This narrative review by DiCaprio and Roberts equips orthopedic surgeons with a practical framework for diagnosing and managing Langerhans cell histiocytosis (LCH) — a rare, histiocyte-driven disorder that frequently first presents with bone lesions to orthopedic surgeons. It covers the clinical spectrum from solitary eosinophilic granuloma to disseminated multisystem disease, with disease-specific treatment algorithms and prognosis.
When you see a radiolucent, permeative bone lesion in a child — especially with vertebral collapse or a "soap bubble" diaphyseal lesion — put LCH on your differential before assuming Ewing sarcoma or osteomyelitis; a core needle biopsy sent for CD1a/CD207 immunostaining is the key diagnostic step, and most solitary lesions require nothing more aggressive than curettage or corticosteroid injection.
This narrative review by DiCaprio and Roberts equips orthopedic surgeons with a practical framework for diagnosing and managing Langerhans cell histiocytosis (LCH) — a rare, histiocyte-driven disorder that frequently first presents with bone lesions to orthopedic surgeons. It covers the clinical spectrum from solitary eosinophilic granuloma to disseminated multisystem disease, with disease-specific treatment algorithms and prognosis.
When you see a radiolucent, permeative bone lesion in a child — especially with vertebral collapse or a "soap bubble" diaphyseal lesion — put LCH on your differential before assuming Ewing sarcoma or osteomyelitis; a core needle biopsy sent for CD1a/CD207 immunostaining is the key diagnostic step, and most solitary lesions require nothing more aggressive than curettage or corticosteroid injection.