1
|
Gerrie SK, Navarro OM, Lyons CJ, Marie E, Rajani H, Frayn CS, Hughes ECM, Branson HM. Pediatric orbital lesions: bony and traumatic lesions. Pediatr Radiol 2024; 54:897-909. [PMID: 38411665 DOI: 10.1007/s00247-024-05882-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 02/28/2024]
Abstract
Orbital pathologies can be broadly classified as ocular lesions, extraocular soft-tissue pathologies (non-neoplastic and neoplastic), and bony and traumatic lesions. In this paper, we discuss the key imaging features and differential diagnoses of bony and traumatic lesions of the pediatric orbit and globe, emphasizing the role of CT and MRI as the primary imaging modalities. In addition, we highlight the adjunctive role of ocular sonography in the diagnosis of intraocular foreign bodies and discuss the primary role of sonography in the diagnosis of traumatic retinal detachment.
Collapse
Affiliation(s)
- Samantha K Gerrie
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
- Department of Radiology, University of British Columbia, Vancouver, Canada.
| | - Oscar M Navarro
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Christopher J Lyons
- Department of Ophthalmology, BC Children's Hospital, Vancouver, Canada
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Eman Marie
- Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, Hamilton, Canada
| | - Heena Rajani
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Cassidy S Frayn
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Emily C M Hughes
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Helen M Branson
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| |
Collapse
|
2
|
Cho HJ, Park SC, Lee JM, Jung NY, Park JB. Pediatric Eosinophilic Granuloma Associated With Delayed Epidural Hematoma Following on Seizure: A Case Report. Brain Tumor Res Treat 2024; 12:148-151. [PMID: 38742265 PMCID: PMC11096632 DOI: 10.14791/btrt.2024.0018] [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: 04/08/2024] [Revised: 04/20/2024] [Accepted: 04/22/2024] [Indexed: 05/16/2024] Open
Abstract
Eosinophilic granuloma (EG), a subtype of Langerhans cell histiocytosis (LCH), the monostotic form, is a rare condition characterized by a solitary bone lesion. It is even more unusual for this condition to be accompanied by an epidural hematoma (EDH). This case is unique in that it is the first to involve delayed EDH following a seizure. We describe a remarkable example of EG accompanied by an EDH and consider the rarity of this comorbidity. A 32-month-old boy developed a rapidly growing skull mass following a minor head injury. During surgical preparation for a biopsy, the patient experienced a single convulsion. Imaging following the seizure revealed an EDH in the vicinity of the mass. The mass was excised and confirmed to be an EG, but with positive margins. The patient underwent chemotherapy after systemic skeletal evaluation, in accordance with the LCH III protocol established by the Histiocytosis Society. EG is a rare neoplasm that typically presents as a painless growth on the skull that gradually enlarges over time. The correlation between EG and EDH is exceedingly uncommon, with only a few documented cases. This case study underscores the significance of considering EG in the differential diagnosis of an expanding cranium mass, even when associated with EDH. Prompt diagnosis and treatment can prevent serious complications and improve patient outcomes.
Collapse
Affiliation(s)
- Hyun Jeong Cho
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sung Chan Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jong Min Lee
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Na Young Jung
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jun Bum Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
| |
Collapse
|
3
|
Cheng YF, Wang CC, Tsai PS, Lin DC, Huang WH. Langerhans cell histiocytosis of the thyroid mimicking thyroiditis in a boy: a case report and literature review. BMC Pediatr 2024; 24:66. [PMID: 38245681 PMCID: PMC10799516 DOI: 10.1186/s12887-023-04494-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/19/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Langerhans cell histiocytosis affecting the thyroid commonly presents with nonspecific clinical and radiological manifestations. Thyroid Langerhans cell histiocytosis is typically characterized by non-enhancing hypodense lesions with an enlarged thyroid on computed tomography medical images. Thyroid involvement in LCH is uncommon and typically encountered in adults, as is salivary gland involvement. Therefore, we present a unique pediatric case featuring simultaneous salivary and thyroid involvement in LCH. CASE PRESENTATION A 3-year-old boy with complaints of an anterior neck mass persisting for 1 to 2 months, accompanied by mild pain, dysphagia, and hoarseness. A physical examination revealed a 2.5 cm firm and tender mass in the left anterior neck. Laboratory examinations revealed normal thyroid function test levels. Ultrasonography revealed multiple heterogeneous hypoechoic nodules with unclear and irregular margins in both lobes of the thyroid. Contrast-enhanced neck computed tomography revealed an enlarged thyroid gland and bilateral submandibular glands with non-enhancing hypointense nodular lesions, and multiple confluent thin-walled small (< 1.5 cm) cysts scattered bilaterally in the lungs. Subsequently, a left thyroid excisional biopsy was performed, leading to a histopathological diagnosis of LCH. Immunohistochemical analysis of the specimen demonstrated diffuse positivity for S-100, CD1a, and Langerin and focal positivity for CD68. The patient received standard therapy with vinblastine and steroid, and showed disease regression during regular follow-up of neck ultrasonography. CONCLUSIONS Involvement of the thyroid and submandibular gland as initial diagnosis of Langerhans cell histiocytosis is extremely rare. It is important to investigate the involvement of affected systems. A comprehensive survey and biopsy are required to establish a definitive diagnosis.
Collapse
Affiliation(s)
- Yu Fan Cheng
- Department of Radiology, MacKay Memorial Hospital, Taipei City, 104, Taiwan
| | - Ching Che Wang
- Department of Radiology, MacKay Memorial Hospital, Taipei City, 104, Taiwan.
| | - Pei Shan Tsai
- Department of Radiology, MacKay Memorial Hospital, Taipei City, 104, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, 252, Taiwan
- Nursing and Management, Mackay Junior College of Medicine, New Taipei City, 112, Taiwan
| | - Dao Chen Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei City, Taiwan
- Division of Endocrine and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei City, 112, Taiwan
| | - Wen Hui Huang
- Department of Radiology, MacKay Memorial Hospital, Taipei City, 104, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, 252, Taiwan
- Nursing and Management, Mackay Junior College of Medicine, New Taipei City, 112, Taiwan
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei City, 112, Taiwan
| |
Collapse
|
4
|
Tan HEI, Lakshmanan R, Warne R, Walwyn T, Roebuck D. Neuroimaging manifestations of paediatric histiocytoses. J Med Imaging Radiat Oncol 2023. [PMID: 37964685 DOI: 10.1111/1754-9485.13602] [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: 09/28/2023] [Accepted: 10/23/2023] [Indexed: 11/16/2023]
Abstract
Histiocytoses are rare multi-system disorders marked by abnormal histiocyte cell proliferation, affecting children with diverse clinical presentations. Classified into five groups in 2016, including Langerhans-related (L), cutaneous (C), malignant (M), Rosai-Dorfman disease (R) and haemophagocytic lymphohistiocytosis (H), newer entities such as ALK-positive histiocytosis have also emerged, heralding the era of molecular (sub)classification. Common entities include Langerhans cell histiocytosis (LCH), Erdheim-Chester disease (ECD), Rosai-Dorfman disease (RDD) and haemophagocytic lymphohistiocytosis (HLH). This pictorial essay aids radiologists in recognising and differentiating paediatric histiocytoses based on unique neuroimaging features.
Collapse
Affiliation(s)
- Hsern Ern Ivan Tan
- Department of Medical Imaging, Perth Children's Hospital, Perth, Western Australia, Australia
- Department of Medical Imaging, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Rahul Lakshmanan
- Department of Medical Imaging, Perth Children's Hospital, Perth, Western Australia, Australia
- University of Western Australia, Perth, Western Australia, Australia
| | - Richard Warne
- Department of Medical Imaging, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Thomas Walwyn
- University of Western Australia, Perth, Western Australia, Australia
- Department of Oncology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Derek Roebuck
- Department of Medical Imaging, Perth Children's Hospital, Perth, Western Australia, Australia
- University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
5
|
Petsiou DP, Martinos A, Spinos D. Applications of Artificial Intelligence in Temporal Bone Imaging: Advances and Future Challenges. Cureus 2023; 15:e44591. [PMID: 37795060 PMCID: PMC10545916 DOI: 10.7759/cureus.44591] [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] [Accepted: 09/02/2023] [Indexed: 10/06/2023] Open
Abstract
The applications of artificial intelligence (AI) in temporal bone (TB) imaging have gained significant attention in recent years, revolutionizing the field of otolaryngology and radiology. Accurate interpretation of imaging features of TB conditions plays a crucial role in diagnosing and treating a range of ear-related pathologies, including middle and inner ear diseases, otosclerosis, and vestibular schwannomas. According to multiple clinical studies published in the literature, AI-powered algorithms have demonstrated exceptional proficiency in interpreting imaging findings, not only saving time for physicians but also enhancing diagnostic accuracy by reducing human error. Although several challenges remain in routinely relying on AI applications, the collaboration between AI and healthcare professionals holds the key to better patient outcomes and significantly improved patient care. This overview delivers a comprehensive update on the advances of AI in the field of TB imaging, summarizes recent evidence provided by clinical studies, and discusses future insights and challenges in the widespread integration of AI in clinical practice.
Collapse
Affiliation(s)
- Dioni-Pinelopi Petsiou
- Otolaryngology-Head and Neck Surgery, National and Kapodistrian University of Athens, School of Medicine, Athens, GRC
| | - Anastasios Martinos
- Otolaryngology-Head and Neck Surgery, National and Kapodistrian University of Athens, School of Medicine, Athens, GRC
| | - Dimitrios Spinos
- Otolaryngology-Head and Neck Surgery, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, GBR
| |
Collapse
|
6
|
Lin TE, Chu YY, Chang TY, Liao HT. Craniofacial involvement in Langerhans cell histiocytosis: A review of 44 cases at a single medical center. J Plast Reconstr Aesthet Surg 2023; 82:12-20. [PMID: 37148805 DOI: 10.1016/j.bjps.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 02/27/2023] [Accepted: 03/15/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Craniofacial bones are the most commonly involved site of Langerhans cell histiocytosis (LCH). The main purpose of this study was to clarify the relation between subsites of craniofacial bone and clinical presentation, treatment modalities, outcomes, and permanent consequences (PCs) in patients with LCH. METHODS Forty-four patients diagnosed with LCH involving the craniofacial region presenting at a single medical center during 2001-2019 were collected and divided into four groups: single system with unifocal bone lesion (SS-LCH, UFB); single system with multifocal bone lesions (SS-LCH, MFB); multisystem without risk organ involvement (MS-LCH, RO-); and multisystem with risk organ involvement (MS-LCH, RO+). Data including demographics, clinical presentation, treatments, outcomes, and the development of PC were retrospectively reviewed. RESULTS Temporal bone (66.7% versus 7.7%, p = 0.001), occipital bone (44.4% versus 7.7%, p = 0.022), and sphenoid bone (33.3% versus 3.8%, p = 0.041) involvement were more common in SS-LCH, MFB than they were in SS-LCH, UFB. No difference of reactivation rate was noted among the four groups. The most common PC is diabetes insipidus (DI), reported in 9 of the 16 (56.25%) patients with PC. The single system group was reported with the lowest incidence of DI (7.7%, p = 0.035). The reactivation rate was also higher in patients with PC (33.3% versus 4.0%, p = 0.021) or DI (62.5% versus 3.1%, p < 0.001). CONCLUSION An increased risk of multifocal or multisystem lesions was associated with temporal bone, occipital bone, sphenoid bone, maxillary bone, eye, ear, and oral involvement, which may indicate poor outcomes. Longer follow-up may be indicated if there is the presence of PC or DI due to the high risk of reactivation. Therefore, multidisciplinary evaluation and treatment according to risk stratification are vital for patients diagnosed with LCH involving the craniofacial region.
Collapse
Affiliation(s)
- Tzu-En Lin
- Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Ying Chu
- Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital, College of Medicine, Taiwan; Chang Gung University, Taoyuan, Taiwan
| | - Tsung-Yen Chang
- Division of Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Han-Tsung Liao
- Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital, College of Medicine, Taiwan; Chang Gung University, Taoyuan, Taiwan; Department of Plastic Surgery, Xiamen Chang Gung Memorial Hospital, China.
| |
Collapse
|
7
|
Battal B, Zamora C. Imaging of Skull Base Tumors. Tomography 2023; 9:1196-1235. [PMID: 37489465 PMCID: PMC10366931 DOI: 10.3390/tomography9040097] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 07/26/2023] Open
Abstract
The skull base provides a platform for supporting the brain while serving as a conduit for major neurovascular structures. In addition to malignant lesions originating in the skull base, there are many benign entities and developmental variants that may simulate disease. Therefore, a basic understanding of the relevant embryology is essential. Lesions centered in the skull base can extend to the adjacent intracranial and extracranial compartments; conversely, the skull base can be secondarily involved by primary extracranial and intracranial disease. CT and MRI are the mainstay imaging methods and are complementary in the evaluation of skull base lesions. Advances in cross-sectional imaging have been crucial in the management of patients with skull base pathology, as this represents a complex anatomical area that is hidden from direct clinical exam. Furthermore, the clinician must rely on imaging studies for therapy planning and to monitor treatment response. It is crucial to have a thorough understanding of skull base anatomy and its various pathologies, as well as to recognize the appearance of treatment-related changes. In this review, we aim to describe skull base tumors and tumor-like lesions in an anatomical compartmental approach and present imaging methods that aid in diagnosis, management, and follow-up.
Collapse
Affiliation(s)
- Bilal Battal
- Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Carlos Zamora
- Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| |
Collapse
|
8
|
Palsetia DR, Vijan AV, Gala FB, Sahu AC, Patkar DP, A. AS. Clival and Paraclival Lesions: A Pictorial Review. Indian J Radiol Imaging 2023; 33:201-217. [PMID: 37123565 PMCID: PMC10132890 DOI: 10.1055/s-0043-1761183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
AbstractThe clivus is a midline anatomical structure in the central skull base. It is affected by a wide range of non-neoplastic, benign and malignant pathologies, some of which typically affect the clivus because of its strategic location and embryological origins. Clival lesions may often be asymptomatic with occasional complaints like headache or cranial neuropathy in few. Cross-sectional imaging techniques, namely, computed tomographic scan and magnetic resonance imaging, thus, play a key role in approximating to the final diagnosis and estimating the disease extent. In this article, we highlight the important imaging features of various clival and paraclival pathologies to facilitate effective diagnosis, therapeutic planning, and management.
Collapse
Affiliation(s)
- Delnaz R. Palsetia
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Antariksh V. Vijan
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Foram B. Gala
- Department of Radiodiagnosis and Imaging, Lifescan Imaging Centre & Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Amit C. Sahu
- Department of Interventional Neuro-Radiology, Wockhardt Hospital, Mumbai, Maharashtra, India
| | - Deepak P. Patkar
- Department of Imaging, Nanavati Superspecialty Hospital, Mumbai, Maharashtra, India
| | - Arpita Sahu A.
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| |
Collapse
|
9
|
Ng SW, Zakawi FA, Shanmuganathan J, Al-Yahya SN. Langerhans Cell Histiocytosis in Paediatric Zygoma Swelling. Indian J Otolaryngol Head Neck Surg 2022; 74:5905-5909. [PMID: 36742809 PMCID: PMC9895686 DOI: 10.1007/s12070-021-02480-5] [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: 12/04/2020] [Accepted: 02/20/2021] [Indexed: 02/07/2023] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare neoplasm characterized by accumulation of histiocytes in various tissues. It has a wide clinical spectrum and its presentation may mimic clinical features of common diseases. High level of suspicion is required for early diagnosis. Here is a rare case of a rapidly aggressive LCH which first presented with right zygomatic swelling.
Collapse
Affiliation(s)
- Syiao Wei Ng
- Otorhinolaryngology Department, Hospital Sultanah Aminah, Jalan Persiaran Abu Bakar Sultan, 80100 Johor Bahru, Johor Malaysia
| | - Faredza Aliyaa Zakawi
- Otorhinolaryngology Department, Hospital Sultanah Aminah, Jalan Persiaran Abu Bakar Sultan, 80100 Johor Bahru, Johor Malaysia
| | - Jothi Shanmuganathan
- Otorhinolaryngology Department, Hospital Sultanah Aminah, Jalan Persiaran Abu Bakar Sultan, 80100 Johor Bahru, Johor Malaysia
| | - Syarifah Nafisah Al-Yahya
- Otorhinolaryngology Department, Hospital Sultanah Aminah, Jalan Persiaran Abu Bakar Sultan, 80100 Johor Bahru, Johor Malaysia
| |
Collapse
|
10
|
Ramji HF, Deng F. Langerhans Cell Histiocytosis Reactivation in a Teenager. J Pediatr 2022; 248:131-132. [PMID: 35667446 DOI: 10.1016/j.jpeds.2022.05.057] [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: 05/16/2022] [Accepted: 05/31/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Husayn F Ramji
- University of Oklahoma College of Medicine, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Francis Deng
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
11
|
Miller MJ, Hicks MJ, Foroozan R, Brodsky MC. A high-pressure situation. Surv Ophthalmol 2022:S0039-6257(22)00112-6. [PMID: 35970231 DOI: 10.1016/j.survophthal.2022.08.001] [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: 04/20/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 10/15/2022]
Abstract
An 8-year-old boy presented with acute visual loss in the right eye and nausea, vomiting, and diplopia. Imaging revealed a right orbital apex mass. Biopsy showed Langerhans cell histiocytosis (LCH), and the patient was diagnosed with isolated orbital LCH causing an orbital apex syndrome. A 12-month cytarabine chemotherapy course was begun, during which the patient developed bilateral optic disc edema. He was diagnosed with cytarabine-induced intracranial hypertension, which was successfully treated with acetazolamide. The cytarabine course was completed with complete resolution of the LCH lesion. The ophthalmologic relevance of this rare disorder is discussed.
Collapse
Affiliation(s)
| | - M John Hicks
- Baylor College of Medicine, Houston, Texas, USA; Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, USA; Department of Pathology, Texas Children's Hospital, Houston, Texas, USA
| | - Rod Foroozan
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA.
| | | |
Collapse
|
12
|
Hwang YR, Lee KM, Kim HG, Na K. Diagnostic Challenge in Rapidly Growing Langerhans Cell Histiocytosis with Aneurysmal Bone Cyst in the Maxilla: A Case Report. Diagnostics (Basel) 2022; 12:diagnostics12020400. [PMID: 35204491 PMCID: PMC8870746 DOI: 10.3390/diagnostics12020400] [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] [Received: 01/13/2022] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 02/01/2023] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare neoplastic disorder characterized by the clonal proliferation of CD1a +/CD 207 + dendritic cells, whose features are similar to those of epidermal Langerhans cells. LCH is more common in children than in adults. Localized osteolytic lesions in the craniofacial bones are the most common manifestations of LCH. However, LCH can also present as a multifocal and multisystem disease with poor prognosis. Locally aggressive LCH needs to be differentiated from various diseases such as osteomyelitis, malignant bone tumors, and soft tissue sarcomas. However, it is difficult to diagnose, since the imaging findings are nonspecific. We report a case of a highly aggressive LCH in the maxilla accompanied by a fluid-fluid level.
Collapse
Affiliation(s)
- Ye Rin Hwang
- Department of Radiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, #23 Kyunghee-daero, Dongdaemun-gu, Seoul 02447, Korea;
| | - Kyung Mi Lee
- Department of Radiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, #23 Kyunghee-daero, Dongdaemun-gu, Seoul 02447, Korea;
- Correspondence: (K.M.L.); (H.-G.K.); Tel.: +82-2-958-8623 (K.M.L.); +82-2-958-8622 (H.-G.K.); Fax: +82-2-968-0787 (K.M.L.); +82-2-968-0787 (H.-G.K.)
| | - Hyug-Gi Kim
- Department of Radiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, #23 Kyunghee-daero, Dongdaemun-gu, Seoul 02447, Korea;
- Correspondence: (K.M.L.); (H.-G.K.); Tel.: +82-2-958-8623 (K.M.L.); +82-2-958-8622 (H.-G.K.); Fax: +82-2-968-0787 (K.M.L.); +82-2-968-0787 (H.-G.K.)
| | - Kiyong Na
- Department of Pathology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, #23 Kyunghee-daero, Dongdaemun-gu, Seoul 02447, Korea;
| |
Collapse
|
13
|
Neuroimaging of paediatric pineal, sellar and suprasellar tumours: a guide to differential diagnosis. Childs Nerv Syst 2022; 38:33-50. [PMID: 34529090 DOI: 10.1007/s00381-021-05359-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/05/2021] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Pineal, sellar and suprasellar tumours in children comprise a wide range of diseases with different biological behaviours and clinical management. Neuroimaging plays a critical role in the diagnosis, treatment planning and follow up of these patients, but imaging interpretation can prove challenging due to the significant overlap in radiological features. MATERIALS AND METHOD A review of the literature was performed by undertaking a search of the MEDLINE and EMBASE databases for appropriate MeSH terminology. Identified abstracts were screened for inclusion and articles meeting the objectives of the review were included. RESULTS AND CONCLUSION In this article, we review radiological appearances of common and uncommon pineal, sellar and suprasellar tumours occurring in the paediatric population. We discuss the importance of anatomical localization, clinical information and cerebrospinal fluid tumour markers, and propose a practical approach to differential diagnosis. Lastly, we discuss future directions and prospective new imaging strategies to support state-of-the-art patient care.
Collapse
|
14
|
Matsushita S, Shimono T, Okuma T, Inoue T, Manabe T, Miki Y. Clinical and magnetic resonance imaging feature differences between solitary and multiple type Langerhans cell histiocytosis involving the craniofacial bone. Heliyon 2022; 8:e08741. [PMID: 35071813 PMCID: PMC8761678 DOI: 10.1016/j.heliyon.2022.e08741] [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: 09/15/2021] [Revised: 11/17/2021] [Accepted: 01/07/2022] [Indexed: 10/29/2022] Open
Abstract
PURPOSE To investigate the clinical and contrast-enhanced magnetic resonance imaging (MRI) features of craniofacial bone Langerhans cell histiocytosis (LCH) and discuss the differences between a solitary lesion group (SLG) and multiple lesions group (MLG). METHOD This study included 22 consecutive patients with pathologically proven LCH who underwent contrast-enhanced MRI. The clinical data and MRI features were retrospectively assessed. RESULTS The mean patient age was 5 years, and 15 patients were male. The frontal bone was the most frequently affected bone. Ten and 12 patients were classified into the SLG and the MLG, respectively. The following MRI features were observed in >50% cases: T1WI hyperintensity in 15 (68%) cases, T2WI hyperintensity in 16 (73%) cases, bulging sign in 18 (82%) cases, concentric or eccentric soft tissue mass formation in 13 (59%) cases, soft tissue edema in 16 (73%) cases, any grade of bone marrow edema in 16 (73%) cases, surrounding bone enhancement in 17 (77%) cases, and surrounding soft tissue enhancement in 16 (73%) cases. Patient age was significantly higher in the SLG than that in the MLG (P = 0.0014). Perilesional bone marrow edema and enhancement were significantly more prominent in the SLG than in the MLG (P = 0.032, P = 0.040). CONCLUSIONS Contrast-enhanced MRI showed additional significant findings of mainly the surrounding details. Older age, extensive bone marrow edema, and enhancement may indicate solitary-type LCH rather than multiple-type LCH. These differences may help distinguish between solitary- and multiple-type LCH, which have different treatment strategies.
Collapse
Affiliation(s)
- Shu Matsushita
- Department of Diagnostic Radiology, Osaka City General Hospital, 2-13-22 Miyakojima-Honndori, Miyakojima-ku, Osaka 534-0021, Japan.,Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Taro Shimono
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Tomohisa Okuma
- Department of Diagnostic Radiology, Osaka City General Hospital, 2-13-22 Miyakojima-Honndori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Takeshi Inoue
- Department of Pathology, Osaka City General Hospital, 2-13-22 Miyakojima-Honndori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Takao Manabe
- Department of Diagnostic Radiology, Osaka City General Hospital, 2-13-22 Miyakojima-Honndori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Yukio Miki
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| |
Collapse
|
15
|
Xu J, Gilbert JR, Sutton KS, Goudy SL, Abramowicz S. Head and Neck Langerhans Cell Histiocytosis in Children. J Oral Maxillofac Surg 2021; 80:545-552. [PMID: 34852246 DOI: 10.1016/j.joms.2021.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Controversy exists among head and neck surgical specialties regarding management of Langerhan's Cell Histiocytosis (LCH). The purpose of this study was to evaluate diagnosis, management, and treatment outcomes in children with LCH of the head and neck. METHODS This is a retrospective cohort study of children with LCH of the head and neck who presented to Children's Healthcare of Atlanta hospital from 2009 to 2021. The independent variables were demographic information, lesion locations, clinical presentation, radiographic findings, diagnostic workup, treatment, and length of follow-up. The patients were grouped based on these variables. The outcome variable was disease reactivation. Descriptive statistics were calculated. RESULTS There were 3 presentations of LCH of the head and neck. Group 1 presented as a lesion in 1 system without CNS risk (SS-). There were 24 patients with an average age of 10 years. Lesions were located in calvaria and/or mandible. Majority of the patients were treated with only debridement. Two of the patients experienced reactivation. Group 2 presented as a lesion in 1 system with CNS risk (SS+). There were 30 patients with an average age of 6 years. Common locations were temporal bone and/or orbit. These patients present with recurrent ear infections and ptosis. Majority of the patients were treated with chemotherapy (n = 28). One patient had disease reactivation. Group 3 presented with multisystem involvement. There were 13 patients with an average age of 2 years. LCH was found in skin and the lymphatic system. Imaging demonstrated extracranial organ involvement. All of them were treated with chemotherapy. There was 40% reactivation of LCH. CONCLUSIONS Treatment of LCH depends on presentation. SS- subgroup can be adequately treated via surgical debridement. SS+ and multisystem groups benefit from an early disease diagnosis and require chemotherapy.
Collapse
Affiliation(s)
- Joyce Xu
- Resident in Training, Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Julie R Gilbert
- Fellow in Hematology and Oncology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Kathryn S Sutton
- Assistant Professor, Division of Hematology and Oncology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Steven L Goudy
- Professor and Chief, Division of Pediatric Otolaryngology, Department of Otolaryngology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Shelly Abramowicz
- Associate Professor in Oral and Maxillofacial Surgery and Pediatrics, Department of Surgery, Emory University School of Medicine, Chief of Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, Georgia.
| |
Collapse
|
16
|
Cohen Aubart F, Idbaih A, Emile JF, Amoura Z, Abdel-Wahab O, Durham BH, Haroche J, Diamond EL. Histiocytosis and the nervous system: from diagnosis to targeted therapies. Neuro Oncol 2021; 23:1433-1446. [PMID: 33993305 PMCID: PMC8408883 DOI: 10.1093/neuonc/noab107] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Histiocytoses are heterogeneous hematopoietic diseases characterized by the accumulation of CD68(+) cells with various admixed inflammatory infiltrates. The identification of the pivotal role of the mitogen-activated protein kinase (MAPK) pathway has opened new avenues of research and therapeutic approaches. We review the neurologic manifestations of 3 histiocytic disorders with frequent involvement of the brain and spine: Langerhans cell histiocytosis (LCH), Erdheim-Chester disease (ECD), and Rosai-Dorfman-Destombes disease (RDD). Central nervous system (CNS) manifestations occur in 10%-25% of LCH cases, with both tumorous or neurodegenerative forms. These subtypes differ by clinical and radiological presentation, pathogenesis, and prognosis. Tumorous or degenerative neurologic involvement occurs in 30%-40% of ECD patients and affects the hypothalamic-pituitary axis, meninges, and brain parenchyma. RDD lesions are typically tumorous with meningeal or parenchymal masses with strong contrast enhancement. Unlike LCH and ECD, neurodegenerative lesions or syndromes have not been described with RDD. Familiarity with principles of evaluation and treatment both shared among and distinct to each of these 3 diseases is critical for effective management. Refractory or disabling neurohistiocytic involvement should prompt the consideration for use of targeted kinase inhibitor therapies.
Collapse
Affiliation(s)
- Fleur Cohen Aubart
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Ahmed Idbaih
- Assistance Publique-Hôpitaux de Paris, Service de Neurologie 1, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Jean-François Emile
- Assistance Publique Hôpitaux de Paris, Hôpital Ambroise Paré, Département de Pathologie, Université Versailles-Saint Quentin, Boulogne, France
| | - Zahir Amoura
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Omar Abdel-Wahab
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Benjamin H Durham
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Julien Haroche
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Eli L Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| |
Collapse
|
17
|
Mishra A, Gyawali S, Kharel S, Mishra A, Kuikel S, Pathak N, Gurung A. Incidental finding of Langerhans cell histiocytosis of temporoparietal bone - A case report. Int J Surg Case Rep 2021; 85:106179. [PMID: 34274753 PMCID: PMC8319439 DOI: 10.1016/j.ijscr.2021.106179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction and importance Langerhans cell histiocytosis (LCH) is a rare haematological disorder affecting infants and young children and has an estimated incidence of 2-5 cases per million people per year. LCH invades the reticuloendothelial system and causes the proliferation of Langerhans cells and mature eosinophils. LCH involving the temporoparietal bone has rarely been reported in the literature. Presentation of case A ten-year-old boy presented to the Neurosurgical outpatient clinic with a swelling on the right temporoparietal region following a fall from his bicycle. Local examination revealed a single, 3 × 3 cm, non-tender, cystic, immobile swelling in the right temporoparietal region. On evaluation for recent head trauma, an incidental finding of eosinophilic granuloma was discovered on a CT scan. The FNAC was suggestive of a histiocytic lesion pertaining to a diagnosis of LCH. The patient underwent wide excision of the mass and cranioplasty. A one-month follow-up CT scan of the head had no evidence of residual or recurrent disease. Discussion Eosinophilic granuloma is one of the three variants of LCH and has a relatively better prognosis. Clinical diagnosis can be challenging and mandates tissue sampling for histopathological examination. Treatment modalities including surgery, radiotherapy, chemotherapy, and steroid injection are used alone, or in combination, depending on the extent and severity of the disease. Conclusion Examining a swelling in the temporoparietal region with no other characteristic symptoms could be a case of LCH. The timely diagnosis and surgical excision with other adjuvant treatment options of this rare pediatric disease would help in a better outcome. Langerhans cell histiocytosis can present as a mass in the temporal or parietal region with no symptoms otherwise. The etiology of Langerhans cell histiocytosis is still unknown and diagnosis can be challenging. The prognosis depends greatly on early identification and prompt surgical treatment.
Collapse
Affiliation(s)
- Aakash Mishra
- Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal.
| | - Sandesh Gyawali
- Department of General Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Sanjeev Kharel
- Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Kathmandu, Nepal.
| | - Aman Mishra
- Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Kathmandu, Nepal.
| | - Sandip Kuikel
- Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Kathmandu, Nepal.
| | - Nibesh Pathak
- Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Kathmandu, Nepal.
| | - Ashim Gurung
- Department of Neurosurgery, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| |
Collapse
|
18
|
Sbardella E, Puliani G, Feola T, Pofi R, Pirchio R, Sesti F, Verdecchia F, Gianfrilli D, Moffat D, Isidori AM, Grossman AB. A clinical approach to parasellar lesions in the transition age. J Neuroendocrinol 2021; 33:e12995. [PMID: 34138496 DOI: 10.1111/jne.12995] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/23/2021] [Accepted: 05/11/2021] [Indexed: 12/16/2022]
Abstract
Many reviews have summarised the pathology and management of the parasellar region in adult patients, although an analysis of these aspects in the transition years, from puberty onset to the age of peak bone mass, has been lacking. A comprehensive search of English-language original articles, published from 2000 to 2020, was conducted in the MEDLINE database (December 2019 to March 2020). We selected all studies regarding epidemiology, diagnosis and management of the following parasellar lesions: germinoma, craniopharyngioma, Langerhans cell histiocytosis, optic glioma, hypothalamic hamartoma, tuber cinereum hamartoma, cranial chordoma, Rathke cleft cyst, hypophysitis and hypothalamitis during the transition age from childhood to adulthood. In the present review, we provide an overview of the principal parasellar lesions occurring in the transition age. Symptoms are usually a result of the mass effect of the lesions on nearby structures, as well as anterior pituitary deficits. Diabetes insipidus occurs frequently in these patients. In this age group, pubertal developmental disorders may be more evident compared to other stages of life. Parasellar lesions in the transition age mostly include neoplastic lesions such as germinomas, hamartomas, optic gliomas, craniopharyngiomas Langerhans cell histiocytosis and chordomas, and rarely inflammatory lesions (hypophysitis, hypothalamitis). There are limited data on the management of parasellar lesions in the transition age. Endocrine evaluation is crucial for identifying conditions that require hormonal treatment so that they can be treated early to improve the quality of life of the individual patient in this complex age range. The clinical approach to parasellar lesions involves a multidisciplinary effort.
Collapse
Affiliation(s)
- Emilia Sbardella
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Giulia Puliani
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
- Oncological Endocrinology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Tiziana Feola
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
- Neuroendocrinology, Neuromed Institute, IRCCS, Pozzilli, Italy
| | - Riccardo Pofi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Rosa Pirchio
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - Franz Sesti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Federica Verdecchia
- Dipartimento Pediatrico Universitario Ospedaliero, Bambino Gesù Children Hospital, Rome, Italy
| | - Daniele Gianfrilli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Daniel Moffat
- Department of Neurosurgery, Barts and the London NHS Trust, London, UK
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Ashley B Grossman
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, University of Oxford, Oxford, UK
- Centre for Endocrinology, Barts and the London School of Medicine, London, UK
| |
Collapse
|
19
|
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.
Collapse
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.
| |
Collapse
|
20
|
Tran J, Allen RC. A Mass in the Greater Wing of the Sphenoid in a Pediatric Patient. JAMA Ophthalmol 2021; 138:584-585. [PMID: 32215585 DOI: 10.1001/jamaophthalmol.2020.0372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jeffrey Tran
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - Richard C Allen
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas.,Section of Ophthalmology, Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston
| |
Collapse
|
21
|
Faramand A, Niranjan A, Flickinger J, Monaco E, Lunsford LD. Salvage Gamma Knife Stereotactic Radiosurgery for Recurrent Intracranial Langerhans Cell Histiocytosis: A 36-Year Saga. World Neurosurg 2020; 144:205-208. [DOI: 10.1016/j.wneu.2020.09.090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 12/30/2022]
|
22
|
Gargan ML, Wong JL, Leidhin CN, Owens C, Byrne A. Langerhans cell histiocytosis in children under 12 months of age: The spectrum of imaging and clinical findings: Experience in an Irish tertiary referral centre. Eur J Radiol 2020; 134:109375. [PMID: 33261936 DOI: 10.1016/j.ejrad.2020.109375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/17/2020] [Accepted: 10/20/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Langerhans cell histiocytosis is an uncommon condition and it is unusual for it to present in children under one year of age. Our aim is to review the clinical presentation, and present the radiologic findings and clinical outcome in this particular cohort of patients and determine how this differs from the imaging features of older children presenting with LCH. MATERIALS AND METHODS A database of 17 patients with LCH who presented between 0 and 12 months of age was retrospectively reviewed. Radiologic findings, initial clinical presentation and ultimate clinical outcome were documented in table format. RESULTS Eight patients (47 %) initially presented with cutaneous stigmata, seven patients (41 %) had skeletal involvement, five patients (29 %) had splenic involvement, two patients (24 %) had central nervous system involvement either at presentation or at follow-up, three patients (18 %) had lymphadenopathy, two patients (12 %) had liver involvement, and two patients (12 %) had gastrointestinal (GI) involvement. Four patients (24 %) had multisystem involvement either at presentation or at follow-up. One patient died during follow-up. CONCLUSION LCH in children under one year of age is uncommon and may have an unusual clinical presentation. The radiologic findings are varied and may differ from the classical imaging appearance more commonly seen in the older age group, with multisystem involvement seen more readily in younger patients.
Collapse
Affiliation(s)
- Mary-Louise Gargan
- Children's Health Ireland at Crumlin, Dublin, Ireland; Children's Health Ireland, Cooley Road, Crumlin, Dublin, D12 N512, Ireland.
| | - Jsun Loong Wong
- Children's Health Ireland at Crumlin, Dublin, Ireland; Children's Health Ireland, Cooley Road, Crumlin, Dublin, D12 N512, Ireland.
| | - Caoilfhionn Ni Leidhin
- Children's Health Ireland at Crumlin, Dublin, Ireland; Children's Health Ireland, Cooley Road, Crumlin, Dublin, D12 N512, Ireland.
| | - Cormac Owens
- Children's Health Ireland at Crumlin, Dublin, Ireland; Children's Health Ireland, Cooley Road, Crumlin, Dublin, D12 N512, Ireland.
| | - Angela Byrne
- Children's Health Ireland at Crumlin, Dublin, Ireland; Children's Health Ireland, Cooley Road, Crumlin, Dublin, D12 N512, Ireland.
| |
Collapse
|
23
|
Craniofacial and Intracranial Langerhans Cell Histiocytosis. J Belg Soc Radiol 2020; 104:57. [PMID: 33134817 PMCID: PMC7583707 DOI: 10.5334/jbsr.2245] [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] [Indexed: 11/20/2022] Open
Abstract
Main Teaching Point: Multiple osteolytic calvarial lesions in a child raise suspicion of Langerhans cell histiocytosis.
Collapse
|
24
|
Luna LP, Drier A, Aygun N, Mokhtari K, Hoang-Xuan K, Galanaud D, Donadieu J, Dormont D, Haroche J, Martin-Duverneuil N. MRI features of intra-axial histiocytic brain mass lesions. Clin Radiol 2020; 76:159.e19-159.e28. [PMID: 33077156 DOI: 10.1016/j.crad.2020.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 09/15/2020] [Indexed: 12/29/2022]
Abstract
AIM To describe MRI features, including diffusion-weighted imaging (DWI), magnetic resonance spectroscopy (MRS), and perfusion-weighted imaging (PWI), of intra-axial tumour-like presentations of four different subtypes of histiocytosis. MATERIAL AND METHODS The brain MRI findings of 23 patients with histologically proven histiocytosis were reviewed retrospectively (11 Langerhans cell histiocytosis [LCH], eight Erdheim-Chester disease [ECD], one overlap form LCH/ECD, two Rosai-Dorfman disease [RDD], and one haemophagocytic lymphohistiocytosis [HLH]) with single or multiple enhancing intraparenchymal brain lesions. RESULTS Histiocytic brain mass lesions show some similar MRI features including Supra and/or infratentorial and/or paraventricular subcortical well-delineated masses, linear ependymal enhancement along the ventricles and brain stem lesions. Masses always present with mixed hyper- and hypointense signal on T2-weighted imaging (WI). Their enhancement is often homogeneous. Apparent diffusion coefficient (ADC) values are often normal or elevated. CONCLUSION The presence of multiple periventricular and subcortical enhancing lesions with mixed signal intensity on T2WI and normal or high ADC values should lead radiologists to consider the diagnosis of histiocytic lesions and search for associated systemic lesions.
Collapse
Affiliation(s)
- L P Luna
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, The Johns Hopkins University School of Medicine, Baltimore, USA.
| | - A Drier
- APHP, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - N Aygun
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - K Mokhtari
- APHP, Department of Neuropathology, Pitié-Salpêtrière Hospital, Paris, France
| | - K Hoang-Xuan
- APHP, Department of Neuro-oncology, Pitié-Salpêtrière Hospital, Paris, France
| | - D Galanaud
- APHP, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - J Donadieu
- APHP, Department of Hematology, Trousseau Hospital, Paris, France
| | - D Dormont
- APHP, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - J Haroche
- APHP, Department of Internal Medicine, Pitié-Salpêtrière Hospital, Paris, France
| | - N Martin-Duverneuil
- APHP, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| |
Collapse
|
25
|
Schlund M, Roland-Billecart T, Aubert S, Nicot R. [Tumors affecting the temporomandibular joint - a literature review]. Bull Cancer 2020; 107:1186-1198. [PMID: 33059872 DOI: 10.1016/j.bulcan.2020.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/19/2020] [Accepted: 05/27/2020] [Indexed: 10/23/2022]
Abstract
Benign and malign tumors can affect the temporomandibular joint (TMJ) as any other articulation. Nevertheless, TMJ tumors are rare and mostly benign. Their clinical expression is varied including symptomatology similar to TMJ dysfunctional disorders, otologic or neurologic pathologies. In some cases, they remain totally asymptomatic. Hence, diagnosis is difficult since the symptomatology can be misleading with TMJ dysfunctional disorders or otologic disorders wrongly diagnosed. There is thus frequently a long delay between symptoms onset and diagnosis. The great variety of TMJ lesions explains the wide range of possible treatment modalities, mostly based on surgery. We provide here a review of the lesions originating from the TMJ. Tumoral or cystic mandibular lesion affecting the TMJ through local extension will not be discussed. Osteoma, osteoid osteoma, osteoblastoma, chondroma, osteochondroma, chondroblastoma, tenosynovial giant cell tumors, giant cell lesions, non-ossifying fibroma, hemangioma, lipoma or Langerhans cell histiocytosis are all possible diagnosis among the benign tumors found in the TMJ. Pseudotumors include synovial chondromatosis and aneurysmal bone cyst. Finally, malign tumors of the TMJ include mainly sarcomas (osteosarcoma, chondrosarcoma, synovial sarcoma, Ewing sarcoma, and fibrosarcoma), but also multiple myeloma and secondary metastases. We will review the clinical, radiological and histological aspects of each of these lesions. The treatment and the recurrence risk will also be discussed.
Collapse
Affiliation(s)
- Matthias Schlund
- University Lille, CHU de Lille, service de chirurgie maxillo-faciale et stomatologie, U1008 - Controlled Drug Delivery Systems and Biomaterial, Inserm, 59000 Lille, France.
| | - Thomas Roland-Billecart
- University Lille, CHU de Lille, service de chirurgie maxillo-faciale et stomatologie, 59000 Lille, France
| | - Sébastien Aubert
- University Lille, CHU de Lille, institut de pathologie, 59000 Lille, France
| | - Romain Nicot
- University Lille, CHU de Lille, service de chirurgie maxillo-faciale et stomatologie, U1008 - Controlled Drug Delivery Systems and Biomaterial, Inserm, 59000 Lille, France
| |
Collapse
|
26
|
Orr A, Braunreiter C, Keefe C, Christy M, Betz BW. Pituitary sellar spine in a pediatric patient with diabetes insipidus. Clin Imaging 2020; 69:145-147. [PMID: 32731106 DOI: 10.1016/j.clinimag.2020.07.002] [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: 04/23/2020] [Revised: 07/07/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
Abstract
A sellar spine is a midline bony spur arising from the ventral aspect of the dorsum sellae. Representing a remnant of the anterior notochord, it is often an incidental finding and thought to be of no clinical significance. However, it has recently been suggested that a potential association may exist between sellar spine and pediatric pituitary endocrinopathies, possibly caused by deformation of the developing pituitary gland by the sellar spine. To our knowledge, this is the first case report demonstrating an association between sellar spine and clinical diabetes insipidus.
Collapse
Affiliation(s)
- Adam Orr
- Spectrum Health Diagnostic Radiology Residency, Grand Rapids, MI, United States of America.
| | - Chi Braunreiter
- Department of Pediatric Hematology-Oncology, Helen Devos Children's Hospital, Grand Rapids, MI, United States of America
| | - Christel Keefe
- Department of Pediatric Endocrinology, Helen Devos Children's Hospital, Grand Rapids, MI, United States of America
| | - Matthew Christy
- Department of Diagnostic Radiology, Helen Devos Children's Hospital, Advanced Radiology Services, Grand Rapids, MI, United States of America
| | - Bradford W Betz
- Department of Diagnostic Radiology, Helen Devos Children's Hospital, Advanced Radiology Services, Grand Rapids, MI, United States of America
| |
Collapse
|
27
|
SEONG KİN F, CHENG Aİ O, HUSSAİN FA, GOH BS. A great mimicker of mastoiditis- Multisystem Langerhans’ cell histiocytosis. ENT UPDATES 2020. [DOI: 10.32448/entupdates.673014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
28
|
Guo Y, Ning F, Wang G, Li X, Liu J, Yuan Y, Dai P. Retrospective study of Langerhans cell histiocytosis in ear, nose and neck. Am J Otolaryngol 2020; 41:102369. [PMID: 31870640 DOI: 10.1016/j.amjoto.2019.102369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/23/2019] [Accepted: 12/06/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Langerhans cell histiocytosis (LCH) is a rare clinical disorder. We retrospectively analysed the clinical manifestations, treatments and prognoses of LCH cases involving the ear, nose, and neck. MATERIALS AND METHODS 28 cases with confirmed LCH in ear, nose or neck were reviewed. We recorded patient age, sex, chief complaints, accompanying symptoms, lesional sites, radiological data, treatments and pathologies. Whole-exome sequencing was performed on the patient diagnosed with LCH and Treacher-Collins syndrome (TCS). RESULTS The mean age was 14.86 years. Most LCH was in the ear (93%), usually in the mastoid. The most common symptoms were an ear mass and a purulent discharge. Imaging was not very useful. Treatments included surgery, chemotherapy, and radioactive particle implantation. Some cases exhibited multisystem involvement. Most patients enjoyed good prognoses. One patient was diagnosed with both temporal LCH and TCS. Whole-exome sequencing revealed a heterozygous c.261_272delAGGTACCCTTCC(p.87_91delRGTLPinsR) mutation in exon 2 of the POLR1D gene (NM_015972). CONCLUSION LCH mostly occurs in children. In head and neck it affects principally the mastoid part of the temporal bone. Treatments include surgery, chemotherapy, and irradiation. Most patients enjoy good prognoses. LCH accompanied by TCS is rare and increases the difficulty of diagnosis; molecular data aid in TCS identification.
Collapse
Affiliation(s)
- Yan Guo
- Department of Otolaryngology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China; Department of Otolaryngology, Head and Neck Surgery, PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Fei Ning
- Department of Otolaryngology, Head and Neck Surgery, PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Guojian Wang
- Department of Otolaryngology, Head and Neck Surgery, PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Xiaohong Li
- Department of Otolaryngology, Head and Neck Surgery, PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Jisheng Liu
- Department of Otolaryngology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Yongyi Yuan
- Department of Otolaryngology, Head and Neck Surgery, PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China.
| | - Pu Dai
- Department of Otolaryngology, Head and Neck Surgery, PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China.
| |
Collapse
|
29
|
Wang Y, Camelo-Piragua S, Abdullah A, Ibrahim M, Parmar HA. Neuroimaging features of CNS histiocytosis syndromes. Clin Imaging 2019; 60:131-140. [PMID: 31874337 DOI: 10.1016/j.clinimag.2019.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/01/2019] [Accepted: 10/07/2019] [Indexed: 01/24/2023]
Abstract
Histiocytosis syndromes (HS) are group of heterogeneous disorders characterized by abnormal accumulation and infiltration of histiocytes, cells derived from hematopoietic cells of monocyte/macrophage lineage. Overall these disorders are rare. When they do occur they involve many organ systems including the central nervous system (CNS). While imaging findings can provide important clues, diagnosis of this disorder is challenging and definitive diagnosis often necessitates pathologic examination. In this review, we describe imaging features of HS involving the CNS, with the aim to increase our understanding of these disorders. The entities discussed in this review will include: Langerhans cell histiocytosis (LCH), Rosai-Dorfman Disease (RDD), Erdheim Chester Disease (ECD), hemophagocytic lymphohistiocytosis (HLH), and crystal-storing histiocytosis (CSH).
Collapse
Affiliation(s)
- Yuting Wang
- Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China; Department of Radiology, University of Michigan Health System, Ann Arbor, MI, United States of America
| | - Sandra Camelo-Piragua
- Department of Pathology, University of Michigan Health System, Ann Arbor, MI, United States of America
| | - Asif Abdullah
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, United States of America
| | - Mohannad Ibrahim
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, United States of America
| | - Hemant A Parmar
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, United States of America.
| |
Collapse
|
30
|
Abstract
Short stature in children is a diagnostic challenge to the physician. Bone age assessment can be done using various methods. The causes of short stature are variable; often leading to a series of investigations. The endocrine conditions have typical imaging features. This chapter provides a short overview of the methods of bone age estimation, and imaging findings and algorithmic approach towards a child with short stature.
Collapse
|
31
|
Kim JE, Yi WJ, Heo MS, Lee SS, Choi SC, Huh KH. Langerhans cell histiocytosis of the jaw, a mimicker of osteomyelitis on CT and MR images: A retrospective analysis. Medicine (Baltimore) 2019; 98:e16331. [PMID: 31277182 PMCID: PMC6635274 DOI: 10.1097/md.0000000000016331] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Differential diagnosis of Langerhans Cell Histiocytosis (LCH) in the jaw is essential for early treatment including systemic therapy. Records of 17 patients (6 men and 11 women; mean age, 14 years) with histologically confirmed LCH were reviewed. All the lesions occurred in the mandible. Most of the cases (n=12) were intraosseous type LCH, only 5 patients had alveolar type LCH. Patients complained of facial swelling and pain most likely. In the 14 patients who underwent CT and/or MR imaging, all LCH lesions were osteolytic, with a mean size of 23 mm. LCH presented as expansile lesions with periosteal new bone formation, perilesional sclerosis, fluid attenuation/signal within the lesion, and inflammatory changes in adjacent soft tissues on CT/MR images. Considering the major symptoms of LCH were swelling and pain, the differential diagnosis of LCH from osteomyelitis might be more difficult. The differential diagnosis for osteolytic lesions of the jaw with surrounding inflammatory changes should include LCH, especially in young patients.
Collapse
Affiliation(s)
- Jo-Eun Kim
- Department of Oral and Maxillofacial Radiology, Seoul National University Dental Hospital
| | - Won-Jin Yi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University
| | - Min-Suk Heo
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University
| | - Sam-Sun Lee
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University
| | - Soon-Chul Choi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University
| | - Kyung-Hoe Huh
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| |
Collapse
|
32
|
|
33
|
Matsushita K, Shimono T, Miki Y. Langerhans Cell Histiocytosis with Multiple Fluid-fluid Levels in the Parietal Bone. Magn Reson Med Sci 2019; 19:5-6. [PMID: 30828044 PMCID: PMC7067913 DOI: 10.2463/mrms.ci.2018-0152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Kazuki Matsushita
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine
| | - Taro Shimono
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine
| | - Yukio Miki
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine
| |
Collapse
|
34
|
Lomoro P, Simonetti I, Vinci G, Fichera V, Tarotto L, Trovato P, Prevedoni Gorone MS. Secondary aneurysmal bone cyst in Langerhans cell histiocytosis: Case report, literature review. Eur J Radiol Open 2019; 6:97-100. [PMID: 30809556 PMCID: PMC6376152 DOI: 10.1016/j.ejro.2019.02.002] [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: 01/26/2019] [Revised: 02/03/2019] [Accepted: 02/05/2019] [Indexed: 12/25/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare disease of the myeloid precursor cells, it predominantly occurs in the skull and long bones as unifocal bone lesions. Aneurysmal bone cysts (ABC) are benign, expansive and lytic bone. Reports of secondary ABC occurring in LCH are rare, having only been reported twice in the skull. Here, we report the first case of LCH masquerading as ABC in a 14-month-old female child who presented with a rapidly growing mass in her left femur. The lesion had typical radiological features of ABC, and only histological examination revealed the presence of cells suggestive of LCH.
Collapse
Affiliation(s)
- P Lomoro
- Department of Diagnostic Medicine Institute of Radiology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy
| | - I Simonetti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - G Vinci
- Department of Nephrology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - V Fichera
- Department of Pediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - L Tarotto
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - P Trovato
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - M S Prevedoni Gorone
- Department of Diagnostic and Interventional Radiology and Neuroradiology of IRCCS San Matteo University Hospital Foundation, Pavia, Italy
| |
Collapse
|
35
|
A systematic approach in the diagnosis of paediatric skull lesions: what radiologists need to know. Pol J Radiol 2019; 84:e92-e111. [PMID: 31019602 PMCID: PMC6479152 DOI: 10.5114/pjr.2019.83101] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 12/03/2018] [Indexed: 12/14/2022] Open
Abstract
Paediatric skull lesions are commonly identified on imaging. They can be challenging to image, given their location and size, and often require several imaging modalities to narrow down the differential diagnosis. Accurate diagnosis of these lesions is paramount because the clinical therapy can vary tremendously. In this review, we provide a simple and systematic approach to clinical-radiological features of primary skull lesions. We highlight the imaging characteristics and differentiate pathologies based on imaging appearances. We also accentuate the role of cross-sectional imaging in lesion identification and management implications.
Collapse
|
36
|
|
37
|
Pediatric Tumor Neuroradiology. Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-68536-6_36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
38
|
Bisdas S, D’Arco F. Pediatric Tumor Neuroradiology. Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-61423-6_36-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
39
|
Bisdas S, D’Arco F. Pediatric Tumor Neuroradiology. Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-61423-6_36-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
40
|
Vanhoenacker FM, Verlooy J, De Praeter M. Spontaneous resolution of unifocal Langerhans cell histiocytosis of the skull: potential role of ultrasound in detection and imaging follow-up. J Ultrason 2018; 18:265-270. [PMID: 30427133 PMCID: PMC6442212 DOI: 10.15557/jou.2018.0038] [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] [Accepted: 03/16/2018] [Indexed: 11/22/2022] Open
Abstract
Langerhans cell histiocytosis is a tumor-like condition characterized by idiopathic proliferation of Langerhans cells. The disease may involve the skeleton as well as other organs systems. Bone involvement may be solitary or multifocal. Unifocal osseous Langerhans cell histiocytosis may involve virtually any bone, with the calvarium being most frequently involved. Plain radiography, computed tomography and magnetic resonance imaging are the most used techniques for detection and characterization of the lesion. The use of ultrasound is less known, although it may be a valuable technique in detection and follow-up of superficially located lesions such as calvarial lesions. This case report describes an 8-year-old girl, in whom the lesion was initially detected by ultrasound. Furthermore, ultrasound was used to evaluate spontaneous resolution of the lesion. The knowledge of ultrasound characteristics may be important to avoid unnecessary radiation and gadolinium administration, particularly in a pediatric population.
Collapse
Affiliation(s)
- Filip M Vanhoenacker
- Department of Radiology, Antwerp University Hospital and Antwerp University, Edegem, Belgium ; Department of Radiology, AZ Sint-Maarten, Duffel-Mechelen, Belgium ; Department of Radiology and Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Joris Verlooy
- Department of Pediatrics, Antwerp University Hospital and Antwerp University, Edegem, Belgium
| | - Mania De Praeter
- Department of Neurosurgery, Antwerp University Hospital and Antwerp University, Edegem, Belgium
| |
Collapse
|
41
|
Forman R, Ramesh A, Jhaveri M, John S. Extrapontine myelinolysis effects in intracranial langerhans cell histiocytosis: Case report. eNeurologicalSci 2018; 12:34-35. [PMID: 30211327 PMCID: PMC6129692 DOI: 10.1016/j.ensci.2018.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/20/2018] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rachel Forman
- Rush University Medical Center, Department of Neurological Sciences, 1752 W. Harrison St. Suite 1118, Chicago, IL 60612, United States
| | - Atul Ramesh
- Christiana Care Health System, Department of Neurological Sciences, 4755 Ogletown-Stanton Road, Newark, DE 19718, United States
| | - Miral Jhaveri
- Rush University Medical Center, Department of Diagnostic Radiology, 1653 W Congress Parkway, Chicago, IL 60612, United States
| | - Sayona John
- Rush University Medical Center, Department of Neurological Sciences, 1752 W. Harrison St. Suite 1118, Chicago, IL 60612, United States
| |
Collapse
|
42
|
Isolated Langerhans Cell Histiocytosis of Orbit: A Case Report and Review of the Literature. Case Rep Ophthalmol Med 2018; 2018:1529281. [PMID: 29850325 PMCID: PMC5904803 DOI: 10.1155/2018/1529281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 02/19/2018] [Accepted: 03/05/2018] [Indexed: 12/11/2022] Open
Abstract
A 2-year-old male child presented with a painless progressive mass in the inferolateral aspect of right orbit of three-month duration. Differential leucocyte count revealed raised eosinophil count (13%). On radiological examination, CT scan showed 25 × 27 mm round well-defined smooth-outlined homogenously enhancing extraconal mass arising from the zygomatic bone at the inferotemporal periorbital area of right orbit with bone erosion. Histopathological examination of the incision biopsy revealed characteristic Langerhans cells and immunohistochemical studies were positive for S-100 protein and adenosine deaminase. A diagnosis of Langerhans Cell Histiocytosis (LCH) was made and PET-CT revealed no other foci of uptake anywhere else in the body. The patient received 12 cycles of vinblastine, 0.2 mg/kg body weight, along with oral prednisolone, 1 mg/kg body weight. On completion of three cycles of chemotherapy, a reduction in size of the mass was noticed. A repeat PET scan was done 3 months after completion of chemotherapy did not reveal any activity noted previously.
Collapse
|
43
|
Zheng H, Xia Z, Cao W, Feng Y, Chen S, Li YH, Wang DB. Pediatric Langerhans cell histiocytosis of the temporal bone: clinical and imaging studies of 27 cases. World J Surg Oncol 2018; 16:72. [PMID: 29587787 PMCID: PMC5872572 DOI: 10.1186/s12957-018-1366-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to evaluate the clinical and imaging presentations of Langerhans cell histiocytosis (LCH) in the pediatric temporal bone. METHODS This retrospective study included 27 pediatric cases with pathological confirmed LCH of the temporal bone. The clinical and imaging features of the cases were analyzed. The involvement of ossicular chain and otic capsule was also evaluated. RESULTS A total of 38 lesions (27 cases) with 11 bilateral involvement were identified. For the 27 cases, the most common complaint was periauricular swelling (12/27, 44.4%), followed by otorrhea (9/27, 33.3%) and otalgia (5/27, 18.2%). The mastoid process was the most common involved subsite (31/38, 81.6%) among the 38 lesions. Ten (26.3%, 10/38) lesions belonged to the group of the diffuse involvement, 22 (57.9%, 22/38) were divided into the group of partial involvement and six (15.8%,6/38) localized lesions with punched-out appearance. Erosion of ossicular chains and otic capsule were found in three and seven lesions respectively. CONCLUSION The results indicate that the most common subsite for LCH of the pediatric temporal bone was the mastoid process. The location and extent of pediatric LCH of the temporal bone varied a lot between each other. The ossicular chains usually remain intact and the erosion of otic capsule can occur in some lesions.
Collapse
Affiliation(s)
- Hui Zheng
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Room 203, Building 5, No.1665 Kongjiang Road, Shanghai City, 200092, Yangpu District, China
| | - Zhengrong Xia
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Room 203, Building 5, No.1665 Kongjiang Road, Shanghai City, 200092, Yangpu District, China
| | - Wenjun Cao
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Room 203, Building 5, No.1665 Kongjiang Road, Shanghai City, 200092, Yangpu District, China
| | - Yun Feng
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Room 203, Building 5, No.1665 Kongjiang Road, Shanghai City, 200092, Yangpu District, China
| | - Shuxian Chen
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Room 203, Building 5, No.1665 Kongjiang Road, Shanghai City, 200092, Yangpu District, China
| | - Yu-Hua Li
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Room 203, Building 5, No.1665 Kongjiang Road, Shanghai City, 200092, Yangpu District, China.
| | - Deng-Bin Wang
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Room 203, Building 5, No.1665 Kongjiang Road, Shanghai City, 200092, Yangpu District, China.
| |
Collapse
|
44
|
Elkin VD, Sedova TG, Kopytova EA, Plotnikova EV. Langerhans cell histiocytosis: Skin diseases and visceral lesions. TERAPEVT ARKH 2017; 89:115-120. [DOI: 10.17116/terarkh2017894115-120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a rare clonal proliferative disorder that belongs to class I histiocytoses and is characterized by infiltration of one or many organs by Langerhans cells to form granulomas. The literature analysis could identify a lot of etiological, pathogenetic, and trigger factors and mechanisms for LCH development, which determine the diversity of the clinical picture and course of the disease. The clinical manifestations of LCH are very variable and depend on the severity of lesions and the age of patients. In addition to skin lesions, there is involvement of one or more visceral organs. Difficulties in diagnosing the disease lead to statistical variations of LCH in different countries of the world and require more attention by physicians of all specialties.
Collapse
|
45
|
Abstract
This article reviews the most frequent extra-axial tumors of the central nervous system, from the most common meningioma to some uncommon conditions, like Rosai-Dorfman disease, focusing on imaging techniques, pearls, and pitfalls as well as a more practical approach.
Collapse
Affiliation(s)
- Marta Drake-Pérez
- Department of Radiology, Marqués de Valdecilla University Hospital/IDIVAL, Avda. Valdecilla n° 25, Santander 39008, Cantabria, Spain.
| | - James G Smirniotopoulos
- MedPix, National Library of Medicine, 8600 Rockville Pike, Bethesda, MD 20894, USA; Department of Radiology, George Washington University, 2121 Eye Street Northwest, Washington, DC 20052, USA
| |
Collapse
|
46
|
Thomas VA, Patel B. Teenager With Scalp Mass. Ann Emerg Med 2017; 69:e21-e22. [PMID: 28231999 DOI: 10.1016/j.annemergmed.2016.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Vanessa A Thomas
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, TX
| | - Binita Patel
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, TX
| |
Collapse
|
47
|
Byrne TN, Stone JH, Pillai SS, Rapalino O, Deshpande V. Case Records of the Massachusetts General Hospital. Case 31-2016. A 53-Year-Old Man with Diplopia, Polydipsia, and Polyuria. N Engl J Med 2016; 375:1469-1480. [PMID: 27732818 DOI: 10.1056/nejmcpc1610097] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Thomas N Byrne
- From the Departments of Neurology (T.N.B.), Rheumatology (J.H.S.), Radiology (O.R.), and Pathology (V.D.), Massachusetts General Hospital, and the Departments of Neurology (T.N.B.), Rheumatology (J.H.S.), Radiology (O.R.), and Pathology (V.D.) and the Ragon Institute (S.S.P.), Harvard Medical School - all in Boston
| | - John H Stone
- From the Departments of Neurology (T.N.B.), Rheumatology (J.H.S.), Radiology (O.R.), and Pathology (V.D.), Massachusetts General Hospital, and the Departments of Neurology (T.N.B.), Rheumatology (J.H.S.), Radiology (O.R.), and Pathology (V.D.) and the Ragon Institute (S.S.P.), Harvard Medical School - all in Boston
| | - Shiv S Pillai
- From the Departments of Neurology (T.N.B.), Rheumatology (J.H.S.), Radiology (O.R.), and Pathology (V.D.), Massachusetts General Hospital, and the Departments of Neurology (T.N.B.), Rheumatology (J.H.S.), Radiology (O.R.), and Pathology (V.D.) and the Ragon Institute (S.S.P.), Harvard Medical School - all in Boston
| | - Otto Rapalino
- From the Departments of Neurology (T.N.B.), Rheumatology (J.H.S.), Radiology (O.R.), and Pathology (V.D.), Massachusetts General Hospital, and the Departments of Neurology (T.N.B.), Rheumatology (J.H.S.), Radiology (O.R.), and Pathology (V.D.) and the Ragon Institute (S.S.P.), Harvard Medical School - all in Boston
| | - Vikram Deshpande
- From the Departments of Neurology (T.N.B.), Rheumatology (J.H.S.), Radiology (O.R.), and Pathology (V.D.), Massachusetts General Hospital, and the Departments of Neurology (T.N.B.), Rheumatology (J.H.S.), Radiology (O.R.), and Pathology (V.D.) and the Ragon Institute (S.S.P.), Harvard Medical School - all in Boston
| |
Collapse
|
48
|
Monsereenusorn C, Minkov M, Rodriguez-Galindo C. Current treatment of Langerhans cell histiocytosis. Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2016.1230058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
49
|
Zhu M, Yu BB, Zhai JL, Sun G. Case of Langerhans Cell Histiocytosis That Mimics Meningioma in CT and MRI. J Korean Neurosurg Soc 2016; 59:165-7. [PMID: 26962425 PMCID: PMC4783485 DOI: 10.3340/jkns.2016.59.2.165] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 01/23/2015] [Accepted: 01/26/2015] [Indexed: 11/27/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare disorder histologically characterized by the proliferation of Langerhans cells. Here we present the case of a 13-year-old girl with LCH wherein CT and MRI results led us to an initially incorrect diagnosis of meningioma. The diagnosis was corrected to LCH based on pathology findings. An intracranial mass was found mainly in the dura mater, with thickening of the surrounding dura. It appeared to be growing downward from the calvaria, pressing on underlying brain tissue, and had infiltrated the inner skull, causing a bone defect. The lesion was calcified with the typical dural tail sign. The dural origin of the lesion was verified upon surgical dissection. There are no previous reports in the literature describing LCH of dural origin presenting in young patients with typical dural tail signs and meningioma-like imaging findings. The current case report underscores the need for thorough histological and immunocytochemical examinations in LCH differential diagnosis.
Collapse
Affiliation(s)
- Ming Zhu
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, China
| | - Bing-Bing Yu
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, China
| | - Ji-Liang Zhai
- Department of Radiology, The Branch of Taian Central Hospital, Taian, China
| | - Gang Sun
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, China
| |
Collapse
|
50
|
Teranishi Y, Shin M, Yoshino M, Saito N. Solitary Langerhans cell histiocytosis of the occipital condyle: a case report and review of the literature. Childs Nerv Syst 2016; 32:399-404. [PMID: 26307358 DOI: 10.1007/s00381-015-2850-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 07/19/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Despite the recent advent of various radiographic imaging techniques, it is still very difficult to correctly distinguish a pediatric osteolytic lesion in the occipital condyle, which makes it further complicated to decide on the necessity of and the adequate timing for radical resection and craniocervical fusions. To establish a legitimate therapeutic strategy for this deep-seated lesion, surgical biopsy is a reasonable choice for first-line intervention. The choice of surgical approach becomes very important because a sufficient amount of histological specimen must be obtained to confirm the diagnosis but, ideally, the residual bony structures and the muscular structures should be preserved so as not to increase craniocervical instability. In this report, we present our experience with a case of solitary Langerhans cell histiocytosis (LCH) involving the occipital condyle that was successfully treated with minimally invasive surgical biopsy with a far lateral condylar approach supported by preoperative 3D computer graphic simulation. CASE REPORT An 8-year-old girl presented with neck pain. Magnetic resonance imaging and computed tomography (CT) revealed an osteolytic lesion of the left occipital condyle. At surgery, the patient was placed in the prone position. A 3-cm skin incision was made in the posterior auricular region, and the sternocleidomastoid and splenius capitis muscles were dissected in the middle of the muscle bundle along the direction of the muscle fiber. Under a navigation system, we approached the occipital condyle through the space between the longissimus capitis muscle and the posterior belly of the digastric muscle and lateral to the superior oblique muscle, verifying each muscle at each depth of the surgical field and, finally, obtained sufficient surgical specimen. After the biopsy, her craniocervical instability had not worsened, and chemotherapy was performed. Twelve weeks after chemotherapy, her neck pain had gradually disappeared along with her torticollis, and CT showed remission of the lesion and marked regeneration of the left occipital condyle. Within our knowledge, this is the first reported case of LCH involving the occipital condyle. Although very rare, our case indicated that LCH can be an alternative in the differential diagnosis of osteolytic lesions in the craniocervical junction, in which early bone regeneration with sufficient cervical stability is expected after chemotherapy. CONCLUSIONS In cases of pediatric osteolytic lesions, when they initially presented with apparent cervical instability, craniocervical fusion may possibly become unnecessary after a series of treatments. Thus, the effort to maximally preserve the musculoskeletal structure should be made until its histological diagnosis is finally confirmed.
Collapse
Affiliation(s)
- Yu Teranishi
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-7655, Japan.
| | - Masahiro Shin
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-7655, Japan
| | - Masanori Yoshino
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-7655, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-7655, Japan
| |
Collapse
|