PMC8214889_01
A - Thyroid gland with classic papillary thyroid carcinoma (H&E,40x); B - Cytologic preparation showing cells with reniform nuclei and abundant eosinophilic cytoplasm, the nuclei show prominent grooving (Arrows) (PAP stain 40x); C and D - Positivity for CD68 and CD1a immunostains, respectively done on the cell block (20x).
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Microscopic examination revealed classic papillary thyroid microcarcinoma in multi-nodular goiter (Figure 1A). The nuclei displayed prominent grooving but no nuclear pseudoinclusions (Figure 1B).
Chest CT scan, A and B - axial plane- with tiny pulmonary nodules and cysts (arrows) involving both lungs, likely due to pulmonary Langerhans cell histiocytosis. C and D - Coronal plane - showing pulmonary cysts and nodules.
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Subsequently, a chest CT scan was performed and revealed small pulmonary nodules and cysts affecting both lungs, primarily seen in the lower lobes, likely due to pulmonary Langerhans cell histiocytosis (Figure 2).
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A and B - Bone marrow biopsy with multifocal lesions composed of histiocytic cells with grooved nuclei admixed with multinucleated giant cells and foamy histiocytes in the background with eosinophils and plasma cells (20x and 40x). The histiocytic cells are immunoreactive for S100 and CD1a in C and D, respectively (40x).
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Four years later, the patient presented with anemia leukocytosis, and bone marrow biopsy showed marrow involvement by Langerhans cell histiocytosis (Figure 3).