Localızed langerhans' cell hıstıocytosıs of the chest treated surgıcally
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Langerhans' cell histiocytosis is characterized by a wide spectrum of clinical manifestations, depending on the localized or diffuse form of the disease. This report describes a 27-year-old male patient, a heavy smoker, who presented with a localized bone lesion in the anterior aspect of the right 9th rib. The cardinal symptom was pain in the right lower hemithorax, aggravated by respiratory movements, without any pulmonary or systemic manifestations. A CT scan of the thorax showed a lytic lesion of the right 9th rib. Lung parenchyma was normal. A bone scan showed increased uptake by the anterior aspect of the 9th rib, but no other abnormality. Surgical excision of the involved segment of the right 9th rib was performed. Histological examination of the operative sample showed the characteristic Langerhans' cells. The diagnosis of Langerhans' cell histiocytosis was confirmed by immuno-histochemical stain of the bone tissue and detection of S-100 protein, which is considered diagnostic. During a 6-year follow-up period, the patient remained asymptomatic, without any evidence of recurrence. Localized Langerhans' cell histiocytosis of the bone, if accessible as in our case, may be treated effectively by surgical excision.