Congenital systemic Langerhans cell histiocytosis presenting as hydrops fetalis

The changing landscape of pediatric histiocytoses: Birth, life, and transdifferentiation of pediatric histiocytes

Histiocytic neoplasms in the children are very rare, and histiocytoses can occur in the perinatal period. The presumed origins and presentation of specific histiocytoses in the pediatric age group are described. Common and newly described histiocytoses are presented including Langerhans cell histiocytosis, Rosai-Dorfman disease, histiocytic sarcoma, ALK positive histiocytosis, and hemophagocytic lymphohistiocytosis. Molecular findings common to pediatric histiocytoses are also discussed.

Langerhans cell histiocytosis: A rare aetiology for fetal pleural effusion

OBJECTIVE

We present fetal pleural effusions associated with Langerhans cell histiocytosis (LCH).

CASE REPORT

We report a case of fetal pleural effusion in late pregnancy. Due to developing rapidly over short period of time, the baby was delivered by caesarean section at 34 weeks gestation. Generalised oedema, sparse haemorrhagic papules, pulmonary involvement, mediastinal mass and liver dysfunction were identified postnatally. Structural malformations, maternal-fetal blood type incompatibility, chromosomal abnormalities and viral infection were excluded. Mediastinal mass biopsy and immunohistochemical examinations confirmed the diagnosis of Langerhans cell histiocytosis (LCH). The baby is currently in a stable condition and undergoing regular chemotherapy.

CONCLUSIONS

Congenital LCH is a rare aetiology of fetal pleural effusions.

Langerhans cell histiocytosis: Presentation in a preterm neonate

Background

Langerhans cell histiocytosis (LCH) is a rare disorder in which Langerhans cells (LC) accumulate in the skin or other organs and cause tumor formation or organ damage. Cutaneous lesions can vary widely and do not predict extent of systemic disease or prognosis.

Case

We present a premature infant with skin findings, multisystem involvement, and immunohistochemical markers consistent with multisystem LCH.

Conclusion

Limited data from preterm neonates with LCH suggest that prognosis is particularly poor, with even limited cutaneous disease often rapidly progressing to become fatal, although diagnosis is not always prompt. Early diagnosis and treatment may affect prognosis.

Case report of Langerhans cell histiocytosis in a fetus detected by magnetic resonance imaging

Langerhans cell histiocytosis (LCH) is a rare disease, and the diagnosis of LCH is mainly based on clinical manifestation, imaging and pathological examinations. But during pregnancy, imaging examinations especially play an important role in the diagnosis and prognostic assessment of fetal LCH. Up to now, there has been no report about magnetic resonance imaging (MRI) features of fetal LCH. We reported a 32-year-old woman at 36 weeks' gestation took fetal MRI because of fetal anomalies diagnosed by ultrasonography. On the fetus's MR images, the thymus was slightly enlarged with smooth or lobulated contour in supra anterior mediastinum, displayed heterogeneous signals and contained multiple small cysts on T2WI. Innumerable irregular nodules and patchy shadows were present throughout both lungs. Pulmonary lesions were bilateral and diffuse with relative sparing of the costophrenic angles. The margins of these lesions were fluffy and indistinct. These lesions showed heterogeneous signals on T2WI. MRI showed no lesions in skin region. After birth, lots of round or oval skin lesions distributed all over the baby's body presenting as ulcerated or blister-like rashes. The chest computer tomography (CT) showed punctate calcification and heterogeneous enhancement in the thymus and bilateral diffuse reticular or reticulonodular opacities in both lungs with fluffy and indistinct margins. Pathological finding was consistent with LCH. Through reporting MRI features of LCH in one fetus, this study aims to improve awareness of fetal LCH in radiologists and clinicians, to improve the prenatal diagnostic rate of this disorder.

A Fatal Case of Congenital Langerhans Cell Histiocytosis with Disseminated Cutaneous Lesions in a Premature Neonate

Background. The outcome of neonates with congenital cutaneous Langerhans cell histiocytosis (LCH) is variable. Observations. We report a case of LCH in a female premature neonate born at 33-week gestation. She had disseminated cutaneous lesions, which consisted of hemorrhagic papules and vesicles, with sparse healthy skin areas, and the hands and feet were contracted with scarring and blackened. She was in respiratory failure although no apparent pulmonary or bone lesions on X-rays were noted. Skin biopsy confirmed a diagnosis of LCH due to observation of CD1a⁺ Langerhans cells, which lacked expression of E-cadherin and CD56. The patient died 57 hours after birth. Conclusions. Based on this case and the literature survey, the outcome of premature babies with congenital cutaneous LCH lesions is noted to be unfavorable, with the majority of such cases suffering from multisystem disease.

Disseminated langerhans cell histiocytosis presenting as cholestatic jaundice

Langerhans cell histiocytosis (LCH) is a disorder associated with proliferation of Langerhans cells in various organs. LCH secondary to multisystem involvement can present in a variety of ways. Because of its infiltrative nature, LCH can involve the skin, lymph nodes, the lung or the liver. Jaundice in LCH is a manifestation of liver disease; biliary dilatation secondary to lithiasis or may be due to coexistent Niemann-Pick disease. However, a case of cholestasis has been very rarely described. Cholestasis may result from lymph nodes obstructing the porta hepatis. In this report, we describe a case of type II histiocytosis X with obstructive cholestasis and pulmonary involvement in the form of cysts without significant lymphadenopathy at the porta.

Congenital langerhans cell histiocytosis with placental involvement

Congenital presentations of Langerhans cell histiocytosis (LCH) are exceedingly rare, and concurrent placental parenchymal involvement has not been definitively documented in the literature. We present 2 cases of congenital multisystem LCH with placental involvement resembling chronic villitis. Placental examination may provide the initial diagnostic evidence of LCH and may significantly influence patient management and outcome; however, the prognostic implications remain unclear. In a clinical context suspicious for congenital LCH, the observation of chronic villitis should prompt consideration of placental involvement by LCH.