Case Report
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World J Gastroenterol. Mar 28, 2012; 18(12): 1410-1413
Published online Mar 28, 2012. doi: 10.3748/wjg.v18.i12.1410
A rare case of langerhans cell histiocytosis of the gastrointestinal tract
Uday Shankar, Monika Prasad, Om P Chaurasia
Uday Shankar, Monika Prasad, Internal Medicine, Mount Sinai School of Medicine at Queens Hospital Center, Jamaica, NY 11432, United States
Om P Chaurasia, Department of Medicine, University of California, Irvine, CA 92697, United States
Author contributions: All the authors have contributed in the literature review process and in writing the article.
Correspondence to: Uday Shankar, MD, Chief Resident, Department of Medicine, Queens Hospital Center, 82-68 164th Street, Jamaica, NY 11432, United States. dr.ushankar@gmail.com
Telephone: +1-718-8834052 Fax: +1-718-8836298
Received: January 18, 2011
Revised: July 28, 2011
Accepted: February 27, 2012
Published online: March 28, 2012
Abstract

Langerhans cell histiocytosis (LCH) is a group of idiopathic disorders characterized by the proliferation of specialized, bone marrow-derived langerhans cells and mature eosinophils. The clinical spectrum ranges from an acute, fulminant, disseminated disease called Letterer-Siwe disease to solitary or few, indolent and chronic lesions of the bone or other organs called eosinophilic granuloma. Involvement of the gastrointestinal tract is very rare in LCH. We present the case of a 53-year-old woman referred by her primary care physician for a screening colonoscopy. A single sessile polyp, measuring 4 mm in size, was found in the rectum. Histopathological examination revealed that the lesion was relatively well circumscribed and comprised mainly a mixture of polygonal cells with moderate-to-abundant pink slightly granular cytoplasm. The nuclei within these cells had frequent grooves and were occasionally folded. Immunohistochemical staining was positive for CD-1a which confirmed the diagnosis of LCH. On further workup, there was no evidence of involvement of any other organ. On follow up colonoscopy one year later, there was no evidence of disease recurrence. Review of the published literature revealed that LCH presenting as solitary colonic polyp is rare. However, with the increasing rates of screening colonoscopy, more colonic polyps may be identified as LCH on histopathology. This underscores the importance of recognizing this rare condition and ensuring proper follow-up to rule out systemic disease.

Keywords: Langerhans cells; Histiocytosis; Colonic polyp; CD-1a; Eosinophilic granuloma; Screening; Colonoscopy