Which conditions are included in the differential diagnoses of Langerhans cell histiocytosis (LCH) with bone involvement?

Updated: Sep 16, 2020
  • Author: Cameron K Tebbi, MD; Chief Editor: Vikramjit S Kanwar, MBBS, MBA, MRCP(UK), FAAP  more...
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Answer

Bone involvement

The differential diagnoses of bone lesions include malignant disorders (eg, metastatic neoplasms), neuroblastomas, primary sarcomas of the bone, and even leukemias. The lesions of Langerhans cell histiocytosis can involve any bone and may be singular or multicentric. [218, 219]

Other lesions that radiologically produce bone defects must be considered. These include congenital disorders, such as meningioma, hemangioma, neurofibromatosis, congenital or developmental defect (eg, lacunar skull), parietal foramina, parietal thinning, pacchionian depressions, primary cholesteatoma, arachnoid cyst, dermoid cyst, meningocele or encephalocele, arteriovenous malformation, fibrous dysplasia, cysts, sarcoidosis, hyperthyroidism, and radiation necrosis.

Because the initial signs and symptoms of patients with bone disease often include local pain and swelling, [218, 220] infections such as osteomyelitis and tuberculosis (TB) should be considered. Paget disease and calvarial doughnut, although rare, must also be included in the differential diagnosis of bone lesions.


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