Bone Langerhans cell histiocytosis with pulmonary involvement in an adult non-smoker: A case report and brief review of the literature

Abstract

Abstract. Langerhans cell histiocytosis (LCH) is a rare disease of unknown cause, which encompasses a set of disorders of multiple organs with various clinical presentations that share the common characteristic of sizeable Langerhans cell infiltration. The clinical spectrum of LCH ranges from solitary bone lesions to involvement of other organs. Lung involvement in LCH may be part of a multisystem disease, which almost exclusively occurs in adult smokers, while it is overlooked or misdiagnosed in the majority of non-smokers. High-resolution computed tomography (HRCT) of the chest is crucial for diagnosis; however, the treatment and prognosis of this disease have not been clearly determined. We herein present the case of a non-smoking adult patient who presented with lower limb pain and was diagnosed via biopsy with LCH with multisystem involvement, including the bone and lungs. Lytic lesions in the corpus of the sacroiliac joint, sacrum, acetabulum and femoral head by a soft tissue mass were observed on diagnostic CT. In addition, chest HRCT revealed multiple cysts in the bilateral lungs, predominantly in the upper lobes. The final diagnosis of LCH was confirmed by histopathological examination and immunohistochemical staining for CD1a and S-100. Corticosteroid treatment alleviated lower limb pain and improved the patient's quality of life; thus, corticosteroids may be considered as a potential treatment option for patients with LCH. IntroductionLangerhans cell histiocytosis (LCH) is a rare disease of unknown etiology characterized by mixed cellular infiltration. Although the etiology of LCH has not been fully elucidated, the gold standard for the diagnosis of LCH is the presence of Birbeck granules, and positivity for CD1a, S-100 and/or CD45 on pathological examination (1,2). LCH may occur at any age, although it is more common in children, and has various clinical manifestations, depending on the type and number of systems or organs involved throughout the body (3).Specific acute symptoms may include local pain, weight loss, fatigue, fever, skin rash and neurological changes, while the bone and lung are the most commonly involved organs (4). It has been reported that the proportion of LCH with lung involvement in adults is higher compared with that in children (4). Furthermore, the disease is self-limited in the majority of pediatric patients, which is not the case in adults. A variety of factors have been implicated in the prognosis of LCH, such as patient age and extent of the disease. Several therapeutic approaches may be considered, including surgery, radiotherapy and chemotherapy; however, there is currently no standard treatment for LCH patients with multisystem involvement (MS-LCH). Case reportA 38-year-old male patient with a 2-year history of left leg pain, involving numbness extending from the left thigh to the knee, was referred to Nanjing Chest Hospital, Medical School of Southeast University. The pain and numbness in the left thigh were aggravated by exertion, such as walking or running, and they ...

Cystic Lung Disease in an Adult Non-Smoker

“…pLCH has an association with smoking in 95% of patients. However, it has been reported in non-smokers also [2,3]. Our patient had never smoked tobacco or marijuana.…”

Langerhans Cell Histiocytosis in an Adult Female with Multisystem Involvement

“…63,66 Few have reported even in non-smokers. 67,68 Nodular pattern is predominant in the initial phase of pulmonary LCH, whereas the cystic pattern is typically predominant in the later phase. 63,69 Pulmonary LCH transforms from a cellular nodule to a cavitary nodule and finally into a cyst as the course of the disease progresses.…”

Langerhans cell histiocytosis: A case report with oral manifestations and the role of pediatric dentists in the diagnosis

“…The combination of the rarity of the disease (it affects fewer than five people per million), the diversity of its clinical manifestations, and the need for histopathological diagnosis lead to difficulty in diagnosis . The histiocytes may infiltrate and damage single or multiple organs particularly bones . LCH occurs most commonly in the head and neck region, and when jaws and gingiva are affected, the patients may have nonspecific symptoms and signs such as gingival necrosis and hypermobility of the teeth (floating teeth) that may lead to misdiagnosis .…”

“…[1][2][3][5][6][7] The histiocytes may infiltrate and damage single or multiple organs particularly bones. [8][9][10][11][12] LCH occurs most commonly in the head and neck region, and when jaws and gingiva are affected, the patients may have nonspecific symptoms and signs such as gingival necrosis and hypermobility of the teeth (floating teeth) that may lead to misdiagnosis. 4,7,[13][14][15][16][17] This article discusses the oral manifestations of LCH, radiological findings, histological features, review of literature, and the role of dentists in the diagnosis.…”