Langerhans cell histiocytosis

Case contributed by Dr Jeremy Jones

Presentation

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Patient Data

Age: 4 years
Gender: Female
x_ray

Ill-defined lucency within the femoral shaft with surrounding layering periosteal reaction. The differential includes LCH and Ewing sarcoma (the latter being less likely because of age). 

mri

Solitary lesion on the imaging provided. Mid-shaft femoral bone edema with surrounding periosteal reaction and soft-tissue edema. No associated mass. 

Case Discussion

The diagnosis was between Langerhans cell histiocytosis (LCH) and Ewing sarcoma. Ewing sarcoma would be unusual in a child under 5 and biopsy confirmed LCH as the diagnosis.

Skeletal survey was performed to identify any additional lesions: there were none. This is solitary, single system LCH.

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