From simple neck pain to the diagnosis of Langerhans cell histiocytosis in the thyroid gland
Introduction. Langerhans cell histiocytosis (LCH), as a hematopoietic neoplasm, is a clonal proliferation of Langerhans dendritic cells. A comprehensive clinical examination is sometimes crucial for detecting rare adult diseases, such as LCH with concomitant autoimmune thyroid disease. Case report....
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| Format: | Article |
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Military Health Department, Ministry of Defance, Serbia
2023-01-01
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| Series: | Vojnosanitetski Pregled |
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| Online Access: | https://doiserbia.nb.rs/img/doi/0042-8450/2023/0042-84502200095D.pdf |
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| author | Dželetović Gordana Ivković-Kapicl Tatjana Radovanović Bojan Stević Snežana Novaković Emilija Todorović Ivana |
| author_facet | Dželetović Gordana Ivković-Kapicl Tatjana Radovanović Bojan Stević Snežana Novaković Emilija Todorović Ivana |
| author_sort | Dželetović Gordana |
| collection | DOAJ |
| description | Introduction. Langerhans cell histiocytosis (LCH), as a hematopoietic neoplasm, is a clonal proliferation of Langerhans dendritic cells. A comprehensive clinical examination is sometimes crucial for detecting rare adult diseases, such as LCH with concomitant autoimmune thyroid disease. Case report. A 43-year-old female patient first presented for an endocrinology consultation due to front neck pain and swelling accompanied by fatigue and malaise. The physical examination revealed an enlarged right thyroid gland lobe of extremely firm consistency that was painfully tender on palpation. Echosonographic findings confirmed that the right thyroid gland lobe was enlarged and was not clearly demarcated from the surrounding tissue while exhibiting pronounced parenchyma inhomogeneity characterized by reduced echogenicity of the anterior aspect and pronounced hypoechoicity of the posterior aspect, permeated with fibrous bands and calcifications. The structure of the left thyroid lobe was pseudonodular, with the characteristics of a chronic inflammatory process. Biohumoral findings indicated chronic auto-immune thyroiditis and primary hypothyroidism. Medical history, clinical findings, and personal and family predisposition to malignancy confirmed the need for accelerated additional diagnosis. Fine-needle aspiration biopsy was indicative of atypia of undetermined significance involving Hurthle cells, nuclear overlaps, anisocytosis, anisonucleosis, and the presence of nuclear incisions. Analyses performed after thyroidectomy pointed to the fibrous form of chronic thyroiditis, with suspected monoclonal proliferation of histiocytic and/or lymphoid cells. Immunohistochemical findings confirmed Hashimoto’s thyroiditis and LCH. As the post-operative course was favorable, the patient was prescribed L-thyroxine replacement therapy, along with continuous and systematic monitoring for histiocytosis. Conclusion. Histiocytosis should be suspected more often, given the high incidence of autoimmune thyroid disease in adulthood. A timely LCH diagnosis largely determines the outcome. |
| first_indexed | 2024-03-11T23:33:26Z |
| format | Article |
| id | doaj.art-10d2cf3f550c4dcea14f6170fb94e4be |
| institution | Directory Open Access Journal |
| issn | 0042-8450 2406-0720 |
| language | English |
| last_indexed | 2024-03-11T23:33:26Z |
| publishDate | 2023-01-01 |
| publisher | Military Health Department, Ministry of Defance, Serbia |
| record_format | Article |
| series | Vojnosanitetski Pregled |
| spelling | doaj.art-10d2cf3f550c4dcea14f6170fb94e4be2023-09-20T06:03:22ZengMilitary Health Department, Ministry of Defance, SerbiaVojnosanitetski Pregled0042-84502406-07202023-01-0180871772210.2298/VSP210501095D0042-84502200095DFrom simple neck pain to the diagnosis of Langerhans cell histiocytosis in the thyroid glandDželetović Gordana0Ivković-Kapicl Tatjana1https://orcid.org/0000-0003-4249-9260Radovanović Bojan2Stević Snežana3https://orcid.org/0000-0003-2605-7913Novaković Emilija4https://orcid.org/0000-0001-8000-7955Todorović Ivana5https://orcid.org/0000-0002-9009-894XMilitary Hospital, Novi Sad, SerbiaInstitute of Oncology of Vojvodina, Sremska Kamenica, SerbiaInstitute of Oncology of Vojvodina, Sremska Kamenica, SerbiaFaculty of Medicine, Priština/Kosovska Mitrovica, SerbiaFaculty of Medicine, Priština/Kosovska Mitrovica, SerbiaUniversity Medical Center Zvezdara, Eye Clinic “Prof. Dr. Ivan Stanković”, Belgrade, SerbiaIntroduction. Langerhans cell histiocytosis (LCH), as a hematopoietic neoplasm, is a clonal proliferation of Langerhans dendritic cells. A comprehensive clinical examination is sometimes crucial for detecting rare adult diseases, such as LCH with concomitant autoimmune thyroid disease. Case report. A 43-year-old female patient first presented for an endocrinology consultation due to front neck pain and swelling accompanied by fatigue and malaise. The physical examination revealed an enlarged right thyroid gland lobe of extremely firm consistency that was painfully tender on palpation. Echosonographic findings confirmed that the right thyroid gland lobe was enlarged and was not clearly demarcated from the surrounding tissue while exhibiting pronounced parenchyma inhomogeneity characterized by reduced echogenicity of the anterior aspect and pronounced hypoechoicity of the posterior aspect, permeated with fibrous bands and calcifications. The structure of the left thyroid lobe was pseudonodular, with the characteristics of a chronic inflammatory process. Biohumoral findings indicated chronic auto-immune thyroiditis and primary hypothyroidism. Medical history, clinical findings, and personal and family predisposition to malignancy confirmed the need for accelerated additional diagnosis. Fine-needle aspiration biopsy was indicative of atypia of undetermined significance involving Hurthle cells, nuclear overlaps, anisocytosis, anisonucleosis, and the presence of nuclear incisions. Analyses performed after thyroidectomy pointed to the fibrous form of chronic thyroiditis, with suspected monoclonal proliferation of histiocytic and/or lymphoid cells. Immunohistochemical findings confirmed Hashimoto’s thyroiditis and LCH. As the post-operative course was favorable, the patient was prescribed L-thyroxine replacement therapy, along with continuous and systematic monitoring for histiocytosis. Conclusion. Histiocytosis should be suspected more often, given the high incidence of autoimmune thyroid disease in adulthood. A timely LCH diagnosis largely determines the outcome.https://doiserbia.nb.rs/img/doi/0042-8450/2023/0042-84502200095D.pdfdiagnosis, differentialhistiocytosis, langerhans-cellhistological techniquesimmunohistochemist |
| spellingShingle | Dželetović Gordana Ivković-Kapicl Tatjana Radovanović Bojan Stević Snežana Novaković Emilija Todorović Ivana From simple neck pain to the diagnosis of Langerhans cell histiocytosis in the thyroid gland Vojnosanitetski Pregled diagnosis, differential histiocytosis, langerhans-cell histological techniques immunohistochemist |
| title | From simple neck pain to the diagnosis of Langerhans cell histiocytosis in the thyroid gland |
| title_full | From simple neck pain to the diagnosis of Langerhans cell histiocytosis in the thyroid gland |
| title_fullStr | From simple neck pain to the diagnosis of Langerhans cell histiocytosis in the thyroid gland |
| title_full_unstemmed | From simple neck pain to the diagnosis of Langerhans cell histiocytosis in the thyroid gland |
| title_short | From simple neck pain to the diagnosis of Langerhans cell histiocytosis in the thyroid gland |
| title_sort | from simple neck pain to the diagnosis of langerhans cell histiocytosis in the thyroid gland |
| topic | diagnosis, differential histiocytosis, langerhans-cell histological techniques immunohistochemist |
| url | https://doiserbia.nb.rs/img/doi/0042-8450/2023/0042-84502200095D.pdf |
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