2018 Volume 57 Issue 3 Pages 177-182
Background : LCH is a disease of unknown etiology that is mainly characterized by the proliferation of Langerhans cells. While it is known to affect many organs, involvement of the thyroid gland is rare.
Case : A man in his 40’s presented to us with a history of having suffered from pneumothorax when he was in his 20’s and of having been diagnosed, based on histopathology of a surgical specimen, as having eosinophilic granuloma syndrome of the lung. However, he had not been followed up since. Only recently, he had noticed an axillary lump on both sides and swelling of the right shoulder, and he was referred to our hospital. Axillary skin resection was carried out on both sides. The patient developed pneumothorax and partial lung resection was performed. Histopathology of both the resected surgical samples revealed features consistent with the diagnosis of Langerhans cell histiocytosis (LCH). Infiltration into the thyroid gland was also suspected, and fine-needle aspiration cytology examination of the thyroid gland was performed. This examination revealed tumor cells with enlarged nuclei and pale cytoplasm, and some cells showed prominent nuclear grooves. Multinucleated cells with 2-9 similar-looking nuclei with abundant cytoplasm were also seen. Immunocytochemical analysis revealed that these cells were positive for CD1a and langerin, and negative for TTF-1. Based on these features, the diagnosis of LCH of the thyroid gland was made.
Conclusion : Fine-needle aspiration cytology of the thyroid gland enabled us to make a diagnosis of LCH from the morphological characteristics of the cells.
