J Korean Neurosurg Soc.  2016 Mar;59(2):165-167. 10.3340/jkns.2016.59.2.165.

Case of Langerhans Cell Histiocytosis That Mimics Meningioma in CT and MRI

• Zhu M
• Yu BB
• Zhai JL
• Sun G

• KMID: 2192049
• DOI: http://doi.org/10.3340/jkns.2016.59.2.165

Abstract

Langerhans cell histiocytosis (LCH) is a rare disorder histologically characterized by the proliferation of Langerhans cells. Here we present the case of a 13-year-old girl with LCH wherein CT and MRI results led us to an initially incorrect diagnosis of meningioma. The diagnosis was corrected to LCH based on pathology findings. An intracranial mass was found mainly in the dura mater, with thickening of the surrounding dura. It appeared to be growing downward from the calvaria, pressing on underlying brain tissue, and had infiltrated the inner skull, causing a bone defect. The lesion was calcified with the typical dural tail sign. The dural origin of the lesion was verified upon surgical dissection. There are no previous reports in the literature describing LCH of dural origin presenting in young patients with typical dural tail signs and meningioma-like imaging findings. The current case report underscores the need for thorough histological and immunocytochemical examinations in LCH differential diagnosis.

Keyword

CT; MRI; Meningioma; Langerhans cell histiocytosis

MeSH Terms

Adolescent
Brain
Diagnosis
Diagnosis, Differential
Dura Mater
Female
Histiocytosis, Langerhans-Cell*
Humans
Langerhans Cells
Magnetic Resonance Imaging*
Meningioma*
Pathology
Skull
Tail

Figure

• 

  Fig. 1 A : Plain CT scan. Soft-tissue window, high-density mass on the right calvaria with internal calcification spots. B : Plain CT scan. Bone window and adjacent bone deficit with unclear edges. C and D : Enhanced MRI revealing an irregularly shaped tumor with clear boundaries and a wide base attached to the meninges (sagittal and coronal planes, respectively).

• 

  Fig. 2 Histopathological demonstration of LCH. Hematoxylin-eosin staining of the resected mass revealed a large number of Langerhans cells, multinucleated giant cells, and diffuse eosinophil and lymphocyte infiltration (A). Immunohistochemistry revealed the presence of membranous CD1a (B), cytoplasmic CD68 (C), and nuclear S-100 (D). Original magnification : ×200.

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