Isolated hypothalamic-pituitary langerhans’ cell histiocytosis in female adult

Abstract

Rationale:Langerhans cell histiocytosis (LCH) is characterized by clonal proliferation of immature dendritic cells, mainly affects children. LCH in adult sellar region is extremely rare. In literature, optimal treatments remain unclear and only a few cases of LCH were treated using surgery. Here, we present a rare case of isolated hypothalamic-pituitary LHC in female adult. We focused on elucidating the clinical manifestations and immunohistochemical features of LCH, and exploring the proper treatment in adults.Patient concerns:A 50-year-old woman was admitted to our hospital, presenting with polydipsia and polyuria for over 3 months.Diagnoses:Radiological studies revealed lesions (0.5 × 0.9 × 0.4 cm) on posterior pituitary and enlarged pituitary stalk, which was moderately enhanced on contrast magnetic resonance imaging (MRI) of sellar region. In biopsy, pathological examination of Langerhans cells were observed with positive S-100 protein and Ki-67 antigen markers, findings were sufficient to establish a diagnosis of central nervous system (CNS) LCH.Interventions:The patient with LCH restricted in the sellar region received both surgery and chemotherapy. Gamma knife radiosurgery was performed after diagnosed as central diabetes insipidus (CDI) induced by pituitary lesion. And tumorectomy was performed 5 years later. However, in the latest MRI in 2017, the nodular shadow became larger (about 1.4 cm), chemotherapy and further systemic therapy were given.Outcomes:At 12-month follow-up, no local reoccurrence was noticed.Lessons:For LCH, though difficult to be diagnosed and none defined standard therapeutic approach to adults, surgery should be considered if there are neurological symptoms or histological diagnosis. The present study showed that some manifestations can be meaningful when central nervous system (CNS) is involved. For complex diseases in the sellar region, multi-disciplinary team (MDT) model of diagnosis and treatment should be helpful for better clinical efficacy.

Adult-onset Langerhans cell histiocytosis changing CNS lesion from pituitary to suprasellar extension

“…Interestingly, the LCH lesion was altered from the pituitary to the hypothalamus in the present case. Similar cases have been previously reported, and the courses of MRI findings indicate that the LCH lesion was altered from pituitary or hypothalamus to suprasellar extension ( Table 2 ) ( 5 , 7 , 9 , 10 ). We could not find LCH lesions that extended in a reverse manner (from the hypothalamus to the pituitary) in the literature.…”

Multifocal, multisystem presentation of adult-onset langerhans cell histiocytosis on 18F-Fluorodeoxyglucose Positron-emission tomography–Computed tomography: A rare case report

“…[ 10 ] Although isolated CNS-LCH is reported, CNS-LCH is mainly diagnosed as multisystemic disease with male predominance. [ 8 11 12 ] Our case also had involvement of the pituitary gland based on MRI findings with central diabetes insipidus.…”

Histiocytic Disorder Mimicking a Brain Tumor: A Report of 2 Rare Cases

“…Tan et al reported a similar case that occurred in the seller area in a 50-year-old woman. Their patient presented with DM-like symptoms, polydipsia, and polyuria, for over 3 months [ 8 ].…”