Cutaneous adult xanthogranuloma with a small portion of BRAFV600E mutated Langerhans cell histiocytosis populations: A case report and the review of published work

Histiocytoses, including Langerhans cell histiocytosis (LCH), juvenile or adult xanthogranuloma (AXG) and Rosai–Dorfman disease (RDD), are rare disorders characterized by the proliferation of cells derived from monocyte/macrophage lineages. A few cases of LCH coexisting with xanthogranuloma or RDD have been reported. The etiology of these diseases remains unclear. However, oncogenic BRAF^V600E mutations have been identified in LCH. Here, we report the case of a 26‐year‐old Japanese man with a 3‐month history of a solitary occipital nodule. No abnormality was detected in his other organs, and a total resection of the nodule was performed. Histopathological examination revealed the coexistence of LCH and AXG with prominent emperipolesis characteristic of RDD. Immunohistochemistry showed that most of the large histiocytes were positive for CD68, weakly positive or negative for S100, and negative for CD207 and CD1a, supporting the diagnosis of AXG. The tumor cells with emperipolesis did not show S100‐positive findings characteristic of RDD. The focally aggregated oval histiocytic cells were positive for CD1a, CD207, CD68 and S100, and were compatible with the immunophenotype of LCH cells. In addition, these cells were positive for BRAF^V600E mutation. The tumor cells in our patient exhibited a cellular morphology characteristic of multiple histiocytoses in a solitary cutaneous nodule, which may imply an etiological association among LCH, AXG and RDD. To our knowledge, this is the first report of a BRAF^V600E mutation‐positive case of LCH coexisting with AXG. Because patients with BRAF^V600E mutation have higher risks of multisystemic LCH and recurrence, we should carefully follow up the patient.     

Primary cutaneous localized/clearly-outlined true histiocytic sarcoma: Two long-term follow-up cases

Histiocytic sarcoma (HS) is a rare hematopoietic tumor that mainly involves extranodal sites, including the intestinal tract, skin, soft tissues and other organs. It is well known as an aggressive neoplasm that shows a poor response to therapy. However, a subset of patients with resectable disease has shown a favorable outcome with surgical treatment. Primary cutaneous HS is exceedingly rare and, to date, its long-term prognosis has thus not been well described. Here, we highlight two cases of primary cutaneous HS that showed long-term survival. Case 1 was a healthy 47-year-old woman who found a 12-mm tumor on her forehead. Case 2 was a 66-year-old woman, under follow up of a myxoid liposarcoma in her leg, who presented with a 25-mm tumor in her hypothenar eminence. Histologically, the tumors in both cases had a smooth outline with proliferating atypical tumor cells that showed histiocytic differentiation as revealed by immunohistochemistry with antibodies to CD68 (KP-1) and lysozyme in case 1; and CD68, lysozyme and CD163 in case 2. Tumor cells in case 1 had a monotonous appearance. After complete resection, cases 1 and 2 have survived for 10 and 4 years, respectively, without recurrence. To date, such patients are relatively long follow-up cases of survival from HS and highlight how a clear outline of the primary cutaneous HS tumor may be associated with its resectability and be an important factor in the assessment of its curability.     

Phenotypic and molecular characterization of Escherichia albertii: Further surrogates to avoid potential laboratory misidentification

Escherichia albertii is an emerging gastrointestinal pathogen, related to Escherichia coli, which can be misidentified as enteropathogenic E. coli (EPEC) and enterohemorrhagic E. coli (EHEC), due to the presence of the eae gene in E. albertii. The aim of this study was to verify our hypothesis that E. coli cytolethal distending toxin-II (Eccdt-II) gene-positive E. coli is E. albertii and to accumulate the data regarding the bacteriological characteristics of E. albertii. For these purposes, we attempted to detect E. albertii in eae gene-positive bacteria previously identified as E. coli and to examine if re-identified E. albertii contained Eccdt-II-homologous gene and remaining eae gene-positive E. coli did not. A total of 373 eae gene-positive E. coli strains were analyzed by biochemical tests, multilocus sequence analysis and an E. albertii-specific PCR. The strains re-identified as E. albertii were also examined for the presence of cdt genes by using ³²P-labled DNA probes, followed by their toxin-typing. Of the 373 strains, 17 were re-identified as E. albertii by three above-mentioned methods. Furthermore, all the 17 re-identified E. albertii possessed cdt genes highly homologous to Eccdt-II and Eacdt genes. Moreover, Eccdt-I or both Eccdt-I and stx2f genes were detected in two re-identified E. albertii strains. However, the remaining 356 strains did not carry such cdt genes. These data indicate that all re-identified E. albertii isolates specifically carried cdt genes homologous to Eccdt-II and Eacdt genes. We suggest that Eccdt-II gene-positive E. coli may be identical to E. albertii.