Multicentric Reticulohistiocytosis

Tani, Masahiro

doi:10.1001/archderm.1981.01650080049028

Cited by 23 publications

(1 citation statement)

References 16 publications

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“…she was found to have infiltrating ductal carcinoma of Multicentric reticulohistiocytosis is quite rare, and the breast with metastases to 3 of 35 axillary lymph only 82 reports have been documented in the literature nodes. A radical mastectomy followed by bilateral OO- 14,[6][7][8][9][10][11]. MR has been associated with tuberculosis (6%), hypothyroidism (6%), diabetes (6%), and cancer (15-27 %) [ 1,4,14].…”

Section: No Effective Ther-mentioning

confidence: 99%

Multicentric reticulohistiocytosis and cancer: A case report and review of the literature

Nunnink

Krusinski

Yates

1985

Med. Pediatr. Oncol.

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Multicentric reticulohistiocytosis (MR) is a syndrome characterized by papulonodular skin lesions, a debilitating polyarthritis, and characteristic histologic findings. It is a rare disorder with only 82 cases reported. Twenty-eight percent had an associated neoplasm. Hematologic malignancies (four) and neoplasms arising from the breast (four), cervix (three), stomach (three), ovary (two), colon (two), lung (one), pleura (one), and from an unknown source (two) were all seen associated with MR. Eleven cases (including our own) were available for review. The papulonodular skin involvement was the initial manifestation (alone or concurrent with the polyarthritis) in 90% of our cases. The diagnosis of MR preceded that of the associated neoplasm in 73% of the cases. A case report is presented illustrating the relapse of MR before the clinical relapse of the associated tumor, and the response of both the tumor and MR to combination chemotherapy with cyclophosphamide, methotrexate, 5-fluorouracil, and prednisone when prednisone and aspirin alone failed to relieve the symptoms of MR. Steroids were not beneficial in the patients reviewed. The best management of MR associated with a neoplasm is the best management of the primary neoplasm. Cytotoxic chemotherapy including cyclophosphamide should be considered if there is progression of the MR in order to control the symptoms of MR and prevent a progressive debilitating arthritis.

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Section: No Effective Ther-mentioning

confidence: 99%

Multicentric reticulohistiocytosis and cancer: A case report and review of the literature

Nunnink

Krusinski

Yates

1985

Med. Pediatr. Oncol.

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Multicentric reticulohistiocytosis: Case report with immunohistochemical analysis and literature review

Gorman

Danning

Schumacher

et al. 2000

Arthritis & Rheumatism

126

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This report describes the case of a patient with multicentric reticulohistiocytosis. Immunohistochemical analysis revealed prominent markers of monocyte/ macrophage origin, as well as the presence of tumor necrosis factor ␣, interleukin-1␤ (IL-1␤), and IL-12; the occurrence of the latter in this disease has not previously been reported. Clinical, laboratory, radiographic, and histologic findings in multicentric reticulohistiocytosis are reviewed. In addition, all published cases of multicentric reticulohistiocytosis which included reports of cytokine and immunohistochemical analysis are reviewed, and evidence for a monocyte/macrophage origin and role in disease pathogenesis is provided.Multicentric reticulohistiocytosis is a rare systemic disorder of unknown etiology, characterized by severe destructive arthritis, development of cutaneous nodules, and a significant association with malignancies. Histologic analysis of cutaneous and synovial lesions reveals multinucleated foreign body-type giant cells and smaller histiocytes. The presence of lysosomes and the giant cell's ability to phagocytose have led many to suspect a monocyte/macrophage origin of the multicentric reticulohistiocytosis cells (1-3). More recently, immunohistochemical studies have yielded conflicting findings, with some supporting either a lymphocyte or dermal dendrocyte origin and others still reporting a monocyte/macrophage origin (2-7).We report herein a case of multicentric reticulohistiocytosis in which detailed immunohistochemical data were gathered. The data further support the notion of a monocyte/macrophage origin of the multicentric reticulohistiocytosis cells. In addition, we review the literature on multicentric reticulohistiocytosis, with particular emphasis on immunohistochemical findings. CASE REPORTClinical, laboratory, and radiographic findings. The patient, a 44-year-old African American woman, presented with a 2 1 ⁄2-month history of relatively painless symmetric deformity and swelling of her distal interphalangeal (DIP) joints. She recently had noted the onset of a pruritic skin eruption on her right ear and a nodular lesion on the fourth finger of her right hand. Her earlier medical history was significant for cervical atypia with human papillomavirus. Other earlier medical history included menorrhagia and dysmenorrhea, microcytic anemia, and hypertension. Family history was significant only for type 2 diabetes mellitus. There was no history of travel, toxin exposure, or illicit substance use, and the patient had no pets.Physical examination revealed a single nodule on the right fourth finger as well as nodules in a beaded appearance over the cuticles on the same hand. Papules with slight scale were noted in the right external ear canal. Musculoskeletal examination revealed pain and moderate swelling in the second DIP joints bilaterally and in the left fifth DIP joint. Results of the clinical examination were otherwise unremarkable.Laboratory studies disclosed a microcytic anemia and thrombocytosis (hematocrit 35%, mean corp...

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Multicentric Reticulohistiocytosis in a Patient With Malignant Melanoma: A Response to Cyclophosphamide and a Unique Cutaneous Feature

Kenik

Huerter

Hurley

et al. 1990

Arthritis & Rheumatism

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We describe a patient with multicentric reticulohistiocytosis and a history of malignant melanoma. His widely disseminated disease did not affect the site of surgical removal of the malignant melanoma nor the donor site of a skin grafi. The multicentric reticulohistiocytosis progressed while the patient was taking nonsteroidal antiinflammatory agents, but showed significant response during a 10-month course of cyclophosphamide. While he was taking the cyclophosphamide, however, his melanoma recurred, and the patient subsequently died.Multicentric reticulohistiocytosis (MR) is a rare disorder of unknown etiology characterized by infiltration of lipid-laden histiocytes and multinucleated giant cells into various tissues (1.2). The disease manifests as destructive arthritis and characteristic erythematous and nodular skin lesions (3,4). In a recent review, 28% of the MR patients described had an associated malignancy ( 5 ) . Various agents, including cyclophosphamide, have been used to treat the condition; however, the rarity of this disorder has precluded adequate therapeutic trials (6-10). We describe a patient with MR and a history of malignant melanoma. The disease, which was widely disseminated, did not affect the site of surgical removal of the malignant melanoma nor the donor site of a skin graft. This progressive disease showed significant resolution while the patient was taking cyclophosphamide.Case report. The patient, a 52-year-old man, presented in November 1985 with a 3-month history of progressive pain, stiffness, and swelling of the hands, shoulders. and knees. At the same time, he developed a diffusely erythematous and slightly pruritic eruption predominantly over the trunk, back, and extremities. He developed nodular skin lesions involving the hands and extensor surfaces of the forearms and elbows. He had a history of Clark's level 111 malignant melanoma, which was diagnosed and surgically removed in 1980. The patient was disease free over the next 5 years.At the time of physical examination, he had multiple nodular lesions on the extensor and flexor surfaces of his hands, as well as the extensor surfaces of his forearms and elbows ( Figures 1A and B).Lesions were also present at the borders of his lips and nares, and at pressure sites on his nose caused by his glasses ( Figure IC). A diffuse erythroderma was also present ( Figure ID). The site of surgical removal of a malignant melanoma on the patient's right arm and the skin graft donor site on his left thigh were clinically uninvolved (Figures 2A and B). Although there was joint-line tenderness at the metacarpophalangeal and proximal interphalangeal joints of his hands, there was no evidence of active synovitis. There was joint tenderness at the shoulders, and significant effusions were noted at the knees.

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Multicentric Reticulohistiocytosis

Cited by 23 publications

References 16 publications

Multicentric reticulohistiocytosis and cancer: A case report and review of the literature

Multicentric reticulohistiocytosis and cancer: A case report and review of the literature

Multicentric reticulohistiocytosis: Case report with immunohistochemical analysis and literature review

Multicentric Reticulohistiocytosis in a Patient With Malignant Melanoma: A Response to Cyclophosphamide and a Unique Cutaneous Feature

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