Langerhans Cell Histiocytosis in Bilateral Mastoid Cavity

A 39-year-old male was admitted to our clinic with symptoms of headache, dizziness, nausea, otalgia, otorrhea, tinnitus, and hearing loss in both ears for 3 weeks. Physical examination revealed edema in the tympanic membrane and external ear canal, and pain by palpation in the mastoid area bilaterally. There was no nystagmus, and the rest of the physical examination was otherwise normal. Temporal bone high resolution computed tomography (CT) showed a lesion causing erosion in the mastoid cortex, tegmen tympani, ossicles, and in the bone covering the sigmoid sinus bilaterally. There was also erosion in the superior semicircular canal and petrous bone on the left side. Cortical mastoidectomy was performed under general anesthesia. Histopathologic examination of the tissue revealed Langerhans cell histiocytosis (LCH). In this paper a case with LCH, presenting with bilateral mastoid involvement which has been rarely reported in the literature, is discussed with the existing literature. 1. Introduction Langerhans cell histiocytosis (LCH) which originates from immature Langerhans cells is a clonal myeloproliferative disease with a variety of clinical presentations and prognosis. Although the lesions can be asymptomatic, it can present with swelling, pain, or pathological fractures in the site of involvement. In addition, there may be fever, loss of apatite, recurrent upper respiratory infections, cervical lymphadenopathy, otitis media, vertigo, facial paralysis, hearing loss, or hepatosplenomegaly. Mastoid bone involvement is not uncommon as well. Otologic involvement can be seen in 15% to 61% of the patients [1]. Although spontaneous recovery is possible in some cases, local curettage with or without postoperative radiotherapy is usually the choice of treatment. However, treatment of LCH includes surgical excision, radiotherapy, chemotherapy, and systemic corticosteroids either alone or indifferent combinations. Herein, we presented a case of LCH of the mastoid bone in an adult patient with bilateral aural involvement. 2. Case Report A 39-year-old man was admitted with headache, dizziness, nausea, and otalgia, otorrhea, tinnitus, and hearing loss in both ears for 3 weeks. On physical examination, there was edema in the tympanic membrane and external ear canal as well as pain by palpation in the mastoid area bilaterally. There was no nystagmus. The physical examination was otherwise normal. Complete blood count, blood biochemistry, and serology were unremarkable. Tympanometry revealed type B tympanogram and absence of stapes reflexes on both sides. On