Radiographic findings in Langerhans' cell disease affecting the mandible

Multifocal Eosinophilic Granuloma of Jaws and Skull with Classical and Unusual Radiographic/Imaging Findings

Eosinophilic granuloma is basically a disorder of reticuloendothelial system and is one of the variants of langerhans cell histiocytosis. Multifocal eosinophilic granuloma affecting jaws and skull is relatively a rare disorder. We hereby report a case of multifocal eosinophilic granuloma involving mandible, maxilla and several skull bones. The present case has mixture of classical floating teeth appearance and an unusual radiographic/imaging finding of periosteal remodeling, which is rarely seen in adult patients of eosinophilic granuloma and pseudo-multilocular appearance in anterior mandibular region in coronal sections and moth-eaten appearance of skull was appreciated in axial slices of Computed Tomography (CT).

Hypothetical pathogenesis of eosinophilic infiltration in Langerhans cell histiocytosis of the jaw

OBJECTIVE

The present study investigated the densities of mast cells and CCL-11/eotaxin-1 expression of tumor cells in Langerhans cell histiocytosis (LCH) of the jaw.

STUDY DESIGN

Eleven LCH cases arising in the jaws were selected. We evaluated eotaxin-1 expression in LCH cells via immunohistochemical staining. Toluidine blue was used to stain mast cells, with 20 periapical granuloma specimens serving as the control group.

RESULTS

In all 7 patients with multifocal LCH, jaw lesions were the earliest manifestation. Toluidine blue staining revealed that most of the mast cells involved in LCH were degranulated, and the number of mast cells in LCH lesions was not significantly higher than in periapical granulomas. Upon immunohistochemical examination, all patients but one showed positivity for eotaxin-1 in LCH cells.

CONCLUSION

This preliminary study suggests that eotaxin-1 expression in LCH cells may contribute to eosinophilic infiltration. Further studies of chemokine-receptor interactions will be needed to confirm this.

Langerhans cell histiocytosis in a child: a 10-year follow-up

BACKGROUND

This report describes a case of the benign form of Langerhans cell histiocytosis, which involves only the maxilla and mandible, and has no extraskeletal manifestations.

CASE REPORT

A 2.9-year-old boy was referred to a paediatric dentistry clinic, where clinical, radiographic and histological findings were found to be consistent with Langerhans cell histiocytosis. The difficulties involved in the diagnosis and the subject's functional oral rehabilitation are described. In view of the presence of large bone lesions, systematic treatment consisted of oral chemotherapy and the administration of methylprednisolone by intralesional infiltration. Oral examination revealed complete resolution of the ulcerative lesions. The soft tissue appeared healthy and had a normal colour. There was no tooth mobility and radiography provided evidence of bony healing.

CONCLUSION

This case is particularly interesting because follow-up clinical and radiographic observations have been made over the past 10 years. The successful treatment had several objectives, including providing the patient with an aesthetic appearance and recovering the lost vertical dimension of occlusion.

Clinical and radiographic features of eosinophilic granuloma in the jaws: review of 41 lesions treated by surgery and low-dose radiotherapy

Eosinophilic granuloma within the jaws may radiographically mimic other benign odontogenic cysts and tumors, and different protocols have been suggested in the literature for treating eosinophilic granuloma of the jaws. Forty-one lesions of eosinophilic granuloma, diagnosed in 25 patients, were reviewed retrospectively, and data were collected regarding age, gender, ethnic origin, location, symptoms, clinical appearance, radiographic features, treatment, and recurrence. The lesions were found in youngsters (18.1 +/- 4.7 years of age), mostly in the posterior parts of the mandible, and the most common presenting symptom was pain (92%), often accompanied by swelling. Approximately one half of the lesions were radiographically well defined without ossification. All patients were treated by enucleation (with or without peripheral ostectomy) and radiotherapy; 7.3% lesions recurred during follow-up (9.3 +/- 4.6 years). In addition, the different treatments suggested in the literature for eosinophilic granuloma of the jaws were reviewed.

Langerhans cell histiocytosis presenting as bilateral eosinophilic granulomata in the molar region of the mandible. A case report

Eosinophilic granuloma represents one of a triad of lesions encompassing a disease under the generic name, histiocytosis X or Langerhans cell histiocytosis. Localised eosinophilic granuloma, multifocal eosinophilic granuloma, Hand-Schüller-Christian disease, and the most malignant form of histiocytosis, Letterer-Siwe disease, can all present as destructive bony lesions of the jaws. The present case was a 30-year-old man who presented with almost total destruction of the periodontal support to the left and right mandibular, 1st and 2nd molars. Whereas the radiographic features were typical of eosinophilic granuloma, the clinical appearance and mirror image presentation were unusual.