Solitary eosinophilic granuloma in bone
01 May 1970-Journal of Bone and Joint Surgery-british Volume (Bone and Joint Journal)-Vol. 52, Iss: 2, pp 238-243
TL;DR: Forty patients with solitary eosinophilic granuloma of bone from the Hospital for Sick Children, Toronto, have been reviewed and the differential diagnosis includes sarcoma is included, which is a more widespread manifestation of histiocytosis X.
Abstract: 1. Forty patients with solitary eosinophilic granuloma of bone from the Hospital for Sick Children, Toronto, have been reviewed. They had clinical and laboratory findings similar to those reported by others except for the erythrocyte sedimentation rate, which was raised in nearly half the patients tested. 2. Radiographs in all cases showed the lesion to be osteolytic. In the skull and cervical spine there was no bony reaction ; in the thoracic and lumbar spine the typical picture of Calves disease was produced; in long bones the cortex commonly showed endosteal erosion and periosteal reaction. 3. In one patient the lesion progressed so rapidly that the body of a cervical vertebra was destroyed within ten days. 4. The differential diagnosis includes sarcoma. Biopsy is essential. 5. All the patients improved regardless of the treatment they received. Complications were due either to the site of the lesion or to its treatment. 6. Expansion of the lesion after biopsy indicates a more widespread manifestation of histiocytosis X.
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TL;DR: The preferred treatment for oral lesions was surgical curettage, and the prognosis was generally very favorable, as evidenced by the over-all recurrence rate of 16 percent.
182 citations
TL;DR: It is revealed that Eosinophilic granuloma of bone manifests itself primarily in males under 20 years of age of all races, and the most common symptom is pain, with or without swelling.
Abstract: Eosinophilic granuloma of bone is an uncommon granulomatous process for which therapy recommendations vary considerably. Consequently, a survey of the world literature from 1940 to 1974 was undertaken in an attempt to develop more concrete guidelines. This survey revealed that the disease manifests itself primarily in males under 20 years of age of all races. The most common symptom is pain, with or without swelling. Multiple sites in a single case are frequent. The clinical course is generally benign, unlike Letterer-Siwe disease or Hand-Schuller-Christian disease. A remission rate of 95% was noted, with relapses usually occurring as distant disease within the first year. Simple excision or curettage was the most common surgical procedure utilized, and radiotherapy doses varied widely. Excellent local control of the disease can be provided using conservative surgery, low-dose irradiation, or both. Morbidity secondary to pathologic fracture or to overly aggressive treatment are the major concerns, not failure to control the disease.
169 citations
TL;DR: In most cases of cervical eosinophilic granuloma, immobilization is an adequate therapy, if the process continuous to progress, radiotherapy is recommended, and surgical treatment should be reserved for cases with instability or neurologic defects.
Abstract: Study design A meta-analysis was performed based on 53 cases of cervical eosinophilic granuloma reported in the literature and 1 in an adult treated by the authors. Objective To stress the clinical and radiologic differences between cervical and thoracolumbar spinal eosinophilic granuloma and to point out differences between adults and children with cervical eosinophilic granuloma to avoid false diagnosis. Summary of background data Until now, cervical eosinophilic granuloma has been reported in 43 children and 9 adults. In 1 case the age is unknown. In previous studies, differences between adults and children with cervical eosinophilic granuloma have not been analyzed, nor has cervical eosinophilic granuloma been compared with thoracolumbar eosinophilic granuloma. Methods All reported cases of cervical eosinophilic granuloma were analyzed concerning age and sex distribution, clinical and radiologic presentation, therapy, and outcome. The authors' case in a 46-year-old patient is discussed. Results The presenting symptoms of cervical eosinophilic granuloma are usually pain and restricted range of motion. In contrast to eosinophilic granuloma of the thoracic spine and lumbar spine, the neurologic symptoms are less frequent, and the first radiographic sign is an osteolytic lesion. Vertebra plana is a rare sign in cervical eosinophilic granuloma. In children, the middle cervical spine is most often affected, whereas in adults it is the second vertebra. The outcome of the patients has been good in most cases, independently of treatment. Conclusion In most cases of cervical eosinophilic granuloma, immobilization is an adequate therapy. If the process continuous to progress, radiotherapy is recommended. Surgical treatment should be reserved for cases with instability or neurologic defects.
117 citations
Cites result from "Solitary eosinophilic granuloma in ..."
...This reinforces the opinion that EG is a selflimiting process.(33,45,61) Furthermore, Sbarbaro and Francis(83) noticed in 37 patients with solitary skeletal lesions that there was not a single recurrence....
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TL;DR: For treatment of single or dual spinal lesions, observation with or without bracing seems to be sufficient and chemotherapy produces good results, and for treatment of neurologic deficit, low-dose radiotherapy is favored.
Abstract: STUDY DESIGN Retrospective review of clinical and radiologic data in four major tertiary referral centers. OBJECTIVES To report clinical and roentgenographic findings, to evaluate the results of various treatment methods, and to propose a protocol for management. SUMMARY OF BACKGROUND DATA Langerhans' cell histiocytosis of the spine is a rare condition, and therefore, appropriate management is still controversial. METHODS Clinical and roentgenographic findings of 38 vertebral lesions of 23 children, with average follow-up of 5.4 years, were investigated. This is the most extensive report apparent in the literature to date. The results of treatment were assessed clinically and radiologically. Anterior vertebral body height was measured sequentially to evaluate reconstitution of the vertebral body. RESULTS The last follow-up examination demonstrated no clinical evidence of disease in all patients, regardless of treatment method. Neurologic deficits developed in four patients, but they completely disappeared. Satisfactory restoration of height was demonstrated in all except five vertebrae: one that had collapsed maximally when the patient was more than 15 years of age and four that had been fused anteriorly or posteriorly. Unsatisfactory results were also seen in a patient with progressive scoliosis and in one with an irregular endplate with disc space narrowing. Both of these complications developed after curettage. CONCLUSIONS For treatment of single or dual spinal lesions, observation with or without bracing seems to be sufficient. In patients with multifocal lesions, chemotherapy produces good results. For treatment of neurologic deficit, low-dose radiotherapy is favored. Patients who underwent surgery--especially curettage and anterior fusion--had the worst outcome.
109 citations
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TL;DR: Clinical and pathological observations during this period tended to substantiate the integrated concept of histiocytosis X as a nosological entity embracing eosinophilic granuloma of bone, Letterer-Siwe disease, and Schuller-Christian disease.
Abstract: The literature on histiocytosis X has been reviewed from 1952 to date. Clinical and pathological observations during this period tended to substantiate the integrated concept of histiocytosis X as a nosological entity embracing eosinophilic granuloma of bone, Letterer-Siwe disease (when this is non-neoplastic), and Schuller-Christian disease. The impression has been reinforced that the lesion of eosinophilic granuloma is the pathological expression of an early, rather rapidly developing reaction to an etiological agent. This appears to be especially true in the chronic disseminated form of the malady (Schuller-Christian disease). Recent recorded experience has added new sites of involvement—the liver, kidneys, female genitalia, and, possibly, the cranial nerves and eye, as well. Altogether, the manifestations of the disease may be quite protean. Especially noteworthy are the numerous reports on pulmonary eosinophilic granuloma, occurring with or without demonstrable lesions elsewhere.
Stress was placed on the practical importance of making a clear distinction between acute (or subacute) histiocytosis X and neoplastic reticuloendotheliosis, both of which require different therapy. From existing evidence it would appear that cytotoxic agents, radioactive isotopes, and the like should be avoided in acute disseminated histiocytosis X since they may seriously injure an already damaged bone marrow. In these circumstances, as in many severe cases of chronic disseminated histiocytosis X (Schuller-Christian disease), the experience of recent years points up the value of steroids in tiding patients over critical situations. Collaterally, the value of selected antibiotics in combating secondary infections and of roentgen therapy, especially for mucocutaneous and skeletal lesions, has been further documented.
Among the features brought out by our own material are: (1) specific involvement of the liver in chronic disseminated histiocytosis X, leading to serious intrahepatic obstructive jaundice; (2) extension of eosinophilic granuloma in bone to regional lymph nodes (reinforcing the concept of infection); and (3) reappearance of the lesion of eosinophilic granuloma as the pathological expression of recrudescence in chronic disseminated histiocytosis X (Schuller-Christian disease) of long standing.
175 citations
TL;DR: In 20 cases, the skull, ribs, and spine were the most frequent sites; an unusual site in the femoral epiphysis is recorded.
Abstract: Eosinophilic granuloma of bones is of special interest to radiologists because it is first identified in roentgenograms and may mimic many benign and malignant conditions. Since this entity was first described 26 years ago, it has been reported in many skeletal locations. In our 20 cases, the skull, ribs, and spine were the most frequent sites; an unusual site in the femoral epiphysis is recorded. Local pain and disability are the usual symptoms, but vertebral granulomas may damage the spinal cord, and pathologic fracture of long bones may occur. Correct diagnosis usually requires biopsy. Results of conservative treatment are good; it is important not to overtreat this benign tumor in the fallacious assumption that it is a malignant tumor. The most frequently advocated treatment is curettage, with or without postoperative radiation therapy in moderate dosage.
62 citations