Photoclinic Diagnosis: Langerhansʹ Cell Histiocytosis

A37-year-old man presented with symptoms presumably related to peptic ulcer disease. Further workup, however, including ultrasonography and CT scan, demonstrated multiple hepatic nodules. His past medical and drug histories were both unremarkable. Most of the routine laboratory tests proved to be normal, except for a WBC count of 14200 cell/μL and a serum alkaline phosphatase level of 760 U/L (normal range in adults: 40 – 140 U/L). A presumptive diagnosis of multiple liver metastases was made, leading to an exploratory laparotomy in order to better explore the lesions hilar nodes. The liver lobes harbored multiple nodules. Upon closer inspection, the remaining organs were free of any tumor involvement.