An Elderly Smoker Presenting With Pulmonary Langerhans Cell Histiocytosis: An Unusual Demographic

Abstract

Pulmonary Langerhans cell histiocytosis (PLCH) is a rare neoplastic condition that occurs almost exclusively in young smokers and presents with multiple solid and/or cystic nodules in a primarily upper lobe distribution on chest imaging. Frequently, suspicion arises incidentally on imaging performed for alternative reasons, such as lung cancer screening, but diagnosis requires biopsy studies. We describe an uncommon case of PLCH in an elderly female patient presenting with mild dyspnea and a significant history of smoking. Diagnosis was made with a biopsy of a new pulmonary nodule in her left lung found on lung cancer screening computed tomography (CT) scan. No gold standard therapy exists, and novel agents are being studied for future use. At present, she has been advised to quit smoking and is being followed with serial imaging studies to determine additional measures.

Pulmonary Langerhans Cell Histiocytosis: An Unusual Differential for a Solitary Lung Nodule

“…Pulmonary LCH presenting as an isolated lung nodule is extremely rare, with only a handful of cases published in the literature [3][4][5][6][7][8]. In a patient with a substantial smoking history with a lung nodule, malignancy is the primary differential warranting a biopsy, as was done in our patient.…”

“…The role of PET scans may be limited in differentiating LCH nodules from malignant lung nodules, as often both might be metabolically active, especially in the early diffuse nodular stage of pulmonary LCH [1]. In rare cases, PET scans can be negative in both malignancy and LCH, and a biopsy is often needed to confirm the diagnosis [6]. Additionally, PET scan can also help to identify easier access sites for biopsy; however, in our patient, after discussing with the patient the pros and cons of biopsy, and per patient preference, the decision was taken to pursue biopsy prior to performing PET scan.…”