Endocrine Abstracts

Introduction: Langerhans cell histiocytosis (LHH) is an idiopathic, clonal, pleomorphic, neoplastic disorder characterized by the presence of atypical histiocytic cells which are locally or commonly seen in bone, lung, hypothalamus, liver, lymph nodes, mucocutaneous tissues with damaging them.

Case: 58 year-old male patient applied to our clinic due to fatigue. On his physical examination, lymphadenopathy and hepatosplenomegaly were absent. In his history, he had an operation owing to Large-cell neuroendocrine carcinoma in 2014. He took chemotherapy but no radiation. In surveillance, a thyroid nodule was detected in PET-CT. Thyroid US revealed a nodule 5 cm in diameter in the right lobe. He underwent bilateral total thyroidectomy. In pathological examination, left lobe was reported as thyroid papillary microcarcinoma, follicular variant and langerhans cell histiocytosis, right lobe was reported as follicular nodular disease. The focus of papillary microcarcinoma in 0.2 and 0.1 cm diameter was seen in the left lobe and langerin positive focus was observed in the morphology of langerhans cell histiocytosis consisting of langerhans cells and eosinophils. Bone marrow biopsy and abdominal MR were normal. On his laboratory examination urine dansity was normal. FSH: 5.44 mlU/ml (1.5–12.4), LH: 4.74 mlU/ml (1.7–8.6), total testosterone: 2.35 ng/ml (2.8–8), prolactin: 5.87 ng/ml (4.6–21.4), TSH: 0.37 μIU/ml (0.35–5.50), tyroglobulin<0.9 ng/ml (1.6–60) were detected. In pituitary MRI, nodular focus with different contrast enhancement according to pituitary gland referred as intermediate lobe was detected in the middle posterior of pituitary gland

Discussion: In LHH and papillary thyroid carcinoma coexistence, papillary microcarcinoma was frequently encountered.Gold standard treatment for limited LHH is surgical resection and it has usually good prognosis. Diffuse goitre (59%) or nodules (25.8%) can be detected in patients with LHH having thyroid gland involvement. Large cell neuroendocrine carcinoma of the lung is rarely seen and has poor prognosis.