Langerhans cell histiocytosis diagnosed in mediastinal lymph nodes by endoscopic ultrasound-guided fine-needle aspiration
DOI:
https://doi.org/10.23938/ASSN.1137Keywords:
Endoscopic Ultrasound-Guided Fine Needle Aspiration, Histiocytosis, Langerhans-Cell, Mediastinum, Cytological Techniques, BronchoscopyAbstract
A 57-year-old male smoker underwent endobronchial ultrasound-guided fine-needle aspiration due to increased radiotracer uptake on positron emission tomography. The cytopathologist prepared in situ smears for immediate (Diff-Quick) and definitive (Papanicolaou) evaluation. Solid tissue fragments and blood clots were used to create a cell block processed as a biopsy.
Cytological analysis revealed histiocytic cells with clefted nuclei expressing CD68, CD1a, Langerin, and S100, along with a numerous eosinophils, establishing the diagnosis of Langerhans cell histiocytosis. Accurate cytological identification of this entity in mediastinal lymph nodes remains a significant diagnostic challenge. This case underscores the importance of the cytopathologist´s active involvement in sample handling during the procedure to optimize material performance, enabling the use of ancillary techniques required for a comprehensive diagnosis, avoiding more aggressive diagnostic approaches.
Downloads
References
1. ALLEN CE, MERAD M, MCCLAIN KL. Langerhans-cell histiocytosis. N Engl J Med 2018; 379(9): 856-868. https://doi.org/10.1056/NEJMra1607548
2. YI ES, WEISS LM, GO RS. Haematolymphoid tumours of lung. En: Chan JKC, Wendy A. Cooper (eds). WHO Classification of tumours of the lung, pleura, thymus and heart (5th ed). Lyon (France): International Agency for Research on Cancer; 2021.
3. VASSALLO R, HARARI S, TAZI A. Current understanding and management of pulmonary Langerhans cell histiocytosis. Thorax. 2017; 72(10): 937-945. https://doi.org/10.1136/thoraxjnl-2017-210125
4. PHULWARE RH, GULERIA P, IYER VK, BAKHSHI S, SETH R, Mridha AR et al. Cytological diagnosis of Langerhans cell histiocytosis: A series of 47 cases. Cytopathol Off J Br Soc Clin Cytol 2019; 30(4): 413-418. https://doi.org/10.1111/cyt.12709
5. ZEPPA P, COZZOLINO I. Fine-needle cytology: Technical procedures and ancillary techniques. Monogr Clin Cytol 2018; 23: 4-13. https://doi.org/10.1159/000478877
6. GUPTA A, GUPTA P, GUPTA N, DHOORIA S, VAIDYA PC, PRABHAKAR N et al. Pulmonary Langerhans cell histiocytosis: Diagnosis in bronchoalveolar lavage liquid-based cytology samples. Acta Cytol 2024; 68(4): 379-383. https://doi.org/10.1159/000540011
7. KAKKAR S, KAPILA K, VERMA K. Langerhans cell histiocytosis in lymph nodes. Cytomorphologic diagnosis and pitfalls. Acta Cytol 2001; 45(3): 327-332. https://doi.org/10.1159/000327626
8. CHAKRABORTY R, BURKE TM, HAMPTON OA, ZINN DJ, LIM KPH, ABHYANKAR H et al. Alternative genetic mechanisms of BRAF activation in Langerhans cell histiocytosis. Blood 2016; 128(21): 2533-2537. https://doi.org/10.1182/blood-2016-08-733790
9. BALLESTER LY, CANTU MD, LIM KPH, SARABIA SF, FERGUSON LS, RENEE WEBB C et al. The use of BRAF V600E mutation-specific immunohistochemistry in pediatric Langerhans cell histiocytosis. Hematol Oncol 2018; 36(1): 307-315. https://doi.org/10.1002/hon.2388
10. NA JI, KIM JH, KIM HJ, KIM HK, MOON KS, LEE JS et al. VE1 immunohistochemical detection of the BRAF V600E mutation in thyroid carcinoma: a review of its usefulness and limitations. Virchows Arch Int J Pathol 2015; 467(2): 155-168. https://doi.org/10.1007/s00428-015-1773-0
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Anales del Sistema Sanitario de Navarra
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
La revista Anales del Sistema Sanitario de Navarra es publicada por el Departamento de Salud del Gobierno de Navarra (España), quien conserva los derechos patrimoniales (copyright ) sobre el artículo publicado y favorece y permite la difusión del mismo bajo licencia Creative Commons Reconocimiento-CompartirIgual 4.0 Internacional (CC BY-SA 4.0). Esta licencia permite copiar, usar, difundir, transmitir y exponer públicamente el artículo, siempre que siempre que se cite la autoría y la publicación inicial en Anales del Sistema Sanitario de Navarra, y se distinga la existencia de esta licencia de uso.
