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Schwartz TR, Elliott LA, Fenley H, Ramdas J, Scott Greene J. Langerhans Cell Histiocytosis of the Head and Neck: Experience at a Rural Tertiary Referral Center. Ann Otol Rhinol Laryngol 2023; 132:431-439. [PMID: 35656804 DOI: 10.1177/00034894221098466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Retrospectively analyze head and neck Langerhans Cell Histiocytosis at a rural tertiary referral center and compare results with previously published data. METHODS Electronic health record review was performed from 2003 to 2019. Patients with biopsy proven LCH with primary head and neck involvement were included. Demographics, presentation, imaging characteristics, treatment modality, delay in diagnosis (DD, ≥60 days), and outcomes were analyzed and reported. RESULTS Twenty-four patients were included. The most common presenting symptoms were otorrhea (n = 6) and scalp pain or swelling (n = 6). All patients had bony involvement. The most common site was facial or skull lesions (n = 20). Most skull lesions (75%) demonstrated CNS risk. Six patients were treated with primary surgery, 15 with primary chemotherapy, and 3 with surgery plus adjuvant chemotherapy. Nine patients experienced relapse of disease with median time to documented relapse of 11.4 months; all were treated with salvage chemotherapy to achieve complete remission (median follow-up: 72 months). Patients most likely to relapse were those with multisystem disease (5/7, 71.4%), temporal bone lesions (4/7, 57.1%), and DD (7/12, 58.3%). Of the 9 total patients who experienced relapse, 78% had a delay in diagnosis. CONCLUSIONS LCH is a complex disease process in which diagnosis can be delayed if not considered in the differential. Within the head and neck, the skull, including isolated temporal bone involvement, is the most common site of involvement. Treatment modality does not appear to have an influence on relapse rates. Relapse was more likely to occur in the first year after treatment and close monitoring is required.
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Affiliation(s)
- Tyler R Schwartz
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Leighton A Elliott
- Division of Hematology/Oncology, University of Florida Department of Medicine, Gainesville, FL, USA
| | - Heather Fenley
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Jagadeesh Ramdas
- Department of Pediatric Hematology and Oncology, Janet Weis Children's Hospital, Geisinger Medical Center, Danville, PA, USA
| | - Joseph Scott Greene
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, PA, USA
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Trabelsi I, Kbaier S, Rekaya S, Ouederni M, Hamouda S, Boussetta K. Title: Langerhans cell histiocytosis of the cervical spine in a child: A case report and review of the literature. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2022. [DOI: 10.1016/j.phoj.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Zhao M, Tang L, Sun S, Cui J, Chen H. Radiologic findings that aid in the reduction of misdiagnoses of Langerhans cell histiocytosis of the bone: a retrospective study. World J Surg Oncol 2021; 19:146. [PMID: 33971894 PMCID: PMC8112044 DOI: 10.1186/s12957-021-02261-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/05/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND This study aimed to identify the characteristic radiological signs for the diagnosis of Langerhans cell histiocytosis (LCH) of the bone. METHODS We retrospectively studied 82 cases of LCH with bone lesions confirmed by pathology. Clinical and radiological features of the patients were analyzed. RESULTS A total of 64 and 18 patients had single and multiple bone lesions, respectively. With regard to LCH with single bone lesions, 37.5% (24/64) of lesions were located in the skull and presented as bone destruction with or without soft tissue mass. The correct diagnosis rate of these lesions was 60.0% (9/15) in children and adolescents, but was only 22.2% (2/9) in adults. A total of 26.5% (17/64) of the solitary lesions were found in the spine. Of these, 88.2% (15/17) were located in the vertebral body and appeared to have different degrees of collapse, and 66.7% (10/15) of these lesions were correctly diagnosed. Of the unifocal lesions, 21.8% (14/64) were located in other flat and irregular bones and manifested as osteolysis. Only 21.4% (3/14) of these cases were correctly diagnosed. In total, 14.1% (9/64) of the isolated bone LCH lesions were located in the long bones. Of these, 77.8% (7/9) were located in the diaphysis and presented as central bone destruction with or without fusiform periosteal reaction and extensive peripheral edema, of which 42.9% (3/7) were correctly diagnosed before surgery or biopsy. With regard to LCH with multiple bony destructive lesions, 71.4% (10/14) of cases in children and adolescents were correctly diagnosed; however, all four cases among adults were misdiagnosed. CONCLUSION In all age groups, isolated diaphyseal destruction of the long bone with fusiform periosteal reaction and extensive peripheral edema, vertebra plana of the spine, and bevelled edge of skull defects accompanied by soft tissue masses strongly suggest LCH diagnosis. Moreover, the multiple bone osteolytic destruction in children and adolescents strongly suggests LCH diagnosis. Familiarity with these typical radiological signs of LCH is necessary to decrease misdiagnoses.
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Affiliation(s)
- Mimi Zhao
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Limin Tang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Shiqing Sun
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Jiufa Cui
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Haisong Chen
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China.
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Zhao SS, Yan LF, Feng XL, Du P, Chen BY, Dong WT, Gao Y, He JB, Cui GB, Wang W. Incidence and radiological pattern of eosinophilic granuloma: a retrospective study in a Chinese tertiary hospital. J Orthop Surg Res 2019; 14:123. [PMID: 31072377 PMCID: PMC6507022 DOI: 10.1186/s13018-019-1158-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 04/16/2019] [Indexed: 11/30/2022] Open
Abstract
Background The incidence and radiological patterns of eosinophilic granuloma (EG) in China is not clear. We described the incidence, presentation, and imaging characteristics of Chinese EG patients in a tertiary hospital. Methods A retrospective chart review was performed from January 2004 to October 2017 at a single tertiary general hospital. Seventy-six patients were pathologically identified as EG. Besides, 60 patients with preoperative imaging diagnosis of “EG” were analyzed to reveal the radiological patterns and their diagnostic power. Results Fifty-three male and 23 female EG patients with a mean age of 18.1 ± 16.7 years (range 1–58 years) were retrospectively included. Significant differences were observed in gender (male to female = 2.3:1) and age (the highest incidence at the age of 0~5 years) for EG. EG predominantly involved the skeletal system: flat bones (31.43%) > irregular bones (24.76%) > long bones (22.86%) > other organs (20.95%). No obvious relationships between season, biochemical markers, and EG incidence were observed. The common presenting symptoms were pain followed with local mass, and most patients underwent surgical resection. Among 60 imagingly diagnosed “EG” patients from April 2009 to October 2017, only 22 were with histological confirmation. The correct diagnosis rates were 37.1% (13 out of 35), 16.7% (5 out of 30), and 22.2% (8 out of 36) for plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI), respectively. Conclusions Chinese EG has a varied presentation, age distribution, and gender difference. EG diagnosis is still based on biopsy or histopathology instead of imaging techniques. Electronic supplementary material The online version of this article (10.1186/s13018-019-1158-1) contains supplementary material, which is available to authorized users.
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Atsumi Y, Saito Y, Hataya H, Yuza Y. Initial Symptoms of Langerhans Cell Histiocytosis: A Case Series. Glob Pediatr Health 2019; 6:2333794X19857377. [PMID: 31259209 PMCID: PMC6585240 DOI: 10.1177/2333794x19857377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 04/29/2019] [Accepted: 04/29/2019] [Indexed: 12/17/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare childhood hematopoietic disease, and hence, there are few reports summarizing the course leading to the diagnosis. We described the initial symptoms and the clinical course of LCH. We carried out a retrospective review of charts from a single medical center, and 21 patients with the diagnosis of LCH were enrolled. The initial symptoms of 16 cases were caused by bone lesions; of these cases, there were 8 instances of soft tissue swelling as the initial symptom (38%) and 8 instances of bone pain without swelling (38%). Among the cases of bone lesion, 4 of 6 cases of skull lesion were painless while all vertebral body lesions and long bone lesions were accompanied by pain. LCH bone lesions caused various symptoms depending on the site of the lesion and this makes the diagnosis difficult. A detailed physical examination and imaging studies are recommended for early diagnosis.
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Affiliation(s)
- Yukari Atsumi
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yuya Saito
- Department of Hematology and Oncology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Hiroshi Hataya
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yuki Yuza
- Department of Hematology and Oncology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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Zhang X, Zhou J, Chai X, Chen G, Guo B, Ni L, Wu P. The application of x-ray, computed tomography, and magnetic resonance imaging on 22 pediatric Langerhans cell histiocytosis patients with long bone involvement: A retrospective analysis. Medicine (Baltimore) 2018; 97:e0411. [PMID: 29702989 PMCID: PMC5944563 DOI: 10.1097/md.0000000000010411] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The studies focusing on x-ray, computed tomography (CT), and magnetic resonance imaging (MRI) in pediatric Langerhans cell histiocytosis (LCH) patients were still rare. Therefore, we aimed to evaluate the application of x-ray, CT, and MRI in pediatric LCH patients with long bone involvement.Total 22 pediatric LCH patients were included in this study. The diagnosis of LCH was confirmed by pathological examination. All patients were followed up for 3 years. X-ray, CT, or MRI was performed and the results were recorded for further analyses.Among 22 pediatric patients, x-ray (n = 20), CT (n = 18), or MRI (n = 12) were used to scan the lesion on long bones affected by LCH. Femurs (n = 13, 38.24%), tibia (n = 11, 32.35%), humerus (n = 5, 14.71%), and radius (n = 4, 11.76%) were the most frequently affected anatomic sites. Ovoid or round radiolucent lesions, aggressive periosteal reaction, and swelling of surrounding soft tissues were characteristic image of long bones on x-ray, CT, and MRI in pediatric LCH.Femurs, tibia, humerus, and radius were the most commonly affected long bones of pediatric LCH. The application of x-ray, CT, and MRI on long bones could help with the diagnosis of pediatric LCH.
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Affiliation(s)
| | - Jing Zhou
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine
| | | | | | | | | | - Peng Wu
- Department of Hematology, Children's Hospital of Nanjing Medical University, Nanjing, China
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Lam S, Reddy GD, Mayer R, Lin Y, Jea A. Eosinophilic granuloma/Langerhans cell histiocytosis: Pediatric neurosurgery update. Surg Neurol Int 2015; 6:S435-9. [PMID: 26539317 PMCID: PMC4604648 DOI: 10.4103/2152-7806.166761] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 06/16/2015] [Indexed: 01/21/2023] Open
Affiliation(s)
- Sandi Lam
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - Gaddum D Reddy
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - Rory Mayer
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - Yimo Lin
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - Andrew Jea
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
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Thigh pain in an 18-year-old man. Clin Orthop Relat Res 2014; 472:4046-50. [PMID: 25123245 PMCID: PMC4397774 DOI: 10.1007/s11999-014-3871-8] [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: 05/02/2014] [Accepted: 07/31/2014] [Indexed: 01/31/2023]
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Lee SK, Jung TY, Jung S, Han DK, Lee JK, Baek HJ. Solitary Langerhans cell histocytosis of skull and spine in pediatric and adult patients. Childs Nerv Syst 2014; 30:271-5. [PMID: 23780406 DOI: 10.1007/s00381-013-2198-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 05/31/2013] [Indexed: 12/30/2022]
Abstract
PURPOSE Langerhans cell histiocytosis (LCH) is a rare neoplasm and has heterogeneous clinical presentation and behavior. We analyzed solitary lytic lesions of the skull and spine in pediatric and adult patients. METHODS Between 2001 and 2011, 42 patients underwent surgery for LCH. Skull and/or spine involvement were evident in 21 (63.6%) of the 33 pediatric patients and 8 (88.9%) of the 9 adults. The 21 pediatric patients showed the unifocal monosystemic lesions in 10, multifocal monosystemic in 4, and multisystemic in 7. The eight adults comprised seven unifocal lesions and one multifocal monosystemic lesion. Of these cases, we analyzed the clinical courses of solitary LCH of skull and spine in 10 pediatric patients and 7 adults. RESULTS The median age was 10.1 years (range: 1.1-14.1) in pediatric patients and 34.6 years (range: 26.1-52.0) in adults. The median follow-up was 3.1 years (range: 0.6-9.5). Total excision was done in 15 patients and biopsy in 2. Postoperative adjuvant chemotherapy was done in four pediatric patients and one adult, and comprised mass with dural adhesion (N = 2), skull base lesion (N = 1), atlas mass (N = 1), and vertebral lesion with soft tissue extension (N = 1). During follow-up, recurrence occurred in one pediatric patient who had a skull LCH with a dural adhesion. The patient experienced central diabetes insipidus and scapular pain due to pituitary stalk and scapula involvement 1.3 and 2.4 years later, respectively. CONCLUSION Even if the solitary lesions of skull and spine show a favorable clinical course, some patients could show aggressive behavior.
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Affiliation(s)
- Seul-Kee Lee
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital and Chonnam National University Medical School, Gwangju, South Korea
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Ness MJ, Lowe GC, Davis DMR, Hand JL. Narrowband ultraviolet B light in Langerhans cell histiocytosis: a case report. Pediatr Dermatol 2014; 31:e10-2. [PMID: 24224945 DOI: 10.1111/pde.12240] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Langerhans cell histiocytosis (LCH) (previously called eosinophilic granuloma, Hand-Schüller-Christian syndrome, Letterer-Siwe disease, and Hashimoto-Pritzker disease) is a rare, heterogeneous disorder with highly variable presentation. LCH commonly affects the skin, as well as internal organs. Because the skin lesions appear benign, and LCH is unfamiliar to most physicians, diagnosis is often delayed. Treatment is controversial, with further clinical study needed. For persons with extensive, skin-limited disease, the existing topical therapies are impractical. We present a child with cutaneous LCH lesions that responded to ultraviolet light phototherapy with minimal adverse effects or patient discomfort.
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Affiliation(s)
- Molly J Ness
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
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Coleman MA, Matsumoto J, Carr CM, Eckel LJ, Nageswara Rao AA. Bilateral temporal bone langerhans cell histiocytosis: radiologic pearls. Open Neuroimag J 2013; 7:53-7. [PMID: 24478812 PMCID: PMC3905351 DOI: 10.2174/1874440001307010053] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 12/23/2013] [Accepted: 12/26/2013] [Indexed: 12/17/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare histiocytic disorder with an unpredictable clinical course and
highly varied clinical presentation ranging from single system to multisystem involvement. Although head and neck
involvement is common in LCH, isolated bilateral temporal bone involvement is exceedingly rare. Furthermore, LCH is
commonly misinterpreted as mastoiditis, otitis media and otitis externa, delaying diagnosis and appropriate therapeutic
management. To improve detection and time to treatment, it is imperative to have LCH in the differential diagnosis for
unusual presentations of the aforementioned infectious head and neck etiologies. Any lytic lesion of the temporal bone
identified by radiology should raise suspicion for LCH. We hereby describe the radiologic findings of a case of bilateral
temporal bone LCH, originally misdiagnosed as mastoiditis.
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Affiliation(s)
- Mira A Coleman
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, Mayo Clinic, Rochester, Minnesota, USA
| | - Jane Matsumoto
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Carrie M Carr
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Amulya A Nageswara Rao
- Department of Pediatric and Adolescent Medicine/Division of Pediatric Hematology-Oncology, Mayo Clinic, Rochester, Minnesota, USA
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