Li Jing, Ren Mingyu, Wang Jianjie, Cheng Yanyan, Li Ruimiao, Lu Lu, Zhang Ruina
Intensive Care Unit, Xingtai Central Hospital, Xingtai, Hebei, China.
Department of Orbital Disease and Ocular Tumor, Hebei Eye Hospital, Xingtai, Hebei, China.
Medicine (Baltimore). 2024 Dec 20;103(51):e41039. doi: 10.1097/MD.0000000000041039.
The orbital Langerhans cell histiocytosis (LCH) is rare clinically, due to its ability to mimic other conditions, distinguishing LCH from hematoma when these disorders coexist can be particularly challenging.
A 3-year-old boy presented with a 2-week history of unresolved bruising and swelling of the left eye. CT revealed a well-defined cystic lesion in the preseptal tissues of the left eyelid, with an incomplete bone structure at the lower margin of the orbit. MRI revealed a well-circumscribed circular mass in the lower margin of the orbit, and a second lesion under the hematoma.
Postoperative histological examination revealed a diagnosis of LCH with concurrent hematoma.
The lesions in the left eye were surgically removed through a lower eyelid skin incision under general anesthesia. The patient received 6 courses of systemic chemotherapy, consisting of a combination of vinblastine and prednisolone.
No recurrence was observed after a follow-up period of 11 months.
LCH rarely occurs at the infraorbital margin. When external factors, lead to local bleeding and hematoma formation, the presence of lesions may be masked, resulting in a missed diagnosis. Radiographic features such as localized "worm-eaten" bone destruction should not be overlooked for timely LCH diagnosis and treatment.
眼眶朗格汉斯细胞组织细胞增多症（LCH）临床罕见，因其能模仿其他病症，当这些病症并存时，将LCH与血肿区分开来可能极具挑战性。
一名3岁男孩，左眼出现持续2周的淤青和肿胀。CT显示左眼睑眶隔前组织有一个边界清晰的囊性病变，眼眶下缘骨质结构不完整。MRI显示眼眶下缘有一个边界清晰的圆形肿块，血肿下方还有一个病变。
术后组织学检查确诊为LCH并发血肿。
在全身麻醉下通过下睑皮肤切口手术切除左眼病变。患者接受了6个疗程的全身化疗，方案为长春新碱和泼尼松龙联合使用。
随访11个月未观察到复发。
LCH很少发生在眶下缘。当外部因素导致局部出血和血肿形成时，病变的存在可能被掩盖，从而导致漏诊。对于及时诊断和治疗LCH，不应忽视如局限性“虫蚀状”骨质破坏等影像学特征。
