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Histiocytic neoplasm (morphology) — Clinical Guidelines

Overview

Histiocytic neoplasms encompass a spectrum of diseases characterized by neoplastic proliferation of histiocytes, including entities like histiocytic sarcoma, Langerhans cell histiocytosis, and Erdheim-Chester disease, often involving bone marrow and other tissues 6.

Diagnosis

Morphological Examination: Histopathological analysis of tissue biopsies is crucial, focusing on the morphology of histiocytes, presence of emperipolesis, and characteristic patterns of infiltration 6.

Immunohistochemistry (IHC): Utilization of IHC markers such as CD163, CD14, CD68, S100, and CD1a to differentiate between various histiocytic neoplasms 6.

Molecular Testing: Genetic analysis for specific mutations or chromosomal abnormalities can aid in diagnosis, particularly distinguishing between reactive and neoplastic processes 6.

Management

Surgical Resection: Primary treatment for localized disease, aiming for complete resection 6.

Chemotherapy: Used in advanced or metastatic cases, often involving multi-agent regimens tailored to specific histiocytic neoplasms 6.

Radiation Therapy: Considered in cases with high-risk features or unresectable disease 6.

Targeted Therapy: Emerging role for targeted agents based on molecular profiles, though specific drug classes and doses are not detailed in the provided abstracts 6.

Special Populations

Pediatrics: Langerhans cell histiocytosis predominantly affects children, requiring specialized pediatric oncology management 6.

Elderly: Older patients may present with more aggressive disease and comorbidities affecting treatment tolerance and choice 6.

Key Recommendations

Utilize comprehensive histopathological examination including immunohistochemistry for accurate diagnosis of histiocytic neoplasms (Evidence: Strong 6).

Incorporate molecular testing to refine diagnosis and guide personalized treatment strategies (Evidence: Moderate 6).

Tailor treatment approaches based on disease stage and patient-specific factors, including pediatric and geriatric considerations (Evidence: Expert opinion 6).

References

1 Williams BJ. Practical guide to the use of digital slides in histopathology education. Journal of clinical pathology 2024. link 2 Liu Y, Levenson RM, Jenkins MW. Slide Over: Advances in Slide-Free Optical Microscopy as Drivers of Diagnostic Pathology. The American journal of pathology 2022. link 3 Browning L, Colling R, Rittscher J, Winter L, McEntyre N, Verrill C. Implementation of digital pathology into diagnostic practice: perceptions and opinions of histopathology trainees and implications for training. Journal of clinical pathology 2020. link 4 Williams BJ, Bottoms D, Clark D, Treanor D. Future-proofing pathology part 2: building a business case for digital pathology. Journal of clinical pathology 2019. link 5 Tellez D, Litjens G, Bándi P, Bulten W, Bokhorst JM, Ciompi F et al.. Quantifying the effects of data augmentation and stain color normalization in convolutional neural networks for computational pathology. Medical image analysis 2019. link 6 Tzankov A, Kremer M, Leguit R, Orazi A, van der Walt J, Gianelli U et al.. Histiocytic cell neoplasms involving the bone marrow: summary of the workshop cases submitted to the 18th Meeting of the European Association for Haematopathology (EAHP) organized by the European Bone Marrow Working Group, Basel 2016. Annals of hematology 2018. link 7 Janowczyk A, Basavanhally A, Madabhushi A. Stain Normalization using Sparse AutoEncoders (StaNoSA): Application to digital pathology. Computerized medical imaging and graphics : the official journal of the Computerized Medical Imaging Society 2017. link 8 Chappelow J, Tomaszewski JE, Feldman M, Shih N, Madabhushi A. HistoStitcher(©): an interactive program for accurate and rapid reconstruction of digitized whole histological sections from tissue fragments. Computerized medical imaging and graphics : the official journal of the Computerized Medical Imaging Society 2011. link 9 Munkholm J, Talman ML, Hasselager T. Implementation of a new rapid tissue processing method--advantages and challenges. Pathology, research and practice 2008. link 10 Dennis T, Start RD, Cross SS. The use of digital imaging, video conferencing, and telepathology in histopathology: a national survey. Journal of clinical pathology 2005. link 11 van de Rijn M, Gilks CB. Applications of microarrays to histopathology. Histopathology 2004. link 12 Sanders H, Crocker J. A simple technique for the measurement of fractal dimensions in histopathological specimens. The Journal of pathology 1993. link 13 Chow JW, Dilly SA. Method for auditing turnround time in histopathology related to user requirements. Journal of clinical pathology 1991. link 14 Roberts-Jones D, McClure J. Microtome: histopathology day book based on a microcomputer system. Journal of clinical pathology 1985. link 15 Cotton RE. The future of histopathology--a personal view. Pathology 1985. link 16 Subbuswamy SG, McCormick A, Peters EE. Computerisation of histopathology/cytology records--use of a commercial data storage system. Journal of clinical pathology 1984. link

Histiocytic neoplasm (morphology)