Severe periodontal disease manifested in chronic disseminated type of langerhans cell histiocytosis in a 3-year old child

Manifestation of Langerhans cell histiocytosis in the oral cavity: The authors’ experience

Background. Langerhans cell histiocytosis is a rare reactive proliferative disorder marked by excess proliferation and accumulation of mononuclear phagocytes in tissues and organs. Usually, organs and systems where Langerhans cells are normally found are involved. Lesions may be limited to one system and be single- or multisite, or many systems may be involved. The etiology is not fully known. According to one of the hypotheses, immune dysfunction due to exuberant response to an unknown antigen may be the cause. The most common clinical symptoms include skin lesions, bone pain, exophthalmos, and enlarged lymph nodes, affecting the liver and spleen. Gingivitis, pocket granulation tissue, ulceration of the gingival papilla, alveolar bone atrophy leading to loosening and loss of teeth are observed in the oral cavity. The aim of the study was to determine the type and incidence of oral manifestations in patients diagnosed with Langerhans cell histiocytosis.

Methods. We evaluated patients’ medical records to obtain data on the children’s age at diagnosis, sex, the form of Langerhans cell histiocytosis, clinical picture (systemic and local oral symptoms), and radiological findings. Dental examinations (clinical and radiological) were performed to assess oral mucosa and periodontal tissues, and medical records were analyzed for the course and treatment of histiocytosis.

Results. The analysis included the medical records of 43 patients with Langerhans cell histiocytosis. Oral lesions in the form of gingivitis, pathological tooth mobility, and expansion of alveolar mandibular bone were observed in 7 patients. Conclusions. Langerhans cell histiocytosis may be accompanied by maxillary, gingival, and mucosal lesions.

Primary oral manifestation of Langerhans cell histiocytosis refractory to conventional therapy but susceptible to BRAF-specific treatment: a case report and review of the literature

Langerhans cell histiocytosis (LCH) is a diagnostic and therapeutic challenge. We report on a rare case of its primary oral manifestation that was treated successfully with the BRAF-specific agent, vemurafenib, after insufficient standard LCH treatment. This case underlines the importance of proper diagnosis and the evaluation of targeted therapy as a valuable tool in LCH treatment. Furthermore, the close collaboration of surgeons, oncologists, and dentists is mandatory to ensure adequate treatment, restore the stomatognathic system in debilitating post-treatment situations, improve quality of life, and ensure effective disease control in infants and young patients.

Langerhans cell histiocytosis: An enigmatic disease

Background:

Langerhans cell histiocytosis (LCH) is a poorly understood disease with heterogeneous clinical presentation ranging from unifocal bony involvement to disseminated disease with life-threatening complications.

Materials and Methods:

The clinical profile, laboratory findings, treatment, and long-term outcome were retrieved from maintained medical records from January 2006 to January 2016 and were retrospectively analyzed. The extent of the disease was classified as per the LCH-III trial of “The Histiocyte Society.” The assessment and categorization of treatment response followed LCH III trial definitions.

Results:

A total of 28 children with LCH were diagnosed. The age ranged between 5 months and 9 years, with a mean of 3½ years. The M: F ratio was 3:1. Single system, unifocal and multifocal bone diseases were seen in nine (32.1%) and two (7.1%) cases, respectively. Disseminated disease without risk organ involvement was seen in six (21.1%), whereas disseminated disease with risk organ involvement was seen in 11 (39.3%) cases. The most common presentation was bony involvement (19 [67.8%]), out of which 16 (88.8%) had skull involvement. During follow-up, 17 (60.7%) were in complete remission though five (17.8%) of them relapsed, but achieved second remission. Two (7.1%) were lost to follow-up. Six (21.4%) had progressive disease of which four expired and two abandoned treatment. Two (10.7%) refused the initiation of treatment.

Conclusion:

A better understanding of the disease, early suspicion, and diagnosis can improve the outcome of patients with LCH.

Langerhans cell histiocytosis in children: History, classification, pathobiology, clinical manifestations, and prognosis

Langerhans cell histiocytosis (LCH) is an inflammatory neoplasia of myeloid precursor cells driven by mutations in the mitogen-activated protein kinase pathway. When disease involves the skin, LCH most commonly presents as a seborrheic dermatitis or eczematous eruption on the scalp and trunk. Evaluation for involvement of other organ systems is essential, because 9 of 10 patients presenting with cutaneous disease also have multisystem involvement. Clinical manifestations range from isolated disease with spontaneous resolution to life-threatening multisystem disease. Prognosis depends on involvement of risk organs (liver, spleen, and bone marrow) at diagnosis, particularly on presence of organ dysfunction, and response to initial therapy. Systemic treatment incorporating steroids and cytostatic drugs for at least one year has improved prognosis of multisystem LCH and represents the current standard of care.