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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.
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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
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Banks SA, Sartori Valinotti JC, Go RS, Abeykoon JP, Goyal G, Young JR, Koster MJ, Vassallo R, Ryu JH, Davidge-Pitts CJ, Ravindran A, Bennani NN, Shah MV, Rech KL, Tobin WO. Neurological Manifestations of Histiocytic Disorders. Curr Neurol Neurosci Rep 2023; 23:277-286. [PMID: 37209319 DOI: 10.1007/s11910-023-01272-4] [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] [Accepted: 04/04/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE OF REVIEW Histiocytic disorders, including Erdheim-Chester disease (ECD), Langerhans cell histiocytosis (LCH), and Rosai-Dorfman disease (RDD), are rare neoplasms that may present with a spectrum of neurologic involvement. Diagnostic delay is common due to heterogeneity in presentation and challenging pathology. RECENT FINDINGS Recent advances in the treatment of these diseases targeted towards mutations in the MAP kinase pathway have led to an improved prognosis in these patients with neurologic involvement. It is critical for clinicians to have a high index of suspicion to allow for early targeted treatment and optimize neurologic outcomes. A systematic approach to diagnosis is presented in this article to allow for accurate diagnosis of these rare diseases.
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Affiliation(s)
- Samantha A Banks
- Department of Neurology, Mayo Clinic Rochester, 200 First St SW, Rochester, MN, 55905, USA
| | | | - Ronald S Go
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN, USA
| | | | - Gaurav Goyal
- Division of Hematology-Oncology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jason R Young
- Department of Radiology, Mayo Clinic in Jacksonville, Jacksonville, FL, USA
| | - Matthew J Koster
- Division of Rheumatology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Robert Vassallo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic Rochester, Rochester, MN, USA
| | - Jay H Ryu
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN, USA
| | | | - Aishwarya Ravindran
- Division of Laboratory Medicine-Hematopathology, Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - N Nora Bennani
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Mithun V Shah
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Karen L Rech
- Division of Hematopathology, Mayo Clinic Rochester, Rochester, MN, USA
| | - W Oliver Tobin
- Department of Neurology, Mayo Clinic Rochester, 200 First St SW, Rochester, MN, 55905, USA.
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Claude F, Ubertini G, Szinnai G. Endocrine Disorders in Children with Brain Tumors: At Diagnosis, after Surgery, Radiotherapy and Chemotherapy. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1617. [PMID: 36360345 PMCID: PMC9688119 DOI: 10.3390/children9111617] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 10/28/2023]
Abstract
INTRODUCTION Brain tumors are the second most frequent type of all pediatric malignancies. Depending on their localization, patients with brain tumors may present neurological or ophthalmological symptoms, but also weight anomalies and endocrine disorders ranging from growth hormone deficiency, anomalies of puberty, diabetes insipidus to panhypopituitarism. Immediately at diagnosis, all patients with brain tumors require a complete assessment of the hypothalamic-pituitary function in order to address eventual endocrine disorders. Moreover, children and adolescents undergoing brain surgery must receive peri- and postoperative hydrocortisone stress therapy. Post-operative disorders of water homeostasis are frequent, ranging from transient diabetes insipidus, as well as syndrome of inappropriate antidiuretic hormone secretion to persistent diabetes insipidus. Late endocrine disorders may result from surgery near or within the hypothalamic-pituitary region. Pituitary deficits are frequent after radiotherapy, especially growth hormone deficiency. Thyroid nodules or secondary thyroid cancers may arise years after radiotherapy. Gonadal dysfunction is frequent after chemotherapy especially with alkylating agents. CONCLUSION Early detection and treatment of specific endocrine disorders at diagnosis, perioperatively, and during long-term follow-up result in improved general and metabolic health and quality of life.
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Affiliation(s)
- Fabien Claude
- Department of Pediatric Endocrinology and Diabetology, University Children’s Hospital Basel, University of Basel, 4056 Basel, Switzerland
| | - Graziamaria Ubertini
- Department of Pediatric Endocrinology, Bambino Gesù Children’s Hospital, 00165 Rome, Italy
| | - Gabor Szinnai
- Department of Pediatric Endocrinology and Diabetology, University Children’s Hospital Basel, University of Basel, 4056 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, 4056 Basel, Switzerland
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Yavropoulou MP, Tsoli M, Kaltsas G. Neuroendocrine manifestations of Langerhans cell histiocytosis. HANDBOOK OF CLINICAL NEUROLOGY 2021; 181:127-135. [PMID: 34238452 DOI: 10.1016/b978-0-12-820683-6.00009-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a rare inflammatory myeloid neoplasia that can affect any organ or system in the human body. It is usually diagnosed during childhood but can also affect adults. Recent studies have demonstrated involvement of the hypothalamo-pituitary axis (HPA) in a significant proportion of patients with deficiencies in both anterior and posterior pituitary function that in the majority of cases are permanent and require specific hormone replacement regimes. Central diabetes insipidus is considered the most frequent abnormality of HPA involvement in LCH and can be encountered either as isolated deficiency or along with other pituitary deficiencies. Complete hormonal evaluation of pituitary hormones and long-term follow-up of LCH patients are strongly recommended, especially when pituitary involvement is established.
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Affiliation(s)
- Maria P Yavropoulou
- Endocrinology Unit, First Department of Propaedeutic and Internal Medicine, National and Kapodistrian Universtiy of Athens, Medical School, LAIKO General Hospital of Athens, Athens, Greece; Department of Medical Research, LCH Adult Clinic, Hellenic Air Force and VA General Hospital, Athens, Greece.
| | - Marina Tsoli
- Endocrinology Unit, First Department of Propaedeutic and Internal Medicine, National and Kapodistrian Universtiy of Athens, Medical School, LAIKO General Hospital of Athens, Athens, Greece; Department of Medical Research, LCH Adult Clinic, Hellenic Air Force and VA General Hospital, Athens, Greece
| | - Gregory Kaltsas
- Endocrinology Unit, First Department of Propaedeutic and Internal Medicine, National and Kapodistrian Universtiy of Athens, Medical School, LAIKO General Hospital of Athens, Athens, Greece; Department of Medical Research, LCH Adult Clinic, Hellenic Air Force and VA General Hospital, Athens, Greece
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Rompel O, Buslei R, Hammon M, Dörr HG, Chada M, Nikkhah G, Uder M, Trollmann R. Diffuse Encephalopathy Associated with Isolated Cerebral Langerhans Cell Histiocytosis. Pediatr Neurol 2016; 62:62-5. [PMID: 27426422 DOI: 10.1016/j.pediatrneurol.2016.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Langerhans cell histiocytosis is a rare disease of the monocyte-macrophage system. Abnormalities of the hypothalamic-pituitary region are common in individuals with central nervous system involvement. PATIENT DESCRIPTION This six-year-old boy developed rapidly progressive aggressive behavior, central diabetes insipidus, and repeated complex partial seizures. Magnetic resonance imaging revealed a diffuse leukoencephalopathy-like pattern and numerous infratentorial and supratentorial granulomatous nodules in the brain parenchyma along with infundibular and hypothalamic mass lesions. Stereotactic serial biopsies enabled histopathologic and immunohistochemical diagnosis of Langerhans cell histiocytosis. CONCLUSIONS Similar MRI findings have rarely been described in the literature. These findings represent part of the broad neuroradiological spectrum of Langerhans cell histiocytosis of the nervous system in children.
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Affiliation(s)
- Oliver Rompel
- Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.
| | - Rolf Buslei
- Institute of Neuropathology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Hammon
- Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Helmuth-Günther Dörr
- Department of Pediatrics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Martin Chada
- Department of Pediatrics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Guido Nikkhah
- Department of Neurosurgery, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Uder
- Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Regina Trollmann
- Department of Pediatrics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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Di Iorgi N, Morana G, Maghnie M. Pituitary stalk thickening on MRI: when is the best time to re-scan and how long should we continue re-scanning for? Clin Endocrinol (Oxf) 2015; 83:449-55. [PMID: 25759231 DOI: 10.1111/cen.12769] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 02/20/2015] [Accepted: 03/09/2015] [Indexed: 12/19/2022]
Abstract
Magnetic resonance imaging (MRI) has proved to be an essential tool in the assessment of pituitary stalk lesions including lymphocytic infundibulo-hypophysitis, Langerhans cell histiocytosis (LCH), germ cell tumours, nongerminomatous germ cell tumours, pituicytomas and other tumours, metastases from lymphoma or breast cancer, Wegener's hypophysitis, neurosarcoidosis and inflammatory infiltrations by infectious diseases. The diagnosis of lesions determining pituitary stalk thickness is challenging, and the identification of the underlying condition may require a long-term follow-up. Thus, clinicians should readily recognize that, when the diagnosis of central diabetes insipidus has been established, specific MRI sequences should be used in the assessment of the hypothalamic-pituitary region, and whole-brain evaluation is recommended. For clinical practice, a timely diagnosis is advisable to avoid central nervous system damage, pituitary defects and the risk of dissemination of germ cell tumours or organ involvement by LCH. Proper aetiological diagnosis can be achieved via a series of steps that start with careful observation of several neuroimaging predictors and endocrine dysfunction and then progress to more sophisticated and advanced imaging techniques.
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Affiliation(s)
- Natascia Di Iorgi
- Pediatric Endocrine Unit, Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Giovanni Morana
- Pediatric Neuroradiology Unit, Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Mohamad Maghnie
- Pediatric Endocrine Unit, Istituto Giannina Gaslini, University of Genova, Genova, Italy
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Porto L, Schöning S, Hattingen E, Sörensen J, Jurcoane A, Lehrnbecher T. Central nervous system imaging in childhood Langerhans cell histiocytosis - a reference center analysis. Radiol Oncol 2015; 49:242-9. [PMID: 26401129 PMCID: PMC4577220 DOI: 10.1515/raon-2015-0024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 06/01/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The aim of our study was (1) to describe central nervous system (CNS) manifestations in children with Langerhans cell histiocytosis (LCH) based on images sent to a reference center and meeting minimum requirements and (2) to assess the inter-rater agreement of CNS-MRI results, which represents the overall reproducibility of this investigation. METHODS We retrospectively reviewed brain MRI examinations in children with LCH, for which MRI minimum requirements were met. Abnormalities were rated by two experienced neuroradiologists, and the inter-rater agreement was assessed. RESULTS Out of a total of 94 imaging studies, only 31 MRIs met the minimum criteria, which included T2w, FLAIR, T1w images before/after contrast in at least two different section planes, and thin post contrast sagittal slices T1w through the sella. The most common changes were osseous abnormalities, followed by solid enlargement of the pineal gland, thickened enhancing stalk and signal changes of the dentate nucleus. Whereas inter-rater agreement in assessing most of the CNS lesions was relatively high (κ > 0.61), the application of minimum criteria often did not allow to evaluate the posterior pituitary. CONCLUSIONS The diversity of radiological protocols from different institutions leads to difficulties in the diagnosis of CNS abnormalities in children with LCH. Although the inter-rater agreement between neuroradiologists was high, not all the LCH manifestations could be completely ruled out when using the minimum criteria. Brain MRIs should therefore follow LCH guideline protocols and include T1 pre-gadolinium sagittal images, and be centrally reviewed in order to improve the comparison of clinical trials.
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Affiliation(s)
- Luciana Porto
- Neuroradiology Department, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - Stefan Schöning
- Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - Elke Hattingen
- Neuroradiology Department, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - Jan Sörensen
- Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - Alina Jurcoane
- Neuroradiology Department, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - Thomas Lehrnbecher
- Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
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Gabbay LB, Leite CDC, Andriola RS, Pinho PDC, Lucato LT. Histiocytosis: a review focusing on neuroimaging findings. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:548-58. [PMID: 25054989 DOI: 10.1590/0004-282x20140063] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 04/23/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Histiocytosis is a systemic disease that usually affects the central nervous system. The aim of this study is to discuss the neuroimaging characteristics of Langerhans cell histiocytosis (LCH), the most common of these diseases; and the non-Langerhans cells histiocytosis (NLCH), which includes entities such as hemophagocytic syndrome, Erdheim-Chester and Rosai-Dorfman diseases. METHOD Literature review and illustrative cases with pathologic confirmation. RESULTS In LCH, the most common findings are 1) osseous lesions in the craniofacial bones and/or skull base; 2) intracranial, extra-axial changes; 3) intra-axial parenchymal changes (white and gray matter); 4) atrophy. Among the NLCH, diagnosis usually requires correlation with clinical and laboratory criteria. The spectrum of presentation includes intraparenchymal involvement, meningeal lesions, orbits and paranasal sinus involvement. CONCLUSION It is important the recognition of the most common imaging patterns, in order to include LCH and NLCH in the differential diagnosis, whenever pertinent.
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Affiliation(s)
- Larissa Barcessat Gabbay
- Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Cláudia da Costa Leite
- Departamento de Radiologia, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Ranieli Saraiva Andriola
- Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Paula da Cunha Pinho
- Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
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Kaidar-Person O, Eran A, Haim N, Amsalem Y, Kuten A, Bar-Sela G. Suspected CNS Metastases of Askin's Tumor: Would You Irradiate the Neural Axis? World J Oncol 2012; 3:288-290. [PMID: 29147321 PMCID: PMC5649808 DOI: 10.4021/wjon564w] [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] [Accepted: 09/24/2012] [Indexed: 11/03/2022] Open
Abstract
We present a case of a young-adult patient who was diagnosed with Askin's tumor, with central nervous system lesions suspected as metastases. The patient achieved complete response after chemotherapy, and the question of consolidation radiotherapy to the CNS is discussed.
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Affiliation(s)
| | - Ayelet Eran
- Department of Radiology, Rambam Health Care Campus, Haifa, Israel
| | - Nissim Haim
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel
| | - Yaakov Amsalem
- Department of Radiology, Rambam Health Care Campus, Haifa, Israel
| | - Abraham Kuten
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel
| | - Gil Bar-Sela
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel,Corresponding author: Gil Bar-Sela, Integrated Oncology and Palliative Care Unit, Rambam Health Care Campus, POB 9602, Haifa 31096, Israel.
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Hervey-Jumper SL, Ghori A, Ziewacz JE, McKeever PE, Chandler WF. Langerhans cell histiocytosis of the optic chiasm: case report. Neurosurgery 2011; 68:E556-61. [PMID: 21135729 DOI: 10.1227/neu.0b013e31820206c7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Langerhans cell histiocytosis (LCH) is an uncommon disease, usually affecting the cranium and peripheral bones. We present a rare case of isolated optic chiasm involvement by LCH to highlight the importance of considering LCH in the differential diagnosis of optic chiasm lesions. CLINICAL PRESENTATION A 71-year-old woman presented with a 6-week history of worsening peripheral vision, headaches, weakness, cold sensitivity, and fatigue. She was found to have dense bitemporal hemianopsia. Magnetic resonance imaging revealed a 2-cm lesion, contrast enhancing on T1 and bright on T2 signal, involving the optic chiasm but not the pituitary gland. Preoperative considerations included optic nerve glioma, choristoma of the stalk, sarcoid, hypothalamic glioma, and Langerhans cell histiocytosis. The patient underwent a right subfrontal craniotomy for biopsy of the lesion. The optic chiasm was grossly enlarged with no tissue external to the chiasm. A midline incision was made in the lamina terminalis, and multiple biopsies were taken of firm fibrous material. Histologically, the tumor was characteristic for LCH and included a mixture of histiocytes with features of Langerhans cells, eosinophils, small lymphocytes, macrophages, neutrophils, and plasma cells. CONCLUSION LCH is a rare disease, generally affecting bone, skin, lymph nodes, and in more severe cases, visceral organs. LCH involving the optic pathways is a rare condition that should be included in the differential for adults with mass lesions involving the orbit, eye, optic nerve, or chiasm. Future clinical and basic science research is needed to better understand LCH, its molecular origin, and its growth pattern.
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Affiliation(s)
- Shawn L Hervey-Jumper
- Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA
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Grois N, Fahrner B, Arceci RJ, Henter JI, McClain K, Lassmann H, Nanduri V, Prosch H, Prayer D. Central nervous system disease in Langerhans cell histiocytosis. J Pediatr 2010; 156:873-881.e1. [PMID: 20434166 DOI: 10.1016/j.jpeds.2010.03.001] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Revised: 01/11/2010] [Accepted: 03/02/2010] [Indexed: 10/19/2022]
Affiliation(s)
- Nicole Grois
- St. Anna Children`s Cancer Research Institute, Vienna, Austria
| | | | - Robert J Arceci
- Sydney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MA
| | - Jan-Inge Henter
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Kenneth McClain
- Texas Children's Cancer Center and Hematology Service, Houston, TX
| | - Hans Lassmann
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Vasanta Nanduri
- Watford General Hospital, Watford Hertfordshire, United Kingdom
| | - Helmut Prosch
- Otto Wagner Spital, Department of Radiology, Vienna, Austria
| | - Daniela Prayer
- Department of Neuroradiology; Medical University of Vienna, Vienna, Austria
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Demaerel P, Van Gool S. Paediatric neuroradiological aspects of Langerhans cell histiocytosis. Neuroradiology 2007; 50:85-92. [PMID: 17985124 DOI: 10.1007/s00234-007-0323-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Accepted: 09/19/2007] [Indexed: 12/11/2022]
Abstract
Langerhans cell histiocytosis, previously known as histiocytosis X, is a complex disease consisting of three entities that are all characterized by a proliferation of the Langerhans cell. The clinical course is variable and ranges from a solitary lytic bone or skin lesion with complete remission to a multisystem disorder with possible lethal outcome. The clinical suspicion can be increased based on radiological findings that are important criteria in defining the extent of the disease involvement. A biopsy is often necessary for establishing the final diagnosis. The lytic craniofacial bone lesions are the most common craniospinal abnormality in Langerhans cell histiocytosis. Abnormalities in the hypothalamic-pituitary region are the most frequent manifestations, often accompanied with diabetes insipidus as the presenting symptom. A range of different central nervous system abnormalities can be recognized. It is important to be able to recognize the extensive spectrum of neuroradiological abnormalities in order to arrive at the diagnosis. Neuroimaging plays an even more important role in assessing the response to treatment or possible relapse.
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Affiliation(s)
- Philippe Demaerel
- Department of Radiology , University Hospital K.U.Leuven, Herestraat 49, 3000, Leuven, Belgium.
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