背景:Erdheim-Chester病(ECD)是一种罕见的组织细胞疾病,其特征是多系统黄色肉芽肿性浸润被脂质负载的组织细胞。我们报告了两例涉及眼眶的ECD病例,并描述了其临床病理因素,治疗,和预后。一例是罕见的ECD并发原发性血小板增多症。
方法:本研究描述了两名双侧眼眶ECD患者。均表现为眼球突出和视力丧失;影像学发现显示双侧眶内肿块。两者均有不同程度的全身症状(胸腔积液,心包积液,腹水,和心力衰竭)之前出现眼部症状,并且在眼科肿瘤切除和病理活检之前未找到原因。经病理活检和检测BRAFV600E突变后确诊为ECD。患者2还患有原发性血小板增多症并且具有CALR突变以及BRAFV600E突变。建议两名患者接受靶向治疗。患者1出于经济原因拒绝靶向治疗,仅在局部放疗后出院。患者的两只眼睛都没有光感知,全身症状也没有改善。患者2在诊断后开始靶向治疗,2周后达到出院标准。他目前情况良好,但不幸的是,由于他的视觉功能受到不可逆转的损害,他的视力没有改善。
结论:ECD罕见且临床表现多样,易误诊和漏诊。轨道受累在ECD中很常见,手术是最常用的方法。尽管手术切除并不能治愈,其意义在于活检以建立诊断和/或手术减积以减轻肿块效应,尽量减少视觉功能的进一步损害。靶向治疗是BRAF突变基因阳性患者最有效的治疗方法。在启动难治性ECD的靶向治疗之前,评估伴随的骨髓性肿瘤也至关重要。
BACKGROUND: Erdheim-Chester disease (
ECD) is a rare histiocytic disorder characterized by multisystem xanthogranulomatous infiltration by lipid-laden histiocytes. We report two cases of
ECD involving the orbit and describe their clinicopathologic factors, treatments, and prognosis. One was a rare case of
ECD complicated with primary thrombocytosis.
METHODS: This study describes two patients with bilateral orbital
ECD. Both presented with proptosis and visual loss; imaging findings showed bilateral intraorbital masses. Both had different degrees of systemic symptoms (pleural effusion, pericardial effusion, ascites, and heart failure) before the ocular symptoms and did not find the cause before ophthalmic tumor resection and pathological biopsy. The diagnosis of ECD was confirmed after pathological biopsy and detection of BRAFV600E mutation. Patient 2 also with primary thrombocytosis and had a CALR mutation as well as the BRAFV600E mutation. Both patients were recommended to receive targeted therapy. Patient 1 refused targeted therapy for financial reasons and was discharged after local radiotherapy only. The patient had no light perception in either eye and no improvement in systemic symptoms. Patient 2 began targeted treatment after diagnosis and reached the discharge criteria 2 weeks later. He is in good condition at present, but unfortunately, his eyesight has not improved because of the irreversible damage to his visual function.
CONCLUSIONS: ECD is easily misdiagnosed and missed because of its rarity and diverse clinical manifestations. Orbital involvement is common in
ECD, and surgery is the most frequently employed approach. Despite the surgical resection is not curative, its significance lies in biopsy to establish diagnosis and/or surgical debulking to relieve mass effect, minimizing further impairment of visual function. Targeted therapy is the most effective treatment for patients with a positive BRAF mutation gene. Evaluation of a concomitant myeloid neoplasm is also critical before initiating targeted therapies for refractory ECD.