Age / Sex : 3 / F

Age/Sex : F/3

Langerhan's cell histiocytosis

Discussion

Findings:

On C spine lateral image, Osteolysis at C2 body, widening of C2-3 disc space and retrolisthesis at C2 on C3, are noted with prevertebral soft tissue density.

On MRI, The C2 body shows T1 low and T2 high signal intensity with enhancement. Near vertebra plana state of C2 body is noted. Enhancing soft tissue mass is seen at prevertebral space and anterior epidural space of C2. There are abnormal signal intensity of bone marrow at clivus and T5 vertebral body with collapse.

Differential Diagnosis:

 Leukemia, lymphoma, Neuroblastoma

Diagnosis: Langerhans’  histiocytosis in C spine

Discussion:

l  Lesions of the spine in children in whom vertebra plana develops are regarded by many as pathognomonic of histiocytosis X until proven otherwise, especially if the following radiologic features for a solitary lesion are fulfilled:

1. Only one vertebra is involved.

2. Adjacent discs of the involved vertebra are intact.

3. Disc space is about a third wider than the next space above and below.

4. Homogeneous density of the collapsed vertebral body is observed.

l  MR :

1.     T1 low and T2 high signal intensity of lesion with edema at adjacent bone marrow and soft tissue

2.     Posterior element and pedicle involvement

3.     Epidural, paravertebral mass,

4.     clear demonstration of preservation of disc space, a finding that helps differentiate the lesion from infection

References:

 Eesiophilic granuloma of the cervical spine. Spine 2002;27(13):1408-1413