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      Percutaneous vertebroplasty for Langerhans cell histiocytosis of the lumbar spine in an adult: Case report and review of the literature

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          Abstract

          Langerhans cell histiocytosis (LCH) is extremely rare in the lumbar spine of adults. The radiological features typically manifest as vertebral tumors. The exact etiology of LCH remains unknown. Langerhans cells may cause local or systemic effects. The most frequent sites of these bony lesions are the skull, femur, mandible, pelvis and spine. To date, only 3 spinal LCH cases treated by percutaneous vertebroplasty (PVP) have been reported. The present study reports a case of LCH of the fourth lumbar vertebra (L4) in a 51-year-old male with a 10-day history of low back pain, limited waist motion and right lower limb numbness. The patient was treated using PVP. The use of PVP for treating LCH of the spine was successful. The present study provides an up-to-date literature overview of LCH.

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          [Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty].

          P Galibert, H Deramond, P Rosat … (1987)
          Findings in several cases are used to demonstrate that certain vertebral angiomas may not be congenital and can ultimately provoke medullary or radicular neurologic complications. Radiotherapy is the usual treatment but is not always accepted unconditionally close to spinal cord. Destruction of angioma and consolidation of vertebral column can be obtained by percutaneous intrasomatic injection of acrylic cement. The preoperative radiologic examination includes direct phlebography with insertion of trocar, the vertebroplasty being performed under television screen surveillance. Results in seven patients treated are very encouraging but the current 2-year follow up requires extension. However, the method appears to be able to be included amongst treatment for an affection of sometimes seriously questioned benign nature.
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            Langerhans cell histiocytosis in adults. Report from the International Registry of the Histiocyte Society.

            M Aricò, M Girschikofsky, T Généreau … (2003)
            Langerhans cell histiocytosis (LCH), characterised by the infiltration of one or more organs by large mononuclear cells, can develop in persons of any age. Although the features of this disease are well described in children, they remain poorly defined in adults. From January 2000 to June 2001, 274 adults from 13 countries, with biopsy-proven adult LCH, were registered with the International Histiocyte Society Registry. Information was collected about clinical presentation, family history, associated conditions, cigarette smoking and treatment, to assist in future management decisions in patients aged 18 years and older. There were slightly more males than females (143:126), and the mean ages at the onset and diagnosis of disease were 33 years (standard deviation (S.D.) 15 years) and 35 years (S.D. 14 years), respectively. 2 patients had consanguineous parents, and 1 had a family history of LCH; 129 reported smoking (47.1%); 17 (6.2%) had been diagnosed with different types of cancer. Single-system LCH, found in 86 patients (31.4%), included isolated pulmonary involvement in 44 cases; 188 patients (68.6%) had multisystem disease; 81 (29.6%) had diabetes insipidus. Initial treatment consisted of vinblastine administered with or without steroids, to 82 patients (29.9%), including 9 who had received it with etoposide, which was the sole agent given to 19 patients. 236 patients were considered evaluable for survival. At a median follow-up of 28 months from diagnosis, 15 patients (6.4%) had died (death rate, 1.5/100 person years, 95% Confidence Interval (95% CI) 0.9-2.4). The probability of survival at 5 years postdiagnosis was 92.3% (95% CI 85.6-95.9) overall, 100% for patients with single-system disease (n=37), 87.8% (95% CI 54.9-97.2) for isolated pulmonary disease (n=34), and 91.7% (95% CI 83.6-95.9) for multisystem disease (n=163). Survival did not differ significantly among patients with multisystem disease, with or without liver or lung involvement) 5-year survival 93.6% (95% CI 84.7-97.4) versus 87.5% (95% CI 65.5-95.9), respectively; P value 0.1). LCH in adults is most often a multisystem disease with the highest mortality seen in patients with isolated pulmonary involvement. It should be included in the differential diagnosis of disseminated or localised disease of the bone, skin and mucosa, as well as the lung and the endocrine and central nervous system, regardless of the age of the patient. A prospective international therapeutic study is warranted.
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              Langerhans' cell histiocytosis: pathology, imaging and treatment of skeletal involvement.

              A Podda, E Azouz, J. L. Rodriguez … (2005)
              Langerhans' cell histiocytosis (LCH) is manifested in a variety of ways, the most common being the eosinophilic granuloma, a localized, often solitary bone lesion that occurs predominantly in the pediatric age group. The hallmark of LCH is the proliferation and accumulation of a specific histiocyte: the Langerhans' cell. In bone this may cause pain and adjacent soft-tissue swelling, but some lesions are asymptomatic. LCH can involve any bone, but most lesions occur in the skull (especially the calvarium and temporal bones), the pelvis, spine, mandible, ribs, and tubular bones. Imaging diagnosis of the disease in bone is first based on the plain radiographic appearance, which is usually a central destructive, aggressive-looking lesion. In the skull, the lesions develop in the diploic space, are lytic, and their edges may be beveled, scalloped or confluent (geographic), or show a "button sequestrum." Vertebral body involvement usually causes collapse, resulting in vertebra plana. With significant recent improvements in the quality of gamma cameras, imaging techniques, and in studying children, bone scintigraphy at diagnosis and on follow-up usually reveals the sites of active disease, especially when the involvement is polyostotic. CT and MR imaging are very useful in providing detailed cross-sectional anatomic detail of the involved bone, including the bone marrow and the adjacent soft tissues. CT is better suited for demonstrating bone detail and MR imaging for bone marrow and soft-tissue involvement.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Exp Ther Med
                Journal ID (iso-abbrev): Exp Ther Med
                Journal ID (publisher-id): ETM
                Title: Experimental and Therapeutic Medicine
                Publisher: D.A. Spandidos
                ISSN (Print): 1792-0981
                ISSN (Electronic): 1792-1015
                Publication date (Print): January 2013
                Publication date (Electronic): 01 November 2012
                Publication date PMC-release: 01 November 2012
                Volume: 5
                Issue: 1
                Pages: 128-132
                Affiliations
                Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P.R. China
                Author notes
                Correspondence to: Professor Hai Tang, Department of Ortho pedics, Beijing Friendship Hospital, Capital Medical University, 95 Yongan Road, Chaoyang, Beijing 100050, P.R. China, E-mail: tanghai@ 123456medmail.com.cn
                Article
                Publisher ID: etm-05-01-0128
                DOI: 10.3892/etm.2012.791
                PMC ID: 3524240
                PubMed ID: 23251253
                SO-VID: e729a08a-44d2-4590-b25e-775ee762a1eb
                Copyright © Copyright © 2013, Spandidos Publications
                License:

                This is an open-access article licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License. The article may be redistributed, reproduced, and reused for non-commercial purposes, provided the original source is properly cited.

                History
                Date received : 25 July 2012
                Date accepted : 08 October 2012
                Categories
                Subject: Articles

                ScienceOpen disciplines: Medicine
                Keywords: adult,langerhans cell histiocytosis,percutaneous vertebroplasty,spine
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: adult, langerhans cell histiocytosis, percutaneous vertebroplasty, spine

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