以尿崩症为首发症状的多系统郎格汉斯细胞组织细胞增生症一例并文献复习

摘要

目的 探讨郎格汉斯细胞组织细胞增生症(LCH)的临床特点、诊断及治疗,进一步提高对LCH的认识.方法 回顾分析1例以中枢性尿崩症为首发症状的多系统LCH患者的临床症状、实验室检查、影像学检查及病理和免疫组织化学结果,并复习相关文献.结果 患者早期以中枢性尿崩症起病8年,数年间逐步发展为肋骨、肢体长骨多发损害,肝、脾、淋巴结侵犯,通过胫骨及淋巴结活组织检查示正常组织结构破坏,具有典型形态学特征的郎格汉斯细胞局灶性增生,该细胞核型不规则,扭曲、分叶,可见特征性的核沟纹(咖啡豆样核),免疫组织化学示表达S-100、CD1a、Langerin,明确诊断为多系统LCH.结论 LCH临床表现及生物学行为呈明显的异质性,既可以表现为孤立的溶骨性损害(如嗜酸性肉芽肿),也可表现为白血病样侵袭性的病程.LCH损害可累及全身所有器官,典型的LCH累及骨骼较为多见.以累及垂体前后叶并以中枢性尿崩症起病的多系统LCH症状较为隐匿,容易延误诊断,LCH导致的神经内分泌损害需要终生的激素替代治疗.%Objective To study the clinical features and differential diagnosis of Langerhans cell histiocytosis (LCH).Methods A case of LCH was reported and the literatures were reviewed.Results The of multisystem LCH patient,presented with a diabetes insipidus (DI) and panhypopituitarism,was 44 years old,and developed costal,tibial and femoral multiple lesions.The final diagnosis as LCH was made based on biopsy of tibia and lymph nodes.The biopsy specimen showed that the cells were infiltrated exhibiting the characteristic morphologic features of Langerhans cell (LC) with a convoluted shape,elongated nuclei exhibiting longitudinal grooves,and immunohistochemistry results revealed positive LC for the S-100,CD1a and Langerin immunostaining.Conclusions LCH may range from a solitary lytic bone lesion (for example eosinophilic granuloma) with a favorable course to a fatal disseminated leukaemia-like form.LCH typically involves the bone,lesions almost can be found in all organs.DI and CNS involvement often present as a puzzling syndrome,which renders the diagnosis problematicly,and often delays the diagnosis of LCH.The damage to the pituitary/hypothalamus axis results in life-long hormonal replacement therapy.