Erdheim-Chester disease is a very rare xanthogranulomatous, non-Langerhans cell systemic histiocytosis with an unknown etiology and pathogenesis. It involves the marrow space of the long bones. Extraosseous sites most commonly affected include the eyes, lungs, pituitary glands, and kidneys.
Localization
bones: symmetric osteosclerosis of the long bones
extraskeletal lesions (more than 50%)
- retroperitoneal space (8037299), perirenal space (ureteral obstruction)
- mediastinum, periaortal space (10852289)
- lungs (11202482, 10912934) causing interstitial lung disease (17304381)
- kidneys
- brain (12687308, 17063320)
- pitutary (insipide diabetes, hypopituitarism)(11838810)
- cavernous sinus
- epidural space (17063320)
- retro-orbital space: orbital xanthogranuloma (14506422)
- heart (11755517), pericardium (pericardial effusion) (12186113)
- liver (12873197)
- dermal nodules, eyelid xanthelasma, pretibial dermopathy
- lips and buccal mucosa
- associated haematological abnormalities: normochromic normocytic anaemia, thrombocytopenia, eosinophilia
- breast (10752893, 16297093, 20216377)
- sinonasal region (10997572)
- muscle (10855472)
Associations
A amylosis (11014995)
Microscopical synopsis
fibrosing xanthogranulomatous infiltration of multiple organs
diffuse infiltration with large, foamy histiocytes
rare Touton-like giant cells
lymphocytic aggregates
fibrosis and fibrobastic cells
extensive coagulative necrosis (11469352)
Immunochemistry
CD68+
CD1a-
protein S-100- or S-100+ (10912934)
factor XIIIa+ (10912934)
Ultrastructure
lack of Birbeck granules
This study presents the case of a patient with Erdheim-Chester disease with vertebral destruction and, for the first time, to our knowledge, involvement of the liver. The diagnosis is based on radiologic, histologic, immunohistochemical, and ultrastructural findings.
Cytogenetics
balanced chromosomal translocation t(12;15;20)(q11;q24;p13.3) (17255779)
Differential diagnosis
- fat necrosis
- histocytoses
- systemic histiocytoses
- non-Langerhans cell histiocytoses
- systemic histiocytoses
histiocytoid invasive carcinomas
Reference
Erdheim-chester disease presenting as bilateral clinically malignant breast masses. Provenzano E, Barter SJ, Wright PA, Forouhi P, Allibone R, Ellis IO. Am J Surg Pathol. 2010 Apr;34(4):584-8. PMID: 20216377
Vencio EF, Jenkins RB, Schiller JL, Huynh TV, Wenger DD, Inwards CY, Oliveira AM. Clonal cytogenetic abnormalities in Erdheim-Chester disease. Am J Surg Pathol. 2007 Feb;31(2):319-21. PMID: 17255779
Chetritt J, Paradis V, Dargere D, Adle-Biassette H, Maurage CA, Mussini JM, Vital A, Wechsler J, Bedossa P. Chester-Erdheim disease: a neoplastic disorder. Hum Pathol. 1999 Sep;30(9):1093-6. PMID: 10492045
Egan AJ, Boardman LA, Tazelaar HD, Swensen SJ, Jett JR, Yousem SA, Myers JL. Erdheim-Chester disease: clinical, radiologic, and histopathologic findings in five patients with interstitial lung disease. Am J Surg Pathol. 1999 Jan;23(1):17-26. Review. PMID: 9888700
Favara BE, Feller AC, Pauli M, Jaffe ES, Weiss LM, Arico M, Bucsky P, Egeler RM, Elinder G, Gadner H, Gresik M, Henter JI, Imashuku S, Janka-Schaub G, Jaffe R, Ladisch S, Nezelof C, Pritchard J. Contemporary classification of histiocytic disorders. The WHO Committee On Histiocytic/Reticulum Cell Proliferations. Reclassification Working Group of the Histiocyte Society. Med Pediatr Oncol. 1997 Sep;29(3):157-66. PMID: 9212839