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Age / Sex : 27 / M
Age/Sex: 27/M
C.C.: Left radiating pain for 2 months
1) What is your impression?
Courtesy : Tae Yong Moon, M.D., Pusan National University Hospital
Diagnosis: LCH
Discussion
Findings:
Fig.1 : Pelvis radiography shows large osteolytic endosteal defects in the left iliac bone. Lung CT reveals irregular consolidation and focal cavitary lesion in the right lung
Fig. 2 : Left iliac CT shows multifocal osteolytic lesions
Fig. 3 : Left iliac MR shows multifocal inhomogenous enhancing high signal lesions with relatively well defined border. Spine MR with sagittal T1 image reveals no remarkable abnormal fndings.
Differential Diagnosis:
• Radiological impression of Lumbar and hip MR before excisional biopsy ; hematologic disorder such as leukemia, lymphoma, multiple myeloma • Radiological impression of lung CT before biopsy ; active cavitary pulmonary tuberculosis
Diagnosis: - Langerhans’ cell histiocytosis (LCH) by excisional iliac bone biopsy - Langerhans’ cell histiocytosis (LCH) by lung biopsy
Discussion:
LCH of bone is a disorder of histiocytic proliferation with variable and often unpredictable behavior. • Ranged from 3 months to 50 years old (mean, 12 years; median, 10 years) in 245 patients by Mayo Clinic. • The skull was the most frequent osseous site. • Diabetes insipidus was documented in 12% of the patients.
References:
1. Kilpatrick SE, Wenger DE, et al. Langerhans’ cell histiocytosis (histiocytosis X) of bone. A clinicopathologic analysis of 263 pediatric and adult cases. Cancer 1995; 76:2471-84
2. Baillet A, Grange L, Lafaix PA, Gaudin P, Juvin R. Radiculopathy as a manifestation of Langerhans’ cell histiocytosis. Joint Bone Spine 2007; 74: 190-3
3. Hamre M, Hedberg J, Buckley J, et al. Langerhans cell histiocytosis: an exploratory epidemiologic study of 177 cases. Med Pediatr Oncol 1997; 28: 92-7
4. Dacic S, Trusky C, Bakker A, et al. Genotypic analysis of pulmonary Langerhans cell histiocytosis. Hum Pathol 2003; 34: 1345-9
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