Thyroid involvement in Langerhans Cell Histiocytosis (LCH) is rare. We report a 10-year-old Filipino male who presented with a rapidly enlarging goiter. Computed tomography scan showed thyroid and bilateral submandibular masses with malignant features, pulmonary blebs and hepatic cysts. Ultrasound-guided core needle biopsy findings were consistent with LCH and chemotherapy was initiated. This case demonstrates that LCH should be considered in patients with goiter. Multidisciplinary management is warranted to achieve proper diagnosis and institute timely treatment.
Histiocytosis, Langerhans-Cell ; Thyroid Gland

Background: Adolescent onset diabetes is currently showing different facets as far as phenotypic and autoimmune characteristics, clinical course, age at onset of the disease and prevalence of its different types are concerned. Alarming increase in the prevalence of type 2 diabetes (T2DM) has been reported from pediatric diabetes centers in North America and elsewhere in the world. Autoimmunity has been identified not only in type 1 adolescent diabetics but also among patients diagnosed clinically as type 2. Previous studies have shown that race or ethnic differences in this population can be identified. With the foregoing studies, we strongly believed that if significant associations can be made among the clinical, immunological and biochemical variables in this study, these associations can serve as guide for physicians in the management of adolescent onset diabetes.Objectives: To describe the phenotypic and immuno-biochemical characteristics of adolescent onset Filipino diabetic. Specifically to correlate the body mass index, acanthosis nigricans and age at onset of diabetes with C-peptide and anti-GAD antibody levels and to find association between anti-GAD and C-peptide levels.Study Design: Descriptive AnalyticalParticipants: Twenty six adolescent diabetics from Makati Medical Center, camp COPE, and Philippine General Hospital Section of Pediatric Endocrinology service patients were included in the study.Results: A total of 26 subjects were included in the study. The mean age was 15.2 years old with male preponderance (17/26; 65%). Mean age at onset of diabetes mellitus was 12.34 years (range 10 - 18 years) BMI ranged from 13.95 to 39.5 (mean 32.4 kg/m2). Seven (27%) were obese and two (8%) were overweight. The waist circumference ranged from 54 - 126 cm (mean of 73.2), the hip circumference ranged from 54 to 114 cm while the waist to hip ratio ranged from 0.85 to 1.1 cm (mean of 0.97). In six cases (23%) acanthosis nigricans was present while 2 subjects has elevated pressure (8%). Using the NCEP III Criteria, only three subjects (11.5%) fulfilled the criteria for metabolic syndrome. Nine subjects were positive for the anti-GAD antibody while 17 subjects (65%) had normal values. C-peptide values and anti-GAD titers did not significantly vary among obese/ overweight adolescents and non obese. A statistically higher ne underweight / normal BMI than those who are obese had low C-peptide values (13 versus 6), while those with high C-peptide values, a higher frequency were overweight (6 versus 3). (p=0.41). There is a negative or inverse statistical correlation between C-peptides and anti-GAD titers, although the relationship is weak. (r = .127, p=.06).Conclusion: The mean BMI of the adolescent onset Filipino diabetics is 21.4 kg/m2, with mean waist circumference of 73.2cm and mean waist to hip ratio of 0.97cm. Eleven percent of the population has metabolic syndrome. Body mass index has no statistically significant correlation with anti-GAD antibody and C peptide level. However, higher number of patients who are underweight or with normal BMI has low C-peptide levels. Twenty three percent of the population has acanthosis nigricans and 75% of them are obese diabetics with elevated C peptide. A trend towards inverse relationship between anti-GAD antibody levels and C-peptide levels has been identified which needs further studies.
Human ; Adolescent Onset Diabetes ; Diabetes Mellitus