Fine‐needle aspiration biopsy of langerhans histiocytosis (histiocytosis‐x)

Akhtar, Mohammed; Ali, Muhammad; Bakry, Mohammed; Sackey, Kwesi; Sabbah, Rajeh

doi:10.1002/dc.2840090511

Cited by 32 publications

(28 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Regardless of anatomic site, aspirates of any of the 3 forms of LCH are characterized by a predominance of LCs in a background of blood, and variable numbers of eosinophils, neutrophils, multinucleated giant cells, macrophages, and capillary fragments [28,29,30,31,32,33]. While LCs sometimes form loose cell groups surrounding transgressing blood vessels, they are most often present as isolated cells as seen in the 3 aspirates that we describe.…”

Section: Discussionmentioning

confidence: 99%

Fine-Needle Aspiration of Primary Langerhans Cell Histiocytosis of the Thyroid Gland, a Potential Mimic of Papillary Thyroid Carcinoma

et al. 2013

View full text Add to dashboard Cite

Background: The clinical presentation of Langerhans cell histiocytosis (LCH) as a primary solitary nodule in the thyroid gland is rare. As a result, there are few reports of its cytologic features in thyroid aspirates where it can pose a diagnostic pitfall. Case and Conclusion: To foster familiarity with its cytomorphology, we report the fine-needle aspiration biopsy (FNAB) findings of 3 specimens from 2 patients with LCH presenting as a solitary thyroid nodule. All aspirates contained numerous dispersed cells with prominent nuclear grooves, and the background showed a mixed pattern of chronic inflammation including scattered eosinophils. The aspirate from patient 1 raised a differential diagnosis that included chronic lymphocytic thyroiditis and a thyroglossal duct cyst, while the aspirate from patient 2 was interpreted as ‘suspicious for papillary thyroid carcinoma'. The diagnosis of LCH was confirmed in both patients after lobectomy and immunohistochemical studies that revealed positive reactivity for CD1a and S-100. LCH of the thyroid gland is rare and can pose significant diagnostic challenges, but increased familiarity with its characteristic cytomorphology can help in avoiding diagnostic pitfalls.

show abstract

Section: Discussionmentioning

confidence: 99%

Fine-Needle Aspiration of Primary Langerhans Cell Histiocytosis of the Thyroid Gland, a Potential Mimic of Papillary Thyroid Carcinoma

et al. 2013

View full text Add to dashboard Cite

show abstract

“…In the early phase, the lesions are characterised by a markedly cellular aspirate with large numbers of LCs (LC predominant pattern) or eosinophils (eosinophil predominant pattern) [20]. The later phase includes a relatively increased number of secondary cells, notably macrophages with a foamy cytoplasm (macrophage predominant pattern), and giant cells are also seen [20].…”

Section: Discussionmentioning

confidence: 99%

“…There is a transient decrease in the number of LCs. With further progression of the lesions, fibrosis increases with a decrease in the cellular component [20]. This stage resembles chronic non-specific inflammation with fibrosis where a specific diagnosis becomes highly challenging.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Cytological Diagnostic Approach in 3 Cases of Langerhans Cell Histiocytosis Presenting Primarily as a Thyroid Mass

Oza

Sanghvi²,

Menon³

et al. 2015

Acta Cytologica

View full text Add to dashboard Cite

Background: Langerhans cell histiocytosis (LCH) is a monoclonal disease of specialised histiocytes characterised by the proliferation of neoplastic Langerhans cells (LCs) with a varying admixture of mature lymphocytes, eosinophils and plasma cells. LCH commonly occurs in the paediatric population and young adults with the involvement of bone, skin and lymph nodes. LCH has a protracted clinical course with an overall mortality rate of 3%. Primary involvement of the thyroid gland in LCH at presentation is a rare phenomenon that can result in misdiagnosis with consequent mismanagement. Case: Ultrasound-guided fine-needle aspiration cytology (FNAC) of the thyroid was performed in 3 cases at a tertiary cancer centre, including 2 referral cases where the patient presented with the only symptom of progressive thyroid enlargement. These cases were reported initially or on review and the results were correlated with histology/ancillary techniques. A cytological diagnosis of suspicion for LCH was offered in 2 cases at our centre and 1 case was referred to our centre with a diagnosis of suspected papillary thyroid carcinoma. On review of outside smears at our centre, the diagnosis was changed to suspected LCH. The diagnosis was confirmed by immunopositivity for CD68, CD1a and S100 in 1 case and Tru-cut biopsy followed by immunohistochemistry for CD1a, S100, TTF-1 and LCA in the other 2 cases. Conclusion: FNAC was helpful in accurately diagnosing LCH even though the presentation was unusual. Thus, unnecessary surgery was obviated.

show abstract

“…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

View full text Add to dashboard Cite

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

show abstract

Fine‐needle aspiration biopsy of langerhans histiocytosis (histiocytosis‐x)

Cited by 32 publications

References 18 publications

Fine-Needle Aspiration of Primary Langerhans Cell Histiocytosis of the Thyroid Gland, a Potential Mimic of Papillary Thyroid Carcinoma

Fine-Needle Aspiration of Primary Langerhans Cell Histiocytosis of the Thyroid Gland, a Potential Mimic of Papillary Thyroid Carcinoma

Cytological Diagnostic Approach in 3 Cases of Langerhans Cell Histiocytosis Presenting Primarily as a Thyroid Mass

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

Contact Info

Product

Resources

About