Department of Internal Medicine, Gachon University Gil Hospital, Namdong-gu, Incheon, Korea.
Korean J Intern Med. 2009 Dec;24(4):393-6. doi: 10.3904/kjim.2009.24.4.393. Epub 2009 Nov 27.
A 31-year-old man presented with a dry cough and exertional dyspnea. The chest X-ray showed multiple nodular opacities throughout the entire lung field. Chest computed tomography (CT) revealed variable-sized nodules with a peribronchiolar or centrilobular distribution, some of which revealed thick-walled cavitary change. Based on the chest CT findings, it was initially assumed that metastatic lung nodules with hematogenous spread were present; therefore, we performed an open lung biopsy. On microscopic examination, several compact cellular interstitial infiltrates composed of Langerhans' cells, eosinophils, and lymphocytes were observed. Immunochemically, the Langerhans' cells showed strong cytoplasmic staining for S-100 protein. Based on these findings, the patient was diagnosed with Langerhans' cell histiocytosis of the lung. High-resolution CT of the chest is a useful, sensitive tool in the diagnosis of pulmonary Langerhans' cell histiocytosis (PLCH). A typical radiologic finding of PLCH is irregularly shaped cysts. The radiological finding in this case of nodular opacities throughout the lung fields only without cysts is rare in PLCH. We report a case of PLCH with atypical multiple nodules mimicking hematogenous metastatic lung nodules.
一位 31 岁男性因干咳和劳力性呼吸困难就诊。胸部 X 光片显示整个肺部有多个结节状阴影。胸部计算机断层扫描（CT）显示大小不一的结节，呈支气管周围或小叶中心分布，其中一些呈现厚壁空洞性改变。根据胸部 CT 结果，最初假设存在血源性播散的转移性肺结节，因此我们进行了开胸肺活检。显微镜下观察到，有几个由朗格汉斯细胞、嗜酸性粒细胞和淋巴细胞组成的致密细胞间质浸润。免疫化学染色显示，朗格汉斯细胞的细胞质对 S-100 蛋白呈强染色。基于这些发现，该患者被诊断为肺朗格汉斯细胞组织细胞增生症。胸部高分辨率 CT 是诊断肺朗格汉斯细胞组织细胞增生症（PLCH）的一种有用、敏感的工具。PLCH 的典型放射学表现为不规则形状的囊肿。本例肺部结节状阴影无囊肿的放射学表现在 PLCH 中较为罕见。我们报告了一例表现为多发结节的不典型 PLCH，类似于血源性转移性肺结节。
