Diagnosis of Langerhans Cell Histiocytosis on Fine Needle Aspiration Cytology: A Case Report and Review of the Cytology Literature

Kumar, Neeta; Sayed, Shahin; Vinayak, Sudhir

doi:10.4061/2011/439518

Cited by 30 publications

(57 citation statements)

References 28 publications

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“…These three conditions are believed to represent different expressions of the same disorder, now known as LCH. [1]…”

Section: Discussionmentioning

confidence: 99%

“…The proliferation may be induced by a viral infection, a defect in T-cell macrophage interaction and/or a cytokine driven process mediated by tumor necrosis factor, interleukin 11 and leukemia inhibitory factor 1. [1]…”

Section: Discussionmentioning

confidence: 99%

“…The course of the disease varies, from spontaneous resolution to a progressive multisystem disorder with organ dysfunction and potential life threatening complications. [12] We present a case of LCH in a child where fine needle aspiration cytology (FNAC) was helpful in establishing a rapid and correct diagnosis in correlation with radiology. The purpose is to highlight common and characteristic cytological features.…”

Section: Introductionmentioning

confidence: 99%

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Cytological diagnosis of Langerhans cell histiocytosis with cutaneous involvement

Chandekar

Shah

Kavishwar

2013

J Cytol

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Langerhans cell histiocytosis (LCH) is a rare disease affecting predominantly children. The course of the disease varies, from spontaneous resolution to a progressive multisystem disorder with organ dysfunction and potential life-threatening complications. Diagnosis of LCH is often difficult and may be delayed because of its rarity and especially so if it occurs with unusual presentation. Fine needle aspiration cytology of a 4 year old male child, a case of LCH is presented with a purpose of highlighting the characteristic cytological features. A high index of suspicion, awareness of characteristic cytological features of LCH and its differential diagnoses is necessary. This can obviate the need of biopsy and electron microscopy. Immunohistochemistry if available can be performed on cytology smear and cell block.

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“…These three conditions are believed to represent different expressions of the same disorder, now known as LCH. [1]…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cytological diagnosis of Langerhans cell histiocytosis with cutaneous involvement

Chandekar

Shah

Kavishwar

2013

J Cytol

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“…1 However, a recent case report by Kumar et al suggests that fine-needle aspiration cytology may also be effective in diagnosing LCH, alleviating the need for an invasive biopsy. 8 Lung involvement in LCH has a variable appearance on chest CT scans, ranging from small peribronchiolar nodular opacities to multiple irregularly-shaped cysts. 1 In the current case, the CT findings were pathognomonic, showing cysts of variable size in both lungs.…”

Section: Discussionmentioning

confidence: 99%

Delayed Treatment Response in a Neonate with Multisystem Langerhans Cell Histiocytosis: Case report and review of literature

Singh

Mandal

Singh

et al. 2017

SQUMJ

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Langerhans cell histiocytosis (LCH) is a rare proliferative disorder of the Langerhans cells, which are part of the mononuclear phagocytic system. The disorder varies in terms of the extent of the disease, its natural course and patient outcomes. While skin rashes are a common presentation of neonatal LCH, other systems or organs may also be involved. Delays in the diagnosis of neonatal LCH may occur due to its non-specific presentation and a lack of awareness of the condition among doctors. We report a two-month-old male neonate who presented to the Chacha Nehru Bal Chikitsalya hospital, New Delhi, India, in 2016 after the onset of pulmonary symptoms. He had been noted to have a generalised rash which had progressively worsened from 15 days of age. Following a skin biopsy and chest imaging, he was diagnosed with multisystem LCH with risk organ involvement. There was a delayed response to combined chemotherapy with no major side-effects.

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“…Akhtar et al have reported that the degree of eosinophilic infiltrate in cytology specimens varies from scant to abundant in different areas of LCH lesions and also in different organs. However, presence of eosinophils or Charcot-Leyden crystals is a subtle feature that should alert the pathologist to include LCH in the differential diagnosis [26,27]. Onsite adequacy assessment with procurement of extra material for ancillary studies is helpful in clinching the diagnosis of this rare entity in thyroid FNA specimens.…”

Section: Fine Needle Aspiration and Biopsymentioning

confidence: 99%

Langerhans Cell Histiocytosis: Diagnosis on Thyroid Aspirate and Review of the Literature

Saqi

Ebner

Ausiello

et al. 2015

Head and Neck Pathol

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Thyroid gland involvement by Langerhans cell histiocytosis is extremely rare. A 35-year-old woman with a history of a suprasellar mass previously diagnosed as a ganglioglioma and complicated by diabetes insipidus, hypogonadotropic hypogonadism, and central hypothyroidism presented with acute onset of neck enlargement. On ultrasound examination, almost the entire thyroid appeared replaced by abnormal lobulated hypoechoic tissue with increased vascularity. Fine needle aspiration (FNA) of the thyroid was performed and revealed singly scattered and loosely cohesive large cells with abundant cytoplasm, including some with irregular nuclear contours and nuclear grooves. No thyroid follicular cells were noted. Based on the cytomorphologic findings and ancillary studies (immunohistochemistry and flow cytometry analysis) a cytological diagnosis of ''positive for neoplastic cells'' with features suggestive of monocytic/histiocytic origin, possibly Langerhans cell histiocytosis (LCH) was rendered. Following FNA, the patient underwent an incisional thyroid biopsy that confirmed the cytological impression of LCH. In light of the new diagnosis of LCH, the prior suprasellar mass biopsy slides were re-reviewed and rare cells suspicious for LCH were observed.Appropriate treatment for systemic LCH was initiated successfully. This case demonstrates that the presence of enlarged and loosely cohesive cells, especially those with irregular nuclear contours, in thyroid FNA specimens should raise suspicion for LCH. The diagnosis of LCH in FNA specimens is challenging. Additional material should be allocated for ancillary studies to confirm the morphological impression. In our case, not only was the thyroid FNA crucial in diagnosing LCH, but instrumental in initiating a thorough diagnostic work-up for multisystem involvement and thus unmasking the true etiology of the patient's suprasellar mass and associated endocrinopathies.Keywords Thyroid Á Langerhans cell histiocytosis Á Fine needle aspiration Á Cytology Á Cytopathology Clinical PresentationA 35-year-old woman with a history of a suprasellar mass, previously diagnosed as a ganglioglioma and complicated by diabetes insipidus (DI), hypogonadotropic hypogonadism, and central hypothyroidism, presented with acute onset of neck enlargement. On physical exam, she appeared euthyroid, and a bilaterally enlarged soft, nontender thyroid of about 60 g was palpated. Radiographic FeaturesOn thyroid ultrasound, the right lobe measured 7.3 9 2.9 9 3.4 cm, and the left lobe measured 5.8 9 2.3 9 2.5 cm; replacement of almost the entire thyroid with abnormal lobulated hypoechoic tissue with increased vascularity was identified (Fig. 1a, b). The rate of growth and the ultrasound

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Diagnosis of Langerhans Cell Histiocytosis on Fine Needle Aspiration Cytology: A Case Report and Review of the Cytology Literature

Cited by 30 publications

References 28 publications

Cytological diagnosis of Langerhans cell histiocytosis with cutaneous involvement

Cytological diagnosis of Langerhans cell histiocytosis with cutaneous involvement

Delayed Treatment Response in a Neonate with Multisystem Langerhans Cell Histiocytosis: Case report and review of literature

Langerhans Cell Histiocytosis: Diagnosis on Thyroid Aspirate and Review of the Literature

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