | issue = 2 | pages = 75-86 | month = Apr | year = 2011 | doi = 10.2165/11538540-000000000-00000 | PMID = 21351807 }}</ref> natural history 2 year survival, 50% five year survival with treatment
| outcome dependent on organ involved,<ref name=pmid21351807>{{Cite journal  | last1 = Minkov | first1 = M. | title = Multisystem Langerhans cell histiocytosis in children: current treatment and future directions. | journal = Paediatr Drugs | volume = 13 | issue = 2 | pages = 75-86 | month = Apr | year = 2011 | doi = 10.2165/11538540-000000000-00000 | PMID = 21351807 }}</ref> natural history 2 year survival, 50% five year survival with treatment
| usu. children < 2 years old, rarely adults<ref name=pmid22470214>{{Cite journal  | last1 = Garg | first1 = A. | last2 = Kumar | first2 = P. | title = Multisystem Langerhans cell histiocytosis in adult. | journal = Indian J Dermatol | volume = 57 | issue = 1 | pages = 58-60 | month = Jan | year = 2012 | doi = 10.4103/0019-5154.92683 | PMID = 22470214 }}</ref>
| usu. children < 2 years old, rarely adults<ref name=pmid22470214>{{Cite journal  | last1 = Garg | first1 = A. | last2 = Kumar | first2 = P. | title = Multisystem Langerhans cell histiocytosis in adult. | journal = Indian J Dermatol | volume = 57 | issue = 1 | pages = 58-60 | month = Jan | year = 2012 | doi = 10.4103/0019-5154.92683 | PMID = 22470214 }}</ref>
| multiple systems (skin, spleen, liver, lung, bone marrow)
| multiple systems (skin, spleen, liver, lung, bone marrow)
| genetic
| possibly genetic ‡
|-
|-
| Unifocal and multifocal unisystem Langerhans cell histiocytosis
| Unifocal Langerhans cell histiocytosis †
| Eosinophilic granuloma, Hand-Schuller-Christian syndrome = bone defect, diabetes insipidus & exopthalmos
| Eosinophilic granuloma
| may spontaneously regress, may cure with surgery
| may spontaneously regress, may cure with surgery
| children (?)
| children (?)
| usu. bone, skin, lungs, stomach
| bone only
| genetic (?)
| possibly genetic ‡
|-
| Multifocal unisystem Langerhans cell histiocytosis †
| multifocal LCH, eosinophilic granuloma, Hand-Schuller-Christian syndrome = bone defect, diabetes insipidus & exopthalmos
| may spontaneously regress, may cure with surgery (?)
| children (?)
| usu. bone; may be in: skin, lungs, stomach
| possibly genetic ‡
|}
|}
Note:
* † Robbins lumps these groups together.
* ‡ Incompletely understood. Somatic BRAF mutations identified in approximately half of the individuals.<ref name=pmid20519626>{{Cite journal  | last1 = Badalian-Very | first1 = G. | last2 = Vergilio | first2 = JA. | last3 = Degar | first3 = BA. | last4 = MacConaill | first4 = LE. | last5 = Brandner | first5 = B. | last6 = Calicchio | first6 = ML. | last7 = Kuo | first7 = FC. | last8 = Ligon | first8 = AH. | last9 = Stevenson | first9 = KE. | title = Recurrent BRAF mutations in Langerhans cell histiocytosis. | journal = Blood | volume = 116 | issue = 11 | pages = 1919-23 | month = Sep | year = 2010 | doi = 10.1182/blood-2010-04-279083 | PMID = 20519626 }}</ref><ref name=pmid22017623>{{Cite journal  | last1 = Badalian-Very | first1 = G. | last2 = Vergilio | first2 = JA. | last3 = Degar | first3 = BA. | last4 = Rodriguez-Galindo | first4 = C. | last5 = Rollins | first5 = BJ. | title = Recent advances in the understanding of Langerhans cell histiocytosis. | journal = Br J Haematol | volume = 156 | issue = 2 | pages = 163-72 | month = Jan | year = 2012 | doi = 10.1111/j.1365-2141.2011.08915.x | PMID = 22017623 }}</ref>


==Microscopic==
==Microscopic==

Revision as of 13:05, 5 May 2012

Langerhans cell histiocytosis, abbreviated LCH, is a rare genetic disorder of tissue macrophages. It broadly fits into the category of histiocytoses. It used to known as eosinophilic granuloma. It has been referred to by several eponyms - Hand-Schüller-Christian disease, Abt-Letterer-Siwe disease or Letterer-Siwe disease, and histiocytosis X.

General

LCH is really four (or three) diseases (depending on how one classifies it) - that happen to share the same histology:[1][2]

Disease Other name(s) Prognosis Demographic Location Risks/cause
Pulmonary Langerhans cell histiocytosis Eosinophilic granuloma good with smoking cessation adults - smokers lung only; typically upper lung field due to smoking
Multifocal multisystem Langerhans cell histiocytosis multisystem LCH, Letterer-Siwe disease outcome dependent on organ involved,[3] natural history 2 year survival, 50% five year survival with treatment usu. children < 2 years old, rarely adults[4] multiple systems (skin, spleen, liver, lung, bone marrow) possibly genetic ‡
Unifocal Langerhans cell histiocytosis † Eosinophilic granuloma may spontaneously regress, may cure with surgery children (?) bone only possibly genetic ‡
Multifocal unisystem Langerhans cell histiocytosis † multifocal LCH, eosinophilic granuloma, Hand-Schuller-Christian syndrome = bone defect, diabetes insipidus & exopthalmos may spontaneously regress, may cure with surgery (?) children (?) usu. bone; may be in: skin, lungs, stomach possibly genetic ‡

Note:

  • † Robbins lumps these groups together.
  • ‡ Incompletely understood. Somatic BRAF mutations identified in approximately half of the individuals.[5][6]

Microscopic

Features:

  • Langerhans cells histiocytes - key feature.
    • Clusters of cells (histiocytes) with a reniform (kidney-shaped) nucleus and abundant foamy cytoplasm.
      • Nucleus may look like a "coffee bean", i.e. have nuclear grooves (similar to those in papillary thyroid carcinoma) -- appearance dependent on the rotation of the nucleus.[7]
      • Chromatin pattern: fine granular, light gray.
  • +/-Eosinophils - often prominent.

Images:

DDx:

IHC

  • CD1a +ve.
  • S100 +ve.
  • CD207 (AKA Langerin) +ve.[8]

Electron microscopy

Etiology:

  • Cell membrane invagination.[9]

Appearance:

  • Electron dense, cytoplasmic tennis racket-like body.

Images:

See also

References

  1. ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 338-9. ISBN 978-1416054542.
  2. ↑ Chhabra, UD.; Desai, SS.; Jambhekar, NA. (Jul 2004). "Langerhans' cell histiocytosis: a clinicopathological study of 50 cases.". Indian J Pathol Microbiol 47 (3): 370-6. PMID 16295427.
  3. ↑ Minkov, M. (Apr 2011). "Multisystem Langerhans cell histiocytosis in children: current treatment and future directions.". Paediatr Drugs 13 (2): 75-86. doi:10.2165/11538540-000000000-00000. PMID 21351807.
  4. ↑ Garg, A.; Kumar, P. (Jan 2012). "Multisystem Langerhans cell histiocytosis in adult.". Indian J Dermatol 57 (1): 58-60. doi:10.4103/0019-5154.92683. PMID 22470214.
  5. ↑ Badalian-Very, G.; Vergilio, JA.; Degar, BA.; MacConaill, LE.; Brandner, B.; Calicchio, ML.; Kuo, FC.; Ligon, AH. et al. (Sep 2010). "Recurrent BRAF mutations in Langerhans cell histiocytosis.". Blood 116 (11): 1919-23. doi:10.1182/blood-2010-04-279083. PMID 20519626.
  6. ↑ Badalian-Very, G.; Vergilio, JA.; Degar, BA.; Rodriguez-Galindo, C.; Rollins, BJ. (Jan 2012). "Recent advances in the understanding of Langerhans cell histiocytosis.". Br J Haematol 156 (2): 163-72. doi:10.1111/j.1365-2141.2011.08915.x. PMID 22017623.
  7. ↑ BN. 15 March 2011.
  8. ↑ Online 'Mendelian Inheritance in Man' (OMIM) 604862
  9. ↑ URL: http://path.upmc.edu/cases/case147/micro.html. Accessed on: 7 January 2012.
  10. ↑ URL: http://path.upmc.edu/cases/case298.html. Accessed on: 14 January 2012.
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