Endocrine Abstracts

Langerhans cell histiocytosis (LCH) is a disease with monoclonal proliferation and infiltration of organs by Langerhans cell. LCH is commonly seen in the skeletal system and skin, but it may also involve paranchymal organs. Thyroid involvement in LCH is unusual, and coexistence of thyroid with lung involvement is seen very rare. Here we present a patient with LCH, who has thyroid and lung involvement.

Case: A 26-old woman, who had LCH of the lung was referred to our clinic for thyroid nodules detected on Thorax computerized tomography. She had no symptoms at admission. On physical examination no pathological findings were detected. No goitre was seen on the examination of the neck. Thyroid function showed subclinical hypothyroidism based on the following hormone levels: free triiodothyronine (FT3): 2.4 pg/ml; free thyroxine (FT4):0.97 ng/dl and TSH: 12.30 mIU/l; antithyroid antibodies were negative. Levothyroxine was prescribed, and the thyroid function returned to normal. On thyroid ultrasound, the right lobe measured 11×10×40 mm and the left lobe measured 10.7×13×40 mm. On the left lobe a 5×6×14 mm hypoechoic area was detected (Figure 1). Fine needle aspiration and biopsy was performed from this area. On pathological analysis proliferation of Langerhans histiocytes with nuclear grooves in a background of scattered eosinophils was detected. Immunohistochemical staining for S-100, CD68 and CD1a were positive. Chemotherapy was administered to the patient.

Discussion: LCH is a rare neoplastic disease of the langerhans cells, which may involve various organs and systems. Thyroid involvement of LCH is rare with only a slow number of patients reported in the literature. The frequency of thyroid involvement was reported as 0.4% among all LCH patients. Diagnosis of thyroid LCH is quite challenging, but thyroid involvement of LCH should be kept in mind in patients suffering from LCH.