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Bhavsar YD, Dudhatra AV, Vyas HS, Pandya RB, Joshi AP. A Rare Case of Combined Langerhans Cell Histiocytosis and Adult-Onset Xanthogranuloma: A Case Report. Cureus 2022; 14:e28640. [PMID: 36196323 PMCID: PMC9525050 DOI: 10.7759/cureus.28640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 11/05/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) and adult-onset xanthogranuloma (AXG) are rare disorders characterized by the accumulation of macrophage, dendritic cells, or monocyte-derived cells in various tissues of the body. Many researchers now consider LCH a form of malignancy, but this classification remains controversial. As per our knowledge, there are only 36 cases of AXG reported so far in the English literature. Here, we report a case of AXG and single-system LCH found in the oral cavity and cervical lymph nodes, respectively. In this article, we intend to define a clear understanding of some classic clinical, radiological, and histopathological findings of LCH and AXG, to differentiate them from oral malignancies. The primary goal of this article is to increase awareness regarding conditions that closely resemble malignancies and to save patients from the burden of extensive treatment under the presumption of malignant disorders. In the medical field, reporting of rare cases is highly encouraged; however, proper treatment for the patient depends on the accurate diagnosis that, in this case, was made postoperatively, which only added more physical and mental distress for the patient and their family.
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Musa J, Siddik AB, Ahmetgjekaj I, Rahman M, Guy A, Rahman A, Ikram S, Kola E, Vokshi V, Ahsan E, Saliaj K, Hyseni F. Multifocal Langerhans cell histiocytosis in a child. Radiol Case Rep 2021; 16:2726-2730. [PMID: 34336078 PMCID: PMC8318828 DOI: 10.1016/j.radcr.2021.06.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/16/2021] [Accepted: 06/16/2021] [Indexed: 11/18/2022] Open
Abstract
Langerhans Cell Histiocytosis (LCH) is a rare disorder sometimes called the disorder of the “monocyte-macrophage system”. This condition is characterized by the proliferation of abnormal Langerhans cells within different tissues. Skin rash is the typical early feature, but bony involvement is the second most common presentation. The most common complications are musculoskeletal disabilities, hearing problems, skin scarring, neuropsychiatric defects and most importantly, progression to secondary malignancies like leukemia. Early recognition and treatment can reduce morbidity and mortality. Herein, we report a case of a 10-year-old male presenting with a tender, palpable mass in the lower limb. On initial imaging, a lesion involving the diaphysis of the fibula was observed, raising concerns of Ewing sarcoma. Biopsy was planned along with whole-body MRI, revealing multifocal single system Langerhans cell histiocytosis. Given the rarity of fibular involvement in LCH, distinguishing between LCH and common malignancies within this age-group can be challenging. Through this case report, we hope to emphasize the importance of considering LCH in the differential diagnosis to ensure a timely diagnosis, fitting treatment and improvement in prognosis of the condition.
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Affiliation(s)
- Juna Musa
- Department of General Surgery, Mayo Clinic, Rochester, MN, USA
- Corresponding author.
| | - Abu Bakar Siddik
- Department of Pain Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Masum Rahman
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Ali Guy
- Clinical assistant professor, Department of Physical Medicine and Rehabilitation, NY University, NY Medical center, NY, USA
| | - Abdur Rahman
- Department of Medicine, Life and Care Hospital, Dhaka, Bangladesh
| | - Samar Ikram
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Erisa Kola
- Department of Pathology, Tirana, Albania
| | - Valon Vokshi
- Department of Anesthesiology, University Clinical Center of Kosovo
| | - Eram Ahsan
- Stem Cell Therapy and Skeletal Regeneration Lab, Mayo Clinic, Rochester, MN
| | | | - Fjolla Hyseni
- Department of Urology, NYU Langone Health, New York,USA
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Faustino ISP, Fernandes PM, Pontes HAR, Mosqueda-Taylor A, Santos-Silva AR, Vargas PA, Lopes MA. Langerhans cell histiocytosis in the oral and maxillofacial region: An update. J Oral Pathol Med 2021; 50:565-571. [PMID: 34091963 DOI: 10.1111/jop.13207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a rare disorder characterized by abnormal proliferation and infiltration of histiocytic cells. METHODS This review focused on the main aspects associated with LCH. RESULTS LCH can involve single or multiple organs and systems, with bone and skin being the most commonly affected sites. Regarding skeletal manifestations, the jawbones are involved in about 20%-30% of all cases. Such lesions may present as unilocular or multilocular images mainly affecting the posterior mandible. Oral soft tissue lesions may also occur, with the gingiva and hard palate being the most frequently affected sites. CONCLUSION The diagnosis and management of LCH are challenging, requiring a multidisciplinary approach, with dentists playing a central role since oral manifestations can be the first sign of the condition.
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Affiliation(s)
| | - Patrícia Maria Fernandes
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | | | | | - Alan Roger Santos-Silva
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Pablo Agustin Vargas
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Marcio Ajudarte Lopes
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
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Xie X, Wang J, Ding Y. Recurrent eosinophilic granuloma involving maxilla and mandible in an adult male: an unusual case report. Aust Dent J 2021; 66 Suppl 1:S88-S92. [PMID: 34043826 DOI: 10.1111/adj.12861] [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: 04/15/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 02/05/2023]
Abstract
Langerhans' cell histiocytosis (LCH) is a disease spectrum characterized by the intense infiltration/accumulation of Langerhans' cells in the affected tissues. Eosinophilic granuloma is the mildest form of LCH which mainly affects the skull, mandible, ribs and femur in children and young adults but rarely occurs in the maxilla. Here, we describe an unusual case of eosinophilic granuloma affecting the tissues adjacent to tooth #25 and tooth #46 (FDI numbering system) in a 35-year-old male. Although lesions underwent clinical remission after local radiotherapy, a new lesion appeared 11 months after initial therapy in tooth #18, indicating recurrence of eosinophilic granuloma. Subsequently, the patient was treated with corticosteroid therapy, achieved remission and is disease free after 3 years of follow-up.
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Affiliation(s)
- X Xie
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - J Wang
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Y Ding
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Vaish A, Vaishya R, Singh LK, Kashyap V. Langerhans cell histiocytosis of a metatarsal bone in an adult female. BMJ Case Rep 2019; 12:12/10/e231343. [PMID: 31645401 DOI: 10.1136/bcr-2019-231343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) commonly occurs in children. It mimics infection and many benign and malignant tumours. This disease mainly involves the spine, skull and long bones, and its incidence is sporadic in the small bones of the foot and hand. We could not find any case reports with the involvement of a metatarsal bone, and hence, awareness about its possibility is essential to suspect it as a differential diagnosis of lytic lesions in the foot bones and therefore treat it judiciously. We have reported a case of a 35-year-old woman with spontaneous onset of pain over her right foot for the last year. An extensive curettage was performed, where the histology confirmed the features of LCH. Awareness about this entity and its differential diagnosis may help to clinch and early diagnosis and to treat effectively.
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Affiliation(s)
- Abhishek Vaish
- Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India
| | - Raju Vaishya
- Orthopaedic & Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi, India
| | | | - Vikas Kashyap
- Pathology, Indraprastha Apollo Hospital, New Delhi, India
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Sakellari D, Klonizakis P, Vlachaki E, Dimitrakopoulos I. Langerhans Cell Histiocytosis Mimicking Aggressive Periodontitis. A Multidisciplinary Approach During an 8-Year Follow-Up Period. Clin Adv Periodontics 2017. [DOI: 10.1902/cap.2017.160046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Dimitra Sakellari
- Department of Preventive Dentistry, Periodontology and Implant Biology, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Philippos Klonizakis
- Hematology Unit, Second Department of Internal Medicine, Aristotle University, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Efthymia Vlachaki
- Hematology Unit, Second Department of Internal Medicine, Aristotle University, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece
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Vargas A, Ramírez H, Ramírez P, Foncea C, Venegas B, Astorga P. Spontaneous remission of eosinophilic granuloma of the maxilla after incisional biopsy: a case report. Head Face Med 2016; 12:21. [PMID: 27251410 PMCID: PMC4890254 DOI: 10.1186/s13005-016-0118-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 05/24/2016] [Indexed: 12/11/2022] Open
Abstract
Background Langerhans cell histiocytosis (LCH), previously known as Histiocytosis X, is an infrequent disease that congregates a wide spectrum of clinical presentations with variable systemic involvement. Unification of these diseases under only one category is based on the almost identical histopathologic features of the lesions, but the etiology and proper approach for each presentation remains controversial. The localized alternative of Langerhans cell histiocytosis (LLCH), known as Eosinophilic Granuloma (EG) of bone, is the predominant clinical presentation of LCH. The maxilla is involved in 1 % of the head and neck region cases, representing an uncommon condition in this area. Case Presentation In this clinical case report, it is described a case of a 16-year-old male patient with an asymptomatic osteolytic lesion at first upper left molar apical level, a finding detected on control radiographic images was reported as “Monostotic Eosinophilic granuloma of the maxillary bone”, which was later confirmed through an incisional biopsy. A surgical excision was initially planned, but finally it was not performed due to a spontaneous healing of the lesion after the incisional biopsy. Conclusions The presented case supports a conservative approach in the management of solitary EG of maxillary and mandibular bone lesions and even supports an expectant attitude in the course of treatment given the possibility of a spontaneous regression after the biopsy, especially in small lesions.
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Affiliation(s)
- Alex Vargas
- DDS. Associated Professor of the Oncology and Maxillofacial Surgery Department, Medicine Faculty, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Hernán Ramírez
- DDS. Associated Professor of the Oncology and Maxillofacial Surgery Department, Medicine Faculty, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Ramírez
- Assistant Professor of Hematology Department, Medicine Faculty, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Camila Foncea
- Resident of Oral and Maxillofacial Surgery Program, Medicine Faculty, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Bernardo Venegas
- Oral Pathologist at the University of Talca and Carlos Van Buren Hospital of Valparaíso, Valparaíso, Chile
| | - Paula Astorga
- Observer of the Oncology and Maxillofacial Surgery Department, Medicine Faculty, Pontificia Universidad Católica de Chile, Santiago, Chile
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