LCH is a clonal proliferative disease caused by the proliferation and aggregation of Langerhans cells (CD207+) with abnormal function in single or whole-body tissues and organs . I the general population, its incidence is estimated to be 1 or 2 cases per 1 million individuals, whereas incidence in children aged 1–3 years is even higher at 3–5 cases per 1 million individuals [2, 3]. LCH can involve a single organ, a single system and multiple organs, or multiple systems and multiple organs . Its symptoms range from single self-absorbed organ hyperplasia (the mildest) to systemic infiltrative hyperplasia (the severest). The organs that are always involved include the bone, lung, central nervous system, liver, thymus, skin, and lymph nodes. As for bones, the skull, long bone, and flat bone are the most susceptible. The mortality rate of patients with multiorgan LCH is 10–20% . The clinical manifestations of LCH are nonspecific, and this lack of specificity makes its diagnosis difficult. However, once LCH is considered as a possibility, the diagnosis can then be confirmed by biopsy. Pathology will show pathological Langerhans cells and mediated inflammatory cells, including lymphocytes, eosinophils, and macrophages. S-100 protein, CD1a, and CD207 in Langerhans cells are positive, whereas Birbeck granules under an electron microscope are specific [6, 7].
LCH can be treated by observation, chemotherapy, radiotherapy, or surgery, or using a combination of several methods. Patients with good prognosis may only require follow-up observation or little intervention, whereas patients with poor prognosis should be actively treated. The long-term efficacy and prognosis still require further follow-up observation . A study has demonstrated that only 2 of 61 patients with LCH of single bone had a recurrence after surgical resection . Another study has demonstrated that the four-year survival rate of patients with LCH of single bone is > 90% . Teratogenic surgery is not recommended for patients with a single small lesion because it is always self-limiting. In such cases, the local lesion of the rib is definitively diagnosed via surgical resection, whereas the resection has little effect on the patient’s function. Similar to other benign tumors, surgical removal is effective in this case [11, 12]. Local radiotherapy of bone lesions is only suitable for patients with lesion progression, which may affect the function of important organs. Patients with systemic invasion should be actively treated using chemotherapy, whereas high-risk patients with multisystem diseases accompanied by organ dysfunction should be treated using systemic therapy along with chemotherapy.
Generally, among young adults, the skeletal loads causing rib fractures are attributed to high-energy traumatic events. In older adults, rib fractures often result from falls [13, 14]. Pathological rib fracture is a common manifestation of malignant tumor rib metastasis. In this study, primary tumor of ribs may lead to rib fracture.