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Central Nervous System Langerhans Cell Histiocytosis

  • Milen Minkov
  • Jennifer Picarsic
  • Karoly Lakatos
Chapter

Abstract

Langerhans cell histiocytosis (LCH) can affect virtually any organ of the human body, including the central nervous system (CNS). Based on correlation of clinical, imaging, and pathology findings, two patterns of CNS-LCH have been identified: granulomatous (“tumorous”) and non-granulomatous “neurodegenerative” (ND)-CNS-LCH. Granulomatous CNS-LCH can manifest with polyuria and polydipsia, seizures, increased intracranial pressure, or other signs, depending on location. The typical location on MRI is extra-axial (hypothalamic-pituitary region, meninges, pineal gland, choroid plexus), and pathology in a proliferative phase reveals CD1a/langerin+ histiocytes. ND-CNS-LCH manifests insidiously with cerebellar and bulbar symptoms. MRI typically reveals parenchymal signal alterations in the cerebellum, pons, basal ganglia, and supratentorial white matter consistent with neuronal loss and demyelination. Biopsies of such lesions are rare. In the few published cases biopsied, variable pathologies are described with perivascular inflammatory changes, variable neuronal loss, demyelination, and gliosis, but are nondiagnostic for CD1a+/CD207+ LCH cells. Granulomatous LCH can be responsive to chemotherapy agents such as vinblastine, cytarabine, or cladribine, while the optimal treatment of ND-CNS-LCH is yet to be defined.

Keywords

Langerhans cell histiocytosis Central nervous system Granulomatous Tumorous Non-granulomatous Neurodegeneration Sequelae 

Abbreviations

CNS

Central nervous system

CSF

Cerebrospinal fluid

DI

Diabetes insipidus

ECD

Erdheim-Chester disease

EDSS

Expanded Disability Status Scale

FDG-PET

Fluorodeoxyglucose positron emission tomography

HPR

Hypothalamic-pituitary region

ICARS

International Cooperative Ataxia Rating Scale

JXG

Juvenile xanthogranuloma

LCH

Langerhans cell histiocytosis

MAPK

Mitogen-activated protein kinase

MRI

Magnetic resonance imaging

MS-LCH

Multisystem LCH

ND

Neurodegeneration

PC

Permanent consequences

RDD

Rosai-Dorfman disease

SS-LCH

Single system LCH

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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Milen Minkov
    • 1
    • 2
  • Jennifer Picarsic
    • 3
  • Karoly Lakatos
    • 2
  1. 1.International LCH Study Reference Center, CCRI, St. Anna Kinderkrebsforschung, Department of Pediatrics and Adolescent Medicine,Medical University of ViennaViennaAustria
  2. 2.St. Anna Children’s Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of ViennaViennaAustria
  3. 3.Department of Pathology, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh of UPMCPittsburghUSA

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