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Solitary Langerhans cell histiocytosis of the external auditory canal
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  1. Andleeb Abrari1,
  2. Vandana Bakshi2
  1. 1Department of Histopathology, Max Super Specialty Hospital, New Delhi, India
  2. 2Department of ENT, New Delhi, India
  1. Correspondence to Andleeb Abrari, abrariand{at}gmail.com

https://doi.org/10.1136/bcr.10.2010.3447

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    Description

    The manifestations of Langerhans cell histiocytosis (LCH) are legion in both local and systemic variants. About 15–61% patients with LCH have otologic involvement; this manifestation is more frequent in children with multisystem disease and a primary manifestation in 5–25% of patients. Among otologic lesions, solitary external ear LCH, as the only site of clinically non-progressive disease, is very rare.1 2

    This case illustrates an instance of external ear canal LCH, initially managed without success as an eczematous lesion/seborrhoeic dermatitis for 8 months in a 3-year-old child; refractoriness of the lesion forced a biopsy, which on histopathology was diagnosed as LCH (figures 1 and 2).

    Figure 1
    Figure 1

    Polygonal cells with moderately abundant amphophilic to eosinophilic cytoplasm and irregularly contoured nuclei with longitudinal nuclear grooves pathognomonic for Langerhans cells.

    Figure 2
    Figure 2

    CD1a immune expression confirms these cells as Langerhans cells.

    The patient was found to have no bone lesion and no other focus on systemic survey.

    In children, this situation underpins the ineffable import of histological evaluation in all refractory/recalcitrant cases of ‘eczematoid’ lesions and a necessary honing of the suspicion index towards the possibility of LCH in such lesions.3

    References

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      . Eosinophilic granuloma of the head and neck: CT and MRI features in three cases. Pediatr Radiol 1994;24:33–6.
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      1. D'Ambrosio N,
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      . Craniofacial and intracranial manifestations of langerhans cell histiocytosis: report of findings in 100 patients. AJR Am J Roentgenol 2008;191:589–97.
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    Footnotes

    • Competing interests None.

    • Patient consent Obtained.