HAEM5:Juvenile xanthogranuloma: Difference between revisions
| [pending revision] | [pending revision] |
mNo edit summary |
Bailey.Glen (talk | contribs) No edit summary |
||
| (3 intermediate revisions by 2 users not shown) | |||
| Line 1: | Line 1: | ||
{{DISPLAYTITLE:Juvenile xanthogranuloma}} | {{DISPLAYTITLE:Juvenile xanthogranuloma}} | ||
[[HAEM5:Table_of_Contents|Haematolymphoid Tumours (WHO Classification, 5th ed.)]] | |||
{{Under Construction}} | {{Under Construction}} | ||
| Line 12: | Line 11: | ||
<span style="color:#0070C0">Scott Turner, PhD </span> | <span style="color:#0070C0">Scott Turner, PhD </span> | ||
==WHO Classification of Disease== | ==WHO Classification of Disease== | ||
| Line 43: | Line 39: | ||
==Synonyms / Terminology== | ==Synonyms / Terminology== | ||
Juvenile | Juvenile Xanthogranuloma <span style="color:#0070C0">(''Instructions: Include currently used terms and major historical ones, adding “(historical)” after the latter.'') </span> | ||
==Epidemiology / Prevalence== | ==Epidemiology / Prevalence== | ||
| Line 122: | Line 118: | ||
|Unknown | |Unknown | ||
|Unknown | |Unknown | ||
|Often associated with localized xanthogranuloma [3] | |Often associated with localized xanthogranuloma [3] | ||
|- | |- | ||
|BRAF fusions | |BRAF fusions | ||
| Line 135: | Line 131: | ||
|Unknown | |Unknown | ||
|Unknown | |Unknown | ||
|Disseminated JXG with ''GAB2::BRAF'' fusion showed favorable response to treatment with Trametinib (MEK1/2 inhibitor). [5]. | |||
|Disseminated JXG with ''GAB2::BRAF'' fusion | |BRAF gene fusions are more often seen in adult and Juvenile JXG as compared with other histiocytic disorders. [10] | ||
|- | |- | ||
|RET fusions | |RET fusions | ||
| | |NCOA4–RET rearrangement | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Treatment with RET inhibitor Selpercatinib showed dramatic resolution of disfiguring skin lesions. [11] | ||
| | |Disseminated cutaneous–xanthogranuloma [11] | ||
|- | |- | ||
|SYK fusions | |||
|CLTC::SYK fusions | |CLTC::SYK fusions | ||
| | |||
| | -exon 5 or intron 5 of SYK that lead to fusion of CLTC exon 31 to SYK exon 6 | ||
| | |||
| | ETV6::SYK fusion | ||
| | |Unknown | ||
| | |Unknown | ||
|Unknown | |||
|Unknown | |||
|May respond to oral SYK inhibitors-fostamatinib and entospletinib [12] | |||
|Lacks or shows rare touton giant cells [12] IHC staining shows strong positivity for p-SYK, positive for cyclin D1 and p-S6. p-Akt negative. [12] | |||
Children between 2months and 2 years of age with soft tissue involvement and no or limited cutaneous involvement. [12] | |||
|- | |- | ||
|ALK fusions/rearrangements | |ALK fusions/rearrangements | ||
|KIF5B–ALK | |KIF5B–ALK | ||
TPM3–ALK | TPM3–ALK | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
| | |A pediatric patient with systemic JXG, CNS lesions and KIF5B-ALK fusion achieved clinical improvement with ALK-inhibitor Alectinib therapy. [7] | ||
|A unique group of infants with an aggressive form of JXG with spleen, liver, and bone | |A unique group of infants with an aggressive form of JXG with spleen, liver, and bone marrow showed infiltration with histiocytes with activating ALK fusions. [8] KIF5B–ALK seen in systemic JXG with CNS involvement. [7] child with JXG of soft tissue | ||
|- | |||
marrow showed infiltration with histiocytes with activating ALK fusions | |''MRC1-PDGFRB'' fusion | ||
|t(5;10)(q32; p12.33) translocation | |||
|in-frame ''MRC1-PDGFRB'' gene fusion | |||
Can be seen with large deletion of exons 21 and 22 [12] | |||
|Unknown | |||
|Unknown | |||
|Unknown | |||
|Targeted therapy of treatment resistant systemic JXG with Dasatinib showed a steady and dramatic clinical response with a reduction in the size of the primary tumor. [9] | |||
|JXG case showing large deletion of CSF1R exons 21 and 22 and MRC1::PDGFRB fusion was a 3 month old female with large intra-abdominal tumor involving greater omentum, intestinal walls and liver hilum. Achieved complete remission without relapse during 24 years of follow up. [12] IHC staining showed diffuse expression of cyclin D1 in tumor cells.[9] . Child with chemotherapy-refractory left chest wall JXG, MRC1::PDGFRB fusion was treated with dasatinib. [12] | |||
|- | |- | ||
| | |TBL1XR1::BOD1L1 fusion (and reciprocal BOD1L1::ABHD10) | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unifocal soft tissue JXG in the nasopharynx [12] | ||
|} | |} | ||
| Line 224: | Line 233: | ||
Common recurrent secondary finding for t(8;21) (add reference). | Common recurrent secondary finding for t(8;21) (add reference). | ||
|- | |- | ||
| | |17 | ||
| | |Gain | ||
|Unknown | |Unknown | ||
|Unknown | |Unknown | ||
| Line 242: | Line 242: | ||
|Diffuse cutaneous juvenile xanthogranuloma [2] | |Diffuse cutaneous juvenile xanthogranuloma [2] | ||
|- | |- | ||
| | |5 | ||
|Gain, Heterozygosity | |||
|Unknown | |Unknown | ||
|Unknown | |Unknown | ||
| Line 248: | Line 249: | ||
|Unknown | |Unknown | ||
|Unknown | |Unknown | ||
| | |Trisomy 5 and 5q heterozygosity in diffuse cutaneous juvenile xanthogranuloma [2] | ||
|- | |- | ||
|Loss | |3 | ||
|Loss | |||
|Unknown | |Unknown | ||
|Unknown | |Unknown | ||
| Line 257: | Line 258: | ||
|Unknown | |Unknown | ||
|Unknown | |Unknown | ||
| | |3p deletion in systemic juvenile xanthogranuloma [2] | ||
|} | |} | ||
==Characteristic Chromosomal Patterns== | ==Characteristic Chromosomal Patterns== | ||
| Line 281: | Line 281: | ||
See chromosomal rearrangements table as this pattern is due to an unbalanced derivative translocation associated with oligodendroglioma (add reference). | See chromosomal rearrangements table as this pattern is due to an unbalanced derivative translocation associated with oligodendroglioma (add reference). | ||
|- | |||
|Gains on 1q and 11q | |||
|Unknown | |||
|Unknown | |||
|Unknown | |||
|Gains on 1q and 11q in systemic juvenile xanthogranuloma [2] | |||
|} | |} | ||
==Gene Mutations (SNV / INDEL)== | ==Gene Mutations (SNV / INDEL)== | ||
| Line 288: | Line 294: | ||
{| class="wikitable sortable" | {| class="wikitable sortable" | ||
|- | |- | ||
!Gene; Genetic Alteration!! | !Gene; Genetic Alteration!!Presumed Mechanism (Tumor Suppressor Gene [TSG] / Oncogene / Other)!!Prevalence (COSMIC / TCGA / Other)!!Concomitant Mutations!!Mutually Exclusive Mutations | ||
! | !Diagnostic Significance (Yes, No or Unknown) | ||
!Prognostic Significance (Yes, No or Unknown) | !Prognostic Significance (Yes, No or Unknown) | ||
!Therapeutic Significance (Yes, No or Unknown) | !Therapeutic Significance (Yes, No or Unknown) | ||
| Line 315: | Line 321: | ||
|MAP2K1 | |MAP2K1 | ||
|p.T28I, p.L37P,p.E129Q, p.Y130C | |p.T28I, p.L37P,p.E129Q, p.Y130C | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
| | |May respond to targeted treatment with (MEK) inhibitors. [5] | ||
|Systemic juvenile xanthogranuloma [4] | |Systemic juvenile xanthogranuloma [4] | ||
<br /> | |||
|- | |- | ||
|CSF1R mutations | |CSF1R mutations | ||
|Kinase driver mutations | |Kinase driver mutations | ||
| | -Deletion in exon 12 | ||
| | |||
| | -multiple missense mutations in exons 9 and 10 | ||
| | |||
| | -large deletion of exons 21 and 22 | ||
| | |||
|Children less than 2years of age with soft tissue involvement | -Alternative CSF1R mutations in exons 9 and 10 | ||
[4] | |||
-Missense mutations in exon 10 | |||
[12] | |||
|Unknown | |||
|Unknown | |||
|Unknown | |||
|Unknown | |||
|Unknown | |||
|CSF-1R-specific small-molecule inhibitors Pexidartinib and BLZ945 is being studied. [11] | |||
| -Exon 10 mutations affect the extracellular region of CSF-1R and might enhance receptor dimerization. [12] | |||
-Large deletion of CSF1R exons 21 and 22 affects the intracellular c-CBL binding domain leading to defective receptor ubiquitination, and degradation [12] | |||
Children less than 2years of age with soft tissue involvement | |||
[4] [12] | |||
|- | |- | ||
|PIK3CA mutations | |PIK3CA mutations | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
|[4] | |[4] | ||
|- | |- | ||
|NF1 | |NF1 | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
| | | | ||
|- | |- | ||
|KRAS | |KRAS | ||
|p.G12D | |p.G12D | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
|[4] | |[4] | ||
|- | |- | ||
|NRAS | |NRAS | ||
|p.Q61R | |p.Q61R | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
|[4] | |[4] | ||
|- | |- | ||
|ARAF | |ARAF | ||
|p.N217K or p.F351L | |p.N217K or p.F351L | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
|[4] | |[4] | ||
|- | |- | ||
|''BRAF'' V600E mutation | |''BRAF'' V600E mutation | ||
|Proto-oncogene | |Proto-oncogene | ||
| | |Unknown | ||
| | |Unknown | ||
| | |Unknown | ||
|Yes, | |Yes, | ||
Might represent pediatric Erdheim–Chester disease. | Might represent pediatric Erdheim–Chester disease. | ||
| Line 413: | Line 434: | ||
|''NRAS'', ''KRAS'', ''ARAF'', ''MAP2K1'', and ''CSF1R, NTRK1 and BRAF gene fusions'' | |''NRAS'', ''KRAS'', ''ARAF'', ''MAP2K1'', and ''CSF1R, NTRK1 and BRAF gene fusions'' | ||
|MAPK/ERK pathway alterations | |MAPK/ERK pathway alterations | ||
| | |Increased cell growth, proliferation, differentiation, apoptosis and stress responses | ||
|- | |- | ||
|''PIK3CD'' mutations | |''PIK3CD'' mutations | ||
|PI3K pathway | |PI3K pathway | ||
| | |Unregulated cell survival, growth, and proliferation | ||
|} | |} | ||
==Genetic Diagnostic Testing Methods== | ==Genetic Diagnostic Testing Methods== | ||
| Line 450: | Line 467: | ||
#Kai-ni Shen, He Lin, Long Chang, Xin-xin Cao, Disseminated juvenile xanthogranuloma harbouring a ''GAB2::BRAF'' fusion successfully treated with trametinib: a case report, ''British Journal of Dermatology'', Volume 192, Issue 1, January 2025, Pages 169–171, <nowiki>https://doi.org/10.1093/bjd/ljae328</nowiki> | #Kai-ni Shen, He Lin, Long Chang, Xin-xin Cao, Disseminated juvenile xanthogranuloma harbouring a ''GAB2::BRAF'' fusion successfully treated with trametinib: a case report, ''British Journal of Dermatology'', Volume 192, Issue 1, January 2025, Pages 169–171, <nowiki>https://doi.org/10.1093/bjd/ljae328</nowiki> | ||
#Picarsic J, Pysher T, Zhou H, Fluchel M, Pettit T, Whitehead M, Surrey LF, Harding B, Goldstein G, Fellig Y, Weintraub M, Mobley BC, Sharples PM, Sulis ML, Diamond EL, Jaffe R, Shekdar K, Santi M. BRAF V600E mutation in Juvenile Xanthogranuloma family neoplasms of the central nervous system (CNS-JXG): a revised diagnostic algorithm to include pediatric Erdheim-Chester disease. Acta Neuropathol Commun. 2019 Nov 4;7(1):168. doi: 10.1186/s40478-019-0811-6. PMID: 31685033; PMCID: PMC6827236. | #Picarsic J, Pysher T, Zhou H, Fluchel M, Pettit T, Whitehead M, Surrey LF, Harding B, Goldstein G, Fellig Y, Weintraub M, Mobley BC, Sharples PM, Sulis ML, Diamond EL, Jaffe R, Shekdar K, Santi M. BRAF V600E mutation in Juvenile Xanthogranuloma family neoplasms of the central nervous system (CNS-JXG): a revised diagnostic algorithm to include pediatric Erdheim-Chester disease. Acta Neuropathol Commun. 2019 Nov 4;7(1):168. doi: 10.1186/s40478-019-0811-6. PMID: 31685033; PMCID: PMC6827236. | ||
#Sugiyama M, Hirabayashi S, Ishi Y, et al. Notable therapeutic response in a patient with systemic juvenile xanthogranuloma with KIF5B‐ALK fusion. ''Pediatric blood & cancer''. 2021;68(11):e29227-n/a. doi:10.1002/pbc.29227 | |||
#McClain KL, Bigenwald C, Collin M, et al. Histiocytic disorders. ''Nature reviews Disease primers''. 2021;7(1):73-73. doi:10.1038/s41572-021-00307-9 | #McClain KL, Bigenwald C, Collin M, et al. Histiocytic disorders. ''Nature reviews Disease primers''. 2021;7(1):73-73. doi:10.1038/s41572-021-00307-9 | ||
#Eissa SS, Clay MR, Santiago T, Wu G, Wang L, Shulkin BL, Picarsic J, Nichols KE, Campbell PK. Dasatinib induces a dramatic response in a child with refractory juvenile xanthogranuloma with a novel MRC1-PDGFRB fusion. Blood Adv. 2020 Jul 14;4(13):2991-2995. doi: 10.1182/bloodadvances.2020001890. PMID: 32609843; PMCID: PMC7362356. | |||
#Zanwar S, Abeykoon JP, Acosta-Medina AA, et al. BRAF Fusions in Histiocytic Disorders: Frequency and Clinical Characteristics. ''Blood''. 2021;138(Supplement 1):2582-2582. doi:10.1182/blood-2021-149802 | |||
#Durham BH, Lopez Rodrigo E, Picarsic J, et al. Activating mutations in CSF1R and additional receptor tyrosine kinases in histiocytic neoplasms. ''Nature medicine''. 2019;25(12):1839-1842. doi:10.1038/s41591-019-0653-6 | |||
#Paul G. Kemps, Hans J. Baelde, Ruben H. P. Vorderman, Ellen Stelloo, Joost F. Swennenhuis, Karoly Szuhai, Meindert H. Lamers, Boyd Kenkhuis, Maysa Al-Hussaini, Inge H. Briaire-de Bruijn, Suk Wai Lam, Judith V. M. G. Bovée, Arjen H. G. Cleven, Robert M. Verdijk, Carel J. M. van Noesel, Marijke R. van Dijk, Marijn A. Scheijde-Vermeulen, Annette H. Bruggink, Jan A. M. van Laar, Andrica C. H. de Vries, Wim J. E. Tissing, Cor van den Bos, Andreas von Deimling, Tom van Wezel, Astrid G. S. van Halteren, Pancras C. W. Hogendoorn, Recurrent CLTC::SYK fusions and CSF1R mutations in juvenile xanthogranuloma of soft tissue, Blood, Volume 144, Issue 23, 2024, Pages 2439-2455, ISSN 0006-4971, <nowiki>https://doi.org/10.1182/blood.2024025127</nowiki>. | |||
==Notes== | ==Notes== | ||