Langerhans Cell Histiocytosis of the Thyroid with Multiple Cervical Lymph Node Involvement Accompanying Metastatic Thyroid Papillary Carcinoma

Abstract

A 37-year-old male case was admitted with goiter. Ultrasonography of thyroid showed a 5 cm cystic nodule in the left lobe with a 1.5 cm solid component. Fine needle aspiration biopsy revealed atypia of undetermined significance or follicular lesion. The patient was operated on. The pathological diagnosis was reported as papillary thyroid carcinoma. The immunohistochemical examination showed multiple foci of Langerhans cell histiocytosis involving both lobes. The patient died due to cardiac arrest with respiratory causes in the early postoperative period. Langerhans cell histiocytosis is a rare primary condition which involves abnormal clonal proliferation of Langerhans cells in various tissues and organs. Thyroid involvement is infrequently seen. Although the etiology is unknown, genetic components may be linked to the disease. It is also associated with a family history of thyroid disease. Papillary thyroid carcinoma is the most common malignant epithelial tumor of the thyroid gland. Langerhans cell histiocytosis presenting with papillary thyroid carcinoma is rare. The privilege of our case is langerhans cell histiocytosis of the thyroid with multiple cervical lymph node involvement accompanying cervical lymph node metastatic thyroid papillary carcinoma.

Langerhans cell histiocytosis; an institutional study

“…In a study by Sieni et al the median age of patient was 8.7 years with 16 males and 11 females. 1 The incidence of the disease is ten times less in adults with a mean in the thirties and only 10 percent above 55 years of age are affected by the disease. 5 In this study 29.2% were adults.…”

“…1 The disease can occur at any age, but a peak is seen at 5-10 years. The etiology remains to be elucidated with unknown pathogenesis.…”

Langerhans cell histiocytosis of the thyroid complicated by papillary thyroid carcinoma

“…It could involve several organs and systems such as the skin, lung, bone, liver, lymph nodes, hypothalamus, and central nervous system. [ 1 – 3 ] The exact etiology is still under investigation. [ 4 , 5 ] Differentiated thyroid cancer, especially papillary thyroid carcinoma (PTC), is the most common subtype of thyroid cancer, having an increasing incidence worldwide, possibly due to the increasing use of diagnostic imaging.…”

“…To our knowledge, reports of such case are very few. [ 3 , 6 , 7 ] This paper aimed to report such a rare case and discuss its clinical features.…”

Challenging diagnosis of two neoplasms, Langerhans cell histiocytosis and papillary thyroid carcinoma, from fine needle aspiration of the thyroid by cell‐block immunocytochemistry and molecular testing for BRAF V600E mutation

“…Over the next LCH in addition to PTC, which was confirmed by immunohistochemistry. 5 Ceyran et al 6 reported a similar case in a 37-year-old man who presented with a thyroid swelling and lymphadenopathy. He was confirmed on histopathology to have both these entities along with lymph node metastasis.…”