Eosinophilic granuloma of the spine

The contribution to the clinical picture of eosinophilic granuloma of the spine. This tumor-like, osteolytic bone lesion presents both diagnostic and therapeutic problems. Solitary eosinophilic granuloma of the spine is not common. Compared to the multiple manifestation of eosinophilic granuloma, which seldom spares the spine, vertebral involvement is rare in cases of solitary eosinophilic granuloma (about 10 p.c.). Spinal involvement of this disease is mainly characterized by an undramatic, uneventful clinical course, even in cases of extensive osteolytic bone defects, varying laboratory findings as well as partial or complete collapse of a vertebra, mostly in form of a true vertebrae plana. Open biopsy is recommended instead of needle aspiration biopsy in solitary eosinophilic granuloma of the spine in order to exclude Ewing's sarcoma, neuroblastoma, or bony manifestations of leukemia. In cases of solitary eosinophilic granuloma various therapeutic methods have been tried. Some authors have registered good results by means of prolonged immobilization, similar to fracture treatment. Others have used radiation therapy in moderate doses. We suggest operative treatment of solitary eosinophilic granuloma. Our procedure comprises open biopsy, frozen section examination, and curettage of the affected vertebral body, taking care not to destroy the epiphyseal plate or the intervertebral disc. Vertebral body replacement is achieved by means of a bone graft, taken from the iliac crest. The original height of the vertebra is thus restored and immediate stability of the involved area guaranteed. Undisturbed bone growth of the end plated of the vertebral body can be observed. This technique is to prevent disturbances of spinal growth and permanent deformities.(ABSTRACT TRUNCATED AT 250 WORDS)     

Spinal cord compression by eosinophilic granuloma of the cervical spine. Case report and review of the literature

Eosinophilic granuloma is an uncommon lesion, often self-limiting. A location in the spine is rare; until now, only 35 cases have been reported. MRI is the most effective diagnostic technique, although conventional X-ray can also be useful as a first approach.Therapy consists of immobilization of the patients, surgery and chemotherapy as required by to the clinical findings of the lesion.The role of radiotherapy is still controversial.The authors describe the fourth case of eosinophilic granuloma of the cervical spine with neurological symptoms reported in literature.     

Atlanto-axial subluxation posssibly due to eosinophilic granuloma of the axis: a case report

A 29-year-old male presented with symptoms of acute severe neck pain with no other neurological symptoms. He had noticed lymph node swelling with pain in his neck about 2 months before admission and had been treated by the transoral administration of antibiotics for about 10 days. His neck was protected with a neck collar and an evaluation of any possible neck lesion was performed. Plain X-ray film and CT scans of the cervical spine showed an anterior subluxation of the atlas and an anterior declination and erosion of the dens. The MRI findings showed long T1 and T2 values in many parts of the bone marrow of the body of the axis and the dens, and both the bone marrow and thickend soft tissue between the pharynx and the axis were slightly enhanced. Inflammatory disease, tuberculosis, rheumatoid arthritis, malignant lymphoma, and leukemia were all ruled out based on the laboratory data, Ga schintigrams and other examinations. Almost no changes in the lesion were observed on MRI at about 6 weeks after admission. As a result, we presumed that this lesion was not likely to be malignant, but might be some kind of granuloma, especially an eosinophilic granuloma. A laminectomy of the atlas and a resection of the posterior margin of the foramen magnum and upper portion of the lamina of the axis was performed to achieve decompression of the craniovertebral junction, and posterior fusion was performed with a rod betweeen the occipital bone and the C4 lamina. The rod was fixed with screws and wires to the occipital bone and with lamina hooks to the axis and C4 laminas. At 14 months postoperatively, the patient is doing well and the axis and the dens have been reconstructed without any need to resect the lesion, or perform either chemothrapy or radiotherapy. Our clinical findings of this case correlate with the opinion that an immobilization of the lesion is a sufficient treatment for many cases of eosinophilic granuloma. Although a biopsy or histological examination of the lesion was not performed, the clinical course of this case strongly suggests that this lesion was indeed an eosinophilic granuloma.     

Eosinophilic granuloma of the cervical spine. A case report and review of the literature

This is a report of a case of eosinophilic granuloma involving the second cervical vertebra in a 33-year-old woman. There have been 32 case reports in the literature describing eosinophilic granuloma presenting as cervical spine disease. Due to its intimate relation to the central nervous system, the opportunity for neurological sequelae and neurosurgical intervention is common in cervical eosinophilic granuloma. In this report a brief history of eosinophilic granuloma is reviewed and case histories from the literature with cervical spine involvement are summarized. The therapeutic options are described and a recommended protocol for management is outlined.     

Solitary eosinophilic granuloma causing spinal cord compression in a child presenting with abdominal pain

This report describes a case of an eosinophilic granuloma of T7 causing spinal cord compression in an 8-year-old boy who presented with abdominal pain. The purpose of this report was to illustrate both the variable clinical presentation and the rare incidence of cord compression due to an eosinophilic granuloma. Eosinophilic granuloma is a benign tumour-like condition that produces focal bone destruction. It is usually managed conservatively after biopsy, necessary to confirm diagnosis. Vertebral involvement is seen in 7–15% of cases with back pain and stiffness being the presenting features. This case is unique in both the initial presentation with abdominal pain, and the subsequent diagnosis of cord compression due to an extensive eosinophilic granuloma requiring urgent surgical intervention. The child underwent a left sided thoracotomy, T7 vertebrectomy and decompression. The spine was stabilised with a tricortical iliac crest graft. Diagnosis was confirmed by both microscopy and immunocytochemistry. The patient tolerated the procedure with no complications, he was discharged home pain free and will be kept under review. This case highlights both the highly variable presentation and the rare complication of cord compression due to eosinophilic granuloma.     

Successful treatment of a bifocal eosinophilic granuloma of the spine with CT-guided corticosteroid injection

Observation and immobilization is adequate for most patients with spinal eosinophilic granuloma; however, in patients with symptomatic lesions, treatment other than simple observation or biopsy alone is recommended. In view of the benign clinical course of eosinophilic granuloma, a simple, minimally invasive, outpatient treatment with a low complication rate such as computed tomography (CT)-guided intralesional corticosteroid injection may be considered the treatment of choice. This article presents a case of a 21-year-old man with a symptomatic bifocal eosinophilic granuloma at the vertebral body of the L3 vertebra and the left T5 costovertebral joint treated effectively by CT-guided intralesional methylprednisolone injection. To the best of our knowledge, this is the first case of successful treatment of a bifocal eosinophilic granuloma with CT-guided corticosteroid injection. Under general anesthesia and CT guidance, the lesion was located through the right transpedicular approach for the L3 lesion and the left posterolateral approach for the T5 lesion using a biopsy trocar. Tissue sample was retrieved and frozen section biopsy showed eosinophilic granuloma. One intralesional CT-guided injection of 80 mg (2 mL) of methylprednisolone acetate was performed in each lesion. Complications related to the procedure were not observed. The patient was admitted postprocedural for overnight medical evaluation and was discharged from the hospital the next day. Complete resolution of pain was observed 72 hours after the procedure. At 5 years after diagnosis and treatment, the patient is asymptomatic; imaging showed healing of both lesions.     

Operative case of eosinophilic granuloma of the skull with dural invasion

Eosinophilic granuloma is the localized form of Langerhans' cell histiocytosis. There are several reports of magnetic resonance (MR) imaging of eosinophilic granuloma of the skull, however there are few reports about dural enhancement. We report an operative case of eosinophilic granuloma of the skull with dural invasion. A 42-year old man was admitted to our hospital. He was neurologically intact and there were no other osseous or soft tissue lesions. CT showed an osteolytic lesion in the left parietal bone. MR images showed the lesion as isointense on T1-weighted, and high intense on T2-weighted images. T1-weighted images with Gd-DTPA demonstrated the mass which was enhanced with dural surface and subgaleal tissue. The angiogram demonstrated a tumor stain fed by the left occipital artery. Bone scintigraphy demonstrated a solitary lesion showing peripheral uptake with a central defect. The patient underwent craniectomy with removal of the dura and a subgaleal lesion. Histological examination revealed characteristic eosinophilic granuloma with dural invasion. No recurrence of the lesion was demonstrated 6 months after surgery.     

Eosinophilic granuloma. A different behaviour in children than in adults

Localised Langerhans-cell histiocytosis of bone (eosinophilic granuloma) is a benign tumour-like condition with a variable clinical course. Different forms of treatment have been reported to give satisfactory results. However, previous series all contain patients with a wide age range. Our aim was to investigate the effect of skeletal maturity on the rate of recurrence of isolated eosinophilic granuloma of bone excluding those arising in the spine. We followed up 32 patients with an isolated eosinophilic granuloma for a mean of five years; 17 were skeletally immature. No recurrences were noted in the skeletally immature group even after biopsy alone. By contrast, four of 13 skeletally mature patients had a recurrence and required further surgery. This suggests that eosinophilic granuloma has a low rate of recurrence in skeletally immature patients.     

Anterior cervical corpectomy and fusion using miniplate and screws in a 7-year-old child with eosinophilic granuloma of the cervical spine.

STUDY DESIGN: This is a case report of a 7-year-old child with eosinophilic granuloma in the cervical spine, which underwent anterior cervical corpectomy and fusion by using Miniplate and screws. OBJECTIVES: To describe the use of Miniplate and screws for pediatric cervical anterior fusion. SUMMARY OF BACKGROUND DATA: Eosinophilic granuloma is a rare disease causing destructive bony lesions of the cervical spine in children. A complete resection and fusion were considered to be the preferable treatment in our case. However, cervical spinal fusion and instrumentation in children may be technically difficult because of the size of the vertebral body and the iliac bone. In addition, a proper device for an internal fixation in pediatric patients is not yet available. METHODS: A case of eosinophilic granuloma in pediatric spine was presented. RESULTS: We confirmed successful bony fusion and the restoration of the normal cervical curvature without recurrence of the tumor 2 years after the procedure. CONCLUSIONS: For proper internal fixation and prevention of dislodgement of the grafted bone, we used the Miniplate and screws as internal fixator after intralesional resection of the tumor mass.     

Benign tumors of the spine in the adolescent. Surgical considerations apropos of 4 cases

About 4 observations of benign tumours of the spine of the adolescent, we have studied the surgical aspect of the treatment of these lesion. The choice of the surgical approach is fundamental in view of the necessity of a complete exeresis, which implies techniques of spinal reconstruction and stabilization. Those problems are illustrated by: 2 cases of aneurysmal cyst, 1 case of eosinophilic granuloma, and 1 case of osteochondroma.     

Solitary eosinophilic granuloma in the frontal lobe: case report.

A rare case of a solitary eosinophilic granuloma in the brain is reported. The mass, located in the right frontal lobe, mimicked a glioma not only grossly, but also by neuroimaging. The lesion was confirmed to be an eosinophilic granuloma by electron microscopy and immunohistochemical staining for S-100 protein and HLA-DR.     

Solitary eosinophilic granuloma of the sternum

We report a rare case of eosinophilic granuloma of the sternum in a 25-year-old woman, who presented with anterior chest pain and a tender mass over the sternum. Total-body bone scintigraphy and computed tomography scanning of the thorax revealed an isolated lytic lesion of the manubrium. An open biopsy showed the typical histologic appearance of an eosinophilic granuloma. Surgical curettage of the solitary lesion was performed, and the sternal defect was filled with a bone replacement material. At the 2-year follow-up, no local recurrence was found, and the patient was in good health.     

Eosinophilic granuloma of the hand

The first reported case of eosinophilic granuloma of the hand is presented. A slowly expanding lesion of the right third metacarpal shaft was treated by biopsy and curettage. Histological examination confirmed the presence of eosinophilic granuloma. A bone scan showed that it was a solitary lesion. There has been no evidence of recurrence of the lesion during follow-up. Eosinophilic granuloma is a rare disease of the mononuclear phagocyte system, representing one of the clinical manifestations of Langerhans-cell histiocytosis. The lesions are usually associated with the skull, femur, mandible and ribs; this condition has not been previously reported in the hand.     

Long-term results of treating histiocytosis X of the spine]

A series of 38 children and juveniles with eosinophilic granuloma located in 44 vertebral bodies was treated. The diagnosis was based on typical radiographic appearance, bone marrow examination and histology in cases where the lesion was surgically resected. Management consisted mainly of immobilization and unloading of the spine for 2-3 years. Since 1972 in order to shorten this period posterior arthrodesis of 3 vertebral bodies in thoracic spine and 2 vertebral bodies in lumbar spine by Albee-Gruca method is performed. Radiotherapy was applied in 1 case. In most of the cases full or partial regeneration of the vertebral body was achieved; the height was restored in 76% on average. The extent of regeneration was higher in younger children and in lumbar and cervical spine possibly because of lordosis in these segments.     

Aggressive eosinophilic granuloma of the parietal bone. An immunohystochemical study of Ki-67 expression

Solitary eosinophilic granuloma (EG) of the skull is a rare lesion, the natural history of which is still to be defined. We report a case of a 26-year-old female who presented with progressive headache and nausea accompanied by a painful firm mass in her left parietal region, which grew very rapidly during the last two weeks before admission. Computed tomography scan showed an osteolytic lesion, which on magnetic resonance imaging appeared hyperintense on both T1- and T2-weighted images, with marked and heterogeneous enhancement after gadolinium administration. Total surgical excision of the lesion was performed and histopathological diagnosis was compatible with eosinophilic granuloma. Immuno-histochemical study of Ki-67 antigen expression was also performed with a labelling index of 10%. In a review of the pertinent literature, we found one case report showing a Ki-67 labelling index of 6.2% in a patient harboring EG of the occipital bone. These two relatively high percentages of proliferative activity suggest a role of local Langerhans'cell proliferation, along with that of inflammatory response, in the aggressive clinical course and rapid expansion observed in some rare cases of solitary eosinophilic granuloma.     

Solitary eosinophilic granuloma invading the clivus of an adult: case report.

A 41-year-old white man with facial pain and diplopia was found to have an invasive lesion of the clivus. The final pathological diagnosis was eosinophilic granuloma. The patient's symptoms resolved completely after transsphenoidal resection of the lesion. The pathological and radiological diagnosis and the treatment of solitary eosinophilic granulomas are discussed.     

Eosinophilic granuloma of spine in adults: a case report and review of literature

A rare case of eosinophilic granuloma in an adult is reported. Eosinophilic granuloma (EG) is a lesion observed more frequently in adults. CT and MRI showed a lytic lesion of the T11 vertebral body. A transpedicular excisional biopsy of the lesion revealed EG. Spinal EG in adults is rare and differs from the childhood disease by the spinal level involvement. Vertebra plana, a condition of spondylitis in which the body of the vertebra is reduced to a sclerotic disc, is not a roentgenographic feature in the 14 cases reported in literature. It should be included in the differential diagnosis of the solitary lytic lesion of vertebrae in adults.     

Multiple lytic lesions of the spine: a rare diagnosis of eosinophilic granuloma in an adult: a case report

Eosinophilic granuloma (EG) is a rare benign osteolytic lesion observed rarely in adults, with only some 18 cases of spinal location reported in the literature. We present an unusual variant of EG in a 23-year-old man with radiological features of multiple spinal lytic lesions which was evocated of metastatic processes. A surgically transpedicular biopsy of the thoracic collapsed vertebrae with posterior stabilization was made. Histological examination of the tissue showed features of eosinophilic granuloma. The clinical and radiological findings of EG present dilemmas of both diagnosis and treatment. The etiology is unclear and the therapeutic approach is still controversial.     

胸腰椎侧前方减压Z型钢板内固定术的临床经验

目的　对胸腰椎侧前方减压Z型钢板内固定术的临床经验进行总结。方法　施行胸腰椎侧前方减压、椎间植骨及Z型钢板内固定术 2 6例 ,包括胸腰椎椎体爆裂性骨折 14例 ,肿瘤 6例 ,椎间盘突出 2例 ,嗜酸性肉芽肿 2例及椎体结核 2例。对结果进行临床和影像学检查评价。结果　所有病例随访 3～ 16个月 ,平均随访 7 2个月。椎间植骨均取得坚强骨愈合。螺栓或螺钉位置偏斜进入相邻椎间盘 2例。无神经系统及术后钢板螺钉松动等并发症。结论　对于胸腰椎病灶采用侧前方减压Z型钢板复位内固定术能取得良好的临床效果     

Solitary spinal eosinophilic granuloma in children

Solitary vertebral eosinophilic granuloma is said to be a rare spinal condition in children. 'Vertebra plana' is considered as the typical radiological feature of the involved vertebra; but it could be observed only in 40% of the patients. We have studied three pediatric patients with solitary vertebral eosinophilic granuloma. Their complaint was pain and/or stiffness of the back. Two of them developed neurological deficits in their lower limbs. The diagnosis in imaging (plain radiographs, computed tomography scan and magnetic resonance imaging) varied from one case to another. Histopathology confirmed the diagnosis of eosinophilic granuloma. These three patients underwent an open biopsy and a resection of the spinal lesion achieved with or without interfixation. The outcome was satisfactory in these three cases after a mean follow-up period of over 2 years (from 23 to 27 months).