VATS biopsy of an adult with pulmonary langerhans cell histiocytosis: case report

Abstract

A 29-year-old Filipino male smoker presented with dyspnea and a right-sided pneumothorax with subsequent chest tube drainage. Chest CT scan revealed multiple diffuse and mostly interconnected thin and thick-walled cystic structures of varying sizes and shapes with most located in both upper lobes.Video-assisted thoracoscopic surgery (VATS) wedge resection of the right lower lobe posterobasal segment and mechanical pleural abrasion were done. Intraoperatively, there were multiple bullae and diffuse small cysts interspersed with normal lung tissue. Histopathology and immunohistochemistry findings revealed pulmonary Langerhans cell histiocytosis (PLCH). Smoking has been hypothesized to induce a clonal proliferative, neoplastic process or a reactive immune activity in PLCH. The patient was advised smoking cessation and is on close follow-up. He is doing well 10 months after hospital discharge. PLCH is a very rare disease and diagnosis was obtained by VATS. To the authors' knowledge, this is also the first fully documented case of PCLH in the Philippines.