case_images: PMC9353717_01
case_images: (A) Photomicrograps of a low power image showing an inflammatory in filtrate composed of Langerhans cells lymphocytes (Hex 4). (B) The clusters of Langerhans cells are accompanied by lymphocytes and an occasional eosinophil (HE x10). (C) The nuclear morphology exhibited by the Langerhan cells, which have relatively uniform was positive to Langerin (D), S-100 protein (E) and to CD1a (F), and Ki-67 (G) antigen markers (x 20). Immunostains for IgH (H) and IgG4 (I) show an IgG4/IgG ratio <40 %, some immune cells were positive and stained, but no positive cells were found in the Langerhans (x 10).
case_images: fendo-13-896227-g001.jpg
case_images: PMC9353717_01_fendo-13-896227-g001.jpg
case_images: f1
case_images: The timeline is shown to better follow the case from symptom onset to final treatment ( Supplementary Figure S1 ). The results suggested an epithelial neoplasm, with heavy eosinophilic infiltration ( Figures 1A-C) , for which immunohistochemistry showed that the Langerhans cells expressed CD207 (langerin) ( Figure 1D ), S-100 ( Figure 1E ), CD1a ( Figure 1F ), and Ki67 ( Figure 1G ), but were negative for IgG4 ( Figure 1H ) and IgG ( Figure 1I ).
case_images: (A) Magnetic resonance image of pituitary gland showd the nodular thickening and enhancement of the hyphothalamus, and the pituitary itself became thinner. PET-CT showed the metabolism of hypothalamus was higher (B); the volume of bilobe thyroid and metabolism increased (C); multiple lymph nodes icreased and metabolism increased, bone marrow metabolism slightly increased (D); multiple slightly low density shadows in the liver (E); bilateral tonsil metabolism increased (F) before chemotherapy.
case_images: fendo-13-896227-g002.jpg
case_images: PMC9353717_01_fendo-13-896227-g002.jpg
case_images: f2
case_images: MRI of the pituitary suggested nodular thickening and enhancement of the hypothalamus ( Figure 2A ). Nodular thickening of hypothalamus and increased metabolism ( Figure 2B ); 2. The volume of bilobed thyroid increased and metabolism increased ( Figure 2C ); 3. Multiple lymph nodes increased (bilateral neck, mediastinum paratracheal, hilar region, portal space, retroperitoneum, bilateral iliac vascular), increased metabolism ( Figure 2D ); 4. Multiple slightly low density shadows in the liver, increased uneven metabolism ( Figure 2E ); 5. Bilateral tonsil metabolism increased, and bone marrow metabolism uneven slightly increased ( Figure 2F ). Comparison with previous PET/CT ( Figures 2B-F) : 1.
case_images: PET-CT showed hyphothalamic nodule was thickened and the metabolism of hypothalamus was higher (A); the volume and metabolism of thyroid gland decreased (B); the range of primary lesions and the metabolism was significantly reduced, the metabolism of bilateral tonsils and bone marrow was similar to the previoud (C); metabolism of the multiple foci in the liver subsided (D) after chemotherapy.
case_images: fendo-13-896227-g003.jpg
case_images: PMC9353717_01_fendo-13-896227-g003.jpg
case_images: f3
case_images: Hypothalamic nodule was thickened, and slightly larger than before; the metabolism of hypothalamus was higher ( Figure 3A ); 2. The volume and metabolism of thyroid gland decreased ( Figure 3B ); 3. The range of primary lesions (neck, mediastinum, and abdominal lymph nodes) was significantly reduced, and the metabolism was significantly reduced/subsided ( Figure 3C ); 4. Metabolism of the multiple foci in the liver subsided ( Figure 3D ); 5. The metabolism of bilateral tonsils and bone marrow was increased, which was similar to the previous ( Figure 3C ).