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Ezeokoli EU, Smith T, Mitchell P, Schlehr E, Borici N, Montgomery N. Presentation, treatment, and outcomes of unifocal and multifocal osseous vertebral Langerhans cell histiocytosis lesions in patients under 18 years old. J Pediatr Orthop B 2024; 33:274-279. [PMID: 37278277 DOI: 10.1097/bpb.0000000000001099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study aims to (1) clinically and radiographically characterize a series of unifocal (single-system single-site) and multifocal (single-system multiple-site) langerhans cell histiocytosis (LCH) lesions in the vertebra and (2) determine the success and recurrence rates with different treatment modalities in a pediatric population at a tertiary children's hospital. Patients younger than 18 years old with a diagnosis of LCH before 1 June 2021 at our institution were reviewed. The inclusion criteria were a unifocal or multifocal vertebral lesion without systemic disease. Clinical presentations, lesion sites, radiographic findings, treatments, complications, recurrence rates, and length of follow-up were reviewed and recorded. Thirty-nine patients had unifocal (36%) or multifocal (64%) vertebral lesions. 44% of patients had vertebral lesions only. The most common clinical presentation was neck or back pain (51%) and difficulty or inability to ambulate (15%). 70 vertebrae were involved in total; 59% cervical, 62% thoracic, 49% lumbar, and 10% sacral. 88% of multifocal patients underwent chemotherapy compared to 60% of unifocal patients. The recurrence rate in the entire cohort was 10%. The median length of follow-up was 5.2 years (0.6-16.8). Chemotherapy is often utilized as a treatment for vertebral LCH lesions regardless of unifocal or multifocal osseous presentation, with good outcomes and low recurrence rates. However other treatments such as observation only and steroid injections may be a better option with smaller and less widespread lesions due to side effects and length of treatment with chemotherapy. Determination of more invasive treatments including surgical excision or fixation will need to be considered on a case-by-case basis. Level of evidence: IV.
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Affiliation(s)
- Ekene U Ezeokoli
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
- Department of Orthopedic and Scoliosis Surgery, Texas Children's Hospital, Houston, Texas
| | - Tyler Smith
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | | | - Eva Schlehr
- University at Buffalo Jacobs School of Medicine, Buffalo, New York
| | - Neritan Borici
- Department of Orthopedic and Scoliosis Surgery, Texas Children's Hospital, Houston, Texas
| | - Nicole Montgomery
- Department of Orthopedic and Scoliosis Surgery, Texas Children's Hospital, Houston, Texas
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas, USA
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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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Percutaneous CT-guided corticosteroid injection for the treatment of osseous Langerhans cell histocytosis: a three institution retrospective analysis. Skeletal Radiol 2022; 51:1037-1046. [PMID: 34605957 DOI: 10.1007/s00256-021-03917-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/16/2021] [Accepted: 09/19/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study is to evaluate the safety and effectiveness of CT-guided corticosteroid injection for the treatment of osseous Langerhans cell histiocytosis (LCH) in a multi-institutional study. MATERIALS AND METHODS This IRB-approved study included patients from three institutions. We retrospectively reviewed clinical, procedural, and imaging data for corticosteroid injections performed to treat osseous LCH. Location of the lesion, lesion maximum dimension and volume, corticosteroid type and dose, and time interval between injection and change in lesion size/volume and symptoms were recorded. Generalized estimating equations (accounting for multiple lesions per subject) were used to evaluate the association between predictors (dose, maximum lesion dimension, and lesion volume) and outcomes (time to partial and complete radiographic resolution, and time to pain control). This analysis was adjusted by anatomic site. RESULTS Forty corticosteroid injections were performed in 36 patients (20 (56%) females, and 16 (44%) males, ages 12 ± 11 (2-57) years). Mean lesion maximum dimension was 3.2 ± 1.7 cm, and volume was 10 ± 17 cm3. Imaging and clinical follow-up were available for 22/40 (55%) and 34/40 (85%) of injections, respectively. All lesions responded to corticosteroid injection. Times to partial and complete imaging resolution were 13 ± 9 and 32 ± 13 weeks, respectively, and time to pain resolution was 22 ± 14 weeks. There were no complications. CONCLUSION CT-guided corticosteroid injection is a safe and effective treatment for LCH. Pain resolution was achieved in all patients and imaging did not show progressive disease in any of the patients.
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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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Abdelaal AHK, Sedky M, Gohar S, Zaki I, Salama A, Hassanain O, El Ghoneimy AM. Skeletal involvement in children with Langerhans cell histiocytosis: healing, complications, and functional outcome. SICOT J 2020; 6:28. [PMID: 32672151 PMCID: PMC7364762 DOI: 10.1051/sicotj/2020024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 06/22/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction: Skeletal involvement in children with Langerhans cell histiocytosis (LCH) is a common feature of the disease. Several options for the treatment of these skeletal lesions have been reported. We describe our experience in the treatment of skeletal involvement of LCH in this retrospective case series study, entailing anatomic distribution, pattern of healing, skeletal deformities, and functional outcome of skeletal LCH. Methods: A retrospective analysis was conducted for patients diagnosed with LCH and having skeletal lesions in the period between 2007 and 2015. Out of a total of 229 cases, 191 (83.4%) had skeletal involvement. Bone healing was divided into partial and complete based on the size of lesion and cortical changes in plain radiograph. Skeletal deformities were serially measured. Time to pain control, resumption of weight bearing, and the final functional status of the patient were reviewed. Results: The mean age at presentation was 4.4 years (3 m–14.8 y) and the mean follow-up period was 53.3 months (0.2–120.7). After screening of skeletal and extra-skeletal lesions, 59 patients (31%) had M-S (Multisystem) LCH and 132 (69%) had S-S (Single system) LCH. Unifocal bone lesions were found in 81 (42.5%) patients, and multifocal bone lesions in 110 patients (57.5%). Single or multiple bone lesions were found in the craniofacial bones in 152 patients (79.5%), femur in 19 patients, (10%), ribs in 18 patients (9.4%), spine in 15 patients (8.1%), pelvis in 14 patients (7.3%), scapula in 8 patients (4.1%), humerus in 6 (3.1%), clavicle in 6 patients (3.1%), tibia in 3 patients (1.5%), radius in 3 patients (1.5%), and the ulna in 2 patients (1%) patients. No lesions were found in the fibula, hand, or foot. Out of all skeletal lesions, 179 (93.7%) patients were treated either medically or conservatively and 12 patients (6.2%) were treated surgically. The mean time to complete healing was 5.2 months (2–12). Skeletal complications included: pathologic fractures (9 vertebra plana, 5 long bone, 1 iliac bone), deformities (9 thoracolumbar kyphosis, 2 cervical spine subluxations, 2 coxa vara deformity of the proximal femur and one flattening of iliac bone). Conclusion: Non-operative treatment can lead to adequate bone healing in few months period. Partial or complete remodeling of bone deformities can be observed without surgical correction. However, surgical intervention might be indicated when cervical spine affection may lead to instability and subsequent neurological affection. Functional impairment is rarely caused by skeletal lesions in LCH.
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Affiliation(s)
- Ahmed H K Abdelaal
- Consultant of Musculoskeletal Tumor Surgery, Children Cancer Hospital-Egypt (57357), 11617 Cairo, Egypt - Lecturer, Department of Orthopedic Surgery, Faculty of Medicine, Sohag University, 82524 Sohag, Egypt
| | - Mohamed Sedky
- Professor of Pediatrics, Pediatric Department National Research Centre, Consultant of Pediatric Oncology Children Cancer Hospital-Egypt (57357), 11617 Cairo, Egypt
| | - Seham Gohar
- Consultant of Pediatric Oncology, Children Cancer Hospital-Egypt (57357), 11617 Cairo, Egypt
| | - Iman Zaki
- Professor of Radiodiagnosis National Cancer Institute NCI, Cairo University Head of Medical Imaging Department, Children Cancer Hospital-Egypt (57357), 11617 Cairo, Egypt
| | - Asmaa Salama
- Professor of Pathology National Cancer Institute NCI, Cairo University Consultant of Pathology, Children Cancer Hospital-Egypt (57357), 11617 Cairo, Egypt
| | - Omayma Hassanain
- Clinical Research Senior Supervisor, Children Cancer Hospital-Egypt (57357), 11617 Cairo, Egypt
| | - Ahmed M El Ghoneimy
- Head of Musculoskeletal Tumor Surgery Unit, Children Cancer Hospital-Egypt (57357), 11617 Cairo, Egypt - Lecturer, Department of Orthopedic Surgery, Faculty of Medicine, Cairo University, 12613 Giza, Egypt
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Oh B, Lee S, Ke Y, Kimpo M, Yeoh A, Quah TC. A "Wait-and-See" Approach to Quiescent Single-System Langerhans Cell Histiocytosis to Spare Children From Chemotherapy. Front Pediatr 2020; 8:466. [PMID: 32903429 PMCID: PMC7434943 DOI: 10.3389/fped.2020.00466] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 07/03/2020] [Indexed: 12/17/2022] Open
Abstract
Background: Langerhans Cell Histiocytosis (LCH) is a childhood disorder of histiocytes that is generally treated with systemic chemotherapy. Spontaneous resolution has been previously reported in Single System LCH (SS-LCH), which is less aggressive than multisystem disease. However, there are no clear guidelines on which patients can be safely spared from systemic chemotherapy. Here, we propose a risk stratification framework based on disease quiescence as determined by clinical and biochemical features of inflammation, to identify low risk patients who may be potentially spared from chemotherapy through a conservative "wait-and-see" approach. Methods: Retrospective analysis in a single institution was conducted in children with SS-LCH, comparing features of inflammation and outcomes of those who received chemotherapy vs. those with quiescent disease, who were managed conservatively. Results: Of 44 children with SS-LCH, only patients without risk-organ involvement were considered for conservative management. A "wait-and-see" approach was adopted for patients with quiescent disease as defined by clinical and biochemical evidence of disease activity. Following 2 weeks of watchful observation, decisions were made to either start treatment or continue conservative management. Based on data collected at diagnosis, patients with quiescent disease had a lower mean platelet count 339 × 109/L (95%C.I: 285-393) vs. 482 × 109/L (95% C.I: 420-544) p < 0.01, a lower mean white cell count 9.3 × 109/L (95%C.I: 7.5-11.1) vs. 13.1 × 109/L (95%C.I: 11-15.2) p < 0.01 and lower Erythrocyte-Sedimentation-Rate (ESR) 8.2 mm/h (95%C.I: 5.4-11) vs. 53.7 mm/h (95%C.I: 11-96.3) p = 0.04, suggesting that these are potential biochemical markers of disease activity. Other features of disease quiescence noted were rapid progression, functional disability, presence of a skull depression rather a lump and the lack of fever. Conclusions: Further studies are required to validate our proposed framework to determine disease activity in SS-LCH. Within the limits of this current analysis, it appears that low-risk patients with clinically and biochemically quiescent SS-LCH, may potentially be spared from chemotherapy with good long-term outcomes.
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Affiliation(s)
- Bernice Oh
- Viva-University Children's Cancer Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Shawn Lee
- Viva-University Children's Cancer Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Yuhe Ke
- Department of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, Singapore
| | - Miriam Kimpo
- Viva-University Children's Cancer Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Allen Yeoh
- Viva-University Children's Cancer Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Thuan Chong Quah
- Viva-University Children's Cancer Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
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