Objective: Langerhans cell histiocytosis (LCH) is an uncommon neoplasm of dendritic cells and predominantly occurs in children and young adults. The study aims to evaluate cytopathologic features and current diagnostic concepts in a large series of LCH on fine needle aspiration (FNA). Study Design: We retrospectively searched the pathology archives of The Johns Hopkins Hospital (JHH) and Emory University Hospital (EUH) to identify all FNA cases diagnosed as LCH in a period of 21 years. Cytologic material and immunohistochemical stains were reviewed. Results: A total of 37 LCH patients (26 from JHH and 11 from EUH) with FNA diagnoses were identified. The sites of LCH included bone in 28, soft tissue of head and neck in 6, and lymph nodes in 3. Thirty-one patients (84%) were diagnosed as LCH, 4 (11%) had a descriptive diagnosis suggesting scant cellularity with epithelioid/histiocyte-like cells and mixed inflammation, and 2 (5%) were non-diagnostic due to insufficient cellularity. Immunohistochemical stains were performed on cell block sections in 26 cases, showing 24 of 24 (100%) positive for CD1a, 22 of 23 (96%) positive for S100-protein, and 3 of 3 (100%) positive for CD68. Conclusions: LCH can be accurately diagnosed in FNA based on the characteristic cytomorphology and selected immunohistochemistry. Diagnosis may be difficult in cases with scant or insufficient cellular material.

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