Key result
Langerhans cell histiocytosis more commonly involved the mastoid (82% vs 33%, P=0.001), whereas rhabdomyosarcoma more frequently involved only the anterior temporal bone (55% vs 7.1%, P=0.018).
Why the study?
Does imaging appearance and location within the temporal bone differentiate pediatric rhabdomyosarcoma from Langerhans cell histiocytosis?
Observational (n=21)
No
Does imaging appearance and location within the temporal bone differentiate pediatric rhabdomyosarcoma from Langerhans cell histiocytosis?
Absolute Event Rate: 82% vs 33%
p-value: p=0.001
Lesions involving only the anterior portion of the temporal bone are more likely to be rhabdomyosarcoma, whereas those involving the mastoid are more likely to be Langerhans cell histiocytosis.
Anterior temporal bone lesions may favor RMS over LCH on imaging; hypothesis-generating and requires prospective validation before guiding diagnosis.
BACKGROUND AND PURPOSE: Rhabdomyosarcoma and Langerhans cell histiocytosis are malignant lesions that can affect the skull base with similar radiographic characteristics on CT and MR imaging. We hypothesized that location within the temporal bone determined radiographically can provide useful adjunctive information in differentiating these distinct neoplasms. MATERIALS AND METHODS: We identified patients with Langerhans cell histiocytosis and rhabdomyosarcoma by using an imaging data base and International Classification of Diseases, Ninth Revision codes at a tertiary care academic medical center. Cross-sectional images were reviewed by a neurotologist and neuroradiologist, who evaluated the location of the lesions and scored each subsite-middle ear, mastoid, petrous apex, retrosigmoid/posterior fossa-on a scale of 0 (no involvement), 1 (partial), or 2 (complete involvement). RESULTS: We identified 12 patients representing 14 cases of Langerhans cell histiocytosis, and 9 patients representing 9 cases of rhabdomyosarcoma. For patients with Langerhans cell histiocytosis, mastoid involvement was rated 23/28 (82%) compared with 6/18 (33%) with rhabdomyosarcoma (P = .001). Langerhans cell histiocytosis was present in only the anterior portion of the temporal bone (petrous apex and middle ear) in 1 case (7.1%) and in the anterior portion of the temporal bone only in 5/9 (55%) cases of rhabdomyosarcoma (P = .018). The cortical bone was more commonly involved in Langerhans cell histiocytosis, 11/28 (39%) of cases compared with 2/18 (11%) cases in rhabdomyosarcoma (P < .05). CONCLUSIONS: These results indicate that lesions involving only the anterior portion of the temporal bone (petrous apex and middle ear) are more likely to be rhabdomyosarcoma. Lesions involving the mastoid are more likely to be Langerhans cell histiocytosis. This difference in primary location may be helpful in predicting the pathology of these lesions on the basis of imaging.
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Chevallier et al. (2016) conducted an observational in Pediatric Rhabdomyosarcoma and Langerhans Cell Histiocytosis of the Temporal Bone (n=21). Langerhans cell histiocytosis vs. Rhabdomyosarcoma was evaluated on Mastoid involvement on cross-sectional imaging (p=0.001). Langerhans cell histiocytosis more commonly involved the mastoid (82% vs 33%, P=0.001), whereas rhabdomyosarcoma more frequently involved only the anterior temporal bone (55% vs 7.1%, P=0.018).
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