Langerhans cell histiocytosis with extensive spinal and thyroid gland involvement presenting with quadriparesis: an unusual case in an adult patient

Abstract

Abstract: Langerhans cell histiocytosis of the spine frequently presents as a solitary lesion and rarely results in neurological deficit. Involvement of thyroid tissue is also rare, even in multifocal disease presentations. We present an unusual variant of Langerhans cell histiocytosis in a 37-year-old man presenting with profound quadriparesis and incidental thyroid involvement. MR imaging and skeletal radiographs revealed widespread involvement of the spine. The patient underwent surgical resection of the tumour and stabilization of the spine. Diagnosis was confirmed by histological and immunohistochemistry analysis. Langerhans cell histiocytosis should be included in the differential diagnosis of radiolucent lesions of the spine in adults.

Key words: Langerhans Cell Histiocytosis, Spine Tumours, Thyroid Mass, Cord Compression With Quadriparesis, Adult.

Fig. 1: (A) MR imaging (T1-weighted) of the thoracic spine. Note the disruption of T6 and T7. (B) Lumbosacral spine on MR imaging (T1-weighted) with osteolytic changes on L3 and L4. (C and D) Post-operative plain radiographs of the thoracic spine.

Fig. 2: (A) Plain radiograph (lateral view) and (B) MR imaging (T1-weighted) of the cervical spine, revealing subluxation of C3/C4 (X). Post-operative plain radiographs, (C) lateral view and (D) anteroposterior view.

Fig. 3: Histological section from (A) T7 vertebral body, and (B) body of C3 vertebra, demonstrating large pale-staining histiocytes (arrows) with eccentric nuclei and nuclear grooves. There is also a proliferation of mixed inflammatory cells characterized by cells with dark-staining nuclei, consistent with lymphocytes, eosinophils and plasma cells (haematoxylin and eosin, x40).