Langerhans cell histiocytosis in the adult lumbar spine: case report

Abstract

IntroductionLangerhans cell histiocytosis (LCH) occurs rarely in the spine of adults. The radiological findings usually resemble vertebral tumors. Etiology of LCH has not been clearly established yet. Therapeutic approaches are still controversial. We describe a case of LCH in an adult spine.Case descriptionA patient who presented with low back pain had an osteolytic lesion in the L1 vertebral body without neurological deficits, and fluoroscopy-guided needle biopsy of the L1 vertebral body was performed. The immunohistochemical diagnosis confirmed LCH. The patient was successfully treated with conservative methods.DiscussionThe choice of appropriate therapy is very important, with treatment options varying from watch-and to aggressive treatment.ConclusionLCH is considered as a pediatric disease that is extremely rare in the spine of adults and should be include in the differential diagnosis of osteolytic vertebral lesions. Conservative treatment is best choice for a patient with LCH without neurological deficit or spinal instability.

Langerhans cell histiocytosis at L5 vertebra treated with en bloc vertebral resection: a case report

“…Reportedly, only 4.1% of LCH osseous lesions occur in the lumbar spine [ 3 ], and involvement of spinal canal, nerve root or, paravertebral tissue is extremely rare [ 6 ]. In literature, no more than 10 cases of lumbar LCH were reported [ 5 , 7 – 12 ], and four of them were treated with partial or complete surgical excision [ 8 , 9 , 11 , 12 ]. In the present case, the intolerable neurological pain, indefinite diagnosis, and suspicious vertebral metastasis reported in biopsy led to a radical surgery to remove the lesion.…”

“…While there is no consensus on the management of LCH, a number of approaches, including surgery, chemotherapy, radiotherapy, glucocorticoid, monoclonal antibody, and even nonsteroidal anti-inflammatory drugs (NSAIDS), were used to treat LCH [ 5 , 11 , 18 , 19 ]. For skeletal LCH, surgery should be considered if there is neurological involvement or histological diagnosis was not confident in biopsy [ 20 – 22 ].…”

“…Typically, skull and femur are the most common bones involved. In rare case, osseous lesions occur in the spine, resulting in back pain, radiculopathy, or neurological deficits [ 5 ]. For spinal LCH, a standard treatment protocol is currently absent.…”

Spinal Langerhans cell histiocytosis with cord compression and neurological deficits: A case report

“…Low back pain was the only presentation in other cases, and a wide variation of neurological deficits (e.g., sensory, motor, bowel, or bladder dysfunction) was described in several reported cases [ 2 , 5 , 6 , 9 ]. The treatment and prognosis also vary among the cases [ 10 ].…”

Langerhans cell histiocytosis: unusual dorsal spine localization in an adult male

“…Langerhans cell histiocytosis (LCH) is a rare proliferative disease characterized by infiltration of a single or multiple organs by dendritic cells that resemble the normal epidermal Langerhans cells. 1 LCH includes a broad spectrum of pathological conditions ranging from the solitary well-treatable eosinophilic granuloma to the disseminated life-threatening variety known as Letterer-Siwe disease. 2–9 Although LCH is considered a pediatric disease, several cases have been reported in the adult population.…”