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126:Intralesional Steroid Injections For The Treatment Of Oral Langerhans Cell Histiocytosis[AAOM2021]
EP36070
Poster Title: 126:Intralesional Steroid Injections For The Treatment Of Oral Langerhans Cell Histiocytosis[AAOM2021]
Submitted on 29 Mar 2021
Author(s): Dennis Shem, Andrew Pischek, Annu Singh, Cherry Estilo
Affiliations: Memorial Sloan Kettering Cancer Center, United States of America
This poster was presented at 2021 American Academy of Oral Medicine Virtual Conference
Poster Views: 254
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Poster Information
Abstract: Background: Langerhans Cell Histiocytosis (LCH) is a rare histiocytic neoplasm that most commonly affects the pituitary glands, bone, and soft tissue. Over 50% of these cases harbor BRAF mutations which has led to developments in targeted therapy to treat systemic disease. Oral manifestations of LCH may include lytic bone lesions, advanced periodontal disease, and ulcerations of the mucosa. Intraoral steroid injections have been documented for the treatment of localized disease.

Case Summary: The patient is a 44-year-old female with recurrent LCH of the submandibular gland diagnosed in 2017. She was given the option to pursue cytarabine or clinical trial on cobimetinib. She ultimately completed cytarabine therapy in November 2018, with residual disease on PET imaging localized to the submandibular and thyroid glands. At this time, she was referred to the Dental Service of Memorial Sloan Kettering Cancer Center in February 2019 for dental evaluation prior to possible radiation therapy. On examination, the patient was found to have erythematous ulceration of her hard palate and gingiva with associated bone loss around the maxillary left premolars. A biopsy of the hard palate lesion was taken revealing LCH. She denied radiation therapy or additional systemic therapy as she had otherwise stable disease aside from these foci. In discussion with her medical oncologist, the patient was offered intralesional steroid injections to the hard palate and gingival lesions. We began monthly intralesional injections with triamcinolone 40mg/ml from June 2019 to February 2020 with improvement in the size of the lesions. Due to the COVID-19 pandemic she had a break in her treatment. In addition, she developed an abscess associated with the involved teeth that required an additional break. She has since recovered and resumed steroid injections as of January 2021 with good response and is free of symptoms at this time.

Conclusion: We document a case with 2-year follow-up of a patient receiving intralesional steroid injections to treat intraoral focally recurrent LCH with improvement and subsequent regression once steroids were discontinued. Dental practitioners can play a role in maintaining patients who are not being treated with systemic interventions for LCH.
Summary: Langerhans Cell Histiocytosis (LCH) is a rare histiocytic neoplasm that most commonly affects the pituitary glands, bone, and soft tissue. Over 50% of these cases harbor BRAF mutations which has led to developments in targeted therapy to treat systemic disease. Oral manifestations of LCH may include lytic bone lesions, advanced periodontal disease, and ulcerations of the mucosa. Intraoral steroid injections

Ask the author questions about this poster:drdshem@gmail.com
References: • Egeler RM, et al. 1992. Intralesional infiltration of corticosteroids in localized langerhans' cell histiocytosis. Journal of Pediatric Orthopaedics.
• Emile J-F, et al. 2016. Revised classification of histiocytoses and neoplasms of the macrophage-dendritic cell lineages. Blood.
• Lee S-H, Yoon H-J. 2013. Intralesional infiltration of corticosteroids in the treatment of localized langerhans cell histiocytosis of the mandible: Report of two cases. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology.
• Neves-Silva R, et al. 2018. Oral manifestations of langerhans cell histiocytosis: A case series. Special Care in Dentistry.
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