Langerhans cell histiocytosis (LCH): skeletal involvement
posted on October 3, 2013

This disorder presents with an abnormal accumulation of histiocytes in miscellaneous tissues, commonly affecting the bone. In children, some radiographic findings such as “vertebra plana” or a solitary lytic lesion of the skull, are suggestive for LCH; other findings may be misinterpreted as a malignancy or osteomyelitis. Common and uncommon skeletal manifestations of LCH are described in this pictorial essay.

Teaching points:
  • Osseous involvement in children with LCH is very similar to that seen in multiple myeloma
  • A solitary lytic lesion of the cranial vault is a typical radiographic finding of LCH
  • A vertebra plana appearance in the spine is another typical radiographic finding
  • Extensive signal intensity changes within bone marrow on MRI are a helpful sign for the diagnosis
  • In long bones, endosteal scalloping may be responsible for a “budding appearance”
Abstract:

Langerhans cell histiocytosis (LCH) represents a disorder characterised by an abnormal accumulation of histiocytes in miscellaneous tissues. The bone is commonly affected, especially the flat bones, the spine and the long bones. Some lesions in children such as a “vertebra plana” or a solitary lytic lesion of the skull may be suggestive for LCH, whereas others can be confused with a malignant tumour or osteomyelitis. This pictorial essay presents the main usual and unusual skeletal manifestations observed in LCH.

Reference:

Suonita Khung, Jean-François Budzik, Elisa Amzallag-Bellenger, Anne Lambilliote, Gustavo Soto Ares, Anne Cotten, Nathalie Boutry (2013) Skeletal involvement in Langerhans cell histiocytosis. Insights Imaging 4(5): 569-579.


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