Investig Magn Reson Imaging.  2020 Mar;24(1):61-65. 10.13104/imri.2020.24.1.61.

Langerhans Cell Histiocytosis of the Rib of an Adult Female Patient: a Case Report

• Oh CH
• Kang WY
• Lee OJ

• KMID: 2508220
• DOI: http://doi.org/10.13104/imri.2020.24.1.61

Abstract

Langerhans cell histiocytosis (LCH) is generally considered a childhood disease that exhibits various nonspecific clinical and radiological manifestations that mimic infection or malignancy. Here, we present a case of LCH involving the rib in an adult patient. CT and MRI revealed an expansile lytic lesion with periosteal reaction on the left 8th rib, suggesting a malignant bone tumor. Surgical resection was performed and histopathological examination was consistent with LCH. Owing to its rare occurrence in adults and nonspecific aggressive features, LCH should be included in the differential diagnosis of an aggressive-appearing rib lesion in both adults and children.

Keyword

Adult; Computed tomography (CT); Langerhans cell histiocytosis (LCH); Magnetic resonance imaging (MRI); Rib

Figure

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  Fig. 1. Forty-year-old female patient with LCH on the left 8th rib. (a) Axial CT image of the chest shows an expansile osteolytic lesion (arrow) with cortical thinning and disruption at the left 8th rib. (b) Axial T2-weighted image with fat saturation shows an intramedullary high-signal intensity mass (arrow) with surrounding soft tissue edema. (c) Axial T1-weighted image shows a low-signal intensity mass (arrow). (d) Axial T1-weighted image with fat suppression after gadolinium administration shows infiltrative enhancement (arrow). Diffusion restrictionis not clearly visible on the (e) axial diffusion-weighted image (DWI) and (f) axial apparent diffusion coefficient map (ADC map) (arrows).

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  Fig. 2. Histopathological examination of the rib mass. (a) Hematoxylin and Eosin (× 400) staining reveals Langerhans cells with ovoid nuclei and occasional nuclear grooves in a mixed inflammatory background with prominent eosinophilia (arrows). (b) Immunohistochemical staining (× 400) is positive for CD1a.

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  Fig. 3. (a, b) PET CT demonstrates focal hypermetabolic bone lesion (SUVmax = 15.1) in the left distal femur (arrows).

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