Langerhans cell histiocytosis (LCH) is characterised by a clonal proliferation of pathologic cells with the characteristics of Langerhans cells, in single or multiple organs.Methods
A 43 years old man was visited to our hospital for a routine health check-up. He had no symptoms, and his vital signs were normal. Physical examination revealed no abnormalities. He denied any past medical history and was not taking any medications. Laboratory examination findings also mostly were normal. Esophagogastroduodenoscopy showed a superficially elevated reddish polypoid lesion, less than 5 mm at the posterior wall, in the region of the fundus of the stomach, suggestive of fundic gland polyp, Yamada type I (figure 1a, b).Results
A cold biopsy was performed, and the histopathologic findings revealed many histiocytoid cells with indented nuclei and abundant eosinophilic infiltration in the deep mucosa (figure 1c, d). Immunohistochemically, the majority of the cells were strongly and diffusely positive for CD1a (figure 2a), S-100 (figure 2b), CD68 (figure 2c) and negative for cytokeratin (figure 2d). We, therefore, made the diagnosis of LCH of the stomach. Following the establishment of the diagnosis of LCH, a comprehensive workup was carried out to determine the extent of the disease, but there was no evidence of multisystem involvement. We performed ESD for complete removal of the lesion. But ESD specimen showed no remnant LCH lesion. The patient‘s 6 month follow-up visit revealed without local or systemic recurrence, and the patient remained in good health.Conclusions
This is a rare case of localised small gastric LCH detected by esophagogastroduodenoscopy, with the diagnosis confirmed by immunohistochemistry. The clinical characteristics of this disease remain unknown, and further detailed studies of a larger number of patients are needed.