1
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Jiang B, Li Q, Guo W, Ju L. Clinical Characteristics of Pediatric Clavicular Lesions: A Retrospective Analysis of 20 Cases. Cureus 2024; 16:e52226. [PMID: 38352108 PMCID: PMC10861358 DOI: 10.7759/cureus.52226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/16/2024] Open
Abstract
Background This research aims to study the diagnostic patterns, anatomical locations, and age-related trends in pediatric clavicular lesions, filling a gap in pediatric-specific data for these conditions. Methodology A retrospective study of 20 pediatric patients (aged ≤14 years) with clavicular lesions was conducted based on inclusion and exclusion criteria emphasizing confirmed diagnosis and treatment specifics. The diagnostic process relied on open biopsy, followed by excision or curettage and histopathological examination. Results The study primarily involved patients with an average age of 7.1 ± 3.8 years. Eosinophilic granuloma was the most common diagnosis (30% of cases), particularly in the age group of 0-3 years. Clavicular lesions predominantly manifested as either a palpable lump or localized swelling with pain. The medial of the clavicle was the most frequent lesion location. No malignant tumors were found, and the functional outcomes post-treatment were satisfactory. Conclusions Pediatric clavicular lesions exhibit distinct diagnostic and anatomical characteristics compared to adults. Eosinophilic granuloma is significantly prevalent in early childhood, necessitating age-specific diagnostic and therapeutic approaches. The study advocates for multidisciplinary collaboration in the treatment and improved understanding of these lesions, which are vital for pediatric orthopedic oncology.
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Affiliation(s)
- Bo Jiang
- Orthopedics, Children's Hospital of Nanjing Medical University, Nanjing, CHN
| | - Qian Li
- Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, CHN
| | - Wang Guo
- Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, CHN
| | - Li Ju
- Orthopedics, Children's Hospital of Nanjing Medical University, Nanjing, CHN
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2
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Lima-Bernardes F, Soares DM, Pereira JM, Catarino I, Vieira SE, Carvalho JDD. Pelvic Ewing Sarcoma: The Great Mimicker. Rev Bras Ortop 2023; 58:e822-e825. [PMID: 37908534 PMCID: PMC10615590 DOI: 10.1055/s-0040-1722582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 09/17/2020] [Indexed: 10/21/2022] Open
Abstract
Ewing sarcoma is the most common malignant bone tumor of the pelvis in children and young adults. Even with aggressive treatment, its survival rate is amongst the poorest. Classical presentation may not be the rule. It may simulate clinically, imagiologically and histopathologically other nonmalignant entities. Therefore, its suspicion should not be overlooked. We report two cases of pelvic Ewing sarcoma: the first mimicking eosinophilic granuloma, and the second mimicking osteomyelitis. In the latter, we also report an atypical finding of its natural history: an initial response to antibiotic and anti-inflammatory treatment. In both cases, we highlight the possibility of an inconclusive percutaneous bone biopsy and the importance of immunochemistry and cytogenetics for the definitive diagnosis.
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Affiliation(s)
- Francisco Lima-Bernardes
- Ortopedista e Traumatologista, Departamento de Ortopedia e Traumatologia, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Diogo Manuel Soares
- Ortopedista e Traumatologista, Departamento de Ortopedia e Traumatologia, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Joana Monteiro Pereira
- Ortopedista e Traumatologista, Departamento de Ortopedia e Traumatologia, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Isabel Catarino
- Ortopedista e Traumatologista, Departamento de Ortopedia e Traumatologia, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Sofia Esteves Vieira
- Ortopedista e Traumatologista, Departamento de Ortopedia e Traumatologia, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - João das Dores Carvalho
- Ortopedista e Traumatologista, Departamento de Ortopedia e Traumatologia, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
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3
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Weidemeier ME, Fleck S, Hosemann W, Vogelgesang S, Ehlert K, Lode HN, Schroeder HWS. Rare clival localization of an eosinophilic granuloma: illustrative case. J Neurosurg Case Lessons 2023; 5:CASE22490. [PMID: 37354435 PMCID: PMC10550531 DOI: 10.3171/case22490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/11/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Eosinophilic granuloma (EG) belongs to the family of Langerhans cell histiocytosis (LCH) and is considered to be a benign disease typically found in children younger than 15 years of age. Here, the authors describe an EG of unusual localization and clinical presentation. OBSERVATIONS The authors report a 9-year-old girl with an EG presenting as an osteolytic lesion of the clivus. After transsphenoidal resection and histological confirmation, adjuvant chemotherapy was initiated. Presenting signs and symptoms were weight loss, episodic grimacing, and moderate ballism-like movements. After a follow-up-period of 32 months, the patient presented with a total resolution of initial symptoms and no further tumor growth. LESSONS Although these lesions are rare, one should consider EG as a differential diagnosis when confronted with osteolytic lesions of the clivus.
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Affiliation(s)
| | | | | | | | - Karoline Ehlert
- Pediatric Oncology and Hematology, University Medicine Greifswald, Greifswald, Germany; and
| | - Holger N. Lode
- Pediatric Oncology and Hematology, University Medicine Greifswald, Greifswald, Germany; and
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4
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Ariyaratne S, Jenko N, Iyengar KP, James S, Mehta J, Botchu R. Primary Benign Neoplasms of the Spine. Diagnostics (Basel) 2023; 13:2006. [PMID: 37370901 DOI: 10.3390/diagnostics13122006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/30/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Benign tumours comprise the majority of primary vertebral tumours, and these are often found incidentally on imaging. Nonetheless, accurate diagnosis of these benign lesions is crucial, in order to avoid misdiagnosis as more ominous malignant lesions or infection. Furthermore, some of these tumours, despite their benign nature, can have localised effects on the spine including neural compromise, or can be locally aggressive, thus necessitating active management. Haemangiomas and osteomas (enostosis) are the commonest benign tumours encountered. Others include osteoid osteoma, osteoblastoma, fibrous dysplasia, osteochondroma, chondroblastoma, haemangioma, simple bone cysts, aneurysmal bone cysts, giant cell tumours, eosinophilic granuloma and notochordal rests. The majority of lesions are asymptomatic; however, locally aggressive lesions (such as aneurysmal bone cysts or giant cell tumours) can present with nonspecific symptoms, such as back pain, neurological deficits and spinal instability, which may be indistinguishable from more commonly encountered mechanical back pain or malignant lesions including metastases. Hence, imaging, including radiography, computed tomography (CT) and magnetic resonance imaging (MRI), plays a critical role in diagnosis. Generally, most incidental or asymptomatic regions are conservatively managed or may not require any follow-up, while symptomatic or locally aggressive lesions warrant active interventions, which include surgical resection or percutaneous treatment techniques. Due to advances in interventional radiology techniques in recent years, percutaneous minimally invasive techniques such as radiofrequency ablation, sclerotherapy and cryoablation have played an increasing role in the management of these tumours with favourable outcomes. The different types of primary benign vertebral tumours will be discussed in this article with an emphasis on pertinent imaging features.
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Affiliation(s)
- Sisith Ariyaratne
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham B31 2AP, UK
| | - Nathan Jenko
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham B31 2AP, UK
| | - Karthikeyan P Iyengar
- Department of Orthopedics, Southport and Ormskirk Hospital NHS Trust, Southport PR8 6PN, UK
| | - Steven James
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham B31 2AP, UK
| | - Jwalant Mehta
- Department of Spinal Surgery, Royal Orthopedic Hospital, Birmingham B31 2AP, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham B31 2AP, UK
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5
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Angelini A, Mosele N, Gnassi A, Baracco R, Rodà MG, Cerchiaro M, Ruggieri P. Vertebra Plana: A Narrative Clinical and Imaging Overview among Possible Differential Diagnoses. Diagnostics (Basel) 2023; 13:diagnostics13081438. [PMID: 37189540 DOI: 10.3390/diagnostics13081438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/14/2023] [Accepted: 04/15/2023] [Indexed: 05/17/2023] Open
Abstract
Vertebra plana is a rare radiologic condition characterized by a uniform loss of height of a vertebral body that represents a diagnostic challenge for surgeons. The purpose of this study was to review all possible differential diagnoses that may present with a vertebra plana (VP) described in the current literature. For that purpose, we performed a narrative literature review in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, analyzing 602 articles. Patient demographics, clinical presentation, imaging characteristics and diagnoses were investigated. VP is not a pathognomonic feature of Langerhans cell histiocytosis, but other oncologic and non-oncologic conditions should be considered. The list of differential diagnoses, based on our literature review, can be recalled with the mnemonic HEIGHT OF HOMO: H-Histiocytosis; E-Ewing's sarcoma; I-Infection; G-Giant cell tumor; H-Hematologic neoplasms; T-Tuberculosis; O-Osteogenesis imperfecta; F-Fracture; H-Hemangioma; O-Osteoblastoma; M-Metastasis; O-Osteomyelitis, chronic.
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Affiliation(s)
- Andrea Angelini
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Nicolò Mosele
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Andrea Gnassi
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Riccardo Baracco
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Maria Grazia Rodà
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Mariachiara Cerchiaro
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
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6
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Lavaee F, Nazhvani AD, Afshari A. A case report of adult Langerhans cell histiocytosis and review of the literature. Clin Case Rep 2023; 11:e6927. [PMID: 36789309 PMCID: PMC9913190 DOI: 10.1002/ccr3.6927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/25/2022] [Accepted: 01/22/2023] [Indexed: 02/12/2023] Open
Abstract
Langerhans cell histiocytosis (LCH) is an uncommon proliferative disease with an unknown cause. Its clinical manifestations vary and can involve a variety of organs. To diagnose LCH, radiographs, histopathological and immunohistochemical findings are essential. The gold standard for a definite diagnosis is positive CD1a/CD207 and S100 in the immunohistochemical results. Different treatment plans are available for patients struggling with LCH. To our knowledge, the LCH incidence rate is about 8.9 in one million children and 1-2 cases in one million adults. Our case shows the importance of early diagnosis of this rare condition for the prevention of any further spreading. This case report is about a 35-year-old male patient struggling with diabetes insipidus with a chief complaint of tooth mobility. Based on his X-ray radiographs, osteolytic lesions were found. A biopsy was performed, and due to histopathological and immunohistochemical findings, it was diagnosed as a case of LCH in adults. This paper shows that although the incidence rate of LCH is rare in adults, dealing with a patient struggling with diabetes insipidus and osteolytic bone lesions with an unknown cause, LCH must be taken into consideration. Due to the fact that LCH's first manifestations are mostly first oral, its good prognosis in the early stages, and if it progresses, it can turn fatal, it is important that dentists are aware of this disease, its clinical manifestations, and patient management. In case of suspicion, X-ray examination, biopsy, histopathological, and immunohistochemical exams must be performed.
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Affiliation(s)
- Fatemeh Lavaee
- Oral and Dental Disease Research Center, Oral and Maxillofacial Medicine Department, School of DentistryShiraz University of Medical SciencesShirazIran
| | - Ali Dehghani Nazhvani
- Oral and Maxillofacial Pathology Department, Biomaterials Research CenterSchool of dentistry, Shiraz University of Medical SciencesShirazIran
| | - Aylar Afshari
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
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7
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Zheng Y, Ning B, Wu C, Qian C, Meng J, Wang D. Posterior Focal Curettage and Spine Stability Reconstruction by Temporary Pedicle Screw Fixation in Children With Collapsed Vertebrae due to Eosinophilic Granuloma. Global Spine J 2022; 12:1745-1750. [PMID: 33583209 PMCID: PMC9609510 DOI: 10.1177/2192568220988269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVES To evaluate the efficacy of growth-preserving posterior spinal column reconstruction surgery in children with collapsed vertebral eosinophilic granuloma (EG). METHODS We retrospectively reviewed 15 confirmed cases of vertebral EG who met the inclusion and exclusion criteria from March 2015 to March 2018 in our hospital. The recovery of diseased vertebrae was assessed. RESULTS The cases were composed of 11 males and 4 females with a mean age of 74.3 ± 38.8 months. Nine cases presented with thoracic vertebral destruction, 6 cases with lumbar vertebral destruction. Under Garg's classification, 10, 3 and 2 cases were classified as Grade IIA, IB and IIB lesions, respectively. All patients had mild to moderate night-aggravated back pain and recovered at 1-week after surgery. Three patients had Frankel D neurologic symptoms and recovered at 1-week, 1-week and 4-weeks after surgery, respectively. Follow-up time after surgery ranged from 1.9 years to 4.5 years, with a mean of 2.9 years. The median vertebral height at 12 months after surgery was significantly higher than the preoperative height. Furthermore, the vertebral heights of all diseased vertebrae displayed significant recovery trends at 3, 6 and 12 months after surgical treatment. The percentages of vertebral height recovery to references at 12 months after surgery ranged from 34.7% to 92.5%, with an average of 71.2%. CONCLUSIONS In children with collapsed vertebral EGs, active surgical treatment is necessary to retain the ability to restore height and to reconstruct the spine stability.
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Affiliation(s)
- Yiming Zheng
- Department of Paediatric Orthopaedics,
Children’s Hospital of Fudan University, National Children’s Medical Center,
Shanghai, China
| | - Bo Ning
- Department of Paediatric Orthopaedics,
Children’s Hospital of Fudan University, National Children’s Medical Center,
Shanghai, China
| | - Chunxing Wu
- Department of Paediatric Orthopaedics,
Children’s Hospital of Fudan University, National Children’s Medical Center,
Shanghai, China
| | - Chuang Qian
- Department of Paediatric Orthopaedics,
Children’s Hospital of Fudan University, National Children’s Medical Center,
Shanghai, China
| | - Junrong Meng
- Department of Paediatric Orthopaedics,
Children’s Hospital of Fudan University, National Children’s Medical Center,
Shanghai, China
| | - Dahui Wang
- Department of Paediatric Orthopaedics,
Children’s Hospital of Fudan University, National Children’s Medical Center,
Shanghai, China,Dahui Wang, Department of Paediatric
Orthopaedics, Children’s Hospital of Fudan University, National Children’s
Medical Center, Wanyuan Road 399, Minhang District, Shanghai 201102, China.
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8
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Zheng Y, Zhang Z, Wang D. Better vertebrae remodeling in pediatric spinal eosinophilic granuloma patients treated with kyphoplasty and short-term posterior instrumentation: A minimal two-year follow-up with historical controls. Front Pediatr 2022; 10:922844. [PMID: 36507140 PMCID: PMC9727175 DOI: 10.3389/fped.2022.922844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess the validity and safety of kyphoplasty combined with short-term posterior instrumentation to treat children with vertebrae plana due to eosinophilic granuloma (EG). PATIENTS AND METHODS Clinical data of EG patients, who received kyphoplasty and short-term instrumentation from March 2019 to March 2020, were retrospectively reviewed. The recovery of diseased vertebrae was assessed and compared with historical case data. RESULTS Nine patients with EG had received kyphoplasty and short-term posterior instrumentation. The mean age at initial treatment was 66.7 months old (range, 28-132 months). The average number of follow-up months was 26.7. (range, 24-30 months).Four and 5 cases presented with thoracic and lumbar vertebral destruction, respectively. Under Garg's classification, 7 and 2 cases were classified as Grade IIA and IIB, respectively. The average diseased vertebral heights at 1-year and 2-year after surgery were significantly higher than the preoperative heights. The average percentages of diseased vertebral heights to references at 1-year and 2-year after surgery were 72.0% and 86.0%, respectively. The average percentage of diseased vertebral heights to the references at 2-year after surgery was significantly higher than that of the historical cases at the same time. No minor or major adverse events were observed. CONCLUSIONS Transpedicular balloon kyphoplasty for the direct restoration of vertebrae plana seems feasible and safe in combination with short-term posterior instrumentation. Better short-time vertebrae remodeling was observed 2 years after surgery. Active surgical treatment is suggested for children who have vertebrae plana as a result of EG in order to maintain the ability to recover vertebral height.
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Affiliation(s)
- Yiming Zheng
- Department of Pediatric Orthopaedics, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Zhiqiang Zhang
- Department of Pediatric Orthopaedics, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Dahui Wang
- Department of Pediatric Orthopaedics, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
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9
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Erdogan K, Solmaz S, Dogan I. First technical report of a pediatric case with thoracic Langerhans cell histiocytosis: Gross total tumor removal, corpectomy, and 360° stabilization via posterolateral approach at a single stage. J Craniovertebr Junction Spine 2021; 12:236-239. [PMID: 34728989 PMCID: PMC8501817 DOI: 10.4103/jcvjs.jcvjs_142_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 04/28/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Langerhans cell histiocytosis (LCH) is a rare nonmalignant disease characterized by a clonal proliferation of mononuclear cells called Langerhans histiocytes and infiltrates surrounding tissues, mostly self-limiting and usually occurring in the first two decades of life. Vertebral involvement is rare, mostly seen in the thoracic region, and involves the anterior elements of the corpus. In the literature, several treatment options and surgical approaches have been reported concerning the treatment of this disease and surgery. Case Presentation: We report an 18-month-old male with thoracic LCH who underwent surgery due to progressive neurological deficit. Gross total removal of the tumor with one level corpectomy in this patient was achieved via a posterolateral approach with postoperative functional improvement. The surgical cavity was supported by corpectomy cage and unilateral screw-rod fixation system at the same stage. Conclusion: Gross total tumor removal, corpectomy, and 360° stabilization via posterolateral approach at a single stage are safe, effective, and definite neurosurgical methods in terms of providing neurological recovery, long-term tumor-free survival, and spinal stability.
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Affiliation(s)
- Koral Erdogan
- Department of Neurosurgery, Ankara University School of Medicine, Ibn-i Sina Hospital, Ankara, Turkey
| | - Serdar Solmaz
- Department of Neurosurgery, Ankara University School of Medicine, Ibn-i Sina Hospital, Ankara, Turkey
| | - Ihsan Dogan
- Department of Neurosurgery, Ankara University School of Medicine, Ibn-i Sina Hospital, Ankara, Turkey
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10
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Xie X, Wang J, Ding Y. Recurrent eosinophilic granuloma involving maxilla and mandible in an adult male: an unusual case report. Aust Dent J 2021; 66 Suppl 1:S88-S92. [PMID: 34043826 DOI: 10.1111/adj.12861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 02/05/2023]
Abstract
Langerhans' cell histiocytosis (LCH) is a disease spectrum characterized by the intense infiltration/accumulation of Langerhans' cells in the affected tissues. Eosinophilic granuloma is the mildest form of LCH which mainly affects the skull, mandible, ribs and femur in children and young adults but rarely occurs in the maxilla. Here, we describe an unusual case of eosinophilic granuloma affecting the tissues adjacent to tooth #25 and tooth #46 (FDI numbering system) in a 35-year-old male. Although lesions underwent clinical remission after local radiotherapy, a new lesion appeared 11 months after initial therapy in tooth #18, indicating recurrence of eosinophilic granuloma. Subsequently, the patient was treated with corticosteroid therapy, achieved remission and is disease free after 3 years of follow-up.
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Affiliation(s)
- X Xie
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - J Wang
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Y Ding
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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11
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Tahririan MA, Nodushan SMHT, Farrokhi M. Chronic recurrent multifocal osteomyelitis in a 3.5-year-old boy. J Res Med Sci 2021; 26:32. [PMID: 34345243 PMCID: PMC8305756 DOI: 10.4103/jrms.jrms_338_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/11/2020] [Accepted: 12/31/2020] [Indexed: 11/04/2022]
Abstract
We report an extremely rare case of multifocal bone disorder in a 3.5-year-old boy who appeared for left forearm and arm pain and multiple periods of fever with an unusual presentation of lymphoma/leukemia and highlight diagnostic challenges leading to a misdiagnosis, which was then diagnosed and treated for chronic recurrent multifocal osteomyelitis (CRMO). Based on a left arm biopsy and whole-body scans, he was eventually diagnosed with CRMO. Taken together, in this case, we noticed a notable amelioration after a 5-month treatment with nonsteroidal anti-inflammatory drugs on multiple bone pains.
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Affiliation(s)
| | | | - Mehrdad Farrokhi
- Bone Joint and Related Tissues Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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12
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Lin CY, Lee CC, Wu KW, Yuan CT, Kuo KN, Wang TM. Solitary tibial lesion as the initial presentation of Langerhans cell histiocytosis: report of two cases and literature review. J Int Med Res 2021; 49:300060520982826. [PMID: 33472472 PMCID: PMC7829610 DOI: 10.1177/0300060520982826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The various presentations of osseous Langerhans cell histiocytosis (LCH) make it
difficult to distinguish from other bone diseases. In addition, there is no
universally accepted protocol for managing osseous LCH for single non-central
nervous system-risk lesions. Here, the rare cases of two paediatric patients,
aged 1 and 2 years, who presented with a solitary tibial lesion at time of LCH
diagnosis, are reported. One patient progressed to multiple lesions after
curettage of the original lesion. Subsequently, both patients received
preventive chemotherapy using the Taiwan Paediatric Oncology Group (TPOG)
revised protocol for treating low risk patients with LCH, namely, TPOG
LCH2002-LR. After receiving this treatment, which included a schedule of
prednisolone and vincristine for 6 weeks, followed by prednisolone, vincristine
and 6-mercaptopurine for a further 48 weeks, both patients are free from
recurrence or progression.
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Affiliation(s)
- Chih-Yang Lin
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chia-Che Lee
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.,School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kuan-Wen Wu
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.,School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chang-Tsu Yuan
- School of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ken-Nan Kuo
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.,School of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Orthopaedic Surgery, Chiayi Christian Hospital, Chiayi, Taiwan
| | - Ting-Ming Wang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.,School of Medicine, National Taiwan University, Taipei, Taiwan
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13
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Ji W, Ladner J, Rambie A, Boyer K. Multisystem Langerhans Cell Histiocytosis in an infant. Radiol Case Rep 2021; 16:1798-1805. [PMID: 34025890 PMCID: PMC8120863 DOI: 10.1016/j.radcr.2021.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/10/2021] [Accepted: 04/11/2021] [Indexed: 11/10/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare enigmatic disease that pre-dominantly affects children under 5 years of age. We report an interesting case of a 5 month old female diagnosed with multisystem LCH. Her disease process included osseous, pulmonary, gastrointestinal, cutaneous, hematopoietic and neurologic involvement. This case highlights the varying clinical symptoms, risk factors, pathogenesis, and management of multisystem LCH. This case also emphasizes the role of diagnostic imaging in this multifaceted disease.
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Affiliation(s)
- William Ji
- Department of Radiology, Madigan Army Medical Center, 9040A Jackson Ave, Joint Base Lewis-McChord, WA 98431, USA
| | - Joshua Ladner
- Department of Radiology, Madigan Army Medical Center, 9040A Jackson Ave, Joint Base Lewis-McChord, WA 98431, USA
| | - Aimee Rambie
- Department of Radiology, Madigan Army Medical Center, 9040A Jackson Ave, Joint Base Lewis-McChord, WA 98431, USA
| | - Kathleen Boyer
- Department of Radiology, Madigan Army Medical Center, 9040A Jackson Ave, Joint Base Lewis-McChord, WA 98431, USA
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14
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Al-Mousa A, Altarawneh M, Alqatawneh O, Bashir Z, Al-Dwairy S, Shtaya A. Eosinophilic Granuloma of the Skull Presenting as Non-Traumatic Extradural Haematoma in Children. Int J Gen Med 2020; 13:1229-1234. [PMID: 33262638 PMCID: PMC7700074 DOI: 10.2147/ijgm.s288512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 11/13/2020] [Indexed: 01/17/2023] Open
Abstract
Cranial extradural haematoma (EDH) is a neurosurgical emergency that can be caused by traumatic or non-traumatic causes with the former being more prevalent. Non-traumatic causes are variable and can include infection, vascular malformation and haematological disorders. This paper will address an extremely rare non-traumatic cause of EDH. More specifically, eosinophilic granuloma (EG), the localized form of Langerhans histiocytosis, may involve the skull and has rarely been reported to present with EDH. The case that will be presented is that of a three-year-old male patient, who presented with progressive vomiting and drowsiness, associated with left parietal swelling. CT scan of the brain showed an extradural haematoma and an osteolytic parietal lesion. He underwent emergent craniectomy, evacuation of the haematoma and dura resection as the lesion was infiltrating the dura. Histopathological examination of the dura and the bone edges showed eosinophilic granuloma (EG). The mechanism of a haemorrhage in this situation is poorly understood and the literature is extremely scarce. In conducting a thorough literature review, only 11 case reports of EG causing non-traumatic EDH were found. The details of these 11 cases will be reviewed and discussed in this paper, in addition to our illustrative case.
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Affiliation(s)
- Alaa Al-Mousa
- Department of General and Special Surgery, Faculty of Medicine, The Hashemite University, Zarqa 13133, Jordan.,Department of Surgery, Prince Hamza Hospital, Amman 11732, Jordan
| | | | - Omar Alqatawneh
- Department of Surgery, Prince Hamza Hospital, Amman 11732, Jordan
| | - Zalina Bashir
- Department of Pathology, Prince Hamza Hospital, Amman 11732, Jordan
| | - Salem Al-Dwairy
- Department of General and Special Surgery, Faculty of Medicine, The Hashemite University, Zarqa 13133, Jordan.,Department of Surgery, Prince Hamza Hospital, Amman 11732, Jordan
| | - Anan Shtaya
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.,Atkinson Morley Neurosurgery Centre, St George's University Hospital NHS Trust, London, UK
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15
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Abstract
We describe and illustrate herein a case of eosinophilic pulmonary granulomatosis (EPG) in a 16-mo-old, castrated male, Great Pyrenees crossbred dog. EPG appears to differ from eosinophilic pneumonias and eosinophilic bronchopneumopathy in dogs by the presence of nodules and masses in the lungs composed of eosinophils, macrophages, and various combinations of lymphocytes, plasma cells, neutrophils, and mast cells within fibrous tissue. Specific information from this dog was added to the information from the limited number of other dogs diagnosed with EPG reported in the veterinary literature, and the information analyzed. EPG appears to have no breed or sex predilection and tends to be a disease of younger dogs, often ≤ 3 y of age. Antemortem imaging of nodules and masses in the lungs, combined with cytologic evidence of eosinophils in the lesions, is highly suggestive of EPG, and the diagnosis can be confirmed postmortem. Concurrent eosinophilia and basophilia can be features of EPG, but their diagnostic value requires further investigation, as does the possible causal association with Dirofilaria immitis infection.
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Affiliation(s)
- Dawn E E Abbott
- Department of Veterinary Pathology, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Current address: Tudor Glen Veterinary Hospital, St. Albert, Alberta, Canada (Abbott)
| | - Andrew L Allen
- Department of Veterinary Pathology, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Current address: Tudor Glen Veterinary Hospital, St. Albert, Alberta, Canada (Abbott)
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16
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Li J, Yong B, Li Y, Xun F, Canavese F, Xu H. Eosinophilic Granuloma of the Thumb Presenting in a 4-Month-Old Child: Case Report and Review of the Literature. J Hand Microsurg 2019; 11:160-165. [PMID: 31814669 DOI: 10.1055/s-0038-1670923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022] Open
Abstract
Eosinophilic granuloma (EG) is a benign bone tumor of unknown origin usually seen in children. It is typically found in flat and long bones of the skull and of the appendicular skeleton, respectively. Small bones are rarely affected. The diagnosis and treatment of EG can be challenging as differential diagnosis includes several disorders that can cause osteolytic lesions. Moreover, surgical treatment can be difficult due to the small size of the bone and surrounding structures. Here we describe a case of EG of the proximal phalanx of the thumb (P1 D1) presenting in a 4-month-old boy with persistent swelling and limited range-of-motion of the interphalangeal joint in the left thumb. Over a 6-year follow-up, no sign of relapse was observed. Moreover, the curetted bone did regenerate, and it appeared homogenously dense as normal trabecular bone on the last plain radiographs; the patient was symptom-free at the last follow-up visit. Clinical presentation, treatment, pathoanatomy, localization, and complication of this form of tumor are discussed, and all previously reported cases are reviewed to give a more comprehensive picture of EG of the hand and fingers.
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Affiliation(s)
- JingChun Li
- Department of Orthopedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - BiCheng Yong
- Department of Orthopedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - YiQiang Li
- Department of Orthopedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - FuXing Xun
- Department of Orthopedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Federico Canavese
- Department of Orthopedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Pediatric Surgery, University Hospital Estaing, Clermont-Ferrand, France
| | - HongWen Xu
- Department of Orthopedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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17
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Abstract
This is a case of a pediatric male who presented with a postauricular mass and pain. Computed tomography and magnetic resonance imaging suggested a diagnosis of Langerhans cell histiocytosis. Characteristic imaging findings and initial workup for Langerhans cell histiocytosis are described.
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Affiliation(s)
- Adrian A Ong
- Department of Otolaryngology, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Mattie Rosi-Schumacher
- Department of Otolaryngology, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Michael Pizzuto
- Department of Otolaryngology, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
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18
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Mendelsohn D, Lewis JR, Scott KI, Brown DC, Reiter AM. Clinicopathological Features, Risk Factors and Predispositions, and Response to Treatment of Eosinophilic Oral Disease in 24 Dogs (2000-2016). J Vet Dent 2019; 36:25-31. [PMID: 31138045 DOI: 10.1177/0898756419834785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objectives of this study were to retrospectively describe clinicopathological features of eosinophilic oral disease in dogs, to identify possible risk factors or predispositions to the condition, and to report overall treatment response. Canine medical records from a veterinary teaching hospital and private referral practice over a 17-year period were reviewed for a diagnosis of eosinophilic oral disease. Twenty-four dogs with 26 lesions met the inclusion criteria. Patient mean age and body weight were 6.8 (3.8) years and 13.4 kg, respectively. Fifteen breeds were represented including Cavalier King Charles spaniel (16.7%), Labrador retriever (12.5%), and West Highland white terrier (12.5%). Eosinophilic lesions were found in the palate (65.4%), tongue (26.9%), and other oral locations (7.7%). Median follow-up time was 5 months. Analysis revealed statistically significant associations between lesion location and body weight (palatal and tongue lesions were more likely in smaller dogs, whereas lesions in the other category [lip or mucosa] were more likely in larger dogs). There was a correlation in lesion location and resolution (all dogs with palatal lesions became asymptomatic at their last recheck), and resolution and the use of antibiotics plus prednisone (greater likelihood of resolution without the use of this combination). Seventy percent of asymptomatic dogs resolved without medication or with allergen therapy alone, suggesting that asymptomatic dogs may respond well to conservative management. No associations were found between lesion location and breed, signalment and response to therapy, lesion resolution and the use of glucocorticoids, or significance of peripheral eosinophilia.
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Affiliation(s)
- Danielle Mendelsohn
- 1 NorthStar Veterinary Emergency, Trauma and Specialty Center, Robbinsville, NJ, USA
| | - John R Lewis
- 2 Veterinary Dentistry Specialists, Chadds Ford, PA, USA
| | | | | | - Alexander M Reiter
- 4 Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
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19
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Ma J, Laird JH, Chau KW, Chelius MR, Lok BH, Yahalom J. Langerhans cell histiocytosis in adults is associated with a high prevalence of hematologic and solid malignancies. Cancer Med 2018; 8:58-66. [PMID: 30597769 PMCID: PMC6346231 DOI: 10.1002/cam4.1844] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 10/04/2018] [Accepted: 10/04/2018] [Indexed: 01/03/2023] Open
Abstract
Background Langerhans cell histiocytosis (LCH) is a rare disorder of histiocyte proliferation. Previous case studies suggest a higher prevalence of hematologic and solid malignancies among LCH patients, possibly due to treatment with tumorigenic agents such as etoposide. We report the first large, single‐institution experience of adult LCH patients with additional malignancies to study the characteristics of these patients. Methods We identified 132 consecutive patients >18 years of age with histologically confirmed LCH at our center between 1990 and 2015. Demographics and detailed oncologic history were recorded to identify patients with additional malignancies. Results Of 132 adult LCH patients, 42 (32%) patients had an additional malignancy. There were 53 malignancies among the 42 patients, with 31 (58%) preceding LCH diagnosis, 11 concurrent (≤3 months; 21%) with LCH diagnosis, and 11 (21%) after. Median age was 54 years (range 28‐89) with a median follow‐up of 3.7 years (0.1‐22.2) for this cohort. OS at 3 years was 98% in patients with LCH alone and 82% among patients with additional malignancies, with 30 (71%) alive at last follow‐up. Solid tumors, lymphomas, and other hematologic malignancies were observed as follows: 39 (74%), 9 (17%), and 5 (9%). Conclusion Our cohort of adult LCH patients demonstrates an unusually high number of additional malignancies. Our study includes predominantly malignancies diagnosed preceding or concurrent with LCH, suggesting a cause of malignancy independent of LCH treatment. Further exploration of the biology of this rare disease may elucidate the mechanism of frequent additional malignancies.
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Affiliation(s)
- Jennifer Ma
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.,Albert Einstein College of Medicine, Bronx, New York
| | - James H Laird
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.,New York University School of Medicine, New York, New York
| | - Karen W Chau
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Monica R Chelius
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.,Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Benjamin H Lok
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.,Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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20
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Eshghi A, Klein R, Eshghi N, Kuo PH. 18F-FDG PET/CT for the Evaluation of Primary Eosinophilic Granuloma of the Hypothalamus. J Nucl Med Technol 2018; 46:290-291. [PMID: 29724799 DOI: 10.2967/jnmt.118.209957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 03/29/2018] [Indexed: 11/16/2022] Open
Abstract
A 21-y-old man who presented with polyuria and polydipsia was discovered to have diabetes insipidus due to eosinophilic granuloma of the hypothalamus. 18F-FDG PET/CT, which was performed as a metastatic work-up, revealed an intensely 18F-FDG-avid hypothalamic mass and no other sites of disease.
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Affiliation(s)
- Anna Eshghi
- Department of Molecular and Cellular Biology, University of Arizona, Tucson, Arizona
| | - Robert Klein
- Department of Pathology, Banner University Medical Center, Tucson, Arizona
| | | | - Phillip H Kuo
- Department of Medical Imaging, University of Arizona, Tucson, Arizona; and
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21
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Affiliation(s)
- Ying-Shiung Kuo
- Department of Dentistry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Oral Biology, School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Yu-Hsueh Wu
- Department of Dentistry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Oral Biology, School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Andy Sun
- Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Oral Biology, School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Chun-Pin Chiang
- Department of Dentistry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Oral Biology, School of Dentistry, National Taiwan University, Taipei, Taiwan
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22
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Abstract
Eosinophilic granuloma is a localized form of Langerhans cell histiocytosis, most commonly involving the skeletal system. Their origin from the dura is rare with only a handful of cases on record. We present one such rare case of an eosinophilic granuloma originating from the dura mater with secondary osseous invasion in an 11-year-old female child who presented with a swelling in the right parietal region. Magnetic resonance imaging demonstrated an enhancing mass with a wide dural attachment with a lytic lesion in the overlying skull. Right parietal extended craniotomy was done with the excision of mass from the dura. Histopathological features of mass were characteristic of eosinophilic granuloma which was confirmed by positive immunohistochemical staining for CD1a.
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Affiliation(s)
- Kavita Mardi
- Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - R C Thakur
- Department of Neurosurgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Lalita Negi
- Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
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23
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Federman DG, Baldassarri RJ, Cain HC. A rare 'incidentaloma' found on low-dose CT screening for lung cancer: 'scanner beware'. Postgrad Med 2017; 129:653-656. [PMID: 28562187 DOI: 10.1080/00325481.2017.1334506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Screening for lung cancer with low-dose computed tomography (LDCT) has been shown to reduce mortality and has been recommended by the U.S. Preventive Services Task Force for adults 55 to 80 years of age with a 30 pack-year smoking history who are either current smokers or those that quit within 15 years. However, the overwhelming majority of abnormalities detected are not from malignancy. We report a case of pulmonary Langerhans' cell histiocytosis, here-to-fore thought of as extremely uncommon, and make readers aware that this may be increasingly found as LDCT is more widely adopted.
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Affiliation(s)
- Daniel G Federman
- a VA Connecticut Healthcare System , West Haven , CT , USA.,b Yale University School of Medicine , New Haven , CT , USA
| | - Rebecca J Baldassarri
- a VA Connecticut Healthcare System , West Haven , CT , USA.,b Yale University School of Medicine , New Haven , CT , USA
| | - Hilary C Cain
- a VA Connecticut Healthcare System , West Haven , CT , USA.,b Yale University School of Medicine , New Haven , CT , USA
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24
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Abstract
RATIONALE Solitary eosinophilic granuloma (EG), the most benign, common form of Langerhans cell histiocytosis, has a self-limiting process and is associated with a good prognosis. Immobilization is recommended as the first treatment strategy for solitary EG, although the treatment protocols are still controversial. Radiotherapy and surgery are secondary treatment choices. Lesions of the upper cervical spine react differently to treatment because of their specific anatomical and motor features. PATIENT CONCERNS We discuss the case of a 29-year-old man with axis EG who underwent immobilization, radiotherapy, and finally surgery. DIAGNOSIS Eosinophilic granuloma (EG). INTERVENTIONS An initial conservative protocol, including immobilization with a collar and radiotherapy, effectively relieved his neck pain, whereas torticollis secondary to atlantoaxial subluxation was not improved. Therefore, he underwent tumor resection through the anterior approach and spinal reconstruction, fixation, and fusion through the posterior approach. OUTCOMES The deformity was well corrected and follow-up was satisfactory. LESSONS Upon review of the literature, we found that EG lesions affecting the axis have more risk factors for instability or deformity, and they have particular anatomical and motor characteristics; thus, they require more consideration and attention in terms of treatment, prognosis, and follow-up.
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Affiliation(s)
- Yu Song
- Department of Orthopedics, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei
| | - Wen Geng
- Department of Ophthalmology, Shengjing Hospital of China Medical University, Shenyang, Liaoning
| | - Tao Guo
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yong Gao
- Department of Orthopedics, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei
| | - Yukun Zhang
- Department of Orthopedics, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei
| | - Shuai Li
- Department of Orthopedics, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei
| | - Kun Wang
- Department of Orthopedics, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei
| | - Ji Tu
- Department of Orthopedics, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei
| | - Cao Yang
- Department of Orthopedics, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei
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25
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Dolzhansky OV, Paltseva EM, Bukaeva AA, Zaklyazminskaya EV, Spivak IA, Fedorov DN. [ Eosinophilic granuloma of the parietal bone of an adult patient with BRAF mutation]. Arkh Patol 2017; 79:33-39. [PMID: 28791997 DOI: 10.17116/patol201779433-39] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The paper describes a case of eosinophilic granuloma of the parietal bone in a 32-year-old man. Histological examination revealed a large number of bean-shaped Langerhans cell histiocytes with lobed nuclei and nuclear grooves. The histiocytes alternated with the foci of obvious eosinophilic infiltration and with eosinophilic microabscesses. There were osteoclast-like multinucleated giant cells, bone resorption, and numerous bone rods covered with osteoblast chains. The histiocytes expressed CD1α, langerin, CD68, S100, and p53 (in 90.0% of the tumor cells). The Ki-67 proliferation index was 18.0%. A molecular genetic study identified BRAFV600E mutation (nucleotide substitution s.1799 T>A (p.V600E) in the heterozygous state). Clinical and morphological data and the results of molecular genetic studies led to the conclusion that there was eosinophilic granuloma of the right parietal bone (the unifocal form of Langerhans cell histiocytosis (LCH), type I, group A1, with the monoossal nature of lesion and with BRAFV600E mutation). In adults, this disease is extremely rare (2-5 cases of LCH per million people, bone loss in the fourth decade of life in 2.5% of the patients).
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Affiliation(s)
- O V Dolzhansky
- Academician B.V. Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - E M Paltseva
- Academician B.V. Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - A A Bukaeva
- Academician B.V. Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - E V Zaklyazminskaya
- Academician B.V. Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - I A Spivak
- OOO 'Hemotest Laboratory', Moscow, Russia
| | - D N Fedorov
- Academician B.V. Petrovsky Russian Research Center of Surgery, Moscow, Russia
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26
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Kojima Y, Takeuchi T, Egashira Y, Higuchi K. A Case of Eosinophilic Granuloma Presenting as a Small Submucosal Tumor. Intern Med 2017; 56:1115-1116. [PMID: 28458323 PMCID: PMC5478578 DOI: 10.2169/internalmedicine.56.7734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | | | | | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical College, Japan
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27
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Stephens BH, Wright NM. Reconstruction of the C-1 lateral mass with a titanium expandable cage after resection of eosinophilic granuloma in an adult patient. J Neurosurg Spine 2016; 26:252-256. [PMID: 27716017 DOI: 10.3171/2016.8.spine15523] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Spinal involvement occurs frequently in cases of eosinophilic granuloma (EG), but surgical treatment is limited primarily to those with spinal instability. Involvement of the cervical spine is rare, but primarily occurs in the vertebral bodies, and is normally amenable to anterior corpectomy and spinal reconstruction. The authors describe a 27-year-old man with pathologically proven EG who presented with complete destruction of the C-1 lateral mass requiring spinal stabilization. A titanium expandable cage was used to reconstruct the weight-bearing column from the occipital condyle to the superior articular surface of C-2 from a posterior approach, with preservation of the traversing vertebral artery. To the authors' knowledge, this is the first reported instance of reconstruction of the C-1 lateral mass using an expandable metal cage, which facilitated preservation of the vertebral artery.
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Affiliation(s)
- Bradley H Stephens
- Department of Neurosurgery, Washington University, Saint Louis, Missouri
| | - Neill M Wright
- Department of Neurosurgery, Washington University, Saint Louis, Missouri
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28
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Zhu J, Yang H, Lv D, Chen F, Xiao H. [ Eosinophilic granuloma of the temporal bone: a case report]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2016; 30:1156-1158. [PMID: 29798446 DOI: 10.13201/j.issn.1001-1781.2016.14.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Indexed: 11/12/2022]
Abstract
One case of Eosinophilic granuloma of the temporal bone was reported which had been misdiagnosed as cholesteatoma.This disease is a rare benign tumour that is lack of specific feature in clinical performances and easy to be misdiagnosed.
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29
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Adamama-Moraitou KK, Soubasis N, Pardali D, Psalla D, Papazoglou LG, Prassinos NN, Anagnostou TL, Rallis TS. Recurrent intraluminal eosinophilic tracheal granuloma in a Siberian husky. Vet Q 2015; 35:116-22. [PMID: 25702591 DOI: 10.1080/01652176.2015.1021493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Katerina K Adamama-Moraitou
- a Companion Animal Clinic (Medicine Unit) , Faculty of Health Sciences, School of Veterinary Medicine , Aristotle University of Thessaloniki , St. Voutira 11 str. , 54627 , Thessaloniki , Greece
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30
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Parihar A, Newaskar V. Management of polyostotic eosinophilic granuloma. Dent Res J (Isfahan) 2012; 9:821-5. [PMID: 23559966 PMCID: PMC3612238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Eosinophilic granuloma is a rare disease which is difficult to diagnose clinically and radiographically. Localized Langerhans' cell histiocytosis, previously known as eosinophilic granuloma, mainly affects the skull, mandible, vertebrae, pelvis and ribs in children and the long bones of adults. We present a case report of a female who developed pain and swelling over the left mandibular region, and was later diagnosed as eosinophilic granuloma, which after administration of intralesional corticosteroid with surgical enucleation showed positive response. This disease is of importance to dental professionals because early clinical signs can occur in the jaw and can cause extensive destruction of the periodontal tissues and bone. The purpose of this case report is to describe a case of eosinophilic granuloma with emphasis on conservative approach for the treatment and the radiographic changes observed during and after the treatment.
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Affiliation(s)
- Ajay Parihar
- Department of Oral Medicine and Radiology, Government College of Dentistry, Indore, Madhya Pradesh, India,Address for correspondence: Dr. Ajay Parihar, Department of Oral Medicine and Radiology, Government College of Dentistry, Indore, Madhya Pradesh, India. E-mail:
| | - Vilas Newaskar
- Department of Oral and Maxillofacial Surgery, Government College of Dentistry, Indore, Madhya Pradesh, India
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Abstract
A nontraumatic spontaneous extradural hematoma, in a fully conscious 10-year-old male child, caused by a solitary eosinophilic granuloma of calvarium presented as a case of localized painful swelling of the head, which rapidly expanded and decreased in size. A plain CT-scan of the head with bone window revealed eroded right parietal bone with subperiosteal debris and extradural hematoma of mixed density. Immediate evacuation of the extradural clot and complete excision of the lesion was performed to prevent the deterioration of the patient and to achieve the histological diagnosis for further management.
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Affiliation(s)
- Abdul Rashid Bhat
- Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Kashmir, India
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Abstract
Lymph node enlargement of neck and axilla is one of the common presenting complaints in pediatrics. We are presenting here a very rare cause of axillary lymphadenopathy detected in a toddler.
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Affiliation(s)
- Veerendra Kumar
- Department of Pediatrics, Institute of Child Health, Government Medical College, Kottayam, Kerala, India
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33
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Abstract
Langerhans cell histiocytosis frequently manifests as lesions of the skull. The disease can present with a wide spectrum of forms, from an isolated eosinophilic granuloma to multiple lesions with diffuse systemic involvement. The authors report the case of a 12-year-old boy with a 1-month history of left temporal and periorbital pain and headaches. Noncontrast computed tomography of the head was done at the time of initial presentation and was interpreted as normal. Over the next month, the patient continued to have headaches and periorbital swelling and began having bloody discharge from his nose. Magnetic resonance imaging of the brain ordered by his pediatrician showed a lesion in the left infratemporal fossa, left orbit, and sphenoid bone. The lesion was biopsied and confirmed to be Langerhans cell histiocytosis. We describe a novel multidisciplinary approach for treatment of this tumor.
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Affiliation(s)
- Mandy J Binning
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah
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Affiliation(s)
- Laura Yacovone
- Department of Otolaryngology and Communication Enhancement, Children's Hospital Boston, Boston, Massachusetts, USA
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35
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Abstract
Eosinophilic granuloma is a variety of histiocytosis-X with unknown etiology. Eosinophilic granuloma occurs as single or multiple lesions of bone destruction. It is seen more commonly in children or young adults although it may be found at all ages. Other sites like the lung and the gastrointestinal tract may also be affected. This is a rare case of eosinophilic granuloma which presented as frontal headache. The radiographic and cytological findings were characteristic of the disease.
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Affiliation(s)
- Rashmi Kaul
- Departments of Pathology, Anatomy and Radiotherapy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
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36
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Uren NG, Hammond PJ. Myopericarditis in Churg-Strauss syndrome. Tex Heart Inst J 1991; 18:127-31. [PMID: 15227496 PMCID: PMC324980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Churg-Strauss syndrome is a disseminated vasculitis with multisystem involvement, characterized by necrotizing arteritis, eosinophilic infiltration, and extravascular granuloma formation. In as many as 60% of all cases, the heart may be affected. We describe a 30-year-old man in whom pericarditis was followed by the development of a large pericardial effusion, with evidence of impaired right and left ventricular function. The patient had a 5-year history of asthma. Early therapy with high-dose prednisolone and azathioprine led to resolution of the pericardial effusion and prevented a further reduction in biventricular function.
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Affiliation(s)
- N G Uren
- Division of Clinical Cardiology, Department of Medicine, Hammersmith Hospital, London
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