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Singh K, Lau L, Wegner EA, Rossleigh MA, Shon IH. Serial 18F-FDG PET/CT Revealing Mixed Histiocytosis in a Pediatric Patient. Clin Nucl Med 2024:00003072-990000000-01243. [PMID: 39150359 DOI: 10.1097/rlu.0000000000005422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
ABSTRACT A 6-month-old boy presented with a left parietal soft tissue swelling and CT findings of multiple calvarial lytic lesions. 18F-FDG PET/CT demonstrated hypermetabolic lesions in the left parietal, right occipital, and right femoral bones. The left parietal lesion was excised, and pathology was consistent with Langerhans cell histiocytosis. Interim PET assessment following induction chemotherapy demonstrated a "mixed metabolic response" with discordant rise in metabolic activity of the right femoral lesion. Subsequent core biopsy of the femoral lesion revealed a non-Langerhans cell histiocytosis, likely juvenile xanthogranuloma. Here we describe a rare pediatric case of mixed histiocytosis, unveiled by serial 18F-FDG PET/CT.
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Affiliation(s)
- Karan Singh
- From the Department of Nuclear Medicine and PET, The Prince of Wales and Sydney Children's Hospitals, Randwick, Australia
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2
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Robinson E, Nawwar A, Searle J, Lyburn I. Adult Presentation of Cutaneous Langerhans Cell Histiocytosis: 18 F-FDG PET/CT Detection of Systemic Disease. Clin Nucl Med 2024; 49:333-334. [PMID: 38377389 DOI: 10.1097/rlu.0000000000005109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
ABSTRACT Langerhans cell histiocytosis (LCH) is a rare hematological disease, more common in pediatric populations. A 26-year-old man with biopsy-proven cutaneous LCH underwent 18 F-FDG PET/CT systemic staging. 18 F-FDG PET/CT highlighted multiple sites of avid cutaneous disease within the natal cleft. Additional characteristic cystic lung disease was seen on the CT component and focal uptake in the pituitary stalk/hypothalamic region noted, a common but occult site of disease in this patient. Because of the rarity of adult-onset cutaneous LCH, guidance on management and staging is lacking. 18 F-FDG PET/CT is critical to baseline evaluation of systemic disease, as illustrated here.
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An R, Ma X, Wang Y. The value of 18F-FDG PET/CT in Langerhans cell histiocytosis. Ann Nucl Med 2024; 38:238-245. [PMID: 38217750 DOI: 10.1007/s12149-023-01892-3] [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: 09/05/2023] [Accepted: 12/03/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVE To investigate the value of 18F-FDG PET/CT in diagnosis and disease evaluation of Langerhans cell histiocytosis (LCH). METHODS A retrospective analysis of 31 patients with LCH confirmed by histopathology was performed. A systematic analysis of the PET/CT imaging manifestations of LCH was performed, recording patients who were treated and receiving PET/CT for efficacy evaluation. In addition, clinical and laboratory data of LCH patients were collected, and the correlation between these data and PET/CT metabolic parameters was initially investigated. RESULTS Of the 31 patients, thirty had at least 1 PET/CT positive lesions (96.7%), and one had only skin damage without abnormalities on PET/CT. Of 31 patients, fifteen (48.4%) had single system (SS) disease (9 cases with a single site and 6 cases with multiple sites) and 16 (51.6%) had multisystem (MS) disease (6 low risk and 10 high risk cases). The incidence of LCH lesions in the bone, lymphatic system, pituitary gland, liver, soft tissue, thyroid gland, thymus, and lungs was 20 cases (64.5%), 12 cases (38.7%), 3 cases (9.7%), 2 cases (6.5%), 2 cases (6.5%), 1 case (3.2%), 1 case (3.2%), and 8 cases (25.8%), respectively. A total of 21 PET/CT follow-up scanning were performed in 13 patients receiving chemotherapy, with 13 (61.9%) partial metabolic remission (PMR), 6 (28.6%) progressive metabolic disease (PMD), and 2 (9.5%) stable metabolic disease (SMD), according to PET Response Evaluation Criteria in Solid Tumors (PRECIST) 1.0. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and Lactic Dehydrogenase (LDH) were positively correlated with TTLG (total TLG) (R2 = 0.3256, 0.2409, 0.4205, P < 0.05). The Re-examine SUVmax is positively correlated with re-examine LDH (R2 = 0.7285, P < 0.05). CONCLUSIONS 18F-FDG PET/CT is an effective way to diagnose and evaluate LCH. PET metabolic parameters were associated with laboratory inflammatory markers, suggesting that 18F-FDG PET/CT may be helpful in evaluating disease activity of LCH.
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Affiliation(s)
- Rongchen An
- Department of Nuclear Medicine, The Second Xiangya Hospital, Central South University, 139# Renmin Middle Road Changsha, Changsha, 410011, Hunan, China
| | - Xiaowei Ma
- Department of Nuclear Medicine, The Second Xiangya Hospital, Central South University, 139# Renmin Middle Road Changsha, Changsha, 410011, Hunan, China
| | - Yunhua Wang
- Department of Nuclear Medicine, The Second Xiangya Hospital, Central South University, 139# Renmin Middle Road Changsha, Changsha, 410011, Hunan, China.
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Filizoğlu N, Özgüven S, Türköz HK, Öneş T, Turoğlu HT, Erdil TY. Isolated Scapular Lesion of Langerhans Cell Histiocytosis Detected by 18F-FDG PET/CT. Mol Imaging Radionucl Ther 2022; 31:237-238. [PMID: 36268929 DOI: 10.4274/mirt.galenos.2021.58672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare disease that occurs mainly in pediatric patients and most adult LCH is considered a part of multisystem or multifocal disease. Only 7.3% of cases present as unifocal bone lesion. Herein, we present a case of an isolated scapular lesion of LCH in a 48-year-old man.
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Affiliation(s)
- Nuh Filizoğlu
- Marmara University, Pendik Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Salih Özgüven
- Marmara University, Pendik Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Hüseyin Kemal Türköz
- Marmara University, Pendik Training and Research Hospital, Clinic of Pathology, İstanbul, Turkey
| | - Tunç Öneş
- Marmara University, Pendik Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Halil Turgut Turoğlu
- Marmara University, Pendik Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Tanju Yusuf Erdil
- Marmara University, Pendik Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
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Luo ZH, Lu PX, Qi WL, Liao FX, Jin AF, Zen QY. Role of 18F-FDG PET/CT in the diagnosis and management of patients with Langerhans cell histiocytosis. Quant Imaging Med Surg 2022; 12:3351-3363. [PMID: 35655814 PMCID: PMC9131337 DOI: 10.21037/qims-21-823] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/04/2022] [Indexed: 03/19/2024]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is an inflammatory myeloid neoplasm that can involve multisystem organs. Positron emission tomography/computed tomography (PET/CT) has been widely used in tumor staging and efficacy evaluation. However, at present, there are few 18F-fluorodeoxyglucose (FDG) PET/CT studies on LCH. This study aimed to explore the possible role of 18F-FDG PET/CT in the diagnosis and management of patients with LCH. METHODS 18F-FDG PET/CT images of 22 Chinese patients diagnosed with LCH on biopsy or surgery histopathology between January 2011 and December 2020 were retrospectively analyzed. The incidence of LCH in each system was assessed by a PET/CT scan. The imaging characteristics were analyzed semiquantitatively and qualitatively. The discrepancies between PET/CT and conventional imaging modalities were recorded. Evaluations of curative effect according to RECIST1.1 and PERCIST1.0 were compared using Fisher's exact chi-squared test, and P values <0.05 were considered significant. RESULTS Eight (36.4%) of the 22 patients presented with single system involvement (4 isolated site involvement, 4 multiple site involvement), and 14 (63.6%) presented with multiple system involvement. Twenty-one (95.5%) patients had hypermetabolic lesions. Musculoskeletal, lymphatic, respiratory, liver, skin-soft tissue and thyroid involvement were seen in 14 (63.6%), 13 (59.1%), 5 (22.7%), 4 (18.2%), 5 (22.7%) and 1 (4.5%) patient, respectively. Cranial and facial bones were the most common sites of musculoskeletal involvement. Ten patients underwent PET/CT follow-up, and there was no significant difference in curative effect evaluations according to RECIST1.1 and PERCIST1.0. However, among the complete remission cases assessed by RECIST1.1, three were partial metabolic responses assessed by PERCIST1.0, while among the partial response cases assessed by RECIST1.1, one was metabolic progressive disease assessed by PERCIST1.0. CONCLUSIONS 18F-FDG PET/CT is an imaging modality option for the diagnosis and assessment of the curative effect of LCH.
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Affiliation(s)
- Zhe-Huang Luo
- PET/CT Center, Jiangxi Provincial People’s Hospital, Nanchang, China
| | - Pu-Xuan Lu
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Wan-Lin Qi
- PET/CT Center, Jiangxi Provincial People’s Hospital, Nanchang, China
| | - Feng-Xiang Liao
- PET/CT Center, Jiangxi Provincial People’s Hospital, Nanchang, China
| | - Ai-Fang Jin
- PET/CT Center, Jiangxi Provincial People’s Hospital, Nanchang, China
| | - Qing-Yun Zen
- PET/CT Center, Jiangxi Provincial People’s Hospital, Nanchang, China
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Liang HX, Yang YL, Zhang Q, Xie Z, Liu ET, Wang SX. Langerhans cell histiocytosis presenting as an isolated brain tumour: A case report. World J Clin Cases 2022; 10:1423-1431. [PMID: 35211579 PMCID: PMC8855195 DOI: 10.12998/wjcc.v10.i4.1423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/03/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a rare proliferative histiocyte disorder. It can affect any organ or system, especially the bone, skin, lung, and central nervous system (CNS). In the CNS, the hypothalamic-pituitary is predominantly affected, whereas the brain parenchyma is rarely affected. LCH occurring in the brain parenchyma can be easily confused with glioblastoma or brain metastases. Thus, multimodal imaging is useful for the differential diagnosis of these intracerebral lesions and detection of lesions in the other organs.
CASE SUMMARY A 47-year-old man presented with a headache for one week and sudden syncope. Brain computed tomography (CT) and magnetic resonance imaging showed an irregularly shaped nodule with heterogeneous enhancement. On 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/CT, a nodule with 18F-FDG uptake and multiple cysts in the upper lobes of both lungs were noted, which was also confirmed by high-resolution CT. Thus, the patient underwent surgical resection of the brain lesion for further examination. Postoperative pathology confirmed LCH. The patient received chemotherapy after surgery. No recurrence was observed in the brain at the 12-mo follow-up.
CONCLUSION Multimodal imaging is useful for evaluating the systemic condition of LCH, developing treatment plans, and designing post-treatment strategies.
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Affiliation(s)
- Han-Xiang Liang
- Department of Nuclear Medicine, Maoming People's Hospital, Maoming 525000, Guangdong Province, China
| | - Yue-Long Yang
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Qing Zhang
- WeiLun PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Zhi Xie
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - En-Tao Liu
- WeiLun PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Shu-Xia Wang
- WeiLun PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
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Abstract
Childhood interstitial lung disease (ChILD) is an umbrella term encompassing a diverse group of diffuse lung diseases affecting infants and children. Although the timely and accurate diagnosis of ChILD is often challenging, it is optimally achieved through the multidisciplinary integration of imaging findings with clinical data, genetics, and potentially lung biopsy. This article reviews the definition and classification of ChILD; the role of imaging, pathology, and genetics in ChILD diagnosis; treatment options; and future goals. In addition, a practical approach to ChILD imaging based on the latest available research and the characteristic imaging appearance of ChILD entities are presented.
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Kesim S, Turoğlu HT, İnanır S, Özgüven S, Erdil TY. The Role of a Bone SPECT/CT Scan in the Follow-up of a Solitary Bone Lesion in a Patient with Langerhans' Cell Histiocytosis. Mol Imaging Radionucl Ther 2021; 30:187-189. [PMID: 34659423 PMCID: PMC8522514 DOI: 10.4274/mirt.galenos.2020.20981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Langerhans’ cell histiocytosis (LCH) is a rare disease observed in childhood characterized by the proliferation of Langerhans’ cells resulting in focal or systemic manifestations (including the bones). Here, we present a pediatric case with a localized biopsy-proven LCH, who underwent progression from solitary to multifocal form detected on bone scintigraphy and single photon emission computerized tomography/computed tomography (SPECT/CT) performed within four months. Emphasizing on localized bone pain (predictive of osseous LCH) and local tenderness and swelling usually guides the nuclear physician to perform additional SPECT/CT with presumably an improvement of the diagnostic accuracy as demonstrated in our case.
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Affiliation(s)
- Selin Kesim
- Marmara University Pendik Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Halil Turgut Turoğlu
- Marmara University Pendik Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Sabahat İnanır
- Marmara University Pendik Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Salih Özgüven
- Marmara University Pendik Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Tanju Yusuf Erdil
- Marmara University Pendik Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
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Rajakulasingam R, Siddiqui M, Michelagnoli M, Saifuddin A. Skeletal staging in Langerhans cell histiocytosis: a multimodality imaging review. Skeletal Radiol 2021; 50:1081-1093. [PMID: 33215231 DOI: 10.1007/s00256-020-03670-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/29/2020] [Accepted: 11/08/2020] [Indexed: 02/02/2023]
Abstract
Evaluating the extent of skeletal disease in Langerhans cell histiocytosis (LCH) is a major predictor of patient outcome. Traditionally, whole-body skeletal staging consists of plain radiography and bone scintigraphy. However, more recently whole-body MRI has been shown to be accurate in detecting osseous and extra-osseous lesions, but no large-scale studies analysing its role within the diagnostic algorithm of LCH skeletal staging currently exist. In addition, FDG PET-CT provides useful information regarding disease activity and treatment response, but has an inherent radiation dose which is not ideal in children. Currently, radiographic skeletal survey remains the gold standard with cross-sectional imaging only performed for further characterisation. However, radiographs have shown a wide sensitivity range for skeletal staging and have clear limitations in detecting extra-skeletal disease, a crucial component of stratification in identifying 'at risk' organs. We aim to highlight the various appearances of bony LCH across all the imaging modalities for primary skeletal staging. We will also review the advantages, disadvantages, sensitivity and specificity of each, and establish their role in staging skeletal LCH. Recent studies using whole-body MRI have shown promising results, with radiographs and other modalities playing a more complementary role.
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Affiliation(s)
- Ramanan Rajakulasingam
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.
| | - Mateen Siddiqui
- Department of Radiology, North West Anglia Foundation Trust, Hinchingbrooke Hospital, Huntingdon, Cambridgeshire, PE29 6NT, UK
| | - Maria Michelagnoli
- Department of Paediatric Oncology, University College Hospital, Bloomsbury, London, NW1 2BU, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
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Rayamajhi SJ, Shahi RR, Maharjan S, Sharma S, Sudhir Suman KC. Muscle Infiltrative Adult Multisystem Langerhans Cell Histiocytosis Detected on Fluorodeoxyglucose Positron Emission Tomography/ Computed Tomography - A Rare Case. Indian J Nucl Med 2021; 35:342-344. [PMID: 33642763 PMCID: PMC7905280 DOI: 10.4103/ijnm.ijnm_88_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/18/2020] [Accepted: 05/23/2020] [Indexed: 11/28/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a disease of unknown pathogenesis characterized by the accumulation of Langerhans cells which show immunopositivity for S-100 and CD1a. LCH with skeletal muscle involvement has been rarely described in literature. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is an important tool in identifying the sites of involvement in LCH. We present a rare case of muscle invasive LCH where 18F-FDG PET/CT showed involvement of multiple other sites such as the liver, bones, bone marrow, and possibly the thyroid gland in our case. Further, the current case also shows that liver involvement by LCH (possibly fibrotic phase) can be negative on PET but show lesions on CT.
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Affiliation(s)
| | | | | | - Samir Sharma
- Narayani Samudaik Hospital and Research Center, Bharatpur, Chitwan, Nepal
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Huynh KN, Nguyen BD. Histiocytosis and Neoplasms of Macrophage-Dendritic Cell Lineages: Multimodality Imaging with Emphasis on PET/CT. Radiographics 2021; 41:576-594. [PMID: 33606566 DOI: 10.1148/rg.2021200096] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Histiocytosis is a rare inflammatory process characterized by pathologic infiltration and accumulation of cells derived from the monocytic lineage in normal tissue. It encompasses more than 100 different subtypes of disorders that were recently classified into five main groups: (a) Langerhans-related histiocytosis, (b) Rosai-Dorfman histiocytosis, (c) cutaneous and mucocutaneous histiocytosis, (d) malignant histiocytosis, and (e) hemophagocytic lymphohistiocytosis and macrophage activation syndrome. Langerhans cell histiocytosis is the most common histiocytic disorder. Less common types include Erdheim-Chester disease, Rosai-Dorfman disease, adult and juvenile xanthogranuloma, necrobiotic xanthogranuloma, histiocytic sarcoma, interdigitating dendritic cell sarcoma, Langerhans cell sarcoma, and hemophagocytic lymphohistiocytosis. Although the pathogenesis of these disorders may be attributable to mutations in the oncogenic driver, recent discoveries have shown that inflammation and fibrosis secondary to mutated histiocytes, rather than a proliferative cell mechanism, result in manifestation of the disease. Diagnosis, which relies on a multidisciplinary approach, is challenging and often delayed because clinical findings are nonspecific and may mimic malignant processes at radiologic evaluation. Compared with conventional imaging, PET/CT allows detection of the increased metabolic activity in histiocytes. Diagnostic algorithms for histiocytic disorders should include functional imaging with fluorine 18 (18F) fluorodeoxyglucose (FDG) PET/CT, which provides a comprehensive whole-body evaluation of their potential involvement with multiple organ systems and allows monitoring of therapeutic response. The most recent revised classification, pathophysiologic and clinical manifestations, sites of involvement, and imaging features of histiocytosis are described in this review and a multimodality approach is used, with emphasis on 18F-FDG PET/CT evaluation. ©RSNA, 2021.
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Affiliation(s)
- Kenneth N Huynh
- From the Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259
| | - Ba D Nguyen
- From the Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259
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Jessop S, Crudgington D, London K, Kellie S, Howman-Giles R. FDG PET-CT in pediatric Langerhans cell histiocytosis. Pediatr Blood Cancer 2020; 67:e28034. [PMID: 31599488 DOI: 10.1002/pbc.28034] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/28/2019] [Accepted: 09/18/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Langerhans cell histiocytosis (LCH) in pediatric patients presents with single-system or multisystem disease. Accurate staging is essential for selecting the most appropriate therapy ranging from local surgery to chemotherapy. METHODS A retrospective review was undertaken of reported fludeoxyglucose (FDG) positron emission tomography - computed tomography (PET-CT) scans performed in children with LCH from June 2006 to February 2017. Findings were compared with a reference standard of biopsy or informed clinical follow-up. RESULTS One hundred nine scans were performed in 33 patients (age 7 weeks to 18 years). Nineteen patients had single-system, bone unifocal disease; seven patients had single-system, bone multifocal disease; four patients had single-system, skin unifocal disease; two patients had multisystem disease; and one patient had single-system, lymph node disease. Twenty-six scans were performed to stage biopsy-proven LCH, and 83 scans were performed during follow-up to assess treatment response or recurrence after therapy completion. At staging, FDG PET-CT detected all sites of biopsy-proven LCH (except where bone unifocal disease had been resected). There was one false-positive thymic finding that resolved without therapy. The per-patient false-positive rate of FDG PET-CT at staging was 4% (1/26). During follow-up, five LCH recurrences and one case of progressive disease on therapy occurred, all positive on FDG PET-CT. During follow-up two patients had FDG PET-CT scans with false-positive findings and one patient with a magnetic resonance imaging false-positive finding. The per-scan false-positive rate of FDG PET-CT during follow-up was 2% (2/83). CONCLUSIONS FDG PET-CT is highly sensitive for the staging and follow-up of pediatric patients with LCH, and has a very low false-positive rate.
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Affiliation(s)
- Sophie Jessop
- Department of Oncology, The Children's Hospital at Westmead, New South Wales, Australia
| | - Donna Crudgington
- Department of Nuclear Medicine, The Children's Hospital at Westmead, New South Wales, Australia
| | - Kevin London
- Department of Nuclear Medicine, The Children's Hospital at Westmead, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, Australia
| | - Stewart Kellie
- Department of Oncology, The Children's Hospital at Westmead, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, Australia
| | - Robert Howman-Giles
- Department of Nuclear Medicine, The Children's Hospital at Westmead, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, Australia.,Discipline of Imaging, University of Sydney Medical School, Sydney, Australia
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13
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Sasaki H, Nagano S, Shimada H, Nakamura S, Setoguchi T, Komiya S. Clinical course of the bony lesion of single-system single-site Langerhans cell histiocytosis - Is appropriate follow-up sufficient treatment? J Orthop Sci 2018; 23:168-173. [PMID: 28927957 DOI: 10.1016/j.jos.2017.08.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 08/17/2017] [Accepted: 08/22/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is categorized into three types, which include single-system single-site (SS-s), single-system multiple-site (SS-m) and multisystem (MS). The most commonly affected site in LCH is bone, and the bony lesion of SS-s LCH has a good prognosis. The bony lesion of SS-s LCH has been thought to regress spontaneously. Although treatments such as curettage, direct injection of corticosteroids, and chemotherapy have been performed, regular follow-up is the first line of treatment for the bony lesion of SS-s LCH. For preventing orthopedic sequelae, strict and appropriate follow-up should be performed, but the appropriate period and method of follow-up has not yet been established. METHODS In the present study, we retrospectively analyzed a series of 7 cases of patients with SS-s LCH with a bony lesion treated in the Department of Orthopedic Surgery at Kagoshima University Hospital (Kagoshima, Japan) from 2006 to 2015. RESULTS The bony lesion regressed spontaneously in all patients. Factors such as location, size, preoperative C-reactive protein (CRP) value, standardized uptake (SUV) value of positron emission tomography (PET), age, sex and direct steroid injection were not related to the clinical course. Temporary expansion of the lesion occurred in 3 patients and a temporary worsening of pain occurred in 1 patient during the follow-up period. These events occurred within 6 weeks after biopsy. CONCLUSION Careful follow-up and the use of an appropriate orthosis can lead to a good clinical course for the bony lesion of SS-s LCH. Future research should seek to determine the appropriate follow-up period.
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Affiliation(s)
- Hiromi Sasaki
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Satoshi Nagano
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
| | - Hirofumi Shimada
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Shunsuke Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Takao Setoguchi
- The Near-Future Locomotor Organ Medicine Creation Course (Kusunoki Kai), Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Setsuro Komiya
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
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14
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Ishibashi M, Tanabe Y, Fujii S, Ogawa T. Pictorial review of 18F-FDG PET/CT findings in musculoskeletal lesions. Ann Nucl Med 2017; 31:437-453. [PMID: 28585058 DOI: 10.1007/s12149-017-1182-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 05/27/2017] [Indexed: 11/26/2022]
Abstract
We herein reviewed 18F-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) findings in a number of musculoskeletal lesions including malignant tumors, benign tumors, and tumor-like lesions with correlations to other radiographic imaging modalities, and described the diversity of the 18F-FDG PET/CT findings of this entity. Malignant primary musculoskeletal tumors are typically 18F-FDG avid, whereas low-grade malignant tumors show mild uptake. Benign musculoskeletal tumors generally show a faint uptake of 18F-FDG, and tumor-like conditions also display various uptake patterns of 18F-FDG. Although musculoskeletal tumors show various uptakes of 18F-FDG on PET/CT, its addition to morphological imaging modalities such as CT and MRI is useful for the characterization and differentiation of musculoskeletal lesions.
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Affiliation(s)
- Mana Ishibashi
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan.
| | - Yoshio Tanabe
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
| | - Shinya Fujii
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
| | - Toshihide Ogawa
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
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