PMC7519281_01
Radiograph of the right clavicle at the initial X-ray: Anteroposterior view : an approximately 1.6 cm sized osteolytic lesion is seen.
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On the simple radiograph (Fig. 1) and the computed tomography(Fig. 2), an osteolytic lesions with the size of 1.6 cm in diameter was observed at the midportion of right clavicle, accompanied by periosteal reaction.
On Bone scan, focal hot uptake is noted in the right clavicle.
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In the whole-body bone scan, partial increase in uptake rate on the right clavicle was found, while no increase in other sites (Fig. 3).
Shoulder MRI. An low intensity lesion is noted at the mid shaft of right clavicle of T1-WI (a), high intensity lesion in T2-WI (b), and high intensity lesion in enhanced T1 -WI (c). Multiple Lymph node enlargement is also observed in the right neck and axillary areas.
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T2-weighted magnetic resonance image, a 1.6 cm-sized, homogeneously enhanced mass was found at the periphery of the midportion of the right clavicle (Fig. 4). The findings of cortical bone destruction were not prominent, while the findings of MRI suggested the possibilities of Ewing's sarcoma, malignant hematologic malignancy (especially multiple myeloma) and osteomyelitis.
(A) Histologic examination of resected specimen reveals fibro-osseous tissue replaced by dense inflammatory cell infiltrations (H&E, x100).. (B) At high power view, some characteristic Langerhans cells with distinct acidophilic cytoplasm were noted in the background of a heterogeneous admixture of eosinophils, plasma cells, neutrophils and lymphocytes (H&E, x400).. (C) Immunohistochemical study shows strong membranous positivity of CD1a and (D) cytoplasmic positivity of S-100 (x200).
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With these overall findings, the patient was confirmed with a diagnosis of LCH (Fig. 5).
Post operative radiograph of the right clavicle taken 10 months after surgery: Anteroposterior view: osteolytic lesion disappeared and consolidation of bone graft with significant homogeneity.
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At 10 months postoperative follow-up, the radiologic findings suggested that surgical site was sufficiently healed with no evidence of recurrence even in other sites of the body (Fig. 6).