Spinal epidural involvement in adult Langerhans cell histiocytosis (LCH): A case report

Abstract

Rationale: Spinal involvement in adult Langerhans cell histiocytosis (LCH) is rare, and epidural involvement is unusual. LCH is mostly indistinguishable from other spinal lesions such as infection, lymphoma, and metastasis. So, it could be easily misdiagnosed without suspicion.

Patient concerns: We report a case of a 33-year-old man who complained of gait disturbance with weakness in both legs and severe back pain.

Diagnoses: A continuous enhancing epidural lesion with cord compression from the T7 to L1 level was detected in magnetic resonance imaging. Laboratory analysis indicated the possibility of spinal infectious disease. We assumed that the lesion could be tuberculous spondylitis.

Interventions and outcomes: The patient underwent posterior laminectomy with marginal excision of the epidural mass to relieve cord compression. Pathological examination confirmed the diagnosis of LCH. The 12-month follow-up evaluation revealed that the patient was neurologically intact and had no gait disturbance.

Lessons: This case report presents a patient with epidural LCH of the thoracic spinal cord, which can mimic spinal infections such as tuberculous spondylitis with abscess formation. Therefore, LCH could be considered as a possible diagnosis when a patient presents with features of infectious spondylitis with vertebral involvement.

Figure 1

Preoperative T2-weighted (A and B), T1 gadolinium-enhanced (C and D) sagittal MR images, and axial images at the level of T10, (E) a sagittal CT reconstructive image showing a homogeneous continuous enhancing epidural lesion and osteolytic bone lesion at the T7–L1 level.

Figure 2

Preoperative T1 gadolinium-enhanced (A and B), T2-weighted (C) sagittal MR images, and axial images at the level of T10 showing a decompression of the cord and remaining mass lesion.

Figure 3

Photomicrographs of the epidural lesion. The tumor is composed of a large number of B cells and plasma cells. (A) H&E staining, X40, (B) H&E staining, X400, (C) CD1a staining, and (D) S-100 immunohistochemical staining.

Figure 4

A comparison of bone scan images between the (A) preoperative and (B) postoperative 1-year period.