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Talasila S, Teichner EM, Subtirelu RC, Talasila NCP, Mannam S, Werner T, Alavi A, Revheim ME. Comprehensive considerations for dermatologists: the application of FDG-PET in evaluating cutaneous lesions in pediatric Langerhans cell histiocytosis. Front Med (Lausanne) 2024; 11:1378638. [PMID: 39071084 PMCID: PMC11273510 DOI: 10.3389/fmed.2024.1378638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 06/28/2024] [Indexed: 07/30/2024] Open
Abstract
Langerhans cell histiocytosis (LCH) is a complex disorder characterized by the clonal proliferation of Langerhans cells, primarily affecting children and adolescents. This condition exhibits a wide spectrum of clinical presentations, necessitating a multidisciplinary approach for diagnosis, treatment, and follow-up. Cutaneous manifestations of LCH are significant, mimicking common dermatoses and posing diagnostic challenges. [18F]Fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) has emerged as an important tool in the evaluation of pediatric LCH, offering insights into disease activity, extent, and therapeutic response. Moreover, FDG-PET provides a non-invasive means to distinguish between active LCH skin lesions and other dermatological conditions with similar clinical appearances, enhancing diagnostic accuracy and aiding in disease monitoring. This educational review summarizes the utility of nuclear imaging techniques, with a focus on PET scans, in the diagnosis and management of cutaneous pediatric LCH. A comprehensive literature search identified seven relevant articles, including retrospective studies and case reports. These studies highlight the efficacy of FDG-PET in localizing active LCH skin lesions, monitoring disease activity, and guiding treatment decisions. FDG-PET represents a valuable imaging modality for dermatologists, oncologists, and pediatricians managing pediatric LCH patients with cutaneous involvement. This non-invasive technique contributes to improved diagnostic accuracy and facilitates early intervention, ultimately enhancing patient care and outcomes.
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Affiliation(s)
- Sahithi Talasila
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Eric M. Teichner
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Robert C. Subtirelu
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | | | - Sricharvi Mannam
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Thomas Werner
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Mona-Elisabeth Revheim
- The Intervention Center, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Reyes MRT, Javaroni JB, Nogueira GM, Zelaya FJMC, de León ASA, Silveira HA, León JE. Resolution of blood eosinophilia and limited mouth opening after short-term follow-up in a pediatric Langerhans cell histiocytosis case. Indian J Otolaryngol Head Neck Surg 2023; 75:2568-2571. [PMID: 37636671 PMCID: PMC10447761 DOI: 10.1007/s12070-023-03741-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/26/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Langerhans cell histiocytosis (LCH) is an inflammatory myeloid neoplasia that often affects children, presenting a broad clinical spectrum. Methods Here, we report a 13-year-old male Salvadorian patient who was referred presenting a nodular swelling at the mandibular angle region, mildly symptomatic, few weeks ago, which relevantly was associated with limited mouth opening. Intraoral examination was unremarkable. Imaginological exams revealed an osteolytic lesion affecting the vestibular cortex at the right mandibular angle. The blood test results were normal, except for eosinophilia (21%; absolute eosinophil count 4 × 109/L). After an incisional biopsy, microscopical and immunohistochemical analyses were consistent with LCH diagnosis, which corresponded to a single system-single site category. After a few weeks, the mandibular movements were re-established, and complete resolution of blood eosinophilia was observed. Conclusion LCH with blood eosinophilia is rarely reported. To our knowledge, 3 cases have been previously published.
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Affiliation(s)
- Magdalena Raquel Torres Reyes
- Department of Pediatric Dentistry – Riberão Preto Dental School (FORP/USP), University of São Paulo, Ribeirão Preto, São Paulo Brazil
| | - Julia Biliato Javaroni
- Department of Pediatric Dentistry – Riberão Preto Dental School (FORP/USP), University of São Paulo, Ribeirão Preto, São Paulo Brazil
| | - Gustavo Milhomens Nogueira
- Department of Pathology and Forensic Medicine, Ribeirão Preto Medical School (FMRP/USP), University of São Paulo, Ribeirão Preto, São Paulo Brazil
| | | | - Anyeli Soraya Alas de León
- Dental Surgeon and Specialist in Oral and Maxillofacial Surgery, University of El Salvador, San Salvador, El Salvador
| | - Heitor Albergoni Silveira
- Oral Pathology, Department of Stomatology, Public Oral Health and Forensic Dentistry, Ribeirão Preto Dental School (FORP/USP), University of São Paulo , 14040-904 Ribeirão Preto, São Paulo Brazil
| | - Jorge Esquiche León
- Department of Pathology and Forensic Medicine, Ribeirão Preto Medical School (FMRP/USP), University of São Paulo, Ribeirão Preto, São Paulo Brazil
- Oral Pathology, Department of Stomatology, Public Oral Health and Forensic Dentistry, Ribeirão Preto Dental School (FORP/USP), University of São Paulo , 14040-904 Ribeirão Preto, São Paulo Brazil
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Potapenko VG, Baykov VV, Zinchenko AV, Potikhonova NA. Langerhans cell histiocytosis in adults: literature review. ONCOHEMATOLOGY 2022. [DOI: 10.17650/1818-8346-2022-17-4-16-32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Langerhans cells histiocytosis is a variant of malignant histiocytosis. The course and symptoms vary. patients with localized forms have a better prognosis, because local therapy is effective. patients with multifocal forms of histiocytosis receive systemic drug therapy, which cures some of the patients. This review provides up-to-date data about typical presentation of the organ involvement, diagnosis, course and therapy of various forms of Langerhans cells histiocytosis.
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Affiliation(s)
| | - V. V. Baykov
- I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
| | - A. V. Zinchenko
- I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
| | - N. A. Potikhonova
- Russian Research Institute of Hematology and Transfusiology, Federal Medical and Biological Agency
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Langerhans Cell Histiocytosis Mimicking Osteomyelitis. Pediatr Infect Dis J 2022; 41:e445-e446. [PMID: 35830510 DOI: 10.1097/inf.0000000000003635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Sinanoglu A, Cakir Karabas H, Soluk Tekkesin M, Bektas Kayhan K, Coskunses FM, Ozcan I. Does Fractal Analysis Have a Role in Diagnosis of Langerhans Cell Histiocytosis? J Oral Maxillofac Surg 2022; 80:1852-1857. [PMID: 35988692 DOI: 10.1016/j.joms.2022.07.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE Langerhans cell histiocytosis (LCH) of the jaws is a rare disease and is often diagnosed at an advanced stage. This study aims to assess the trabecular pattern of jaws via fractal analysis (FA) on initial panoramic radiographs (OPG) of the patients with LCH to facilitate interpretation of the radiographic changes. METHODS A case-control study investigated LCH cases with jaw involvement retrieved from the databases of Istanbul and Kocaeli Universities between 2010 and 2021. Initial OPGs of LCH cases and OPGs of healthy sex- and age-matched controls were investigated with FA. All images were assessed using ImageJ software. On each OPG, a total of 6 regions of interest (ROIs) located on the mandible were investigated bilaterally. The independent variables were the trabecular patterns of jaws of LCH cases and their control matches. The outcome variables were the fractal dimension (FD) values obtained from the ROIs on OPGs. Data were analyzed using the Mann-Whitney U test and Student's t test. RESULTS Fifteen LCH-control pairs were investigated. In one ROI located in the supracortical area above the left mandibular angle, FD values of LCH cases (1.273 ± 112.8) were significantly lower than controls (1.308 ± 85.3; P < .05). Lower FD values were also calculated for some of the remaining ROIs, but there was no significant difference between groups (P > .05). CONCLUSIONS Regarding our results, FA was not a useful parameter to discern radiographical trabecular changes between LCH cases and controls. Multicenter studies with larger populations are needed to investigate the potential of FA in the identification of this rare disease.
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Affiliation(s)
- A Sinanoglu
- Chair and Associate Professor, Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Kocaeli University, Kocaeli, Turkey.
| | - H Cakir Karabas
- Assistant Professor, Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - M Soluk Tekkesin
- Professor, Department of Tumor Pathology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - K Bektas Kayhan
- Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - F M Coskunses
- Private Practitioner, Oral and Maxillofacial Surgery, Kocaeli, Turkey
| | - I Ozcan
- Chair and Professor, Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
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Cunha JLS, de Carvalho RA, de Almeida OP, de Carvalho MGF, Soares CD. Langerhans cell histiocytosis mimicking a residual cyst. Oral Oncol 2022; 128:105831. [PMID: 35395554 DOI: 10.1016/j.oraloncology.2022.105831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 03/19/2022] [Indexed: 11/30/2022]
Abstract
Langerhans cell histiocytosis (LCH) is an uncommon myeloid neoplasm characterized by clonal neoplastic proliferation of Langerhans-type dendritic cells associated with a reactive inflammatory infiltrate composed predominantly of lymphocytes and eosinophils. Only three cases of LCH mimicking periapical lesions have been reported in the English-language literature to date. Herein, we report a rare case of LCH involving the mandible of a 45-years-old woman mimicking microscopically and radiographically a residual cyst. The patient underwent enucleation and curettage of the lesion. Microscopically, the lesion showed fibrous tissue with an intense inflammatory infiltrate and histiocytes with irregular to elongated nuclei with prominent nuclear grooves. The tumor cells were positive for S-100 protein, CD1a, and CD207. After careful evaluation through imaging tests to rule out lesions in other anatomical locations, the diagnosis was solitary LCH of the mandible. After four years of follow-up, the patient remained with no evidence of recurrence. This case emphasizes the importance of a carefully clinical, radiographic, and microscopical evaluation of bone lesions, including periapical or residual cysts, since some neoplasms can mimic common benign lesions of the jaws. Although conservative approaches to treating solitary mandibular bone lesions of LCH can be employed, long-term follow-up is strongly recommended.
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Affiliation(s)
- John Lennon Silva Cunha
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil.
| | | | - Oslei Paes de Almeida
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | | | - Ciro Dantas Soares
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil; Private Pathology Service, Natal, Brazil.
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Tumor-mimicking musculoskeletal infectious lesions: Experience of a single referral center. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh210916050a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Introduction/Objectives. Bone and soft tissue infections might mimic bone and soft tissue tumors. Therefore, differential diagnosis is important to prevent errors in treatment. This report aims to present the data of patients with indistinct clinical and radiological findings mimicking benign and malignant bone and soft tissue tumors, which were later diagnosed as inflammatory infections. Methods. A retrospective chart review of the clinical, microbiological, radiologic, and pathologic findings of patients presented with a presumed diagnosis of a possible malignant lesion was performed. Results. The study included 21 patients with a median age (IQR) of 37 (1 month ? 72 years) years, and 13 (61%) patients were men. In total, 16 (76%) patients were admitted to the hospital with complaints of pain. The diagnoses were hydatid cyst, tuberculous osteomyelitis, cat-scratch disease, chronic osteomyelitis, subacute osteomyelitis, and soft tissue abscess. All patients were treated depending on the diagnosis of the lesion. Conclusion. There are chances of misdiagnosis due to shared common characteristics of tumoral and infectious lesions which might be mildly increased inflammatory markers with deeply seated non-mobile soft tissue masses and aggressive periosteal reactions and/or bone destruction patterns. So, each pseudotumoral lesion due to possible infectious causes should be histopathologically examined and correlated with other clinical and laboratory data in order to achieve a final diagnosis
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Langerhans cell histiocytosis: Case report and literature review. ACTA ACUST UNITED AC 2021; 41:396-402. [PMID: 34559487 PMCID: PMC8519595 DOI: 10.7705/biomedica.5430] [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: 02/21/2020] [Indexed: 12/02/2022]
Abstract
La histiocitosis de células de Langerhans comprende un grupo heterogéneo de enfermedades inflamatorias cuyos principales componentes celulares son las células dendríticas y los macrófagos. El infiltrado inflamatorio puede afectar la piel y otros órganos, y el resultado clínico varía de leve a letal, dependiendo del subconjunto de células involucradas y el compromiso multisistémico. La demora en el diagnóstico puede ocurrir debido a su presentación inespecífica y a que los médicos tratantes no suelen sospecharla. Se reporta el caso de una lactante mayor a la cual, a pesar de múltiples consultas con síntomas inespecíficos pero característicos de la enfermedad, solamente se le pudo hacer el diagnóstico gracias a los hallazgos histopatológicos.
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Kumar J, Vanagundi R, Manchanda A, Mohanty S, Meher R. Radiolucent Jaw Lesions: Imaging Approach. Indian J Radiol Imaging 2021; 31:224-236. [PMID: 34316130 PMCID: PMC8299495 DOI: 10.1055/s-0041-1729769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Jaw lesions are a wide array of benign, malignant, and locally aggressive lesions. On radiography, they can appear radiolucent, mixed, or radioopaque. The imaging appearances of radiolucent jaw lesions are markedly overlapping. The role of the radiologist is to formulate a narrow differential diagnosis based on imaging characteristics and aid appropriate management decisions. The aim of this pictorial review is to familiarize the reader with the imaging approach to radiolucent jaw lesions, which form the bulk of jaw lesions in clinical practice.
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Affiliation(s)
- Jyoti Kumar
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - Rajesh Vanagundi
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - Alpana Manchanda
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - Sujata Mohanty
- Department of Oral And Maxillofacial surgery Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Ravi Meher
- Department of Otorhinolaryngology, Maulana Azad Medical College, New Delhi, India
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Menashe SJ, Aboughalia H, Zhao Y, Ngo AV, Otjen JP, Thapa MM, Iyer RS. The Many Faces of Pediatric Chronic Recurrent Multifocal Osteomyelitis (CRMO): A Practical Location- and Case-Based Approach to Differentiate CRMO From Its Mimics. J Magn Reson Imaging 2020; 54:391-400. [PMID: 32841445 DOI: 10.1002/jmri.27299] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/08/2020] [Accepted: 07/08/2020] [Indexed: 12/12/2022] Open
Abstract
Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory bone disease of childhood and adolescence characterized by episodic bone pain. Diagnosis relies heavily on whole-body MRI and is made by excluding a wide variety of other disorders with overlapping imaging features, depending on location, marrow distribution, and the presence or absence of multifocality. We present an overview of the clinical and imaging features of CRMO and, through various clinical scenarios, provide tips for tailoring the differential diagnosis based on location and distribution of encountered abnormalities. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Sarah J Menashe
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Hassan Aboughalia
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Yongdong Zhao
- Department of Rheumatology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Anh-Vu Ngo
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jeffrey P Otjen
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Mahesh M Thapa
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
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Samara A, Nepute J, Lu HC, Perrin RJ, Eldaya RW. Calvarial Langerhans cell histiocytosis in an Adult: Typical imaging findings in an atypical age group. Radiol Case Rep 2019; 14:1478-1482. [PMID: 31641396 PMCID: PMC6796621 DOI: 10.1016/j.radcr.2019.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 09/08/2019] [Indexed: 12/18/2022] Open
Abstract
Langerhans Cell Histiocytosis (LCH) is a rare disorder characterized by neoplastic proliferation of Langerhans-type dendritic cells. LCH is most frequently encountered in the pediatric populations, and involvement of the skeletal system is a common manifestation. Herein, we report a case of LCH presented as an isolated skull lesion in a 66-year-old patient. This presentation has never been reported in the literature at this advanced age and suggests that, despite being exceptionally rare, clinicians should consider LCH in the differential diagnosis of skull lesions in the elderly with classical radiological appearance.
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Affiliation(s)
- Amjad Samara
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jordan Nepute
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Hsiang-Chih Lu
- Division of Neuropathology, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Richard J Perrin
- Division of Neuropathology, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Rami W Eldaya
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
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