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Langerhans cell histiocytosis diagnosed by FNAC of lymph nodes
Shashikant C U Patne1, Saloni Dwivedi, Richa Katiyar
1Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Insights
Langerhans cell histiocytosis (LCH), a rare dendritic cell disorder, can predominantly affect lymph nodes. Fine-needle aspiration cytology (FNAC) offers a rapid and accurate method for diagnosing this LCH presentation.
Area of Science:
- Oncology
- Pediatrics
- Pathology
Background:
- Langerhans cell histiocytosis (LCH) is a rare clonal disorder involving dendritic cell proliferation.
- While bone, skin, and lymph nodes are common sites, LCH with predominant lymph node involvement is infrequently diagnosed via fine-needle aspiration cytology (FNAC).
Observation:
- A 2-year-old boy presented with generalized lymphadenopathy, fever, cough, hepatosplenomegaly, anemia, and skull lytic lesions.
- FNAC of a submandibular lymph node revealed features consistent with LCH.
- Immunostaining on FNAC smears showed positive S-100 protein in LCH cells.
Findings:
- FNAC demonstrated features of LCH in a pediatric patient with generalized lymphadenopathy.
- Immunohistochemistry, including S-100 protein and CD1a, confirmed LCH diagnosis on lymph node biopsy.
- The patient received chemotherapy and is undergoing follow-up.
Implications:
- This case underscores the diagnostic utility of FNAC for lymph node-predominant LCH.
- FNAC provides a rapid and accurate preliminary diagnosis, guiding further management.
- Early diagnosis through FNAC is crucial for timely treatment of LCH.
Abstract:
Langerhans cell histiocytosis (LCH) is a rare clonal disorder of unknown etiology and characterized by the proliferation of dendritic cells. LCH most commonly involves the bone followed by the skin and the lymph nodes. Recently, only a few cases of LCH with predominant lymph node involvement have been diagnosed by fine-needle aspiration cytology (FNAC). A 2-year-old boy presented with generalized lymphadenopathy, fever, and cough. The patient had hepatosplenomegaly, anemia, and lytic lesions in the skull. FNAC from the largest submandibular lymph node showed features of LCH. The large cells of LCH showed positive immunostaining for S-100 protein on FNAC smears. Later, lymph node biopsy and immunohistochemistry against S-100 protein and CD1a confirmed the diagnosis of LCH. The patient was treated with chemotherapy and he is under regular follow-up. This case report highlights the importance of FNAC as a rapid and accurate investigation in the diagnosis of lymph node predominant LCH.
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