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Pähler vor der Holte A, Welkoborsky´ H. Case report: Langerhans cell histiocytosis of the temporal bone in children: Challenging diagnosis of a rare disease with some pitfalls. Clin Case Rep 2022; 10:e6057. [PMID: 36254150 PMCID: PMC9556999 DOI: 10.1002/ccr3.6057] [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: 07/22/2021] [Revised: 03/12/2022] [Accepted: 05/28/2022] [Indexed: 11/11/2022] Open
Abstract
A 4‐year‐old girl was admitted to hospital with disturbance of balance. After being questioned, parents remembered an otitis with effusion 3 months earlier. CT‐scans revealed destruction of both temporal bones. Initial biopsy showed granulomatous, necrotic inflammation, which led to comprehensive differential diagnoses. A second tissue sample confirmed Langerhans cell histiocytosis.
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Affiliation(s)
- Anja Pähler vor der Holte
- Department of Otorhinolaryngology, Head and Neck SurgeryNordstadt ClinicAcademic HospitalHanoverGermany
| | - Hans‐Jürgen Welkoborsky´
- Department of Otorhinolaryngology, Head and Neck SurgeryNordstadt ClinicAcademic HospitalHanoverGermany
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2
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Ramji HF, Deng F. Langerhans Cell Histiocytosis Reactivation in a Teenager. J Pediatr 2022; 248:131-132. [PMID: 35667446 DOI: 10.1016/j.jpeds.2022.05.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/31/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Husayn F Ramji
- University of Oklahoma College of Medicine, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Francis Deng
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Alhaidri NE, Alim B, Alrushaid NR, Fatani H, Binnasser AS. Temporal Bone Langerhans Cell Histiocytosis: An Uncommon Bilateral Presentation. Cureus 2021; 13:e12732. [PMID: 33614334 PMCID: PMC7883190 DOI: 10.7759/cureus.12732] [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] [Indexed: 11/13/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare condition that presents clinically in various ways. The cause and subsequent development of LCH are idiopathic and not fully understood. This disease is mainly seen in childhood. It is rare to have bilateral temporal bone LCH as the initial presentation. LCH can affect many organs. However, the bilateral involvement of the temporal bone is very uncommon. Therefore, we believe documenting cases of this presentation can lead to a better understanding of the epidemiology and prevalence of the disease, which can contribute to its management planning. A one-year-old boy was referred to a tertiary otolaryngology clinic with bilateral postauricular swelling, hearing loss, but no tenderness or ear discharge. During the patient evaluation, a CT scan was requested to further investigate the bilateral swelling, which showed bilateral bony destructive lesions in the temporal bone area. Next, the patient was scheduled for a biopsy of this lesion under general anesthesia. A biopsy of the right mastoid confirmed the diagnosis of LCH. The patient was started on LCH IV protocol for multifocal bone lesions (MFB) with special site induction. A follow-up fluorodeoxyglucose positron emission tomography/CT (FDG PET/CT) was performed on the whole body with the impression of mild interval improvement of the temporal bones’ masses bilaterally with stable bilateral cervical lymphadenopathy. LCH is a rare pathology that requires comprehensive effort from various medical and surgical teams to reach the right diagnoses and start the patient on the best available treatment plan.
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Affiliation(s)
- Nojood E Alhaidri
- College of Medicine, King Saud University, King Saud University Medical City, Riyadh, SAU
| | - Bader Alim
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, SAU
| | - Nouf R Alrushaid
- College of Medicine, King Saud University, King Saud University Medical City, Riyadh, SAU
| | - Hanadi Fatani
- Department of Histopathology, King Fahad Medical City, Riyadh, SAU
| | - Ameen S Binnasser
- Department of Otolaryngology-Head and Neck Surgery, King Fahad Medical City, Riyadh, SAU
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Lin SC, Lee WI, Jaing TH, Yang CP, Hung IJ, Chang TY, Huang JL, Chen LC, Ou LS, Yao TC, Chen SH. The influence of clinical features mimicking primary immunodeficiency diseases (mPID) on children with Langerhans cell histiocytosis (LCH) - Four with mPID among 39 LCH children from one referral center during 18-year period. Immunobiology 2019; 225:151877. [PMID: 31862125 DOI: 10.1016/j.imbio.2019.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/26/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Recurrent or refractory infections can be a warning sign of primary immunodeficiency diseases (PID). Such mimicking PID (mPID) can occur in patients with Langerhans cell histiocytosis (LCH). Because some cases with refractory molluscum contagiosum-like lesions and persistent otorrhea are finally diagnosed with LCH, we wondered whether such mPID can occur in LCH children and affect on their prognosis. METHODS We retrospectively reviewed all children with LCH at our institute from 2001 to 2018. A complete medical review of sex, age, symptoms, treatment course, and outcome comparison was performed. RESULTS Of 39 enrolled LCH patients, three had persistent otorrhea and one had refractory molluscum contagiosum-like lesions despite aggressive antibiotic therapy. These four cases with mPID had significantly higher rates of multi-system involvement, recurrence and 5-month more lag time, but no risk organ (liver, spleen and bone marrow) involvement compared to those without mPID, although bone and skin were the most involved in both groups. Overall, the lag-time in multi-system was longer than that in single-system involvement (median 2.5 vs. 1.0 months; p = 0.003). The diagnosis-age of risk organ involvement was younger than those without (median 8 vs. 43 months; p = 0.004). There were no significant differences in diagnosis-age, single/multi-system and risk organ involvement between remission and recurrence groups. All were alive excluding four who were lost to follow-up. CONCLUSIONS The LCH children with mPID had greater lag time, multi-system involvement, recurrence and more refractory treatment including transplantation despite the ratio of bone and skin lesions equal to those without mPID.
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Affiliation(s)
- Shiuan-Chen Lin
- Department of Pediatrics, Division of Allergy, Asthma and Rheumatology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wen-I Lee
- Primary Immunodeficiency Care and Research (PICAR) Institute, Taiwan; Department of Pediatrics, Division of Allergy, Asthma and Rheumatology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
| | - Tang-Her Jaing
- Department of Pediatrics, Division of Hematology/Oncology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chao-Ping Yang
- Department of Pediatrics, Division of Hematology/Oncology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Iou-Jih Hung
- Department of Pediatrics, Division of Hematology/Oncology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tsung-Yen Chang
- Department of Pediatrics, Division of Hematology/Oncology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jing-Long Huang
- Department of Pediatrics, Division of Allergy, Asthma and Rheumatology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Li-Chen Chen
- Department of Pediatrics, Division of Allergy, Asthma and Rheumatology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Liang-Shiou Ou
- Department of Pediatrics, Division of Allergy, Asthma and Rheumatology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tsung-Chieh Yao
- Department of Pediatrics, Division of Allergy, Asthma and Rheumatology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shih-Hsiang Chen
- Department of Pediatrics, Division of Hematology/Oncology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Abstract
Langerhans cell histiocytosis (LCH) is a rare disease, which may involve various organ systems; therefore, it has multiple clinical manifestations. CASE REPORT We present the case of a 56-year-old woman admitted to Amerikan Hospital Ear-Nose and Throat outpatient clinic with a complaint of progressive hearing loss in both ears, which had started 10 years ago. She was treated with corticosteroids for 10 years until last year, 2017. Surgical exploration was performed and histologic evaluation revealed LCH. CONCLUSIONS LCH has clinical manifestations depending on the site of infiltration. In adults, isolated bilateral mastoid infiltration, as an initial symptom, is a very rare condition. With corticosteroid uptake, the period of initial symptom was 10 years in our patient, which is, as per our knowledge, the longest reported in literature. This infiltration may mimic acute or chronic infections of the ear. Therefore, LCH should be considered in the differential diagnose of patients who present with bilateral mastoid cavity disease.
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Affiliation(s)
- Seçil Bahar
- Clinic of Ear Nose and Throat, Vehbi Koc Foundation American Hospital, İstanbul, Turkey
| | - Teoman Dal
- Clinic of Ear Nose and Throat, Vehbi Koc Foundation American Hospital, İstanbul, Turkey
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Ong HY, Goh LC, Santhi K, Sha'ariyah MM. Concurrent Mastoid Cellulitis and Langerhans Cells Histiocytosis:
A Challenging Diagnosis. Oman Med J 2018; 33:167-170. [PMID: 29657688 DOI: 10.5001/omj.2018.31] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare proliferative disorder, which commonly arises in the bone and may involve other systems. To date, the diagnosis of temporal bone LCH remains a challenge as it may masquerade as a common ear infection. We report a case of a child who presented to us with persistent bilateral ear discharge for four months and was not responding to treatment. Her condition subsequently worsened, with clinical features and radiological findings suggestive of mastoid cellulitis. Nevertheless, further histopathology study revealed LCH.
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Affiliation(s)
- Hui Yan Ong
- Department of Otorhinolaryngology, Tengku Ampuan Rahimah Hospital, Klang, Selangor, Malaysia
| | - Liang Chye Goh
- Department of Otorhinolaryngology, Tengku Ampuan Rahimah Hospital, Klang, Selangor, Malaysia.,Department of Otorhinolaryngology, University of Malaya, Kuala Lumpur, Malaysia
| | - Kalimuthu Santhi
- Department of Otorhinolaryngology, Tengku Ampuan Rahimah Hospital, Klang, Selangor, Malaysia
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Ni M, Yang X. Langerhans' cell histiocytosis of the temporal bone: A case report. Exp Ther Med 2017; 13:1051-1053. [PMID: 28450940 DOI: 10.3892/etm.2017.4072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 11/10/2016] [Indexed: 12/28/2022] Open
Abstract
Langerhansmporal histiocytosis (LCH) refers to a group of diseases that are characterized by the primary pathogenesis of an abnormal polyclonal proliferation of Langerhans cells that affect different structures of the human body, including the temporal bone. Thus far, the etiology of LCH remains unclear. Diagnosis of LCH is based on a synthetic analysis of the clinical presentations, as well as on features of imaging and histopathology. The clinical features, diagnosis, treatment and prognosis of LCH remain obscure, and temporal LCH is often confused with ear inflammatory lesions and malignant tumors. There are several therapeutic modalities for temporal bone LCH that include surgery, chemotherapy, radiotherapy and steroidal injections. The present study reports the case of an infant presenting a 1-month history of worsening left facial paralysis and a slowly enlarging post auricular mass followed by a 1-month history of postauricular swelling in the left ear. Computed tomography demonstrated a large mass of organized tissue. Moreover, the diagnosis of LCH was confirmed by histopathological and immunohistochemical examinations. The patient also suffered from multiple organ failure, including the liver, kidney, lymphatic system, skin, hematopoietic system and lungs. Following surgical intervention with mastoidotympanectomy, the parents of the patient refused further chemotherapy, and the patient succumbed to the disease ~6 months later.
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Affiliation(s)
- Maomei Ni
- Department of Otorhinolaryngology, Guizhou Provincial People's Hospital, Guiyang, Guizhou 550002, P.R. China
| | - Xiuhai Yang
- Department of Otorhinolaryngology, Guizhou Provincial People's Hospital, Guiyang, Guizhou 550002, P.R. China
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Liang C, Liang Q, DU C, Zhang X, Guo S. Langerhans' cell histiocytosis of the temporal fossa: A case report. Oncol Lett 2016; 11:2625-2628. [PMID: 27073529 DOI: 10.3892/ol.2016.4256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 02/01/2016] [Indexed: 11/05/2022] Open
Abstract
Langerhans' cell histiocytosis (LCH) is a rare disease with a wide spectrum of clinical manifestations, varying from an isolated lesion to systemic involvement. The etiology of this disease remains to be elucidated. The present study reports a case of LCH with temporal fossa localization in an 8-year-old male patient, who had exhibited left temporal pain and headache for 1 month. Physical examination revealed slight exophthalmos and conjunctival hemorrhage in the patient's left eye, and non-contrast computed tomography imaging of the head revealed a soft tissue mass with unclear margins located in the left temporal fossa, as well as a wide bony defect. Magnetic resonance imaging revealed a heterogeneously contrast-enhanced mass near the left temporal pole, which eroded into the patient's left orbit and maxillary sinus. The lesion was totally excised and confirmed to be LCH through biopsy.
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Affiliation(s)
- Chen Liang
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Qianlei Liang
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Changwang DU
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Xiaodong Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Shiwen Guo
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
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9
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Cai YF, Wang QX, Ni CJ, Dong SY, Lv L, Li Q, Chen ED, Zhang XH. A Case Report: The Diagnosis and Therapeutic Evaluation for a Rare Disease of Langerhans Cell Histiocytosis Involving Thyroid. Medicine (Baltimore) 2015; 94:e1891. [PMID: 26554785 PMCID: PMC4915886 DOI: 10.1097/md.0000000000001891] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) involving the thyroid gland is extremely rare. Currently, the diagnosis and therapeutic evaluation for LCH involving thyroid is a challenge.We reported a rare case of LCH involving thyroid, presenting as painless thyroid goiters, and successfully performed positron emission tomography/computed tomography (PET/CT) to make an accurate diagnosis and therapeutic evaluation for LCH.Although the histology or cytology is the golden standard for the diagnosis of LCH involving thyroid, the PET/CT should be keep in mind when LCH involving thyroid with inconclusive cytologic results. During the treatment of LCH, PET/CT can be performed to assess the therapeutic effect and select the most effective and reliable treatment for LCH.
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Affiliation(s)
- Ye-Feng Cai
- From the Department of Oncology (Y-FC, Q-XW, S-YD, LL, QL, E-DC, X-HZ); and Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China (C-JN)
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10
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Langerhans Cell Histiocytosis of the Temporal Bone with Otic Capsule Involvement. Clin Neuroradiol 2015; 27:163-168. [PMID: 26341354 DOI: 10.1007/s00062-015-0461-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 08/17/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION This study is conducted to demonstrate that destructive lesions of the otic capsule by Langerhans cell histiocytosis (LCH) causing both radiographic and audiologic findings can be completely reversed with adequate treatment. Retrospective case review and analysis of clinical and imaging data were obtained as part of the diagnosis and treatment of patients with LCH of the temporal bone. METHODS With Institutional Review Board (IRB) approval, cases of LCH involving the temporal bone were searched for within the institutional databases. Criteria for inclusion was histologic diagnosis of LCH and pretreatment computed tomography (CT) demonstrating temporal bone and/or otic capsule involvement and posttreatment follow-up CT/magnetic resonance imaging (MRI) scans obtained at least 6 months after starting treatment. RESULTS We report eight cases of LCH of the temporal bone with three demonstrating otic capsule involvement radiographically and/or clinically. Review of posttreatment imaging revealed all three patients had complete restoration of the bony labyrinthine architecture and near or complete restoration of their hearing. CONCLUSIONS Though LCH of the temporal bone is a common site within the spectrum of the disease, involvement of the otic capsule remains rare. Here, we report the largest series of otic capsule involvement by LCH and investigate whether both architecture and hearing are recovered with appropriate treatment. Lastly, restoration of the bony architecture of the labyrinth suggests the mechanism of LCH is demineralization and not ablative.
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Xie SM, Liu W, Xiang YY, Xiao ZA, Ren HM, Peng AQ, Wu WJ, Yang XM, Xie DH, Yin TF, Ren JH. A rare disorder mimics otitis media: Langerhans cell histiocytosis of the temporal bone in a child with interstitial pulmonary fibrosis. Am J Otolaryngol 2014; 35:816-21. [PMID: 25139821 DOI: 10.1016/j.amjoto.2014.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 06/25/2014] [Accepted: 06/30/2014] [Indexed: 11/28/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a rare disease ranging from a benign to a rapidly fatal condition affecting young children predominantly, and is characterized by an abnormal clonal proliferation of Langerhans cells. We report a case of a 3-year-old child presenting with a 1-year history of otorrhea and otorrhagia followed by a 6-month history of postauricular swelling in the right ear. Imaging demonstrated a large mass of organized tissue. A biopsy was conducted, and the diagnosis of LCH was confirmed by histopathological and immunohistochemical examination. The child was treated with a 12-month course of vinblastine chemotherapy with prednisolone. No clinical evidence of recurrence was noticed after 3 years of follow-up. This rare case highlights the importance for otolaryngologists to keep LCH in mind for differential diagnosis in very young patients with symptoms and signs suggestive of acute mastoiditis or chronic otitis media.
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Affiliation(s)
- S M Xie
- Department of Otolaryngology Head and Neck Surgery, The Second Xiangya Hospital of Central South University, Changsha, PR China
| | - W Liu
- Department of Otolaryngology Head and Neck Surgery, The Second Xiangya Hospital of Central South University, Changsha, PR China
| | - Y Y Xiang
- Department of Human Anatomy, University of South China, Hengyang, PR China
| | - Z A Xiao
- Department of Otolaryngology Head and Neck Surgery, The Second Xiangya Hospital of Central South University, Changsha, PR China
| | - H M Ren
- Department of Otolaryngology Head and Neck Surgery, The Second Xiangya Hospital of Central South University, Changsha, PR China
| | - A Q Peng
- Department of Otolaryngology Head and Neck Surgery, The Second Xiangya Hospital of Central South University, Changsha, PR China
| | - W J Wu
- Department of Otolaryngology Head and Neck Surgery, The Second Xiangya Hospital of Central South University, Changsha, PR China
| | - X M Yang
- Department of Otolaryngology Head and Neck Surgery, The Second Xiangya Hospital of Central South University, Changsha, PR China
| | - D H Xie
- Department of Otolaryngology Head and Neck Surgery, The Second Xiangya Hospital of Central South University, Changsha, PR China
| | - T F Yin
- Department of Otolaryngology Head and Neck Surgery, The Second Xiangya Hospital of Central South University, Changsha, PR China
| | - J H Ren
- Department of Otolaryngology Head and Neck Surgery, The Second Xiangya Hospital of Central South University, Changsha, PR China.
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Maia RC, de Rezende LMM, Robaina M, Apa A, Klumb CE. Langerhans cell histiocytosis: Differences and similarities in long-term outcome of paediatric and adult patients at a single institutional centre. Hematology 2014; 20:83-92. [DOI: 10.1179/1607845414y.0000000173] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Raquel Ciuvalschi Maia
- Programa de Pesquisa em Hemato-Oncologia MolecularInstituto Nacional de Câncer (INCA), Rio de Janeiro (RJ), Brazil
- Serviço de Hematologia, Hospital do Câncer-I, INCA, RJ, Brazil
| | | | - Marcela Robaina
- Programa de Pesquisa em Hemato-Oncologia MolecularInstituto Nacional de Câncer (INCA), Rio de Janeiro (RJ), Brazil
| | - Alexandre Apa
- Serviço de Hematologia, Hospital do Câncer-I, INCA, RJ, Brazil
| | - Claudete Esteves Klumb
- Programa de Pesquisa em Hemato-Oncologia MolecularInstituto Nacional de Câncer (INCA), Rio de Janeiro (RJ), Brazil
- Serviço de Hematologia, Hospital do Câncer-I, INCA, RJ, Brazil
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Incidence of non-infectious ‘acute mastoiditis’ in children. The Journal of Laryngology & Otology 2011; 126:244-8. [DOI: 10.1017/s0022215111002921] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:The temporal bone may be the first involved site in cases of systemic disease, and may even present with acute, mastoiditis-like symptomatology. This study aimed to evaluate the incidence of such non-infectious ‘acute mastoiditis’ in children.Materials and methods:Retrospective chart review of 73 children admitted to a tertiary referral centre for acute mastoiditis.Results:In 71 cases (97.3 per cent), an infectious basis was identified. In the majority of cases (33 of 73; 45 per cent), the responsible bacteria was Streptococcus pneumoniae. However, histopathological studies revealed a non-infectious underlying disease (myelocytic leukaemia or Langerhans' cell histiocytosis) in two atypical cases (2.7 per cent).Conclusion:‘Acute mastoiditis’ of non-infectious aetiology is a rare but real threat for children, and a challenging diagnosis for otologists. A non-infectious basis should be suspected in every atypical, persistent or recurrent case of acute mastoiditis.
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Yavas US, Incesulu A, Acikalin M, Calisir C, Adapinar B. Eosinophilic granuloma of the temporal bone with extensive bilateral otic capsule involvements: Incomplete reossification despite theraphy. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.pedex.2009.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rodríguez Rivera V, Lesmas Navarro MJ, Paula Vernetta CD, Donderis Sala J, Morera Faet H. Early start eosinophilic granuloma of the temporal bone. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s2173-5735(10)70056-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Prognostic indicators for sensorineural hearing loss in temporal bone histiocytosis. Int J Pediatr Otorhinolaryngol 2009; 73:1616-20. [PMID: 19671478 DOI: 10.1016/j.ijporl.2009.07.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 07/10/2009] [Accepted: 07/14/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Our review aims: (1) to highlight the suspicion of sensorineural hearing loss (SNHL) in temporal bone Langerhans' cell histiocytosis (LCH); (2) to assess the evolution of SNHL in this pathology; (3) to identify radiologic findings of the otic capsule invasion by LCH; (4) to determine prognostic factors for SNHL in temporal bone LCH. METHODS We performed a literature review through MEDLINE for SNHL in temporal bone LCH related articles that were published between 1954 and 2008. We identified 12 related studies of which 18 patients were noted. We also added our case to this series. The information from the reports was analyzed to characterize the clinical and demographic data and to focus on the sensorineural hearing aspect of the disease and on the damage of the semicircular canals (SCC) and the cochlea. RESULTS Ten percent of patients with temporal bone LCH presented SNHL. The mean age of patients is 3.5 years among children and 35.5 years among adults. Male to female ratio is 1:1.14. There were 13 unilateral cases, 6 bilateral cases and 1 case of multisystemic histiocytosis. Cochlea and SSCs were involved in 4 and 20 temporal bones, respectively. The lateral SCC is the most frequently eroded canal. In 23 ears hearing level was reported: 15 ears had a SNHL and the remaining was a mixed or a conductive hearing loss type. 10 ears suffered from a profound hearing loss and none of them improved after treatment regardless otic capsule affected structures. In all cases of normal hearing, moderate hearing loss and severe hearing loss before treatment cochlea have not been affected. However a single or two semicircular canals invasions have been noted. Where it is reported (15 out of 25 temporal bone) there was a radiological healing of the otic capsule lesion after treatment. Remineralization occurs 6 months after treatment. CONCLUSION In LCH, hearing loss level before treatment can be considered as a prognostic indicator for hearing in response to treatment. Even though bone mineralization is essential for a hearing improvement, radiological healing is not a prognostic factor for better hearing level after treatment.
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Rodríguez Rivera V, Lesmas Navarro MJ, de Paula Vernetta C, Donderis Sala J, Morera Faet H. [Early start eosinophilic granuloma of the temporal bone]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2009; 61:315-7. [PMID: 19836006 DOI: 10.1016/j.otorri.2009.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Revised: 04/28/2009] [Accepted: 05/11/2009] [Indexed: 12/25/2022]
Abstract
Langerhans cell histiocytosis is a disease of unknown aetiology which may be isolated or affect multiple organs and which frequently affects the head and neck, with cranial compromise being one of the most common manifestations in children over five years. We present the case of a three year old girl with no otologic history who came to our hospital with a clinic of subperiostic abscess, subsequently diagnosed as eosinophilic granuloma. We describe the treatment and clinical evolution of the case.
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Langerhans' cell histiocytosis of the temporal bone in children. Int J Pediatr Otorhinolaryngol 2008; 72:775-86. [PMID: 18355926 DOI: 10.1016/j.ijporl.2008.02.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Accepted: 02/04/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Langerhans' cell histiocytosis (LCH) is a rare pathology that implies an abnormal proliferation of these kinds of cells associated with a granular infiltration that affects different structures of the human body, including the temporal bone. The authors present their series of LCH of the temporal bone in children at the Sainte-Justine university hospital. The twofold objective of this study is to illustrate the clinical presentation, management and prognosis of this disease, and to compare these results with previously reported series. METHODS A retrospective study was conducted between 1984 and 2007 with patients diagnosed and treated for a LCH of the temporal bone at the Sainte-Justine university hospital, a paediatric tertiary care center. A chart review was performed to obtain demographic, clinical, paraclinical, and therapeutic data. They were analysed and compared to other published series. Through a MEDLINE query, we found that since 1966, 50 articles dealing with a LCH of the temporal bone have been published. RESULTS Fifty-nine cases of LCH were diagnosed and among them, 10 children had temporal bone involvement. They were four females and six males with a mean age of 3.28 years. The two most frequent clinical manifestations were the presence of a mass in the temporal region (70%) and otitis (60%). Two of our patients had a unifocal lesion of the temporal bone implicated. Eight patients had a multisystem involvement among which, two showed evidence of organ dysfunction. In 80% of cases, the diagnosis was made by immunohistochemical findings of the S-100 protein and/or the CD1 antigen. The common radiological finding on a skull CT scan is a lytic lesion in the temporal bone. Seven patients were treated by chemotherapy, two were treated by radiotherapy as a primary treatment, and one received radiotherapy for a recurrence on the pituitary gland. Finally, one patient was treated with local steroid injections. Two patients had a recurrence. All our patients were in total remission on a mean average of 1.6 years after the diagnosis. Our results concord with other studies in which the prognosis of unifocal bone disease is excellent and children with a multifocal disease have a survival rate of 65-100%. CONCLUSION LCH is a rare disease. A high-index suspicion should be raised in the context of a temporal mass, chronic otitis, and otorrhea. A biopsy is recommended in the presence of a temporal bone lytic lesion. Chemotherapy is the preferred therapeutic modality.
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Dong-xiao N, Hui-tu N, An-zhou T, Ruo-ze C. Langerhans' Cell Histiocytosis (Histiocytosis X) of the Temporal Bone. J Otol 2007. [DOI: 10.1016/s1672-2930(07)50007-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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del Río L, Lassaletta L, Martínez R, Sarriá MJ, Gavilán J. Petrous Bone Langerhans Cell Histiocytosis Treated with Radiosurgery. Stereotact Funct Neurosurg 2007; 85:129-31. [PMID: 17228179 DOI: 10.1159/000098528] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a rare disease that may show as a solitary or multifocal lesion of bone, soft tissue or viscera. Involvement of the temporal bone has been described in 15-61% of patients with LCH, usually in association with multisystemic involvement. We report the case of a 30-year-old man presenting with vertigo and fluctuating hearing loss caused by monosystemic LCH of the left petrous bone. The patient was treated with radiosurgery (covering dose 10 Gy at 85% isodose, maximum dose 11.76 Gy). Two years after treatment, no evidence of recurrent disease was found in the CT scan or MRI. We discuss the treatment of temporal bone LCH, traditionally based on surgery, low-dose radiation therapy and intralesional steroids. To our knowledge, this is the first reported case of LCH of the petrous bone successfully treated with radiosurgery. This approach may be interesting in cases of LCH located on nonaccessible areas of the temporal bone.
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Affiliation(s)
- Laura del Río
- Department of Otolaryngology, La Paz University Hospital, Madrid, Spain.
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Mumbuc S, Karatas E, Durucu C, Kanlıkama M, Sirikci A, Bakır K, Deniz H. A rare disorder mimics otitis media in children: Langerhans’ cells histiocytosis. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.pedex.2005.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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