Difference between revisions of "Hemophagocytic syndrome"

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{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Hemophagocytic_syndrome_-_cropped_-_very_high_mag.jpg
| Width      =
| Caption    = Micrograph showing phagocytosed RBCs in hemophagocytic syndrome. [[H&E stain]].
| Synonyms  =
| Micro      = macrophages containing erythrocytes (red blood cells), leukocytes, platelets
| Subtypes  = primary, secondary
| LMDDx      = overlapping cells, [[emperipolesis]]
| Stains    =
| IHC        =
| EM        =
| Molecular  = FHL1 mutation or FHL2 mutation in primary form
| IF        =
| Gross      =
| Grossing  =
| Site      = [[lymph nodes]], [[liver]], [[spleen]], [[bone marrow]], others
| Assdx      = only in ''secondary'' form (EBV infection, malignancy, rheumatologic disease)
| Syndromes  =
| Clinicalhx = +/-consanguinity for ''primary'' form (autosomal recessive)
| Signs      = fever, [[splenomegaly]], jaundice
| Symptoms  =
| Prevalence = rare
| Bloodwork  = +/-EBV serology (secondary form), +/-HIV serology (secondary form)
| Rads      =
| Endoscopy  =
| Prognosis  = dependent on underlying cause
| Other      =
| ClinDDx    = malignancy
| Tx        = dependent on underlying cause
}}
'''Hemophagocytic syndrome''', also known as '''hemophagocytic lymphohistiocytosis''', is a rare condition often associated with viral infections.
'''Hemophagocytic syndrome''', also known as '''hemophagocytic lymphohistiocytosis''', is a rare condition often associated with viral infections.


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*[[Splenomegaly]].
*[[Splenomegaly]].
*Jaundice.
*Jaundice.
Involved organs:
*[[Lymph nodes]].
*[[Liver]].
*[[Spleen]].
*[[Bone marrow]].


==Classification==
==Classification==
Classified by etiology:<ref name=pmid20383897>{{cite journal |author=Gupta S, Weitzman S |title=Primary and secondary hemophagocytic lymphohistiocytosis: clinical features, pathogenesis and therapy |journal=Expert Rev Clin Immunol |volume=6 |issue=1 |pages=137–54 |year=2010 |month=January |pmid=20383897 |doi= |url=}}</ref>
Classified by etiology:<ref name=pmid20383897>{{cite journal |author=Gupta S, Weitzman S |title=Primary and secondary hemophagocytic lymphohistiocytosis: clinical features, pathogenesis and therapy |journal=Expert Rev Clin Immunol |volume=6 |issue=1 |pages=137–54 |year=2010 |month=January |pmid=20383897 |doi= |url=}}</ref>
#Primary, i.e. inherited.
#Primary, i.e. inherited:<ref name=pmid21152410>{{cite journal |author=Nagai K, Yamamoto K, Fujiwara H, ''et al.'' |title=Subtypes of familial hemophagocytic lymphohistiocytosis in Japan based on genetic and functional analyses of cytotoxic T lymphocytes |journal=PLoS ONE |volume=5 |issue=11 |pages=e14173 |year=2010 |pmid=21152410 |pmc=2994802 |doi=10.1371/journal.pone.0014173 |url=}}</ref>
#*Etiology: dysfunction of cytotoxic T lymphocytes with macrophage activating cytokines.
#*Autosomal recessive.
#*Two genes identified:
#**FHL1.<ref>{{OMIM|603552}}</ref>
#**FHL2.<ref>{{OMIM|603553}}</ref>
#Secondary:
#Secondary:
#*Infection, e.g. EBV, HIV.  
#*Infection, e.g. [[EBV]] (most common infectious etiology<ref>{{Ref WMSP|576}}</ref>),<ref name=pmid20819601>{{cite journal |author=Jin YK, Xie ZD, Yang S, Lu G, Shen KL |title=Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis: a retrospective study of 78 pediatric cases in mainland of China |journal=Chin. Med. J. |volume=123 |issue=11 |pages=1426–30 |year=2010 |month=June |pmid=20819601 |doi= |url=}}</ref> [[HIV]].  
#*Malignancy.  
#*Malignancy.  
#*Rheumatologic condition.
#*Rheumatologic condition.
Line 18: Line 60:
Features:<ref name=pmid11076718/>
Features:<ref name=pmid11076718/>
*Macrophages with phagocytosed:
*Macrophages with phagocytosed:
**Erythrocytes.
**[[Erythrocyte]]s.
**Leukocytes.
**Leukocytes.
**Platelets.
**Platelets.


Image(s): [http://en.wikipedia.org/wiki/File:Haemophagocytic_lymphohistiocytosis_Bone_marrow.JPG HLH (WC)].
DDx:
*Overlapping cells (red blood cells overlapping macrophages).
*[[Emperipolesis]] in the context of other pathology.
 
===Images===
<gallery>
Image:Hemophagocytic_syndrome_-_cropped_-_very_high_mag.jpg | Hemophagocytic syndrome - cropped - very high mag. (WC)
Image:Hemophagocytic_syndrome_-_very_high_mag.jpg | Hemophagocytic syndrome - very high mag. (WC)
Image:Haemophagocytic_lymphohistiocytosis_Bone_marrow.JPG | HLH (WC)
</gallery>
www:
*[http://path.upmc.edu/cases/case601.html Hemophagocytic syndrome - several images (upmc.edu)].


==See also==
==See also==
*[[Hematopathology]].
*[[Hematopathology]].
*[[Myospherulosis]].
*[[Emperipolesis]].


==References==
==References==
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[[Category:Haematopathology]]
[[Category:Haematopathology]]
[[Category:Diagnosis]]

Latest revision as of 00:50, 16 July 2015

Hemophagocytic syndrome
Diagnosis in short

Micrograph showing phagocytosed RBCs in hemophagocytic syndrome. H&E stain.
LM macrophages containing erythrocytes (red blood cells), leukocytes, platelets
Subtypes primary, secondary
LM DDx overlapping cells, emperipolesis
Molecular FHL1 mutation or FHL2 mutation in primary form
Site lymph nodes, liver, spleen, bone marrow, others
Associated Dx only in secondary form (EBV infection, malignancy, rheumatologic disease)
Clinical history +/-consanguinity for primary form (autosomal recessive)
Signs fever, splenomegaly, jaundice
Prevalence rare
Blood work +/-EBV serology (secondary form), +/-HIV serology (secondary form)
Prognosis dependent on underlying cause
Clin. DDx malignancy
Treatment dependent on underlying cause

Hemophagocytic syndrome, also known as hemophagocytic lymphohistiocytosis, is a rare condition often associated with viral infections.

Clinical

Features:[1]

Involved organs:

Classification

Classified by etiology:[2]

  1. Primary, i.e. inherited:[3]
    • Etiology: dysfunction of cytotoxic T lymphocytes with macrophage activating cytokines.
    • Autosomal recessive.
    • Two genes identified:
  2. Secondary:
    • Infection, e.g. EBV (most common infectious etiology[6]),[7] HIV.
    • Malignancy.
    • Rheumatologic condition.

Microscopic

Features:[1]

  • Macrophages with phagocytosed:

DDx:

  • Overlapping cells (red blood cells overlapping macrophages).
  • Emperipolesis in the context of other pathology.

Images

  • Hemophagocytic syndrome - cropped - very high mag. (WC)

  • Hemophagocytic syndrome - very high mag. (WC)

  • HLH (WC)

www:

See also

References

  1. ↑ 1.0 1.1 Fisman DN (2000). "Hemophagocytic syndromes and infection". Emerging Infect. Dis. 6 (6): 601–8. PMC 2640913. PMID 11076718. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2640913/?tool=pubmed.
  2. ↑ Gupta S, Weitzman S (January 2010). "Primary and secondary hemophagocytic lymphohistiocytosis: clinical features, pathogenesis and therapy". Expert Rev Clin Immunol 6 (1): 137–54. PMID 20383897.
  3. ↑ Nagai K, Yamamoto K, Fujiwara H, et al. (2010). "Subtypes of familial hemophagocytic lymphohistiocytosis in Japan based on genetic and functional analyses of cytotoxic T lymphocytes". PLoS ONE 5 (11): e14173. doi:10.1371/journal.pone.0014173. PMC 2994802. PMID 21152410. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2994802/.
  4. ↑ Online 'Mendelian Inheritance in Man' (OMIM) 603552
  5. ↑ Online 'Mendelian Inheritance in Man' (OMIM) 603553
  6. ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 576. ISBN 978-0781765275.
  7. ↑ Jin YK, Xie ZD, Yang S, Lu G, Shen KL (June 2010). "Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis: a retrospective study of 78 pediatric cases in mainland of China". Chin. Med. J. 123 (11): 1426–30. PMID 20819601.
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