Langerhans Cell Histiocytosis Langerhans Cell is a dendritic white cell with a wavy nucleus that creates granulomas and infiltrates the interstitium. It thus causes spiculated nodules that appear as spiculated nodules on CT Ashley Davidoff TheCommonVein.net Smoking in Two Puff Harmony From the series “People of Israel” Ashley Davidoff MD TheCommonVein.net Membranous airways (respiratory bronchiole, alveolar ducts, alveolar sacs) At the level of the membranous airways the effect is predominantly related to the loss of elasticity, and aberrant accumulation of smoking related macrophages. The weakening and destruction results in emphysema and the abnormal accumulation of smoking related macrophages relates to DIP Ashley Davidoff TheCommonVein.net
The Bronchocentric Nodule
Image a shows a normal bronchiole. Smoking excites the Langerhans cell which in turn induces attracts early cellular interstitial infiltrates of surrounding the bronchiole (b) including lymphocytes, macrophages, eosinophils, plasma cells, and fibroblasts. The cellular infiltrate progresses in a peribronchial pattern with mass effect on the bronchiole which becomes narrowed (c) and eventually disappears, a nodules of varying size manifest in the bronchiole pathway, sometimes round but often spiculated as the inflammatory reaction extends into the interstitium (d) The wall of the bronchiole breaks down and the cellular infiltrate may undergo necrosis resulting in thick walled cavities, sometimes round in shape (e) and sometimes with bizarre shapes (f) Eventually the inflammation recedes and a thin walled cyst remains (g ,h) Ashley Davidoff MD TheCommonVein.net
Florid Early Phase
Bronchocentric Nodules = Inflammatory Changes Around the Bronchus
Smoking excites the Langerhans cell which in turn induces and attracts early cellular interstitial infiltrates which surround the bronchiole. The diagram shows a bronchiole surrounded by an acute cellular inflammatory response Ashley Davidoff MD TheCommonVein.net lungs-0722
Tree in Bud and Peribronchial Nodules with a Hint of Central Cavitation ie Bronchocentricity
As the inflammatory response progresses it has mass effect on the bronchiole causing the bronchiole to become narrowed. Ashley Davidoff MD TheCommonVein.net lungs-0723 The inflammatory response is often aggressive and may infiltrate the surrounding interstitium resulting in a spiculated appearance. As the inflammatory response progresses it has mass effect on the bronchiole causing the bronchiole to become narrowed. Ashley Davidoff MD TheCommonVein.net lungs-0723b
Stellate Appearance Because of Infiltration of the Inflammatory Process into the Interstitium
It may become a Solid Nodule as It Obliterates the Lumen
As the inflammatory response progresses it has mass effect on the and may eventually occlude the bronchiole becoming a nodule. Ashley Davidoff MD TheCommonVein.net lungs-0724b The inflammatory response is often aggressive and may infiltrate the surrounding interstitium resulting in a spiculated appearance Ashley Davidoff MD TheCommonVein.net lungs-0724
Wall Starting to Break Down Creating a Thick Walled Cyst
The wall of the bronchiole breaks down and the cellular infiltrate may undergo necrosis resulting in thick -walled cavities, sometimes round in shape. Ashley Davidoff MD TheCommonVein.net lungs-0725
Sometimes with Bizarre Shapes
The wall of the bronchiole breaks down and the cellular infiltrate may undergo necrosis resulting in thick -walled cavities, sometimes bizarre in shape. Ashley Davidoff MD TheCommonVein.net lungs-0726
With Time Inflammation Settles and There is Thinning of the Walls of the Cysts
As the inflammatory response subsides, thin-walled cavities evolve. Ashley Davidoff MD TheCommonVein.net lungs-0728b -hi res As the inflammatory response subsides, thin-walled cavities evolve, sometimes bizarre in shape. Ashley Davidoff MD TheCommonVein.net lungs-0728b
