The medical recommendations for adult LCH have been published in Orphanet Journal of Rare Diseases.

More ...
An­nu­al in­ter­na­tio­nal con­fe­rence of sci­en­tists, pa­tho­lo­gists and cli­ni­ci­ans discussing histiocytoses and their backgrounds. More ...
An International Community of Professionals Dedicated to Research and Treatment More ...
PubMed comprises more than 20 million citations for biomedical literature from MEDLINE, life science journals, and online books. More ...

European Union Clinical Trials Register of the European Medicines Agency

More ...

European Clinical Trials Database of the European Medicines Agency

More ...
Rare diseases in EU
Why do rare diseases need specific EU support? More ...
Euro Histio Net has received funding from the European Union, in the framework of the Public Health Programme. More ...
» Expert Histio Net » For Professionals » Guidelines » LCH adult » Pretreatment clinical evaluation » Laboratory / Radiographic evaluation  · 

Laboratory and radiographic evaluation

Author(s): Euro Histio Net Work Group for LCH Guidelines for adults (see introduction page), Created: 2012/07/26, last update: 2014/02/09

The laboratory tests to be performed for all patients independently of affected organs include a complete blood count, blood chemistry, coagulation studies, thyroid stimulating hormone (TSH), freeT4 and urine analysis - see table 3).(Grade D2 *).

A skeletal survey, skull series (or low dose whole bone CT [McClain 2011]) and chest x-ray (AP and lateral) are the first radiographic examinations to be done. CT of specific areas of the skeleton are indicated when mastoid, orbital, scapular, vertebral, or pelvic lesions are found by plain x-rays. MRI may detect additional osseous or extraosseous lesions. A skeletal scintigram (bone scan) alone does not suffice.

Any evidence of a pathological thoracic finding should be followed up by high-resolution chest CT. Ultrasonographic examination of the abdomen may reveal hepatic abnormalities. An ultrasound of the neck with attention to the thyroid gland may be indicated if there are thyroid nodules or evidence of thyroid dysfunction. A MRI of head is needed for hypothalamic/pituitary or brain abnormalities. PET-(CT) scan may identify lesions missed by other modalities and documents response to therapy [Phillips et al 2009].

Tab. 3. Baseline la­bo­rato­ry and ra­dio­gra­phic eva­lua­ti­on




  • Full Blood Count (Hemoglobin, White blood cell and differential count, Platelet count)


  • Blood Chemistry (Total protein, Albumin, Bilirubin , ALT (SGPT), AST (SGOT)


  • Alkaline phosphatase (AP), gammaglutamyl transpeptidase (γGT)
  • Creatinine, Electrolytes, CRP (C-reactive Protein)
  • Erythrocyte Sedimentation Rate (ESR)


  • Coagulation Studies (INR/PT, Fibrinogen)


  • Thyroid Stimulating Hormone (TSH), freeT4


  • Morning Urine Osmolarity


  • Urine Test Strip


  • Ultrasound (liver, spleen, lymph-nodes, thyroid gland)


  • Chest Radiograph (CXR)


  • Low Dose Whole Body (Bone) CT (if not available: X-Ray Skeletal/Scull Survey)


  • Optional: Baseline Head-MRI


  • Optional: PET-CT instead of Ultrasound, CXR and Bone CT


* Grades of recommendation see here.


[McClain 2011] McClain K: Bone and Soft Tissue Involvement - Oral Presentation at the Annual Meeting of the Histiocyte Society, Vienna. 2011.

[Phillips et al 2009] Phillips M, Allen C, Gerson P, McClain K: Comparison of FDG-PET scans to conventional radiography and bone scans in management of Langerhans cell histiocytosis. Pediatric blood & cancer 2009, 52: 97 [PMID: 18951435]