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Bashir HH, Aziz HF, Saeed F, Bari ME, Uddin N. Solitary Skull Langerhans Cell Histiocytosis Presenting With a Pus Draining Fistula: An Unusual Presentation and Review of Literature. Brain Tumor Res Treat 2024; 12:109-114. [PMID: 38742259 PMCID: PMC11096636 DOI: 10.14791/btrt.2023.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/17/2024] [Accepted: 02/15/2024] [Indexed: 05/16/2024] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare condition in adults, especially when it is limited to a single area of the skull, known as solitary calvarial involvement. In this case report, we present a unique instance of LCH affecting the parietal bone with a pus-draining fistula. This is a rare and unusual presentation at this location, which has been scarcely reported in medical literature. A 30-year-old woman with no prior comorbidity presented with complaints of headache that persisted for a year. She also had swelling on her scalp and a yellowish discharge for 3 weeks, but no neurological problems were observed. Radiology revealed thinning of the calvaria, with ragged margins along the inner table, multiple focal erosions, and involvement of overlying soft tissue and bony sequestrum. The patient underwent biparietal craniotomy and excision of the lesion. The histopathology report showed LCH. After 8 months of follow-up, there was no recurrence. The management of solitary calvarial involvement by LCH with masquerading presentation as a scalp infection can be achieved through complete excision of the lesions, resulting in a favorable outcome.
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Affiliation(s)
| | - Hafiza Fatima Aziz
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Faizan Saeed
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Ehsan Bari
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Nasir Uddin
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Wei M, Jiang W, Wang R, Xiao B, Zhan Q. Langerhans cell histiocytosis of the skull in 23 children. Eur J Med Res 2024; 29:136. [PMID: 38368348 PMCID: PMC10874530 DOI: 10.1186/s40001-024-01727-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 02/12/2024] [Indexed: 02/19/2024] Open
Abstract
OBJECTIVE To explore the clinical features, diagnosis, treatment and prognosis of Langerhans cell histiocytosis (LCH) of the skull in children. METHODS This study retrospectively summarized the clinical manifestations, treatment methods and follow-up status of children with skull LCH who were admitted to the Department of Neurosurgery of Shanghai Children's Hospital from January 2014 to June 2021. RESULTS A total of 23 patients confirmed by histology as LCH received hospitalization treatment, including 14 males and 9 females, aged (5.76 ± 3.86) years old. The clinical manifestations were mostly incidentally discovered head masses that gradually enlarged (19 cases, 82.61%). Only 2 cases are affected by multiple systems, while the rest are affected by single systems. 9 patients were involved in multiple skull lesions, and 14 patients had local skull lesions. All patients underwent surgical intervention, with 17 patients undergoing total resection and 6 patients undergoing biopsy. 21 patients received chemotherapy after surgery. The median follow-up was 2.46 years (range 0.33-6.83 years). 21 patients had their symptoms and signs under control or even resolved, and 2 patients experienced recurrence during follow-up. The overall control rate reached 91.30%. CONCLUSION Personalized treatment plans according to different clinical types. Regular outpatient follow-up is crucial to monitor disease recurrence and late effects.
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Affiliation(s)
- Min Wei
- Department of Neurosurgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Luding Rd. 355, Shanghai, People's Republic of China
| | - Wenbin Jiang
- Department of Neurosurgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Luding Rd. 355, Shanghai, People's Republic of China
| | - Rui Wang
- Department of Neurosurgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Luding Rd. 355, Shanghai, People's Republic of China
| | - Bo Xiao
- Department of Neurosurgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Luding Rd. 355, Shanghai, People's Republic of China
| | - Qijia Zhan
- Department of Neurosurgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Luding Rd. 355, Shanghai, People's Republic of China.
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Cochinski R, Agarwal M, Albuquerque J, A de Almeida C, Stricker RP, F Uberti M, K Casqueiro AP, S Mendonça G, do Nascimento GRS, Miraldi F, Decnop M. Anatomy and Diseases of the Greater Wings of the Sphenoid Bone. Radiographics 2022; 42:1177-1195. [PMID: 35657765 DOI: 10.1148/rg.210094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The greater wings of the sphenoid bone (GWS) comprise the components of the sphenoid bone that make up most of the posterior orbital wall and form the anterior and medial parts of the floor of the middle cranial fossa. Many important skull base foramina, which transmit vital neurovascular structures, are present in these paired wings on either side of the central body of the sphenoid bone. A wide variety of diseases can affect the GWS, ranging from benign osseus lesions to malignant primary and secondary bone abnormalities. The complex three-dimensional curved (winged) shape of the GWS and the wide array of pathologic entities that affect this bone can make it challenging for the radiologist to report the imaging findings accurately, especially in relation to the important skull base foramina. The authors describe a systematic approach to understanding the three-dimensional anatomy of the GWS and review important diseases, with the aid of imaging examples. Useful imaging "pearls" that can help in making specific diagnoses are provided throughout the article. ©RSNA, 2022.
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Affiliation(s)
- Renata Cochinski
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
| | - Mohit Agarwal
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
| | - Jessica Albuquerque
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
| | - Carolina A de Almeida
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
| | - Rafaela P Stricker
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
| | - Marcela F Uberti
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
| | - Ana Paula K Casqueiro
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
| | - Gabriel S Mendonça
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
| | - Galba R S do Nascimento
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
| | - Fernanda Miraldi
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
| | - Marcos Decnop
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
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Broaddus WC, Somasundaram A, Carr MT, Opalak CF, Richard HT, Wolber SB, Sangiray HE. Resolution and Re-ossification of Orbital Wall Langerhans Cell Histiocytosis Following Stereotactic Needle Biopsy. J Neurol Surg Rep 2022; 83:e90-e94. [PMID: 35864894 PMCID: PMC9296262 DOI: 10.1055/a-1847-8245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 03/29/2022] [Indexed: 10/29/2022] Open
Abstract
Introduction
Langerhans cell histiocytosis (LCH) is a rare disease that encompasses a spectrum of clinical syndromes. It is characterized by the proliferation and infiltration of white blood cells into organs or organ systems. Reports of management of these lesions have included biopsy, resection, curettage, radiation and/or chemotherapy.
Case Presentation
A 40-year-old man presented with a history of right proptosis and retro-orbital pain and was found to have a lytic mass involving the greater wing of the sphenoid extending into the right orbit. A stereotactic needle biopsy using neuronavigation demonstrated this to be LCH. After no further treatment, the mass spontaneously resolved, with virtual normalization of the orbital MRI at 10 months following the needle biopsy. The bony defect of the temporal bone caused by the mass also re-ossified following the needle biopsy.
Discussion
This report highlights the potential for an isolated LCH lesion to regress after simple needle biopsy, an outcome only rarely reported previously. Thus, expectant management of such lesions following biopsy or initial debridement should be considered prior to proceeding with additional treatment.
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Affiliation(s)
| | | | | | - Charles F Opalak
- Neurosurgery, Virginia Commonwealth University, Richmond, United States
| | - Hope T. Richard
- Pathology, Virginia Commonwealth University, Richmond, United States
| | - Sharon B. Wolber
- Neurosurgery, Virginia Commonwealth University, Richmond, United States
| | - Hayri E. Sangiray
- Neurosurgery, Virginia Commonwealth University, Richmond, United States
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Yang IC, Lee GJ, Han MS, Lee SK, Moon BJ, Lee JK. Langerhans Cell Histiocytosis Involving Second Cervical Vertebra and the Hypothalamus and Pituitary in an Adult. World Neurosurg 2020; 142:142-146. [DOI: 10.1016/j.wneu.2020.06.200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/24/2020] [Indexed: 12/28/2022]
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Management of eosinophilic granuloma in pediatric patients: surgical intervention and surgery combined with postoperative radiotherapy and/or chemotherapy. Childs Nerv Syst 2017; 33:583-593. [PMID: 28247113 DOI: 10.1007/s00381-017-3363-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 02/09/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Eosinophilic granuloma (EG) of spine in pediatric patients presents kinds of clinical manifestation and a difficult management scenario. The choice of treatment, issues of surgical intervention versus conservative treatment, combination therapy or single treatment, all these factors, including neurological deficits, spinal stability, long-term complications, and continued skeletal growth, must be considered. METHODS From 2008 to the 2015, 31 pediatric patients of spinal EG were retrospectively reviewed. They were 17 males and 14 females, with a mean age 8.89 ± 2.84 years old (range, 3.5-14 years old). All the cases were divided into two groups. Twenty-three cases (Group S) accepted surgical interventions and surgery combined with local low-dose radiotherapy and/or chemotherapy. Eight patients (Group C) accepted radiotherapy and/or chemotherapy. All the patients had imaging studies of the lesion including standard radiography, three-dimensional computed tomography (CT) scan, and magnetic resonance imaging (MRI) prior to and after treatment. Cases in group S underwent surgery-related treatment, which include six patients accepted surgery only, nine patients accepted postoperative low-dose radiotherapy, four patients accepted additional chemotherapy, and four patients accepted both. Cases in group C accepted radiotherapy and/or chemotherapy, which include five patients accepted radiotherapy, one patient accepted chemotherapy, and two patients accepted both radiotherapy and chemotherapy. Clinical symptoms, neurologic status, radiologic manifestations, treatment, outcome, and/or complications were recorded and analyzed. RESULTS All the 31 patients had pain relief (both in group S and group C) but the patients in group S obtained more prompt pain relief. All the patients in group S obtained local kyphosis correction, reconstruction of stability of spine, and recovery of neurological deficit after treatment. They have no surgery-related complications after treatment and in follow-up. Seventeen patients who received additional postoperative radiotherapy and/or chemotherapy also had good outcomes. There were no severe radiation and chemotherapy complications in procedure. The patients (group C) who accepted non-surgical treatment also have no severe complications, and a new femur lesion was found in one patient in follow-up. CONCLUSION Surgical intervention, including anterior and/or posterior approach with bone graft or surgery combined with postoperative low-dose radiotherapy and/or chemotherapy is a safe and effective way for treatment of the spinal EG. Compared with radiotherapy and/or chemotherapy, more prompt pain relief can be achieved via surgical intervention or surgery combined radiotherapy and/or chemotherapy.
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Thomas VA, Patel B. Teenager With Scalp Mass. Ann Emerg Med 2017; 69:e21-e22. [PMID: 28231999 DOI: 10.1016/j.annemergmed.2016.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Vanessa A Thomas
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, TX
| | - Binita Patel
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, TX
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Stephens BH, Wright NM. Reconstruction of the C-1 lateral mass with a titanium expandable cage after resection of eosinophilic granuloma in an adult patient. J Neurosurg Spine 2016; 26:252-256. [PMID: 27716017 DOI: 10.3171/2016.8.spine15523] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Spinal involvement occurs frequently in cases of eosinophilic granuloma (EG), but surgical treatment is limited primarily to those with spinal instability. Involvement of the cervical spine is rare, but primarily occurs in the vertebral bodies, and is normally amenable to anterior corpectomy and spinal reconstruction. The authors describe a 27-year-old man with pathologically proven EG who presented with complete destruction of the C-1 lateral mass requiring spinal stabilization. A titanium expandable cage was used to reconstruct the weight-bearing column from the occipital condyle to the superior articular surface of C-2 from a posterior approach, with preservation of the traversing vertebral artery. To the authors' knowledge, this is the first reported instance of reconstruction of the C-1 lateral mass using an expandable metal cage, which facilitated preservation of the vertebral artery.
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Affiliation(s)
- Bradley H Stephens
- Department of Neurosurgery, Washington University, Saint Louis, Missouri
| | - Neill M Wright
- Department of Neurosurgery, Washington University, Saint Louis, Missouri
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Teranishi Y, Shin M, Yoshino M, Saito N. Solitary Langerhans cell histiocytosis of the occipital condyle: a case report and review of the literature. Childs Nerv Syst 2016; 32:399-404. [PMID: 26307358 DOI: 10.1007/s00381-015-2850-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 07/19/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Despite the recent advent of various radiographic imaging techniques, it is still very difficult to correctly distinguish a pediatric osteolytic lesion in the occipital condyle, which makes it further complicated to decide on the necessity of and the adequate timing for radical resection and craniocervical fusions. To establish a legitimate therapeutic strategy for this deep-seated lesion, surgical biopsy is a reasonable choice for first-line intervention. The choice of surgical approach becomes very important because a sufficient amount of histological specimen must be obtained to confirm the diagnosis but, ideally, the residual bony structures and the muscular structures should be preserved so as not to increase craniocervical instability. In this report, we present our experience with a case of solitary Langerhans cell histiocytosis (LCH) involving the occipital condyle that was successfully treated with minimally invasive surgical biopsy with a far lateral condylar approach supported by preoperative 3D computer graphic simulation. CASE REPORT An 8-year-old girl presented with neck pain. Magnetic resonance imaging and computed tomography (CT) revealed an osteolytic lesion of the left occipital condyle. At surgery, the patient was placed in the prone position. A 3-cm skin incision was made in the posterior auricular region, and the sternocleidomastoid and splenius capitis muscles were dissected in the middle of the muscle bundle along the direction of the muscle fiber. Under a navigation system, we approached the occipital condyle through the space between the longissimus capitis muscle and the posterior belly of the digastric muscle and lateral to the superior oblique muscle, verifying each muscle at each depth of the surgical field and, finally, obtained sufficient surgical specimen. After the biopsy, her craniocervical instability had not worsened, and chemotherapy was performed. Twelve weeks after chemotherapy, her neck pain had gradually disappeared along with her torticollis, and CT showed remission of the lesion and marked regeneration of the left occipital condyle. Within our knowledge, this is the first reported case of LCH involving the occipital condyle. Although very rare, our case indicated that LCH can be an alternative in the differential diagnosis of osteolytic lesions in the craniocervical junction, in which early bone regeneration with sufficient cervical stability is expected after chemotherapy. CONCLUSIONS In cases of pediatric osteolytic lesions, when they initially presented with apparent cervical instability, craniocervical fusion may possibly become unnecessary after a series of treatments. Thus, the effort to maximally preserve the musculoskeletal structure should be made until its histological diagnosis is finally confirmed.
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Affiliation(s)
- Yu Teranishi
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-7655, Japan.
| | - Masahiro Shin
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-7655, Japan
| | - Masanori Yoshino
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-7655, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-7655, Japan
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Bezdjian A, Alarfaj AA, Varma N, Daniel SJ. Isolated Langerhans Cell Histiocytosis Bone Lesion in Pediatric Patients: Systematic Review and Treatment Algorithm. Otolaryngol Head Neck Surg 2015; 153:751-7. [PMID: 26243026 DOI: 10.1177/0194599815598969] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 07/14/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The present study reviewed all cases reported of isolated Langerhans cell histiocytosis bone lesions in the head and neck of pediatric patients. The objective was to create a treatment algorithm to facilitate the diagnosis and management of these lesions. DATA SOURCES Eligible articles were identified through a comprehensive search of the following electronic databases: PubMed, Ovid Medline, Embase, and Cochrane Library. REVIEW METHODS Two authors independently reviewed the titles and abstracts retrieved by the electronic search concordant with the criteria for study eligibility. The lists of articles from each author were jointly reviewed and a common list created. All relevant articles were reviewed in hard copies and as full texts to justify inclusion. RESULTS A total of 201 patients (67% male, mean age: 8.1 ± 4.3 years) were included from 45 studies. Clinical presentations included swelling (64%), pain (9%), or both (18%). The skull (61%) and the orbit (24%) were the most common location for isolated bone lesions in the head and neck. The most frequently documented management option was resection, followed by observation, chemotherapy, and intralesional steroid injection. CONCLUSIONS Due to its rarity and variability in presentation and severity, treatment of these lesions has yet to be standardized. Based on the review, a diagnosis and treatment algorithm was created for head and neck surgeons when encountering these types of lesions.
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Affiliation(s)
- Aren Bezdjian
- Department of Otolaryngology-Head and Neck Surgery, The Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Abdullah A Alarfaj
- Department of Otolaryngology-Head and Neck Surgery, The Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Namrata Varma
- Department of Otolaryngology-Head and Neck Surgery, The Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Sam J Daniel
- Department of Otolaryngology-Head and Neck Surgery, The Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
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11
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Pediatric histiocytoses in the United States: incidence and outcomes. J Surg Res 2014; 190:221-9. [DOI: 10.1016/j.jss.2014.03.063] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 03/09/2014] [Accepted: 03/21/2014] [Indexed: 11/22/2022]
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