title: Langerhans's cell histiocytosis in old subjects: two rare case reports and review of the literature.
abstract: BACKGROUND
  Langerhans cell histiocytosis (LCH) is a proliferative disease of histiocyte-like cells that generally affects children; LCH onset is rare in adults; immunohistochemistry is essential to obtain the correct diagnosis, and treatment protocols are controversial.
  
  
  OBJECTIVE
  To describe two new cases of adult onset oral LCH.
  
  
  METHODS
  Case 1: a 71-year-old woman, complaining of diffuse oral pain, presented with erythematous mucosal lesions; the panoramic radiograph and CT scan showed multiple mandible radiolucent areas. Immunohistochemical assay for S-100, CD1a and langerin test was essential in reaching the correct diagnosis. Case 2: a 77-year-old female patient presented with a non-painful, non-bleeding, slightly elevated erythematous palatal lesion of 6 months duration, together with a genital vulvar lesion of uncertain nature. The pathology confirmed the diagnosis of LCH. Many therapies (etoposid, radiotherapy) could induce only a clinical partial remission; Cladribine induced a complete recovery.
  
  
  CONCLUSIONS
  The first case was difficult to diagnose: the clinical presentation and course of the disease (LCH) in the elderly are multiple and unpredictable. An immunohistochemistry study is often essential to obtain the correct diagnosis. The second case required several therapeutic interventions: even though some cases regress spontaneously, others require systemic chemotherapy.
authors.affiliation: School of Dentistry, Catholic University, Largo A. Gemelli, Rome, Italy. clajolo@hotmail.com
authors.forename: Carlo
authors.initials: C
authors.lastname: Lajolo
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Campisi
authors.forename: Giorgio
authors.initials: G
authors.lastname: Deli
authors.forename: Cristiano
authors.initials: C
authors.lastname: Littarru
authors.forename: Rosario
authors.initials: R
authors.lastname: Guiglia
authors.forename: Michele
authors.initials: M
authors.lastname: Giuliani
mesh_terms: D000368:Aged; D015703:Antigens, CD / Q000032:analysis; D018949:Antigens, CD1 / Q000032:analysis; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use; D017338:Cladribine / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004890:Erythema / Q000175:diagnosis; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D006646:Histiocytosis, Langerhans-Cell / Q000175:diagnosis*; D006801:Humans; D037181:Lectins, C-Type / Q000032:analysis; D008336:Mandibular Diseases / Q000175:diagnosis*; D037241:Mannose-Binding Lectins / Q000032:analysis; D009059:Mouth Diseases / Q000175:diagnosis*; D010159:Palate / Q000473:pathology*; D010510:Periodontal Diseases / Q000175:diagnosis; D018714:Radiotherapy, Adjuvant; D009418:S100 Proteins / Q000032:analysis; D014845:Vulvar Diseases / Q000175:diagnosis
chemical_list: D015703:Antigens, CD; D018949:Antigens, CD1; D000970:Antineoplastic Agents; D000972:Antineoplastic Agents, Phytogenic; C419393:CD1a antigen; C121916:CD207 protein, human; D037181:Lectins, C-Type; D037241:Mannose-Binding Lectins; D009418:S100 Proteins; D017338:Cladribine; D005047:Etoposide