Pulmonary Langerhans cell histiocytosis

Case contributed by Dr Domenico Nicoletti


Smoker of thirty menthol cigarettes a day for the past 5 years. Presents with dysponea, non-productive cough, fatigue.

Patient Data

Age: 25 years
Gender: Male

Diffuse reticular pattern with a predominantly upper and middle lobe distribution.

Interstitial thickening and small nodules are distributed around the small airways with cystic lesions of varying size, shape, and wall thickness throughout both lungs, most pronounced in the upper and right middle lobes. The lung bases are relatively spared.

Histological report ​

Case Discussion

Pulmonary Langerhans cell histiocytosis is a cystic interstitial lung disease that primarily affects young adults. Nearly all affected individuals have a history of current or prior cigarette smoking. In pulmonary Langerhans cell histiocytosis, monoclonal Langerhans cells proliferate in alveolar interstitium and bronchioles. Menthol is used as an additive in some cigarette brands because it makes smoking less irritating. Smokers of menthol cigarettes inhale the smoke more deeply, have more difficulty in expelling the smoke from the lungs and moreover, with this type of cigarettes, the males start more easily to smoke and become more quickly dependent.


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