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Cheng YF, Wang CC, Tsai PS, Lin DC, Huang WH. Langerhans cell histiocytosis of the thyroid mimicking thyroiditis in a boy: a case report and literature review. BMC Pediatr 2024; 24:66. [PMID: 38245681 PMCID: PMC10799516 DOI: 10.1186/s12887-023-04494-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/19/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Langerhans cell histiocytosis affecting the thyroid commonly presents with nonspecific clinical and radiological manifestations. Thyroid Langerhans cell histiocytosis is typically characterized by non-enhancing hypodense lesions with an enlarged thyroid on computed tomography medical images. Thyroid involvement in LCH is uncommon and typically encountered in adults, as is salivary gland involvement. Therefore, we present a unique pediatric case featuring simultaneous salivary and thyroid involvement in LCH. CASE PRESENTATION A 3-year-old boy with complaints of an anterior neck mass persisting for 1 to 2 months, accompanied by mild pain, dysphagia, and hoarseness. A physical examination revealed a 2.5 cm firm and tender mass in the left anterior neck. Laboratory examinations revealed normal thyroid function test levels. Ultrasonography revealed multiple heterogeneous hypoechoic nodules with unclear and irregular margins in both lobes of the thyroid. Contrast-enhanced neck computed tomography revealed an enlarged thyroid gland and bilateral submandibular glands with non-enhancing hypointense nodular lesions, and multiple confluent thin-walled small (< 1.5 cm) cysts scattered bilaterally in the lungs. Subsequently, a left thyroid excisional biopsy was performed, leading to a histopathological diagnosis of LCH. Immunohistochemical analysis of the specimen demonstrated diffuse positivity for S-100, CD1a, and Langerin and focal positivity for CD68. The patient received standard therapy with vinblastine and steroid, and showed disease regression during regular follow-up of neck ultrasonography. CONCLUSIONS Involvement of the thyroid and submandibular gland as initial diagnosis of Langerhans cell histiocytosis is extremely rare. It is important to investigate the involvement of affected systems. A comprehensive survey and biopsy are required to establish a definitive diagnosis.
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Affiliation(s)
- Yu Fan Cheng
- Department of Radiology, MacKay Memorial Hospital, Taipei City, 104, Taiwan
| | - Ching Che Wang
- Department of Radiology, MacKay Memorial Hospital, Taipei City, 104, Taiwan.
| | - Pei Shan Tsai
- Department of Radiology, MacKay Memorial Hospital, Taipei City, 104, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, 252, Taiwan
- Nursing and Management, Mackay Junior College of Medicine, New Taipei City, 112, Taiwan
| | - Dao Chen Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei City, Taiwan
- Division of Endocrine and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei City, 112, Taiwan
| | - Wen Hui Huang
- Department of Radiology, MacKay Memorial Hospital, Taipei City, 104, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, 252, Taiwan
- Nursing and Management, Mackay Junior College of Medicine, New Taipei City, 112, Taiwan
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei City, 112, Taiwan
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