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Morcel M, Keribin P, Quenel L, Bertin H, Neel A, Lesclous P. Diagnosis, treatment and recurrence of a mandibular Langerhans cell histiocytosis: a three-year follow-up case report. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2022. [DOI: 10.1051/mbcb/2022027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction: Langerhans cell histiocytosis (LCH) is an abnormal clonal proliferation of Langerhans cells secondary to immune process, mutation of oncogene or genetic predispositions. It preferentially affects bone, lung and skin. The incidence is 2–6 cases per million per year. Prognosis is variable and depends on number and location of lesions, and impact of the initial treatment. Oral lesions may be the first sign of LCH as illustrated by the present case. Observation: A 24-year-old male consulted first for severe gingival inflammation, teeth mobilities and alveolar bone loss with a suspicion of LCH. A pulmonary involvement was secondarily revealed by tomodensitometry. Histological examination, from gingival biopsy, confirmed the diagnostic of LCH, showing cells positive for the anti-CD1A antibody. The patient was managed by oral surgery and chemotherapy approaches. Alveolar bone loss significantly reduced. But 2 years and a half after the diagnosis, a recurrence was noted and managed by surgical approach. After a three-year follow-up, no recurrence was noted. Conclusion: Oral lesions can be inaugural manifestations of LCH. The dentist has an essential role in the early detection of these lesions.
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Mzabi A, Thabet M, Tlili T, Zorgati H, Anoun J, Hassine IB, Karmeni M, Fredj FB, Mokni M, Laouani C. Nasal oral fistula revealing Langerhans´ cell histiocytosis in adult patient: case report. Pan Afr Med J 2021; 40:16. [PMID: 34733384 PMCID: PMC8531974 DOI: 10.11604/pamj.2021.40.16.27074] [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: 11/21/2020] [Accepted: 02/05/2021] [Indexed: 11/25/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare systemic disease caused by proliferation of mature histiocytes; its association to histiocyto fibroma is rarely reported. It rarely affects adults. We report a case of systemic LCH, in an adult patient with osteolytic lesion causing a fistula between the left nasal cavity and hard palate, involving the bone, lung, lymph node and associated to multiple histiocyto fibroma. The patient was operating for a fistula, and he was treated by chemotherapy and corticosteroids. Langerhans´ cell histiocytosis is a rare case, especially in adult patient. The diagnosis was based on histological and immunohistochemical analyses. This patient was treated by steroids and chemotherapy.
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Affiliation(s)
- Anis Mzabi
- Internal Medicine Department, Sahloul Hospital, Faculty of Medicine Sousse, University of Sousse, 4000 Sousse, Tunisia
| | - Maissa Thabet
- Internal Medicine Department, Sahloul Hospital, Faculty of Medicine Sousse, University of Sousse, 4000 Sousse, Tunisia
| | - Taghrid Tlili
- Pathology Department, Farhat Hached Hospital, Faculty of Medicine Sousse, University of Sousse, 4000 Sousse, Tunisia
| | - Hend Zorgati
- Internal Medicine Department, Sahloul Hospital, Faculty of Medicine Sousse, University of Sousse, 4000 Sousse, Tunisia
| | - Jihed Anoun
- Internal Medicine Department, Sahloul Hospital, Faculty of Medicine Sousse, University of Sousse, 4000 Sousse, Tunisia
| | - Imen Ben Hassine
- Internal Medicine Department, Sahloul Hospital, Faculty of Medicine Sousse, University of Sousse, 4000 Sousse, Tunisia
| | - Monia Karmeni
- Internal Medicine Department, Sahloul Hospital, Faculty of Medicine Sousse, University of Sousse, 4000 Sousse, Tunisia
| | - Fatma Ben Fredj
- Internal Medicine Department, Sahloul Hospital, Faculty of Medicine Sousse, University of Sousse, 4000 Sousse, Tunisia
| | - Moncef Mokni
- Pathology Department, Farhat Hached Hospital, Faculty of Medicine Sousse, University of Sousse, 4000 Sousse, Tunisia
| | - Chadia Laouani
- Internal Medicine Department, Sahloul Hospital, Faculty of Medicine Sousse, University of Sousse, 4000 Sousse, Tunisia
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Chugh A, Kaur A, Kumar Patnana A, Kumar P, Chugh VK. Unisystem Langerhans cell histiocytosis in maxillofacial region in pediatrics: comprehensive and systematic review. Oral Maxillofac Surg 2021; 25:429-444. [PMID: 33591444 DOI: 10.1007/s10006-021-00949-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/01/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The study aimed to identify, enlist, and analyze cases of unisystem LCH in the maxillofacial pediatric population to understand the clinical presentation and encourage the consideration of this rare disease in the differential diagnosis. Langerhans cell histiocytosis (LCH) is an aggressive benign condition affecting mainly the pediatric population. It can be easily masked as periodontal disease in the maxillofacial region. Early diagnosis and a systemic evaluation are of utmost importance. METHODOLOGY We are presenting a complete review of literature in the pediatric population according to PRISMA guidelines for clinicopathologic, histopathological, immunohistochemistry, and treatment for unisystem LCH. The risk of bias assessment across studies was done using a Case series appraisal checklist by Guo et al. 53 RESULTS: Forty-nine articles (152 cases) were selected which met our inclusion and exclusion criteria to be included in our review. Most of the patients fall in 6-12 years of age with the involvement of the mandibular body region in 40.79% cases. This disease mainly presents as erythematous gingiva, pain, swelling, and mobile teeth. Management can range from minimal intervention to chemotherapy and surgery. CONCLUSION AND PRACTICAL IMPLICATIONS Although this is a rare condition, it should be considered especially in the pediatric population with periodontitis type lesions and floating teeth and comprehensive management should be followed. Early diagnosis of the disease is very important.
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Affiliation(s)
- Ankita Chugh
- Oral and maxillofacial surgery, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Amanjot Kaur
- Oral and maxillofacial surgery, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Arun Kumar Patnana
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pravin Kumar
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vinay Kumar Chugh
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Solitary Hard Palate Langerhans Cell Histiocytosis Demonstrated on PET/CT Scan in an Adult. Clin Nucl Med 2020; 45:811-812. [PMID: 32804762 DOI: 10.1097/rlu.0000000000003248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Langerhans cell histiocytosis (LCH) is rare in adults. Oral and maxillofacial LCH commonly affects the bones of the skull and jaws. Here we report a case of a 57-year-old man with a painless oral mass evaluated by F-FDG PET/CT. PET/CT showed a solitary F-FDG-avid tumor in his left hard palate. LCH was confirmed after surgery. This case reminds us that LCH should be considered in an adult with hypermetabolic hard palate lesion on F-FDG PET/CT.
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Hammouri EH, Sweidan HA, AShokaibi O, Al Omari L. Langerhans cell histiocytosis: A case report with oral manifestations and the role of pediatric dentists in the diagnosis. Clin Case Rep 2020; 8:545-549. [PMID: 32185056 PMCID: PMC7069888 DOI: 10.1002/ccr3.2726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/23/2019] [Accepted: 12/24/2019] [Indexed: 12/14/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a benign disease that behaves malignantly. Early recognition and treatment of oral manifestation of LCH by pediatric dentist and other medical specialties is important to prevent further organ damage.
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Nezafati S, Yazdani J, Shahi S, Mehryari M, Hajmohammadi E. Outcome of Surgery as Sole Treatment of Eosinophilic Granuloma of Jaws. JOURNAL OF DENTISTRY (SHIRAZ, IRAN) 2019; 20:210-214. [PMID: 31579697 PMCID: PMC6732173 DOI: 10.30476/dentjods.2019.44903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Langerhans cell histiocytosis (LCH) is characterized by the congregation of proliferating langerhans cells (LC). Langerhans cells are a part of dendritic cell system
of primary immune response that is responsible for presenting antigen to lymphocytes. Being a rare disease, the total incidence of LCH is reported to be 1 in 2 million people.
LCH mainly affects children and young adults, with a slight male predilection. LCH is clinically divided into three groups namely Letter-Siwe disease
(multiple multi organ affecting LCH at very young age), Hand-Schuler-Christian disease (LCH of bone involvement exophthalmos and diabetes insipidus),
and Eosinophilic granuloma (LCH of bone, solitary or multiple). The extent of involvement influences the treatment planning. In this retrospective study,
we survey five patients with eosinophilic granuloma in jaws (bony LCH). The diagnosis was confirmed by tissue biopsy and histopathologic examination.
Surgery and curettage of the lesions were carried out under general or local anesthesia. After surgery, the patients were examined clinically every 6 month
in the first year and then once in a year. The overall outcome was excellent. According to the results, it can be concluded that surgical curettage of localized
eosinophilic granuloma is an appropriate and sufficient treatment.
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Affiliation(s)
- Saeed Nezafati
- Dept. of Oral & Maxillofacial Surgery, School of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javad Yazdani
- Dept. of Oral and Maxillofacial Surgery, School of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahriar Shahi
- Dept. of Endodontics, Dental and Periodontal Research Center, School of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahsa Mehryari
- Dept. of Oral Medicine, School of Dentistry, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Emran Hajmohammadi
- Dept. of Oral & Maxillofacial Surgery, School of Dentistry, Ardabil University of Medical Sciences, Ardabil, Iran
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Rao S, Hegde S, Thilak PSG, Babu GS, Ajila V, Shetty U, Buch SA. Langerhans Cell Histiocytosis in a 5-Year-Old Girl: A Case Report and Review of Literature. Indian J Med Paediatr Oncol 2019. [DOI: 10.4103/ijmpo.ijmpo_258_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractLangerhans cell histiocytosis (LCH) is an uncommon hematological disorder affecting infants and young children. LCH is a rare disorder of the reticuloendothelial system associated with proliferation of Langerhans cells and mature eosinophils. LCH can involve any bone, but the most common are pelvis, ribs, skull, long bones, vertebra, and facial bones. In the skull, frontal and parietal bones are commonly involved followed by the jaws, where mandible is more commonly affected than the maxilla. In this article, we report a case of LCH in a 5-year-old child involving the mandible. Swelling of one side of the face and aggressive periosteal reaction led to the diagnosis of monostotic LCH. The manuscript also summarizes the results of a literature search in PubMed of reported cases of LCH over the past 10 years.
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Affiliation(s)
- Shruthi Rao
- Consultant, General Dental Practitioner, Mangala Health Centre, Padil, Karnataka, India
| | - Shruthi Hegde
- Departments of Oral Medicine and Radiology, A B Shetty Memorial Institute of Dental Sciences, Nitte Deemed to be University, Karnataka, India
| | - PS Gopinath Thilak
- Departments of Oral and Maxillofacial Surgery and Oral Pathology and Microbiology, A B Shetty Memorial Institute of Dental Sciences, Nitte Deemed to be University, Karnataka, India
| | - G Subhas Babu
- Departments of Oral Medicine and Radiology, A B Shetty Memorial Institute of Dental Sciences, Nitte Deemed to be University, Karnataka, India
| | - Vidya Ajila
- Departments of Oral Medicine and Radiology, A B Shetty Memorial Institute of Dental Sciences, Nitte Deemed to be University, Karnataka, India
| | - Urvashi Shetty
- Departments of Oral Pathology and Microbiology, A B Shetty Memorial Institute of Dental Sciences, Nitte Deemed to be University, Karnataka, India
| | - Sajad Ahmad Buch
- Departments of Research Scholar, Yenepoya Dental College, Yenopoya (Deemed to be) University, Mangaluru, Karnataka, India
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Almuzayyen A, Elhassan W, Alabbadi M. Intralesional Triamcinolone for Treating Mandibular Langerhans Cell Histiocytosis: A Case Report and Literature Review. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2019; 7:47-50. [PMID: 30787858 PMCID: PMC6381848 DOI: 10.4103/sjmms.sjmms_84_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Langerhans cell histiocytosis is a rare condition ranging in manifestation from a focal boney lesion to multisystem involvement. Several treatment modalities have been proposed including curettage, low-dose radiotherapy, chemotherapy and intralesional injection of corticosteroids. These treatment options can be used as a single or combined approach. Prognosis depends on the extent of systemic involvement, and solitary lesions respond favorable to treatment. Here, the authors report a case of a 10-year-old male patient with Langerhans cell histiocytosis affecting his right posterior mandible that was successfully treated with intralesional injection of triamcinolone in multiple sessions. Complete recovery was confirmed clinically and radiographically in 18 months from the time of diagnosis.
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Affiliation(s)
- Ahmed Almuzayyen
- Department of Surgery, Dental and Maxillofacial Surgery Unit, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Wahbi Elhassan
- Department of Surgery, Dental and Maxillofacial Surgery Unit, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Mousa Alabbadi
- Department of Surgery, Dental and Maxillofacial Surgery Unit, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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Neves-Silva R, Fernandes DT, Fonseca FP, Rebelo Pontes HA, Brasileiro BF, Santos-Silva AR, Vargas PA, Lopes MA. Oral manifestations of Langerhans cell histiocytosis: A case series. SPECIAL CARE IN DENTISTRY 2018; 38:426-433. [DOI: 10.1111/scd.12330] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/13/2018] [Accepted: 07/30/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Rodrigo Neves-Silva
- Oral Diagnosis Department; Piracicaba Dental School; University of Campinas (UNICAMP); Piracicaba São Paulo Brazil
| | - Diego Tetzner Fernandes
- Oral Diagnosis Department; Piracicaba Dental School; University of Campinas (UNICAMP); Piracicaba São Paulo Brazil
| | - Felipe Paiva Fonseca
- Oral Diagnosis Department; Piracicaba Dental School; University of Campinas (UNICAMP); Piracicaba São Paulo Brazil
| | | | | | - Alan Roger Santos-Silva
- Oral Diagnosis Department; Piracicaba Dental School; University of Campinas (UNICAMP); Piracicaba São Paulo Brazil
| | - Pablo Agustin Vargas
- Oral Diagnosis Department; Piracicaba Dental School; University of Campinas (UNICAMP); Piracicaba São Paulo Brazil
| | - Marcio Ajudarte Lopes
- Oral Diagnosis Department; Piracicaba Dental School; University of Campinas (UNICAMP); Piracicaba São Paulo Brazil
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Luz J, Zweifel D, Hüllner M, Bühler M, Rücker M, Stadlinger B. Oral manifestation of Langerhans cell histiocytosis: a case report. BMC Oral Health 2018; 18:106. [PMID: 29884166 PMCID: PMC5994067 DOI: 10.1186/s12903-018-0568-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 05/30/2018] [Indexed: 12/28/2022] Open
Abstract
Background Bone necrosis of the jaw is a serious condition with a broad differential diagnosis of pathologies such as cutaneous histiocytosis, bone metastases or malignant tumours. In addition to the most common cause, medication related osteonecrosis of the jaw (MRONJ), one must consider a number of other causes, such as histiocytosis. Langerhans cell histiocytosis (LCH) is a histiocytic disorder with a large spectrum of clinical manifestations and with possible involvement of a variety of organs. This case shows the importance of an early detection of this rare disease in order to prevent further spreading. Even if an initial diagnosis in the oral cavity is rare, dentists should be aware of this disease. Case presentation The presented case describes a patient who was referred for evaluation and treatment due to exposed bone and extensive osteolysis in the region of the upper and lower jaw. After biopsy and diagnosis of LCH, the patient was treated with systemic therapy, achieved remission and is disease free after a 2 year of follow up. Conclusions This case report illustrates that when dealing with unclear osteolytic changes of the jawbone, Langerhans cell histiocytosis must be taken into consideration in the differential diagnosis and biopsy must be performed in case of suspicion.
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Affiliation(s)
- Julia Luz
- Clinic of Cranio-Maxillofacial and Oral Surgery, University of Zurich, University Hospital Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland.
| | - Daniel Zweifel
- Clinic of Cranio-Maxillofacial and Oral Surgery, University of Zurich, University Hospital Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland
| | - Martin Hüllner
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Marco Bühler
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Martin Rücker
- Clinic of Cranio-Maxillofacial and Oral Surgery, University of Zurich, University Hospital Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland
| | - Bernd Stadlinger
- Clinic of Cranio-Maxillofacial and Oral Surgery, University of Zurich, University Hospital Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland
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Ramos-Gutiérrez E, Alejo-González F, Ruiz-Rodríguez S, Garrocho-Rangel JA, Pozos-Guillén A. Langerhans cell histiocytosis: Current concepts in dentistry and case report. J Clin Exp Dent 2016; 8:e102-8. [PMID: 26855698 PMCID: PMC4739360 DOI: 10.4317/jced.52498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 08/13/2015] [Indexed: 11/23/2022] Open
Abstract
Langerhans cell histiocytosis (LCH), which is a rare granulomatous pediatric disease of unknown etiology, is characterized by the idiopathic proliferation and accumulation of abnormal and clonal Langerhans cells or their marrow precursors, resulting in localized, solitary or multiple destructive lesions. These lesions are most commonly eosinophilic granuloma, which are found in craniofacial bone structures such as the skull and mandible, skin and other organs. In children, the disease has a variable initial presentation, and the clinical course, prognosis and survival are unpredictable. The aims of this report were to present an LCH case in a girl aged 2 years, 8 months and her clinicopathological features, to describe the bucodental management provided, and to discuss special dental considerations of this disease.
Key words:Children, dental management, histiocytosis, Langerhans cells.
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Affiliation(s)
- Efraín Ramos-Gutiérrez
- DDS, Resident, Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, San Luis Potosi University, SLP, Mexico
| | - Francisco Alejo-González
- MD, MS, Associate Professor, Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, San Luis Potosi University, SLP, Mexico
| | - Socorro Ruiz-Rodríguez
- DDS, MS, Chairman, Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, San Luis Potosi University, SLP, Mexico
| | - José-Arturo Garrocho-Rangel
- DDS, MS, PhD, Associate Professor, Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, San Luis Potosi University, SLP, Mexico
| | - Amaury Pozos-Guillén
- DDS, MS, PhD, Associate Professor, Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, San Luis Potosi University, SLP, Mexico
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Lalitha C, Manjula M, Srikant K, Goyal S, Tanveer S. Hand schuller christian disease: a rare case report with oral manifestation. J Clin Diagn Res 2015; 9:ZD28-30. [PMID: 25738095 PMCID: PMC4347186 DOI: 10.7860/jcdr/2015/10985.5481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 10/09/2014] [Indexed: 11/24/2022]
Abstract
Langerhan's Cell Histiocytosis (LCH) is disorders which include abnormalities that result from abnormal proliferation of langerhan's cells or their precursors. LCH is clinically classified into three types-eosinophilic granuloma, Hand Schuller Christian disease and Abt-Letterer- Siwe disease. It is usually manifested in childhood as well as in adulthood. The clinical manifestations are the result of the accumulation and infilteration of the langerhan cells in organs and tissues. Here is a rare case report of 6-year-old boy with extraoral manifestation of exopthalmic right eye and oral manifestation of mobility of teeth and with typical radiological findings. Basing on the clinical, radiological and histopathological examination the diagnosis of Hand Schuller Christian Disease was given.
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Affiliation(s)
- Ch. Lalitha
- Senior Lecturer, Department of Oral Medicine and Radiology, Sri Sai College of Dental Surgery, Vikarabad,Telanagana, India
| | - M. Manjula
- Professor, Department of Oral Medicine and Radiology, Gandhi Hospitals, Hyderabad, India
| | - K. Srikant
- Senior Lecturer, Department of Oral Medicine and Radiology, Sri Sai College of Dental Surgery, Vikarabad, India
| | - Stuti Goyal
- Senior Lecturer, Department of Oral Medicine and Radiology, Sri Sai College of Dental Surgery, Vikarabad, India
| | - Shahela Tanveer
- Senior Lecturer, Department of Oral Pathology, Sri Sai College of Dental Surgery, Vikarabad, India
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Shi S, Liu Y, Fu T, Li X, Zhao S. Multifocal Langerhans cell histiocytosis in an adult with a pathological fracture of the mandible and spontaneous malunion: A case report. Oncol Lett 2014; 8:1075-1079. [PMID: 25120660 PMCID: PMC4114718 DOI: 10.3892/ol.2014.2272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 05/23/2014] [Indexed: 11/22/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is rare in the adult population and even rarer with jaw involvement. The current study presents the case of a 39-year-old male who complained of recurrent pain, swelling of the gingiva and an occasional pus-like discharge in the right mandible for one year. The patient was previously prescribed antibiotics, but this did not resolve the problem. An initial panoramic radiograph showed an osteolytic lesion and bone fracture in the right mandible. Eight months later, a new radiograph showed the spontaneous malunion of the fractured mandible. The patient was eventually diagnosed with Langerhans cell histiocytosis by histopathology and immunohistochemistry. Further lesions were found in the ribs and ilium by nuclear bone scanning. The patient was subsequently treated with systemic chemotherapy, and the lesions are currently effectively being controlled. This study is the first to show that spontaneous intralesional bone regeneration may lead to reunification of the mandible fracture caused by LCH in an adult.
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Affiliation(s)
- Sailang Shi
- Dental Clinic, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, P.R. China
| | - Yanming Liu
- Department of Oral and Maxillofacial Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Tao Fu
- Department of Oral and Maxillofacial Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Xiuzhen Li
- Department of Pathology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Shifang Zhao
- Department of Oral and Maxillofacial Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China ; School of Dentistry, Zhejiang University, Hangzhou, Zhejiang 310006, P.R. China
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15
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Langerhans cell histiocytosis in childhood – Review, symptoms in the oral cavity, differential diagnosis and report of two cases. J Craniomaxillofac Surg 2014; 42:93-100. [DOI: 10.1016/j.jcms.2013.03.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 03/25/2013] [Accepted: 03/25/2013] [Indexed: 12/26/2022] Open
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Lajolo C, Campisi G, Deli G, Littarru C, Guiglia R, Giuliani M. Langerhans's cell histiocytosis in old subjects: two rare case reports and review of the literature. Gerodontology 2012; 29:e1207-e1214. [PMID: 22612839 DOI: 10.1111/j.1741-2358.2012.00629.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a proliferative disease of histiocyte-like cells that generally affects children; LCH onset is rare in adults; immunohistochemistry is essential to obtain the correct diagnosis, and treatment protocols are controversial. OBJECTIVE To describe two new cases of adult onset oral LCH. CASE REPORTS Case 1: a 71-year-old woman, complaining of diffuse oral pain, presented with erythematous mucosal lesions; the panoramic radiograph and CT scan showed multiple mandible radiolucent areas. Immunohistochemical assay for S-100, CD1a and langerin test was essential in reaching the correct diagnosis. Case 2: a 77-year-old female patient presented with a non-painful, non-bleeding, slightly elevated erythematous palatal lesion of 6 months duration, together with a genital vulvar lesion of uncertain nature. The pathology confirmed the diagnosis of LCH. Many therapies (etoposid, radiotherapy) could induce only a clinical partial remission; Cladribine induced a complete recovery. CONCLUSION The first case was difficult to diagnose: the clinical presentation and course of the disease (LCH) in the elderly are multiple and unpredictable. An immunohistochemistry study is often essential to obtain the correct diagnosis. The second case required several therapeutic interventions: even though some cases regress spontaneously, others require systemic chemotherapy.
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Affiliation(s)
- Carlo Lajolo
- School of Dentistry, Catholic University, Largo A. Gemelli, Rome, Italy.
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Martins MAT, Gheno JLN, Sant'Ana Filho M, Pinto DS, Tenis CA, Martins MD. Rare case of unifocal Langerhans cell histiocytosis in four-month-old child. Int J Pediatr Otorhinolaryngol 2011; 75:963-7. [PMID: 21592594 DOI: 10.1016/j.ijporl.2011.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 04/12/2011] [Accepted: 04/17/2011] [Indexed: 11/26/2022]
Abstract
Langerhans cell histiocytosis (LCH) comprises a group of disorders, the common feature of which is Langerhans cell proliferation. The clinical presentation is highly varied. The severity and prognosis of the disease are dependent on the type and extent of organ involvement. This paper reports a rare case of a four-month-old white male with unifocal LCH limited exclusively to the mandible, discussing the diagnosis, radiographic and immunohistochemical aspects, treatment and monitoring multidisciplinary of the case.
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Affiliation(s)
- Marco Antonio T Martins
- Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Rua. Ramiro Barcelos, 2492 Porto Alegre, 90035-003 RS, Brazil
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Annibali S, Cristalli MP, Solidani M, Ciavarella D, La Monaca G, Suriano MM, Lo Muzio L, Lo Russo L. Langerhans cell histiocytosis: oral/periodontal involvement in adult patients. Oral Dis 2009; 15:596-601. [DOI: 10.1111/j.1601-0825.2009.01601.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Fistarol S, Itin P, Häusermann P, Oberholzer M, Raineri I, Lambrecht T, Lindenmüller IH. Unifocal Langerhans cell histiocytosis of the oral mucosa. J Dtsch Dermatol Ges 2009; 7:620-2. [PMID: 19228294 DOI: 10.1111/j.1610-0387.2009.07042.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 24-year-old man was admitted for a painful gingival ulcer. Histology and immunohistochemistry of a lesional biopsy revealed the diagnosis of Langerhans cell histiocytosis (LCH). To rule out multifocal disease, a complete staging was performed. There was no evidence of bony lesions or any other organ involvement. The diagnosis of LCH restricted to the oral mucosa was established. The complete oral lesion was ablated by CO(2) laser and subsequently treated topically with triamcinolone acetonide. The patient is still in remission after one year of follow-up. LCH confined to the oral mucosa is rare. It presents usually as an inflammatory or ulcerative lesion, easily leading to misinterpretation and delayed diagnosis. Patients with limited unifocal mucocutaneous disease, as in the present case, usually have an excellent prognosis. However, the oral lesion may represent an early sign of LCH, predating and progressing to an aggressive life-threatening multiorgan disease.
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Affiliation(s)
- Susanna Fistarol
- Department of Dermatology, University of Basel, Basel, Switzerland.
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Moralis A, Kunkel M, Kleinsasser N, Müller-Richter U, Reichert TE, Driemel O. Intralesional corticosteroid therapy for mandibular Langerhans cell histiocytosis preserving the intralesional tooth germ. Oral Maxillofac Surg 2008; 12:105-11. [PMID: 18594882 DOI: 10.1007/s10006-008-0113-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH, histiocytosis X, ICD-O 9751/1) refers to a neoplastic proliferation of Langerhans cells. The course of the disease determines the treatment and prognosis. Solitary forms (eosinophilic granuloma) and limited multilocational lesions may be treated successfully with local surgical intervention and intralesional corticosteroid injection. PURPOSE Presentation of our own case will review LCH, a very rare disease entity in oral-facial surgery and will document that intralesional corticosteroid injection is a less invasive alternative to the classical surgical curettage and local radiation therapy. CASE REPORT In a 10-year-old boy, a progressive, pressure-sensitive swelling had developed within 1 week in the left paramandibular and submandibular area. Dental status was good. Diagnostic imaging demonstrated a diffusely contoured osteolysis caudal to tooth germ 37 with infiltration of the adjacent chewing muscles. Histological evaluation of the intraoral biopsy sample established an LCH. Having excluded a multifocal form of LCH, treatment with intralesional injection of methylprednisolone 200 mg was chosen. Symptoms of pain were quickly relieved and the swelling receded. Follow-up visits 6 weeks, 3 months, and 6 months after corticosteroid injection revealed continuous regression of mandibular osteolysis. OPG and MRI after 17 months demonstrated a good osseous consolidation in the left mandibular angle area, but a still discernible bone marrow edema. Development of the intralesional tooth germ 37 appeared normal. CONCLUSION Local surgical interventions continue to be central to the range of accepted therapeutic measures. However, the increasing numbers of reports on the successful treatment of solitary LCH by intralesional corticosteroid injection suggest that this treatment option should be considered especially in children to preserve tooth germs.
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Affiliation(s)
- Antonios Moralis
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Universität Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, Germany
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21
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Moraes PDC, Bönecker M, Furuse C, Teixeira RG, Araujo VC. Langerhans cell histiocytosis in a child: a 10-year follow-up. Int J Paediatr Dent 2007; 17:211-6. [PMID: 17397466 DOI: 10.1111/j.1365-263x.2006.00802.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND This report describes a case of the benign form of Langerhans cell histiocytosis, which involves only the maxilla and mandible, and has no extraskeletal manifestations. CASE REPORT A 2.9-year-old boy was referred to a paediatric dentistry clinic, where clinical, radiographic and histological findings were found to be consistent with Langerhans cell histiocytosis. The difficulties involved in the diagnosis and the subject's functional oral rehabilitation are described. In view of the presence of large bone lesions, systematic treatment consisted of oral chemotherapy and the administration of methylprednisolone by intralesional infiltration. Oral examination revealed complete resolution of the ulcerative lesions. The soft tissue appeared healthy and had a normal colour. There was no tooth mobility and radiography provided evidence of bony healing. CONCLUSION This case is particularly interesting because follow-up clinical and radiographic observations have been made over the past 10 years. The successful treatment had several objectives, including providing the patient with an aesthetic appearance and recovering the lost vertical dimension of occlusion.
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Affiliation(s)
- Paulo de Camargo Moraes
- Department of Oral Surgery, Centre for Odontological Research, São Leopoldo Mandic Dental Research Inistitute, Campinas, São Paulo, Brazil
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22
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Loeb I, Shahla M, Javadian R, Hermans P. [Pathological mandibular fracture]. REVUE DE STOMATOLOGIE ET DE CHIRURGIE MAXILLO-FACIALE 2007; 108:159-61. [PMID: 17383697 DOI: 10.1016/j.stomax.2006.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Accepted: 12/20/2006] [Indexed: 05/14/2023]
Affiliation(s)
- I Loeb
- Service de stomatologie et chirurgie maxillofaciale, CHU Saint-Pierre, 1000 Bruxelles, Belgique.
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Mortellaro C, Pucci A, Palmeri A, Lucchina AG, Berta M, Celeste A, Costantino S, Del Prever AB, Forni M. Oral Manifestations of Langerhans Cell Histiocytosis in a Pediatric Population. J Craniofac Surg 2006; 17:552-6. [PMID: 16770197 DOI: 10.1097/00001665-200605000-00028] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Langerhans Cell Histiocytosis is a rare and protean disease of unknown etiology, clinically characterized by single or multiple osteolytic and/or soft tissue lesions. Oral involvement may predate systemic manifestations or mimic infectious/inflammatory disorders. In the present series, oral involvement characterized eight cases of pediatric Langerhans Cell Histiocytosis and oral symptoms represented a very early sign of this disease in four patients. A careful clinical investigation and a proper histologic analysis were required for achieving a definite diagnosis and for confirming clinical suspicion of disease relapse. Immunohistochemistry, that nowadays represents a reliable and accessible ancillary histological technique, allowed the definite diagnosis in all cases of our series.
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Affiliation(s)
- C Mortellaro
- Division of Oral Maxillofacial Pathology, Department of Oral Medicine and Diagnostic Sciences, and Dental and Stomatologic Clinic of Novara, Dental School, University of Eastern Piedmont, Piazza D' Armi 1, 28100 Novara, Italy.
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Hicks J, Flaitz CM. Langerhans cell histiocytosis: current insights in a molecular age with emphasis on clinical oral and maxillofacial pathology practice. ACTA ACUST UNITED AC 2006; 100:S42-66. [PMID: 16037792 DOI: 10.1016/j.tripleo.2005.06.016] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Langerhans cell histiocytosis (LCH) commonly involves the oral and maxillofacial region, and comes to the attention of dental practitioners when a patient presents with orofacial pain and a bony or soft tissue lesion. This is a relatively rare entity, which has made it difficult to investigate the clinical, biologic, and molecular aspects of the disease. Treatment protocols are not well defined, particularly in adults. During the past decade, the Histiocyte Society has formulated various LCH categories, based on risk stratification, and treatment protocols for the pediatric population. Adult trials are currently available through the Histiocyte Society. Although there has been considerable controversy, the neoplastic nature of LCH has been established by demonstrating clonality. LCH symptoms and the development and persistence of LCH lesions have been ascribed to a "chemokine/cytokine storm" due to autocrine and paracrine mechanisms. Discovery of biologic, cytogenetic, and molecular abnormalities in LCH have already affected treatment by providing novel therapeutic targets.
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Affiliation(s)
- John Hicks
- Surgical and Ultrastructural Pathology, Texas Children's Hospital, Houston 77030-2313, USA.
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Eckardt A, Schultze A. Maxillofacial manifestations of Langerhans cell histiocytosis: a clinical and therapeutic analysis of 10 patients. Oral Oncol 2003; 39:687-94. [PMID: 12907208 DOI: 10.1016/s1368-8375(03)00080-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The definition of Langerhans cell histiocytosis (formerly known as histiocytosis X) includes the clinical syndromes Hand-Schueller-Christian syndrome, Abt-Letterer-Siwe syndrome, and eosinophilic granuloma. The paper gives an overview of current diagnostic and treatment strategies of LCH. Furthermore, records and clinical data of 10 patients with LCH were evaluated retrospectively. Patients' age ranged from 13 years to 42 years. The mandible was more frequently involved than the maxilla. Three patients (30%) had systemic manifestations of LCH in addition to their oral lesions. The longest follow-up period was 12 years. During follow-up six patients (60%) developed recurrent LCH and received adjuvant chemo- or radiation therapy. For solitary bone lesions, surgical curettage is the recommended treatment. Those patients with multi-organ involvement or recurrent LCH should be included into clinical trials initiated by the Histiocyte Society.
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Affiliation(s)
- A Eckardt
- Department of Oral and Maxillofacial Surgery, Hannover Medical University, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
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