NR8. INTRODUCTION A rare multisystem non Langerhans cell histiocytosis First described by Jakob...
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Transcript of NR8. INTRODUCTION A rare multisystem non Langerhans cell histiocytosis First described by Jakob...
NEUROLOGICAL MANIFESTATIONS OF THE ERDHEIM CHESTER DISEASE:
MRI FEATURES
S BOUABIDI, S JERBI OMEZZINE, Z KHADIMALLAH K MRAIDHA, B ZANTOUR* , HA HAMZA
DEPARTEMENT OF MEDICAL IMAGING TAHAR SFAR UNIVERSITY HOSPITAL CENTER, MAHDIA,TUNISIA
*DEPARTEMENT OF INTERNAL MEDICINE TAHAR SFAR UNIVERSITY HOSPITAL CENTER,MAHDIA,TUNISIA
NR8
INTRODUCTION
A rare multisystem non Langerhans cell histiocytosis
First described by Jakob Erdheim and William Chester in 1930
Since then less than 100 cases have been reported
Defined by the xanthomatous or xanthogranulomatous infiltration of tissues with foamy histiocytes, surrounded by fibrosis.
Clear increase in its incidence due a better understanding of its radiological semiology.
The aetiology remains unknown
The disease can affect multiple organs systems, including musculoskeletal, central nervous, cardiac, pulmonary and renal systems
The most common neurologic manifestation is central diabetes insipidus.
We report the case of adult-onset ECD with neurologic involvement
To study the MRI appearance of neurological lesions
Materials and methods :
A 50 year old woman Consulted for a polyuria-polydipsia syndrome Physical examination was normal except the presence of a xanthelasma lesions on the eyelidsA water restriction and a DHA test concluded to a central diabetes insipidus X -Rays , Brain MRI centered on the hypothalamic-pituitary axis were performed
Femur X –rays: Symmetric metaphyseal osteosclerosis
MRI brain showed:
Diffuse infiltration of the pituitary stalk massively enhanced after gadolinium injection
Disappearance of the normal T1 hyperintensity of the post hypophysis
Pituitary MRI, coronal T1:Homogeneous diffuse thickening of the pituitary stalk Normal cavernous sinus ( )
Pituitary MRI, coronal T1 GADO:Diffuse intense enhancement of the pituitary stalk( )
Pituitary MRI, sagittal T1GADO:Diffuse thickening of the pituitary stalk massively enhanced with gadolinium
Homogeneous enhancement of the posterior hypophysis
Characterestic radiological findings
+Histological features (a skin biopsy ) with a proliferation of foamy histiocytes that stain for CD68 but not CD1a
Confirmed the diagnosis
Discussion
ECD is a rare disease
A non-Langerhans' cell histiocytosis Defined by infiltration of foamy lipid-laden histiocytes that stain positively for CD68
With characteristic radiological and
histological features
Discussion
Extraskeletal manifestations including involvement of:
Hypothalamus-pituitary axis: diabetes insipidus Lung :diffuse pulmonary fibrosis Heart Retroperitoneum Skin Orbit Liver, Kidneys, Spleen
Discussion
Characterized by a bilateral symmetric sclerosis of the diametaphyseal regions of long bones
Radiographic studies reveal: Bilateral, patchy or diffuse increase in density Sclerosis, and cortical thickening Mainly in the metaphyses Minor changes or sparing of the epiphyses
Discussion
Neurologic Manifestations:
The most common neurologic manifestation is a central diabetes insipidus
The hypothalamic location was found in 40% of intracranial locations
Next in frequency is cerebellar symptoms, usually ataxia of gait.
MRI of the brain in patients with neurologic symptoms demonstrates:
Intra-axial lesions with T2 hyperintensity
Often intense gadolinium enhancement
The MRI findings mimic a demyelinating process and are often confused with multiple sclerosis
The MRI findings in patients with diabetes insipidus vary:
Often no structural changes are seen
Loss of the normal T1 hyperintensity of the posterior pituitary
Pituitary enhancement
Enlargement of the infundibulum
Orbital Manifestations
Infiltration of the retroconal fat Optic nerve sheath Retrobulbar, intraconal masses
Retroperitoneal Manifestations
Fat stranding Soft tissue masses Hydronephrosis leading to renal failure and hypertension Periaortic fibrosis
Pulmonary Manifestations:
The most common symptom is progressive dyspnea
Chest X-Rays :diffuse interstitial prominence and pleural thickening
CT typically shows: interlobular septal pleural thickening patchy centrilobular ground glass opacities
Prognosis and Therapy:
Related to the extent of visceral involvement
Most patients die within two to three years after diagnosis congestive heart failure, lung fibrosis or renal insufficiency
Treatment options: corticosteroids, radiotherapy, combination therapy
None have been highly effective
The disease is typically relentless in its course
Conclusion:
Erdheim Chester disease is a rare non-Langerhans Histiocytosis Characterized by a bilateral symmetric sclerosis of the diametaphyseal regions of long bones
With various extraskeletal manifestationsThe hypothalamic location was found in 40% of intracranial locationsThe typical features on imaging are often the basis of diagnosis, and should be well knownThe disease is typically relentless in its course.
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