Respir Case Rep. 2016; 5(1): 38-42 | DOI: 10.5505/respircase.2016.78309

Pulmonary Langerhans Cell Histiocytosis Imitating Metastatic Lung Carcinoma

Funda Coþkun¹, Feyza Sen², Ahmet Ursavas¹, Ahmet Sami Bayram³, Ömer Yerci⁴, Sinem Kantarcýoðlu Coþkun⁴, Eray Alper², Mehmet Karadað^1
1Department of Pulmonology, Uludað University, Faculty of Medicine, Bursa, Turkey
²Department of Nuclear Medicine, Uludað University, Faculty of Medicine, Bursa, Turkey
³Department of Chest Surgery, Uludað University, Faculty of Medicine, Bursa, Turkey
⁴Department of Pathology, Uludað University, Faculty of Medicine, Bursa, Turkey

Pulmonary Langerhans cell histiocytosis (PLCH) is a rarely seen disease. We think our case is worthy of publication due to its presentation with anamnesis and clinical findings very similar to metastatic pulmonary carcinoma, from the patient’s admittance to the clinic until the thoracosopic evaluation. A 40-year-old male patient was admitted with a compliant of lower back pain. Five or six round lesions with regular contours in both lungs on the left and lower zone, the largest with dimension of 2cm, were observed on the patient’s thoracic CT examination. During bronchoscopy, a vegetant tumoral mass was detected in left lower lobe apical segment. Mucosal tissue samples containing pseudostratified respiratory epithelium, seromucous glandular structures in the submucosa, surrounding eosinophilic leukocytes and lymphoplasmocytic inflammatory infiltration were detected in the transbronchial biopsy. Significantly increased FDG enhancement was observed in the posteromedial pleural based mass located in the left lung lower lobe bronchus contiguity in the PET-CT examination (SUVmax: 14.9). Wedge resection was performed, as the diagnosis was not established following bronchoscopy examinations. Pathological diagnosis was compatible with PLCH. We thought our case worthy publication as the disease is seen rarely in adulthood and furthermore the clinical presentation imitated pulmonary carcinoma.

Keywords: Langerhans cell histiocytosis, lung cancer, PET.

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Metastatik Akciðer Karsinomunu Taklit Eden Pulmoner Langerhans Hücreli Histiositoz

Funda Coþkun¹, Feyza Sen², Ahmet Ursavas¹, Ahmet Sami Bayram³, Ömer Yerci⁴, Sinem Kantarcýoðlu Coþkun⁴, Eray Alper², Mehmet Karadað^1
1Uludað Üniversitesi Týp Fakültesi, Göðüs Hastalýklarý Anabilim Dalý, Bursa
²Uludað Üniversitesi Týp Fakültesi, Nükleer Týp Anabilim Dalý, Bursa
³Uludað Üniversitesi Týp Fakültesi, Göðüs Cerrahisi Anabilim Dalý, Bursa
⁴Uludað Üniversitesi Týp Fakültesi, Patoloji Anabilim Dalý, Bursa

Pulmoner Langerhans hücreli histiositoz (PLHH) nadir görülen bir hastalýktýr. Kliniðe baþvuru anýndan kesin tanýya ulaþýlana dek metastatik akciðer kanserini düþündüren olgu, nodüler akciðer lezyonlarýnýn ayýrýcý tanýsýnda histiositozun da düþünülmesini hatýrlattýðýndan sunmayý uygun bulduk. Kýrk yaþýnda erkek hasta bel aðrýsý ile baþvurdu. Toraks tomografisinde her iki akciðerde solda orta ve alt zonda ve en büyüðü yaklaþýk 2 cm çapýnda olan 5-6 adet düzgün sýnýrlý yuvarlak lezyonlar izlenmekteydi. Bronkoskopisinde sol alt lob apikal segmentte vejetan tümöral kitle saptandý. Biyopsisinde psödostratifiye solunum epiteli ile döþeli mukozal doku örnekleri, submukozal alanda serömüköz bez yapýlarý çevrede eozinofil lökosit, lenfoplazmositer iltihabi hücre infiltrasyonu saptandý. PET-CT’sinde sol akciðer alt lob bronþu komþuluðunda posteromedial plevral tabanlý kitlede belirgin artmýþ FDG tutulumu izlenmekteydi (SUVmax: 14,9). Yapýlan bronkoskopilerin sonucunda taný gelmemesi üzerine hastaya sað akciðerden wedge rezeksiyon uygulandý. Patolojik taný PLHH ile uyumlu geldi. Olgumuzu yaygýn tutulumun eriþkin yaþta nadir görülmesi ve özellikle akciðer karsinomunu taklit edici klinik tablo nedeniyle yayýnlamayý uygun gördük.

Anahtar Kelimeler: Langerhans hücreli histiositoz, akciðer kanseri, PET.

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