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Extracellular Signal-regulated Kinase Activation Of Self-healing Langerhans Cell Histiocytosis: A Case Report

Kaneshima, A., Yamaguchi, S., Miyagi, T., Kariya, Y., Awazawa, T., Ohshiro, T., Hyakuna, N., Nakanishi, K., & Takahashi, K. (2019). Extracellular signal-regulated kinase activation of self-healing Langerhans cell histiocytosis: A case report. The Journal of dermatology, 46(9), 812–815. https://doi.org/10.1111/1346-8138.14996

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Abstract

A 3-month-old boy developed small papules on his trunk. After the papules increased in number, the patient was diagnosed with Langerhans cell histiocytosis based on the pathological findings. He was referred to our department for further examination. Upon initial examination, the papules and nodules were scattered on his back, abdomen and lumbar region. Because he did not present with any organ involvement except the skin, he was diagnosed with single-system and skin-limited Langerhans cell histiocytosis. Skin rashes were treated with a topical steroid and started regressing 3 months after onset. All papules disappeared 6 months after onset. In this boy, the Langerhans cell histiocytosis tumor cells expressed phosphorylated extracellular signal-regulated kinases. In Langerhans cell histiocytosis, BRAF V600E and other genes are known to mutate to act as driver mutations in stem cells of the myeloid dendritic cell lineage. Consequently, extracellular signal-regulated kinases are continuously activated, which contributes to Langerhans cell histiocytosis carcinogenesis.

Case Details

Disease Location

Skin

Personal Characteristics

3-month-old boy

Clinical Characteristics

Papules on the trunk, and diagnosed as having molluscum contagiosum. Because the papules increased in number, a skin biopsy was performed, and he was finally diagnosed with langerhans cell histiocytosis (lch). Histopathological findings at 3 months of age showed that the corneum and epidermis were thickened, and the tumor cells with a lightly stained eosinophilic cytoplasm proliferated in the epidermis. The tumor cells also proliferated along the appendages in the dermis langerin-positive tumor cells expressed phosphorylated extracellular signal-regulated kinase (p-erk). The patient was diagnosed with single- system and skin-limited lch and was treated solely with topical steroids.

Remission Characteristics

The skin rashes started regressing 3 months after onset and had completely disappeared 6 months later

Treatment & Mechanisms

Proposed Remission Mechanisms

None reported

Clinical Treatment

Topical steroids biopsy

Non-Clinical Treatment

None reported