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Moullet B, Kolev M, Ebner L, Langer R, Gräni C, Obmann V, Maurer M, Semmo N, Christe A, Huber AT. Adult form of Langerhans cell histiocytosis with pulmonary and hepatic involvement mimicking malignancy in a patient with chronic hepatitis C infection. Radiol Case Rep 2020; 16:327-333. [PMID: 33318775 PMCID: PMC7724096 DOI: 10.1016/j.radcr.2020.11.022] [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: 08/12/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 11/28/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a myeloid neoplasm with inflammatory properties. There are few published reports of adult LCH with liver involvement, which is still poorly understood, but shows high morbidity and mortality. We report a case of a 37-year-old woman suffering from hepatitis C showing a LCH affecting the lung as well as the liver. Consistent with histology, we found an early stage of a proliferative/granulomatous phase of hepatobiliary LCH, whereas pulmonary findings showed a nodular stage of adult pulmonary LCH. Although hepatocellular carcinoma is a common malignancy in patients suffering from hepatitis C, it is crucial to keep in mind differential diagnosis for newly appearing liver lesions.
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Affiliation(s)
- Barbara Moullet
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital, University of Bern, Freiburgstrasse 10, Inselspital, 3010, Bern, Switzerland
| | - Mirjam Kolev
- Hepatology, Department of Visceral Surgery and Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital, University of Bern, Freiburgstrasse 10, Inselspital, 3010, Bern, Switzerland
| | - Rupert Langer
- Department of Pathology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Verena Obmann
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital, University of Bern, Freiburgstrasse 10, Inselspital, 3010, Bern, Switzerland
| | - Martin Maurer
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital, University of Bern, Freiburgstrasse 10, Inselspital, 3010, Bern, Switzerland
| | - Nasser Semmo
- Hepatology, Department of Visceral Surgery and Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Christe
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital, University of Bern, Freiburgstrasse 10, Inselspital, 3010, Bern, Switzerland
| | - Adrian Thomas Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital, University of Bern, Freiburgstrasse 10, Inselspital, 3010, Bern, Switzerland
- Corresponding author.
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Diabetes Mellitus, Extreme Insulin Resistance, and Hypothalamic-Pituitary Langerhans Cells Histiocytosis. Case Rep Endocrinol 2019; 2019:2719364. [PMID: 31341684 PMCID: PMC6612391 DOI: 10.1155/2019/2719364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 04/21/2019] [Accepted: 06/09/2019] [Indexed: 01/14/2023] Open
Abstract
Background Langerhans Cell Histiocytosis (LCH) is a rare inflammatory neoplasm characterized by an infiltration of organs by Langerin + (CD207+) and CD1a+ histiocytes. Diabetes insipidus is a frequent manifestation of the disease, while diabetes mellitus is very rare. We report the first case of a 20-year-old man suffering from hypothalamopituitary histiocytosis and diabetes mellitus with serum anti-insulin receptor antibodies. Case Presentation A 20-year-old patient was admitted for the evaluation of growth delay and hyperphagia. HbA1c level and fasting blood glucose were in the normal range. The diagnosis of hypothalamopituitary histiocytosis was based on histological features after biopsy of a large suprachiasmatic lesion identified on magnetic resonance imaging (MRI). Association of vinblastine and purinethol was started followed by a second-line therapy by cladribine. During the follow-up, the patient was admitted for recurrence of hyperglycemic states and extreme insulin resistance. The screening for serum anti-insulin receptor antibodies was positive. Each episode of hyperglycemia appeared to be correlated with tumoral activity and increase in serum anti-insulin receptor antibodies and appeared to be improved when the disease was controlled by chemotherapy. Conclusion We report the first description of a hypothalamopituitary histiocytosis associated with serum anti-insulin receptor antibodies, extreme insulin resistance, and diabetes. Parallel evolution of glucose levels and serum anti-insulin receptor antibodies seemed to be the consequence of immune suppressive properties of cladribine.
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Langerhans cell histiocytosis and Erdheim-Chester disease overlap syndrome with bone marrow involvement and type 2 diabetes mellitus. Ann Hematol 2017; 97:189-192. [DOI: 10.1007/s00277-017-3126-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022]
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Shima H, Inokuchi M, Shimada H. A case of multisystem Langerhans cell histiocytosis with primary hypothyroidism followed by type 1 diabetes mellitus. Pediatr Blood Cancer 2009; 53:232-4. [PMID: 19367615 DOI: 10.1002/pbc.22066] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We report a case of a 13-year-old female with Langerhans cell histiocytosis (LCH) and primary hypothyroidism followed by type 1 diabetes mellitus (DM), both of which are rare complications. In LCH diagnosis, imaging studies showed an enlargement of the thyroid gland, suggesting the involvement of LCH cells. While the pancreas appeared normal, insulin secretion markedly deteriorated 11 months after cessation of chemotherapy. Even without direct pancreatic involvement, there is a possibility that LCH could induce DM as a part of its long-term complications. In particular, thyroid involvement may be related to the onset of DM.
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Affiliation(s)
- Haruko Shima
- Department of Pediatrics, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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Makras P, Piaditis G, Kaltsas GA. Systemic and endocrine manifestations of Langerhans' cell histiocytosis: current concepts in diagnosis and management. Expert Rev Endocrinol Metab 2007; 2:773-783. [PMID: 30290476 DOI: 10.1586/17446651.2.6.773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Langerhans' cell histiocytosis (LCH) is a rare disease of unknown etiology and variable biologic behavior and course. Almost every organ can be affected; however, it frequently involves the bones, lungs, skin and lymph nodes. LCH exhibits a particular predilection for involvement of the hypothalamo-pituitary axis resulting in diabetes insipidus and/or other anterior pituitary deficiencies. Although LCH can sometimes resolve spontaneously, it usually follows a chronic course and systemic treatment is mandatory for the management of multisystem disease. However, a significant number of patients will develop at least one permanent sequela as a consequence of the disease, with diabetes insipidus being the most common. A multidisciplinary approach is always needed in diagnosis, treatment and follow-up of all patients with LCH.
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Affiliation(s)
- Polyzois Makras
- a Hellenic Air-Force General Hospital and VA, Department of Endocrinology & Diabetes, 251 Hellenic Air-Force General Hospital and VA, 3 Kanellopoulou Street, 11527, Athens, Greece.
| | - Georgios Piaditis
- b 'G.Gennimatas' General Hospital, Department of Endocrinology & Diabetes, 'G.Gennimatas' General Hospital, 154 Mesogion Ave, 11525, Athens, Greece.
| | - Gregory A Kaltsas
- c National University of Athens, Division of Endocrinology, Department of Pathophysiology, Laiko University Hospital, National University of Athens, 75 Mikras Asias Street, 115 67 Athens, Greece.
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Makras P, Alexandraki KI, Chrousos GP, Grossman AB, Kaltsas GA. Endocrine manifestations in Langerhans cell histiocytosis. Trends Endocrinol Metab 2007; 18:252-7. [PMID: 17600725 DOI: 10.1016/j.tem.2007.06.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Revised: 05/24/2007] [Accepted: 06/13/2007] [Indexed: 12/25/2022]
Abstract
Langerhans cell histiocytosis is a rare, multisystem disease that shows a particular predilection for hypothalamo-pituitary axis involvement. Diabetes insipidus is the most frequent permanent consequence of Langerhans cell histiocytosis, developing in around a quarter of patients. Although the exact prevalence of anterior pituitary hormone deficiencies is not known, it is probably high and is almost always associated with diabetes insipidus. Established pituitary hormone deficiencies are mostly permanent and require prompt diagnosis and treatment, whereas continuous follow-up is needed to detect deficiencies that might evolve later during the course of the disease. Involvement of endocrine tissues other than the pituitary has also been described but is relatively rare. Further studies are needed to evaluate the effect that endocrine deficiencies exert on the overall prognosis of patients with Langerhans cell histiocytosis.
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Affiliation(s)
- Polyzois Makras
- Department of Endocrinology and Diabetes, 251 Hellenic Air-Force and VA General Hospital, Athens, Greece
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Ben Ghorbel I, Houman MH, B'chir S, Chamakhi S, Miled M. [A disseminated form of Langerhans histiocytosis associated with diabetes insipidus and diabetes mellitus]. Rev Med Interne 2001; 22:469-74. [PMID: 11402519 DOI: 10.1016/s0248-8663(01)00373-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Langerhans' cell histiocytosis is a rare disorder of unknown etiology characterized by a wide clinical spectrum and varied behavior. Diabetes insipidus is a relatively common feature in Langerhans' cell histiocytosis. The presence of both diabetes insipidus and mellitus associated with histiocytosis in an adult is rare. To our knowledge, only three previous cases have been reported. EXEGESIS We report the clinical presentation, pathologic findings and clinical progress in an adult female who had disseminated Langerhans' cell histiocytosis (hypothalamic infiltration, multifocal bone involvement) associated with both diabetes insipidus and mellitus. CONCLUSION The pathogenesis of diabetes mellitus in such an association will be discussed.
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Affiliation(s)
- I Ben Ghorbel
- Service de médecine interne, hôpital La Rabta, 1007 Tunis, Tunisie
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Lévy S, Capron D, Joly JP, Cordonnier C, Sevestre H, Delamarre J, Tribout B, Capron JP. Hepatic nodules as single organ involvement in an adult with Langerhans cell granulomatosis. A case report. J Clin Gastroenterol 1998; 26:69-73. [PMID: 9492869 DOI: 10.1097/00004836-199801000-00019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Liver involvement manifesting as hepatomegaly in Langerhans cell granulomatosis (LCG) is well known, but the definitive diagnosis is generally possible because other organs are involved. We report a 41-year-old white man who presented with cholestasis and liver nodules as an isolated hepatic LCG. The diagnosis of LCG was suspected based on routine histopathologic examination; the diagnosis became definitive 4 years later when Birbeck granules were found in the liver, an uncommon occurrence in this organ. This is an unusual presentation of a benign form of this disease and one of the first that reported Birbeck granules in the liver.
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Affiliation(s)
- S Lévy
- Department of Hepato-Gastroenterology, Amiens Hospital, France
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Chauffaille MDL, Valério RM, Diniz CM, Simões MM, Enokihara S, Michalany N, Ferreira KV, Martinez JA, Hassun KM, Atallah AN, Kerbauy J. Langerhans cell histiocytosis. SAO PAULO MED J 1998; 116:1625-8. [PMID: 9699385 DOI: 10.1590/s1516-31801998000100006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The authors present a rare case of Langerhans cell histiocytosis in a 31 year old female patient with vulvar, peri-anal and oral lesions, diabetes insipidus, pulmonary skin and bone infiltrations. Skin biopsy immunohistochemistry presented positive S100 protein and vimentin, but the diagnosis was done with the demonstration of Birbeck granules with electronic microscopy. The treatment was based on systematical chemotherapy although vulvar lesion has a bad response to chemotherapy.
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Affiliation(s)
- M de L Chauffaille
- Disciplina de Hematologia e Hemoterapia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
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Bhatia S, Nesbit ME, Egeler RM, Buckley JD, Mertens A, Robison LL. Epidemiologic study of Langerhans cell histiocytosis in children. J Pediatr 1997; 130:774-84. [PMID: 9152288 DOI: 10.1016/s0022-3476(97)80021-2] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The etiology and pathogenesis of Langerhans cell histiocytosis (LCH) remain poorly understood. We conducted an exploratory epidemiologic study to investigate potential risk factors associated with LCH. STUDY DESIGN We used a case-control study design to obtain data from parents of children with LCH (n = 459) who were members of the Histiocytosis Association of America and Canada. The two control groups consisted of 683 community control subjects and 3719 children with childhood cancers treated at participating Children's Cancer Group institutions. RESULTS The median age at diagnosis of LCH was 1.8 years (range 0.1 to 14.6 years). Cases were categorized as multisystem LCH (MS-LCH) (n = 208) and single-system LCH (SS-LCH) (n = 198). Statistically significant associations included the following: infections in the neonatal period (MS-LCH, odds ratio (OR) = 2.2), solvent exposure (SS-LCH, OR = 54.9), childhood vaccinations (MS-LCH and SS-LCH, OR = 0.4), thyroid disease in the proband (MS-LCH and SS-LCH, OR = 21.6), and family history of thyroid disease (MS-LCH and SS-LCH, OR = 1.4). The association with thyroid disease in the proband was explained partially by the involvement of the pituitary, with the relative risk decreasing when patients with diabetes insipidus and thyroid involvement were excluded from analysis. CONCLUSIONS This large hypothesis-generating study provides directions for future investigations in well-designed population-based or hospital-based epidemiologic studies.
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Affiliation(s)
- S Bhatia
- Department of Pediatrics, University of Minnesota, Minneapolis 55455, USA
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Levendoglu-Tugal O, Noto R, Juster F, Brudnicki A, Slim M, Beneck D, Jayabose S. Langerhans cell histiocytosis associated with partial DiGeorge syndrome in a newborn. J Pediatr Hematol Oncol 1996; 18:401-4. [PMID: 8888752 DOI: 10.1097/00043426-199611000-00014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE We report the unrecognized association of Langerhans cell histiocytosis (LCH) with partial DiGeorge syndrome. PATIENT AND METHODS A 7-week-old infant with endocrine and immunologic characteristics of DiGeorge syndrome displayed multisystem involvement of Letterer-Siwe disease at birth. RESULTS Despite vigorous medical support and chemotherapy, she died at 9 months of age with multisystem failure. CONCLUSIONS This case supports the role of the thymus n the pathogenesis of LCH.
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