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Gupta V, Noh KW, Maschek H, Thal S, Welter S. A unique case of thoracic endometriosis syndrome and pulmonary Langerhans’ cell histiocytosis: Six recurrent pneumothoraces. Respir Med Case Rep 2022; 36:101603. [PMID: 35242517 PMCID: PMC8866092 DOI: 10.1016/j.rmcr.2022.101603] [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: 03/08/2021] [Accepted: 02/15/2022] [Indexed: 11/18/2022] Open
Abstract
Spontaneous pneumothorax (SP) in women of reproductive age with causes such as thoracic endometriosis syndrome (TES) presents a diagnostic and therapeutic challenge. A 33-year-old women was treated conservatively with chest tube insertion for a first occurrence of a right-sided pneumothorax in September 2015. In January 2016, a right-sided video-assisted thoracoscopic surgery (VATS) wedge resection and partial parietal pleurectomy was performed due to a recurrence. A right-sided VATS was again performed in December 2016 with multiple wedge resections and a total pleurectomy revealing a pulmonary Langerhans’ cell histiocytosis (PLCH) in the histological and immunohistochemical examinations. The patient was recommended an abstinence of smoking and further course was unremarkable until May 2019, when due to a recurrent pneumothorax, she received a talc pleurodesis via right-sided VATS. Due to yet another recurrence, she underwent a talc slurry pleurodesis over a right sided chest drain. In March 2020 due to recurrence, a right-sided VATS was performed and a blueish nodular lesion was resected from the diaphragm. The histological examination revealed an endometriosis with a diagnosis of TES. Since the patient did not exhibit a temporal relationship between her periods and the onset of pneumothorax symptoms, a final diagnosis of non-catamenial endometriosis-related pneumothorax was made. The patient is currently continuing smoking abstinence and is under hormone therapy. She has not presented with a recurrence. In clinical practice, it is important not to just relay on the information available to us, but to reevaluate the patient history to uncover new clues leading to a new diagnosis. A rare combination of two rare diagnoses, PLHC and TES, only recognized through multiple hospital stays and operations. Symptoms of endometriosis-related pneumothorax are not always directly related to the menstrual cycle. As clinicians, we should remember that it is not impossible to suffer from two rare disorders. A thorough history taking and a precise intraoperative evaluation might reveal clues towards diagnosis and correct treatment.
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Tang Z, Jiang Y, Shi Y, Fan J, Wang W. Langerhans cell histiocytosis of the rib. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2020.101698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Karamouzos V, Prokakis C, Kosmopoulou F, Karanikolas E, Kalogeropoulou C, Aretha D, Panagiotopoulos N, Koletsis E, Velissaris D. Simultaneous Bilateral Spontaneous Pneumothorax in an Adult Patient With Pulmonary Langerhans Cell Histiocytosis: A Case Report. J Investig Med High Impact Case Rep 2018; 6:2324709618792945. [PMID: 30094268 PMCID: PMC6080074 DOI: 10.1177/2324709618792945] [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] [Received: 04/08/2018] [Revised: 07/01/2018] [Accepted: 07/12/2018] [Indexed: 11/17/2022] Open
Abstract
We report a case of a young female with known history of pulmonary Langerhans
cell histiocytosis who was initially presented in the emergency department of a
university hospital with respiratory distress. Clinical assessment and
diagnostic workup revealed left hemithorax subcutaneous emphysema, bilateral
pneumothorax, and atelectasis in both lower lung lobes. The patient was treated
with bilateral staged thoracoscopic bullectomy and mechanical abrasion of the
parietal pleura combined with chemical pleurodesis with talc. A new occurrence
of right-sided pneumothorax was noticed 3 days after surgery, which was treated
with chest tube insertion and chemical pleurodesis. The aforementioned surgical
approach resulted in complete lung expansion and the patient’s full recovery. A
review of pulmonary Langerhans cell histiocytosis and treatment options in cases
of pneumothorax due to lung histiocytosis is also presented in this report.
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Yazicioglu A, Turkkan S, Demirag F, Subasi M, Yekeler E. Recurrence Pattern of Pulmonary Langerhans Cell Histiocytosis After Lung Transplantation: A Case Report. Transplant Proc 2016; 48:3231-3233. [DOI: 10.1016/j.transproceed.2016.07.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 07/28/2016] [Indexed: 10/20/2022]
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Li CW, Li MH, Li JX, Tao RJ, Xu JF, Cao WJ. Pulmonary Langerhans cell histiocytosis: analysis of 14 patients and literature review. J Thorac Dis 2016; 8:1283-9. [PMID: 27293848 DOI: 10.21037/jtd.2016.04.64] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pulmonary Langerhans cell histiocytosis (PLCH) is an orphan disease in respiratory medicine, which most affects adult smokers. The purpose of this article was to discuss the clinical features, especially the radiologic features of PLCH patients during their hospitalization through a retrospective analysis on clinical data. Furthermore, the current literature was also reviewed. METHODS Between December 2008 and June 2012, 14 patients with PLCH were assessed at Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China. Among these patients, seven patients were diagnosed through tissue biopsy from the lung and one patient from enlarged cervical lymph nodes; the rest of six patients were diagnosed based on the clinical-radiological data. The data consisting of demographics, clinical presentation, smoking habits, pulmonary function tests (PFTs) and radiographic image from the medical records was analyzed retrospectively. RESULTS The average age of patients (11 males and 3 females) was 42.79 (±13.71) years old. All male patients and one female patient had a long smoking history. The common manifestations were cough and exertional dyspnea. Spontaneous pneumothorax was found in three patients. Varieties of pulmonary shadows such as nodular, cystic, patch-like and cord-like were revealed by chest computed tomography (CT) examination. Large Langerhans cells (LCs) were discovered in biopsy tissue by immunohistochemical stains. CONCLUSIONS PLCH is still an orphan disease and maybe related to smoking. Clinical symptoms such as cough and exertional dyspnea are non-specific. We shall pay attention to recurrent pneumothorax as clinically it is associated with PLCH. The characteristic radiological manifestation is cystic or nodular shadow in the lungs, which plays crucial roles in diagnosing PLCH.
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Affiliation(s)
- Cheng-Wei Li
- 1 Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Soochow University, Suzhou 215006, China ; 2 Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Man-Hui Li
- 1 Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Soochow University, Suzhou 215006, China ; 2 Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Jiang-Xiong Li
- 1 Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Soochow University, Suzhou 215006, China ; 2 Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Ru-Jia Tao
- 1 Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Soochow University, Suzhou 215006, China ; 2 Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Jin-Fu Xu
- 1 Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Soochow University, Suzhou 215006, China ; 2 Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Wei-Jun Cao
- 1 Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Soochow University, Suzhou 215006, China ; 2 Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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Pierro J, Vaiselbuh SR. Adult Langerhans Cell Histiocytosis As a Diagnostic Pitfall. J Clin Oncol 2016; 34:e41-5. [DOI: 10.1200/jco.2013.50.3045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Joanna Pierro
- Staten Island University Hospital, Staten Island, New York
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Wei P, Lu HW, Jiang S, Fan LC, Li HP, Xu JF. Pulmonary langerhans cell histiocytosis: case series and literature review. Medicine (Baltimore) 2014; 93:e141. [PMID: 25415669 PMCID: PMC4616338 DOI: 10.1097/md.0000000000000141] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 09/02/2014] [Accepted: 09/04/2014] [Indexed: 12/27/2022] Open
Abstract
Pulmonary Langerhans cell histiocytosis (PLCH) is a rare disease with insidious onset and nonspecific manifestations. The objective of this article was to characterize the clinical manifestations and features of PLCH by retrospectively analyzing clinical data of patients with PLCH in addition to simultaneous review of literature.A retrospective analysis was conducted on clinical data of patients with PLCH (n = 7), whose conditions were diagnosed by biopsy from pulmonary tissue (n = 6) or enlarged lymph nodes in the neck (n = 1) and confirmed by PLCH typical radiological features on computed tomography (CT) scan, between January 2001 and September 2012 at the Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China. The review of published reports was made to further emphasize the clinical manifestation and radiological features of PLCH.Long history of cigarette smoking was found in 6 patients. Two patients had recurrent pneumothorax and the other 2 had pulmonary arterial hypertension (World Health Organization group 5 pulmonary hypertension), diagnosed through ultrasonic cardiogram. The nodular shadows were revealed by chest CT scan in 5 patients, cystic shadows in 5 patients, and reticular shadows in 2 patients, as major manifestations, respectively; most of the lesions were located in the middle or upper segments of the lung. The obvious shrank of lesion was found in 1 patient after completely quitting smoking.The pathogenesis of PLCH might be closely associated with smoking. The cystic or nodular lesion was the typical radiological features. Further prospective studies with large sample size are required to further validate the study results and understand the clinical characteristics of PLCH to avoid misdiagnosis.
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Affiliation(s)
- Ping Wei
- From the Department of Respiratory Medicine (PW, H-WL, L-CF, H-PL, J-FX); and Department of Radiology (SJ), Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai China
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Schneider F, Murali R, Veraldi KL, Tazelaar HD, Leslie KO. Approach to Lung Biopsies From Patients With Pneumothorax. Arch Pathol Lab Med 2014; 138:257-65. [DOI: 10.5858/arpa.2013-0091-ra] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—Patients with pneumothorax occasionally require limited lung resections to control persistent air leaks. In some patients, especially smokers, histopathologic findings suggest that a ruptured bulla or bleb caused the pneumothorax. Other patients only exhibit histopathologic changes related to the physical trauma of acute, and likely occult recurrent, peripheral lung injury in the setting of “spontaneous,” or idiopathic, lung rupture. Sometimes, pneumothorax occurs secondary to an underlying localized or diffuse parenchymal lung disease. A comprehensive description of the morphologic findings that may be seen in these specimens will help the surgical pathologist distinguish patients with more common and indolent occurrences of pneumothorax from those requiring additional workup or treatment.
Objective.—To develop a diagnostic approach for surgical pathologists encountering lung specimens obtained in the context of pneumothorax repair.
Data Sources.—Literature review and consultation experience of the authors.
Conclusions.—Two general categories of histopathologic changes can be identified: (1) nonspecific changes, reflecting the lung's acute and chronic response to localized injury, and (2) changes suggesting an underlying lung disease that may have played an etiologic role in the development of pneumothorax. The latter changes are important to recognize because they may require additional workup or treatment of clinically occult lung disease. Difficulty arises when nonspecific histopathologic changes overlap with those of an underlying lung disease. Awareness of these diagnostic challenges and pitfalls, together with clinicoradiographic correlation, is essential in these situations and will help guide the surgical pathologist toward an accurate diagnosis and the appropriate management of clinically occult disease.
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Affiliation(s)
- Frank Schneider
- From the Departments of Pathology (Dr Schneider) and Medicine (Dr Veraldi), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; the Department of Pathology and the Human Oncology and Pathogenesis Program Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Murali); and the Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona (Drs Tazelaar and Leslie). Drs Schneider and Murali contributed equally to this article
| | - Rajmohan Murali
- From the Departments of Pathology (Dr Schneider) and Medicine (Dr Veraldi), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; the Department of Pathology and the Human Oncology and Pathogenesis Program Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Murali); and the Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona (Drs Tazelaar and Leslie). Drs Schneider and Murali contributed equally to this article
| | - Kristen L. Veraldi
- From the Departments of Pathology (Dr Schneider) and Medicine (Dr Veraldi), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; the Department of Pathology and the Human Oncology and Pathogenesis Program Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Murali); and the Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona (Drs Tazelaar and Leslie). Drs Schneider and Murali contributed equally to this article
| | - Henry D. Tazelaar
- From the Departments of Pathology (Dr Schneider) and Medicine (Dr Veraldi), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; the Department of Pathology and the Human Oncology and Pathogenesis Program Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Murali); and the Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona (Drs Tazelaar and Leslie). Drs Schneider and Murali contributed equally to this article
| | - Kevin O. Leslie
- From the Departments of Pathology (Dr Schneider) and Medicine (Dr Veraldi), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; the Department of Pathology and the Human Oncology and Pathogenesis Program Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Murali); and the Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona (Drs Tazelaar and Leslie). Drs Schneider and Murali contributed equally to this article
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