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KONO M, INOMOTO C, HORIGUCHI T, SUGIYAMA I, NAKAMURA N, SAITO R. Adult Langerhans Cell Histiocytosis Diagnosed by Biopsy of the Skull Tumor Generated after Craniotomy. NMC Case Rep J 2021; 8:101-105. [PMID: 34012758 PMCID: PMC8116926 DOI: 10.2176/nmccrj.cr.2020-0094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/09/2020] [Indexed: 11/20/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a disease characterized by the proliferation of Langerhans cells. Most cases of LCH occur in children, although it can be seen in adults as well. We encountered an adult case of LCH. A 44-year-old woman who was diagnosed as diabetes insipidus underwent a magnetic resonance imaging (MRI) of the head which revealed sellar and suprasellar gadolinium-enhanced mass. Prolactin level was high and cabergoline was prescribed. The size of this mass had reduced, so we supposed the tumor was prolactinoma. However, after 4 years of observation, it had increased once again. The biopsy of pituitary stalk lesion was performed via transcranial approach. The histological diagnosis was initially gangliocytoma. The patient complained of back pain after surgery. Three months after the biopsy, a computed tomography (CT) scan revealed multiple osteolytic lesions throughout the entire body. One of the osteolytic lesions of the skull was removed to determine the diagnosis. The pathological examination of the skull led to a diagnosis of LCH. We concluded retrospectively that the lesion of the pituitary stalk was LCH mimicking gangliocytoma though classical pathological findings were not obtained. In conclusion, LCH should be considered as a differential diagnosis in adult cases of diabetes insipidus with hypothalamic-pituitary lesion.
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Affiliation(s)
- Maya KONO
- Department of Neurosurgery, National Hospital Organization Kanagawa Hospital, Hadano, Kanagawa, Japan
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Chie INOMOTO
- Department of Pathology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Takashi HORIGUCHI
- Department of Neurosurgery, National Hospital Organization Kanagawa Hospital, Hadano, Kanagawa, Japan
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Ichiro SUGIYAMA
- Department of Neurosurgery, National Hospital Organization Kanagawa Hospital, Hadano, Kanagawa, Japan
- Department of Neurosurgery, Inagi Municipal Hospital, Inagi, Tokyo, Japan
| | - Naoya NAKAMURA
- Department of Pathology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
- Department of Pathology, National Hospital Organization Kanagawa Hospital, Hadano, Kanagawa, Japan
| | - Ryoichi SAITO
- Department of Neurosurgery, National Hospital Organization Kanagawa Hospital, Hadano, Kanagawa, Japan
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Seilanian Toosi F, Aminzadeh B, Faraji Rad M, Nekooei S, Nahidi M, Keykhosravi E. Pineal and Suprasellar Germinoma Cooccurence with Vertebra Plana: A Case Report. Brain Tumor Res Treat 2018; 6:73-77. [PMID: 30381920 PMCID: PMC6212690 DOI: 10.14791/btrt.2018.6.e9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 07/02/2018] [Accepted: 08/06/2018] [Indexed: 12/27/2022] Open
Abstract
Germinoma is the most common type of intracranial germ cell tumors (GCTs). Pineal gland and suprasellar region are the most frequent sites of central nervous system (CNS) involvement. Intracranial masses caused by Langerhans cell histiocytosis (LCH) mimics features of CNS GCTs. LCH frequently involve spine and is the most common cause of vertebra plana in children. A 15-year-old boy presented with progressing symptoms of polydipsia, polyuria, general headache, nausea and severe back pain. Brain MRI showed brain tumor with simultaneous involvement of suprasellar region and pineal gland. An excisional biopsy of suprasellar mass was done. The pathologic assessment confirmed the diagnosis of germinoma. Patient's treatment continued accordingly. A spine MRI, done due to persistent backache, showed a vertebra plana. We reevaluated the primary diagnosis suspecting LCH. Germinoma of CNS was confirmed and a biopsy of vertebral lesion resulted in hemangioma. Thus we report a case of CNS germinoma with co-occurrence of vertebra plana. We emphasized the importance of histopathologic diagnosis of pineal/suprasellar masses and primary investigation of other CNS regions including spine for possible metastasis or comorbidities.
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Affiliation(s)
- Farrokh Seilanian Toosi
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Behzad Aminzadeh
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mohammad Faraji Rad
- Department of Neurosurgery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sirous Nekooei
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahsa Nahidi
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ehsan Keykhosravi
- Department of Neurosurgery, Mashhad University of Medical Sciences, Mashhad, Iran
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