Liang Han-Xiang, Yang Yue-Long, Zhang Qing, Xie Zhi, Liu En-Tao, Wang Shu-Xia
Department of Nuclear Medicine, Maoming People's Hospital, Maoming 525000, Guangdong Province, China.
Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China.
World J Clin Cases. 2022 Feb 6;10(4):1423-1431. doi: 10.12998/wjcc.v10.i4.1423.
Langerhans cell histiocytosis (LCH) is a rare proliferative histiocyte disorder. It can affect any organ or system, especially the bone, skin, lung, and central nervous system (CNS). In the CNS, the hypothalamic-pituitary is predominantly affected, whereas the brain parenchyma is rarely affected. LCH occurring in the brain parenchyma can be easily confused with glioblastoma or brain metastases. Thus, multimodal imaging is useful for the differential diagnosis of these intracerebral lesions and detection of lesions in the other organs.
A 47-year-old man presented with a headache for one week and sudden syncope. Brain computed tomography (CT) and magnetic resonance imaging showed an irregularly shaped nodule with heterogeneous enhancement. On F-fluorodeoxyglucose (F-FDG) positron emission tomography/CT, a nodule with F-FDG uptake and multiple cysts in the upper lobes of both lungs were noted, which was also confirmed by high-resolution CT. Thus, the patient underwent surgical resection of the brain lesion for further examination. Postoperative pathology confirmed LCH. The patient received chemotherapy after surgery. No recurrence was observed in the brain at the 12-mo follow-up.
Multimodal imaging is useful for evaluating the systemic condition of LCH, developing treatment plans, and designing post-treatment strategies.
朗格汉斯细胞组织细胞增多症（LCH）是一种罕见的组织细胞增殖性疾病。它可累及任何器官或系统，尤其是骨骼、皮肤、肺和中枢神经系统（CNS）。在中枢神经系统中，下丘脑 - 垂体是主要受累部位，而脑实质很少受累。发生在脑实质的LCH很容易与胶质母细胞瘤或脑转移瘤混淆。因此，多模态成像有助于对这些脑内病变进行鉴别诊断，并检测其他器官的病变。
一名47岁男性，出现头痛1周并突发晕厥。脑部计算机断层扫描（CT）和磁共振成像显示一个形状不规则的结节，强化不均匀。在F - 氟脱氧葡萄糖（F - FDG）正电子发射断层扫描/CT上，发现一个有F - FDG摄取的结节以及双肺上叶的多个囊肿，高分辨率CT也证实了这一点。因此，患者接受了脑病变的手术切除以进行进一步检查。术后病理证实为LCH。患者术后接受了化疗。在12个月的随访中，脑部未观察到复发。
多模态成像有助于评估LCH的全身状况、制定治疗方案以及设计治疗后策略。
