Langerhans cells are antigen presenting dendritic cells and tumours arising from these are rare. The tumours arising from these dendritic cells are divided into two categories according to a WHO classification: Langerhans cell histiocytosis and Langerhans cell sarcoma. It is the degree of atypia and clinical aggressiveness that distinguishes the two subtypes. Langerhans cell sarcoma (LCS) is a neoplastic proliferation of Langerhans cells which can occur in skin, bone marrow, lymph nodes, spleen, liver, and lung. LCS can present with multiple cutaneous and systemic lesions. We present a case of Langerhans cell sarcoma with a unique morphological appearance and variable immunohistochemical profile within a single cutaneous lesion. LCS is a rare malignancy and its diagnosis is based on morphology, immunophenotypical examination, and ultrastructural analysis by electron microscopy. Our case highlights a unique morphological description of LCS wherein the pleomorphic neoplastic cells show epidermotropism and are surrounded by a variable amount of inflammatory infiltrate within a single cutaneous lesion. A single cutaneous lesion of Langerhans cell sarcoma with variable immunohistochemical profile has not been described so far.
Background
The coronavirus disease 2019 (COVID-19) pandemic has had a disproportionate impact on the well-being of adolescents and young adults. Worldwide, eating disorder (ED) experts have observed worsening symptoms in youth with pre-existing EDs and an escalation in the number of new cases compared to prior years. Disruption of routine, work and school closures, as well as social isolation are potential contributing factors. The Canadian province of Ontario (specifically the most highly populated cities) experienced one of the most prolonged lock downs worldwide with approximately 20 weeks of face-to-face school closure and/or restriction to virtual learning.
Objectives
We sought to better understand the impact of COVID-19 on new pediatric ED presentations, patient characteristics and hospital admissions in a tertiary care Children’s Hospital.
Design/Methods
We completed a retrospective chart review of patients presenting for new ED assessments at a single centre pediatric ED program within a tertiary care children’s hospital between January 1st, 2015 and June 1st 2021. Patients aged 9-18 years old with a new diagnosis of Anorexia Nervosa (AN) restrictive type or binge/purge type or Other Specified Feeding and Eating Disorder (OSFED) - Atypical Anorexia Nervosa (AAN) were included. Demographic and clinical variables for pre and post pandemic were analyzed using Chi-Square and T-Tests. Interrupted time series regression was used to examine pre-pandemic and post-pandemic monthly summary data over time.
Results
Overall, 425 youth were newly diagnosed with AN or AAN (N=329 pre-pandemic, N=96 pandemic) during the study period (Jan 1 2015 – December 31 2020). Average age was 14.7 years (SD 1.8, range 8.1 – 17.9). Most youth were diagnosed with DSM-5 AN-restrictive type (65.6%). The number of new diagnoses of AN and AAN during the pandemic more than doubled when compared to pre-pandemic years. In the 5-year period preceding the pandemic, mean number of newly diagnosed cases was 5.1/month (ßcoeff=0.043, p=0.33), increasing to 10.6/month (p=<0.001) during the pandemic and demonstrating an upward trend coinciding with onset of lockdown measures (ßcoeff=5.95, p<0.001). At the time of initial assessment, more youth presented with medical instability and increased illness severity. Hospitalization increased from an average of 2.2/month to 6.3/month (ßcoeff -0.008 vs. 3.23, p<0.0001). Average heart rate also decreased from 58.6 bpm (SD 16.6) pre-pandemic to 53.3 bpm (SD 16.3), p<0.008.
Conclusion
With this study, we found a significant increase in both new diagnoses and admissions for medical instability for AN and AAN among youth at our institution during the COVID-19 pandemic. Our study contributes to the growing body of global evidence tracking the unanticipated surge of eating disorder diagnoses and severity in already under-resourced health systems. It is unclear how long the effects of the pandemic may last. Further research is required to better understand the illness trajectory and treatment outcomes of pandemic-triggered EDs in adolescents.
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