Isolated Langerhans' cell histiocytosis of the spine: A diagnostic and therapeutic challenge
Al-Asiri, R.H.; Van Dijken, P.J.; Al-Wagga, M.; Msaddi, A.; Al-Shahed, M.
Saudi Medical Journal 19(4): 507-509
1998
ISSN/ISBN: 0379-5284 PMID: 27704129 Document Number: 488568
In this report we present two cases of vetebra plana as seen in Langerhans' cell histiocytosis. In the first patient repeated biopsies showed nonspecific changes leading us to conclude in retrospect that he was in the healing phase of Langerhans' cell histiocytosis. In the second patient a biopsy was not done as the vertebral lesion was regarded as typical for Langerhans' cell histiocytosis. Both patients remained well and free of symptoms after 4 and 3 years of careful followup, respectively. We conclude that patients with vertebral Langerhans' cell histiocytosis are at risk to undergo unnecessary investigations and therapy. Even histology can be misleading because the disease may be inactive and/or in the healing phase. In selected cases of isolated vertebra plana typical of Langerhans' cell histiocytosis, a biopsy is not needed. In such cases close follow up and monitoring of disease activity would be the ideal approach.