LCH of Bone : Mandible
Jaws are affected in 10%-20% of all cases of Langerhans cell histiocytosis (LCH). Patients present with dull ache and tenderness at the site of the lesion. Within mandible, the lesion is usually seen in posterior areas. It has a scooped-out appearance on imaging when superficial alveolar bone is destroyed.
Extensive bone destruction leads to loosening of teeth and they appear to float in air in a background of sharply punched-out osteolytic lesion on plain films. The clinical picture may resemble severe periodontitis. The disease process may extend beyond bone to produce ulcerative lesion or a proliferative gingival mass, as was the situation in this case. Note the hyperplastic gingival mucosa. The submucosa contained extensive fibrosis, Langerhans cell infiltrate as well as other inflammatory cells.